Introduction
In order to understand the scope of social work intervention in mental health sector, first let us look into what is mental health.
“Health is a state of complete physical, mental and social wellbeing and not merely absense of a disease or infirmity” (WHO).
“Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community.” (WHO)
Mental health is the key to a prosperous and a healthy life. But often it is neglected or ignored and remedies for physical health are more focused upon as compared to mental health. As per psychological theories root causes of many physical ailments lie in the mental processes.
Mental disorders
As compared to physical disorders, mental disorders are far more complex, vast, individual specific and of various types. In this article we will discuss broadly about types of mental disorders which come under the area of practice of social work.
Mental disorders are broadly classified as
- Psychosis
- Neurosis
Psychosis
These are acute forms of mental disorders in which the individual loses conscious awareness. In other words,the individual is unaware of his/her surroundings. These disorders are further classified as schizophrenia, hysteria,acute mania etc. Hallucinations are common symptoms of these disorders. Studies have shown that the cause of these disorders are certain chemical imbalances in the brain which are irreversible.
Most of these disorders are irreversible, and can be treated only partially through medications.
Neurosis
In these types of mental disorders the individual has conscious awareness. The disorders show their symptoms but can be controlled with medication and therapy. The individual can lead a normal life with treatment. Some of neurotic disorders are phobia, anxiety, bipolar disorders etc.
Social workers work with these types of individuals. Before discussing how social workers intervene in this area let us try to understand what are some of these neurotic disorders.
Anxiety
It is an acute form of stress. If the stress is not controlled it leads to anxiety. It is a common emotion to a stressful situation. We all feel stress and anxiety at some point, be it before an interview or in a meeting, before an exam etc. After the event the anxiety gets subdued. Anxiety becomes a disorder when this feeling of fear persists and starts to hamper the normal functioning of the individual. It may also lead to certain physical ailments.
Some if these anxiety disorders are explained below:
- Generalised anxiety disorder: The person feels excessive and unrealistic fear constantly.
- Social anxiety disorder: The person is afraid of social gatherings. They fear being judged by others. They become self-conscious and overwhelmed in social situations.
- Panic disorder: This is an advanced or intense stage of anxiety. The person feels a sudden attack of fear which is accompanied by chest pain, palpitations sweating etc.
Phobia
It is a form of fear which is associated with a particular event or situations. For example some people are afraid of going to high buildings or they are afraid of looking down from a high building. They have height phobia. Some people are afraid of water. They suffer from hydrophobia. Similarly some people are afraid of closed places. They suffer from claustrophobia.
Bipolar disorder
These are a combination of mania and depression which occurs in phases and in a cyclic manner. The person has an attack of depression which remains for sometime and then it is followed by an attack of mania. The intensity may vary from one to another.
Treatment
Treatment of mental illnesses is a time taking process and it sometimes takes years to heal the patient. The first line of treatment is institutionalised care when the individual is brought to the agency by the significant others in case of psychotic disorders or by the person himself in case of neurotic disorders.
The diagnosis and the treatment is carried on by a team of professionals (a medical practitioner, a psychologist and a social worker. Each of these professionals formulate their diagnosis as per their area of expertise and design the treatment. The treatment is carried out in a collaborative manner. In case of psychotic illnesses social workers do not have a role to play during the initial phase of treatment. It is only when the person has received treatment and is in the stage of rehabilitation, the social workers have a role to play. Social workers work at three levels-
Preventive
There is a lack of awareness regarding mental health and its importance in the Indian context. Often people who suffer do not realize that they are mentally ill and that treatment is available. Even if they want to avail treatment they are unaware about the agencies. As a preventive measure for mental illnesses social workers can organize awareness generation campaign regarding treatment, facilities etc. and encourage people to go for treatment.
Curative
During the treatment phase social workers play active role in therapies and working with significant others of the individual.
Occupational therapy: occupational therapies are provided to persons who have undergone treatment and are now ready to leave institutional care. In this therapy certain skill building activities are done so that the individuals can use it as an occupation. These skills do not require high level of concentration, is repetitive in nature and require less use of intellect. For Example: cane weaving, fabric weaving etc.
Family therapy: social workers also need to work with the family members of the individual. The behaviour of the family members with the person during the time of the treatment plays crucial role in the recovery process. The social worker or counselling and guidance to each family members as well as significant others so that they maintain the desired attitude towards the person. It is important because often the behaviour of the family members can aggravate the problem. These may include parents, spouse, siblings etc.
Rehabilitative
Mojor role played by social workers is during the rehabilitation process of the treated person. Once the treatment is complete the person has to go back to the society. The community and the family members need to accept the person as normal and maintain a desirable behaviour towards the individual.
The social worker also work with the client to link him/her to any occupation so that they are able to earn their livelihood.
Stigma and discrimination related to mental disorder is another factor which persists in the society and the social worker has to work towards this to minimize it. For this campaigns and awareness generation for mental disorders is taken up. The social worker also looks into the legal provisions for such patients and if required provides legal support in case of stigma and discrimination faced by the client.
Legislations related to mental health:
Mental Health Act, 1987
This act make provision for the treatment and care of mentally ill persons,and with respect to their property and affairs. It also deals with issues of licensing and supervising of psychiatric hospitals, providing custody of mentally ill persons, safeguarding the rights of detained persons, protecting citizens from
being detained unnecessarily, providing free legal aid to poor mentally ill.
Persons with Disability (Equal Opportunities, Protection of Rights and Full participation) Act, 1995.
This act also provided for the rights and opportunities for the mentally disabled.
Rehabilitation Council of India Act, 1992
Provides for the new opportunities for vocation, education and welfare of the mentally ill.
National Trust for Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disability Act, 1999
Provides for welfare activities to be undertaken for the mentally disabled.
Conclusion
Advancement of research in the area of psychology has provided solutions to mental problems. In order to deal with it collaborative efforts are required. Social work profession has the scope of intervention at the macro level which if promoted can deal with this issue in the best possible way.