In this essay I will discuss the impact of change, loss and grieving process. I will also discuss how the ability to support service users and carers is seen as the key skill of the social worker, which requires a non judgmental approach which is essential to working in an anti oppressive practice. Anti oppressive practice entails the appropriate support is available when supporting a person with mental health. Within this agenda I will also discuss the relevant law and policy which pertains to the mental health service user and their carer’s.
Although loss is normally associated with death it can also be associated in the loss of a limb, or a person through divorce or even loss of independence or self esteem. Social workers should always try to understand how the impact of loss, change or grieving processes can affect the individual. It can be seen through Kï¿½bler Ross (1969) and her researched theory on anticipatory grief, in which she states that, people go through set procedures for loss or grief, these stages were denial, anger, bargaining depression and acceptance, and although they may oscillate between them they are apparent in most cases.
By recognising or endorsing the need to grieve and give the individual the acknowledgement that a loss has occurred, social workers can assist to open doors which may allow the grieving process to begin. Although the acknowledgement factor is simple to do, many people have a tendency to bypass the subject for fear of the upset it may cause, and as Currier (2007) states sometimes people feel able to open up to a stranger as they feel safer and as professionals social workers can be seen in the position of a stranger, therefore the person may feel they can portray their feelings, and as such they may feel their grief can be released verbally. Therefore as stated by Dominelli (2002: 86) although the social worker is not normally the part of the counselling process, they can work with the individual in a therapeutic way which is seen as an anti oppressive approach. This aids to empower the service user to develop their own views on how they perceive the crisis they are facing, which can also create autonomous views on their needs to enable change to a more acceptable level.
When loss or grief is apparent, it is vitally important that everyone involved is alert to expressions of grief this would enable them to respond at the appropriate time, although it is necessary to bear in mind to be careful not to dismiss what they say as trivial or belittle the person’s feelings. Supporting people through an emotional crisis can make considerable demands on the workers resources. Therefore it is vital to acknowledge that other agencies may be involved in the care which will alleviate the demand on resources and support. For example :- referring to a voluntary service to aid with assistance in the “reintegration” of the service user into the social community the service users are now living in and come to terms with changes that may be unavoidable.
When intervention is unavoidable it is important to recognise that although practical help is a valuable response in the situation of loss or grief, allowing the person to accomplish control over their life is also vital to their wellbeing. Currer (2007: 109) states that the social worker may be seen to carry the power to control and therefore, try to contain distress which may be inconvenient, frightening, bizarre or upsetting by assisting in the application of a legal straight jacket or referring them to begin healing through the medical model, by the use of a chemical application, which can be seen as a short term answer to the distress that grief and loss can create.
Although as Thompson (2006: 80) states “it is well acknowledged that mental health services have the power to be involved in social control and as such mental health professionals also have power to enforce controlling functions including the use of law, although he also acknowledges that inappropriate use of powers under the Mental Health Act 1983, can be an easy trap for social workers to fall into, especially if they are not aware of how certain ethnic cultures, and how they deal with loss or grief.
It therefore becomes apparent that anyone working in the mental health field should show an interest in discriminating between stress and a crisis needing mental health intervention. Coulshed and Orme (1998) have researched into the assessments for black service users and those from an ethnic minority background and found disturbing evidence which has shown that the social workers assessments have been negligent in showing the difference between stress and madness in this culture which was shown by the rate of admission to the psychiatric hospital. Rack (1982) studies have shown that the admission rate is five times greater than it should when looking at their percentage of population. Other research completed by Aros-Atolagbe (1990: 36) have shown that the second generation of black people in the UK suffer tremendous crisis of cultural identification which may precipitate in temporary breakdown. Hence knowledge of the cultural background may prevent future institutionalisation in many cases, which would reduce theses statistics to a more accurate figure.
Value commitments and ethical principles are seen as the core of social work professions; therefore, when assessing a service user under s47 of the Community Care Act (1990) social workers need to have an understanding of how culture is important when completing an assessment and understand that it is vital to work with the service user and their carers to create a tailor made package of care suitable to their needs, therefore the social worker would need to acknowledge the social model is necessary as well as the medical model to ensure our practice is not evasive or oppressive. Although legislation provides guidelines in which the social worker ensures the service user and the carer’s welfare and care needs are catered for, social workers still require a good understanding of the concepts and principles of social justice autonomy and welfare and to accomplish this requires confidence, commitment and motivation, especially when faced with difficult and challenging situations (Banks 2006: 52).
The NHS Community Care Act 1990 was defined to aid people to avoid being institutionalised and maintained in their own homes. To do this requires some form of care. To Ensure this was ongoing, The Carers (Equal Opportunities) Act 2004 was brought into practice, which made it a duty for the LA to inform carers about “their” rights to an assessment which would mean that if the person they cared for refused assistance, then as a carer they would be entitled to an assessment in their own right. The social workers ability to support service users and their carers through the Carers (Equal Opportunities) Act 2004, was aimed at empowering the carer and promoting joint agency participation through working with health and welfare professionals.
It also made it a duty to ensure the carer’s outside interests both in and out of the home (Leisure, study or work) would be taken into consideration during the assessment. The social worker now had the power to empower the carer to become autonomous, and to make the choice of how they could retain their former life and maintain a social life and return to daily life in society as they previously had whether it is to pursue a career or leisure activities. To assist in the accomplishment of this legislation provided the application of The Community Care (Direct Payments 1996) Act, which was to enable them to purchase the care or respite of their choice once the need was assessed.
The defining feature of social death according to Mulkay and Ernest, (1991: 178) cited in Currier (2007) is “the cessation of the individual person as an active agent in others lives”. In mental health the person with dementia could be seen to have died a social death, although they are still very much alive. Currier (2007) also states that societal images are reinforced by any decline in ability, when the cognitive ability is reduced, as it is in dementia, the service user may be seen as socially invisible or even a burden as they appear to decrease in value in the eyes of society and as a person. People with mental health may be seen in the model of disability, but society in itself can create the stigma of creating what is classed as the norms of socialisation.
We use theoretical ideas to provide a framework or a starting point. Through which we can use our sociological imagination to view the holistic situation to assist us to view the complete picture. By using the different theories available we can draw on them in an eclectic way to broaden our approach to different situations and challenges we are faced with on a day to day basis. This may give us the insight to understand how things are as they are and a hypothesis to begin understanding on how individuals react to certain losses and appear resilient and others do not. Used flexibly, theories can provide a way of reflecting on our own practice especially when used to analyse how to justify an action or view something from a different prospective to justify our actions (Currier 2007).
Aros-Atolagbe (1990) Soapbox, Social work Today: Vol21 No. 35
Banks, S. (2006)Ethics and Values in Social Work: Basingstoke: Palgrave Mac Millan
Currer, C. (2007)
Coulshed, V. & Orme, J. (1998) 3rd ed. Social Work Practice: An Introduction: Basingstoke: Palgrave Mac Millan
Dominelli, L. (2002) Anti-Oppressive Social Work. Theory and Practice. Basingstoke: Palgrave Macmillan.
Kï¿½bler Ross (1969)
Rack, P.(1982) Race, Culture and Mental Disorder: London: Travistock
Thompson, N. (2006) 4th ed. Anti- Discrimination Practice: Basingstoke: Palgrave Macmillan