General Category of Service User.
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The World Health Organisation defines Mental Health as " a state of complete physical and mental well being, and not merely the absence of disease" (World Health Organisation, 2010) For tuning in purposes is a difficult concept given Mental health is wide ranging and people are effected to varying extents. The Department of Health and Social Services describes mental health as a continuum of experience ranging from mental health and well being through to severe and enduring mental illness.
"We all experience changes in our mental health state, influenced by social, personal, financial and other factors. Major life events such as a close bereavement, or leaving home, can impact significantly on how we feel about ourselves, for example, leading to depression and anxiety." (DHSSPS, 2003:18))
This is an important starting place to understand the impact of Mental Health on the service user's life and how it affects them. Post Natal Depression is defined as a "mood disorder that begins after childbirth and lasts more than six weeks" (Medical Dictionary â€¦â€¦.)
Article 3 of the Mental Health (NI) Order 1986 highlights " Mental illness as a state of mind which effects a persons thinking, perceiving, emotion or judgment to the extent that requires care or medical treatment" (Mental Health (NI) Order 1986). Therefore Postnatal depression would be considered a mental illness.
In order to gauge the issues that may be arising for Mrs Andrews it is useful to consider this within the context of life span development theories. Erickson (Cited in Bee, 1999) describes the ages of 26-40 as the "Generatively versus stagnation" (1999:278) a time when rearing children and occupational achievement are the focus of life. This has relevance in considering how to support Mrs Andrews to move through this stage given her current emotional state.
It also necessary to consider the stages of the children Mrs Andrews is caring for and gauge the amount of pressure and the demands they place upon her at this stage in their lives. Brian is two and according to Erickson is at the "Autonomy versus shame and doubt stage"(Bee, 1999:279), therefore requiring support and reassurances from his parents.
"if a child's efforts for independence are not carefully guided by a parent and they experience repeated failures or ridicule, then this results of all the new opportunities for exploration may be shame and doubt instead of a basic sense of self control and worth" (Bee, 1999:279)
Christine is 3 months old and according to Erickson's stages of development is within the "Basic trust versus basic mistrust" (Bee, 1999:276), however given the concerns of the service user and referral information it may be useful to consider this in tandem with Bowlby's theory on attachment (Thompson 2002). This theory pays particular reference to early childhood attachments being secure and central to this is the notion of maternal deprivation. The emphasis is on a child s relationship with its mother and and "children who do not enjoy such a relationship will be hampered in their development" (Thompson 2002:14)
In preparation for working with Mrs Andrews I must consider relevant legislation. The laws effecting people with Mental Health difficulties affects other people also i.e. The Chronically Sick and Disabled Persons 1978 and Health and Social Care Act 2001. Additionally to this I have also given cognisance the Human rights Act 1998, particularly 6 and 8 outlining the right to fair trial and the right to a private and family life which I feel makes reference to social services intervening no more than necessary than to foster this families independence and to ensure that any assessment of need is fair and non bias.
As highlighted previously post natal depression is recognised as a mental illness under the Mental Health Order (NI) 1986 given this Mrs Andrew is entitled to an assessment of her needs, treatment and additional supports to help her manage her condition.
The Children (NI) Order 1995 outlines a child's welfare is paramount and in light of the information contained within the referral pertaining not only to Mrs Andrews mental health but also potential relationship issues the children could be considered children in need, in accordance with article 17 section b which defines a child in need as a child who's health or development is likely to be significantly impaired without service provision for them.
Information Specific service user
Mrs Andrews is 27 years old and mother of two children, Brian who is 3 years old and Christine who is 3 months, she has been married to husband Terry for four years.
Mrs Andrews has reported to the GP she is having difficulties bonding with her young baby and that her relationship with her husband has become strained. Mrs Andrews has no previous symptoms of depression with her first child Brian and has told her GP he was an easy baby to look after sleeping through the night. Mrs Andrews also reports low moods and struggling with her daily routines. The GP is querying postnatal depression.
My objectives when meeting with Mrs Andrews will be to discuss how she is feeling currently and explore her daily routine. I will also discuss what supports she has in terms of her husband and other family members and in light of Brian's age and stage of development whether he attends any mothers and toddlers groups. Lastly I will explore Mrs Andrews feelings in relation to her daughter and the differences between the experiences she had with her first child.
Specific Phase of Work
As a student social worker visiting Mrs Andrews at home I will need to be aware of how she may feel before I arrive.
The main questions on clients mind in individual work is "what is this going to be about?" and "what kind of worker is this going to be"
(Shulman, 2009: 56)
Therefore I should consider Mrs Andrews potential feelings about my visit and her understanding of why I am there. I recognise she may be concerned about my visit and that she may feel she is perceived as a bad mother and I am there to judge her. Mrs Andrews may however view my visit as a life line in her current situation, viewing me as someone who can offer hope and be a potential support.
I recognise that Mrs Andrews is the expert in her own situation and it will be up to me to gain from her the information to best meet her needs.
"A general rule of social work is the more information gleaned the more is learnt about peoples reactions by asking open questions" (Coulshed & Orme 1998: 95).
Some possible objectives Mrs Andrews may have may be to change her situation, or to feel better and manage her routines. Mrs Andrews may have issues she needs to discuss that she may not have spoken about yet perhaps in relation to her husband and the support she needs. I will want to ensure Mrs Andrews feels listened to and has control of her situation.
"Supporting services users rights to control their lives and make informed choices about the services they receive" (NISCC 2002: 1.3).
Tuning in to own feelings
When Tuning in to my own feelings, I recognise I will be nervous and apprehensive during my first visit. In light of the information gathered from the referral, I recognise I have concerns about my ability to understand the complexities of Mrs Andrews life and the pressures she is under.
I realise I have significant experience of direct work with service users and relevant experience of working with service users with Mental health difficulties, however my previous work experience has had different objectives as I would be involved more from the child care perspective. Mrs Andrews has been referred to the Community Mental Health Team as the service user and while the children's needs are paramount and may have to be referred on to the childcare team, I will have to be conscious Mrs Andrews herself is my priority and a holistic assessment of her needs undertaken.
My intention would be to have a positive first meeting and as well as completing all the relevant reading I will strive to work in partnership with Mrs Andrews in order to find the best supports for her situation. Partnership is an important social work value, Parrott (2006), highlights the importance of working in partnership with service users in order to check validity of information being gathered rather than assuming it is correct.
I would not intentionally oppress or discriminate against service users, however I feel it may be difficult not to unconsciously oppress given my lack of experience. Thompson's Personal, Cultural, Structural model will be useful in helping me identify and be aware of how this could impact on my practice.
"Our thoughts feelings and attitudes about particular groups in society, will to a certain degree at least, be shaped by our experiences at a personal level" (Thompson:2006:27)
I recognise while I am a female a similar age to Mrs Andrews there will be challenges in my role to fully grasp the complexities of being married and caring for two small children given this is not my experience.
I feel that given this is my first visit with Mrs Andrews, I will want to gain as much understanding of her situation as I can. I will use all my communication skills and in particular focus on skills of empathy.
Shulman (2009) cites empathy as an important skill when working with people, highlighting that it is critical the worker begins to tune in and gain understanding of the service user in the beginning stages. Howe (2008) agrees on the importance of empathy stating:
The ability to show empathy, to see and feel the world from the others point of view, is particularly important quality that defines a successful social worker (Howe: 2008:173)
Non verbal communication is also important in particular Egan's (1990) SOLER acronym I intend to use this as a means of conveying openness and approachability thereby encouraging Mrs Andrews to share her story.
Word Count 1648.
Bee, H. (1999) The Developing Child, Allyn/Bacon
Coulshed, V. & Orme, J. 1998 Social Work Practice. 3rd ed. Hampshire: Palgrave Macmillan
Egan, G. 1990. The skilled Helper. 4th ed. Pacific Grove, CA: Brooks/Cole
Howe, D (2008) The Emotionally Intelligent Social Worker. Palgrave: Macmillan
Northern Ireland Social Care Council Code Of Practice for Social Workers. 2002
Parrot, L 2006. Values and Ethics in Social Work Practice. Exeter: Learning Matters.
Shulman, L. (2009) The skills of Helping Individuals, Families, Groups and Communications. USA Thompson/Cole
Thompson, N (2002) Building the Future,
Thompson, N. (2006) Anti Discriminatory Practice, Palgrave: Macmillan
Department of Health and Social Services. (2003). Promoting Mental Health, Castle Building: Belfast
World Health Organisation 2010: http://www.who.int/topics/mental_health
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