Social Service Worker SSW311 Lecture Notes - Lecture 3: Crisis Management, Deinstitutionalisation, Assertive Community Treatment
15 Nov 2020
School
Department
Professor
09/29/2020
Medical Model
• In the medical model, conditions of mental health are attributed to physiological factors
o Treatment in the medical model is primarily limited to medication
• This model can lead to individuals feeling labelled by their diagnosis; strengths and
resiliency of individuals often not explored
• Treating mental health as a disease fails to take into account systemic factors or varied
life circumstances that contribute to mental health; lacks intersectional and trauma
analysis
• 1960s and 1970s, when many psychiatric hospital beds were closed and psychiatric
inpatients were discharged into the community
• Deinstitutionalization of mental healthcare and shift to psychosocial and recovery
models of health have lead to a shift in mental health care where social, cultural,
political and environmental factors are considered
• Individuals may still require a diagnosis to access services
Accessing Mental Health Case Management
• Individuals living with different forms of mental health who require support around
living or stabilizing in the community may access case management services
• What types of mental health specific goals would a client might access management
services for?
o Connection to psychiatry or therapy
o In need of coordination of health related services
o Experiencing a sudden change in their mental health or baseline; can be linked to
broader crisis
o Advocacy and system navigation around both health and social service system
o Connection to supports around decreasing isolation
o Coordinating services with different healthcare providers can involve evaluation
of current condition ex. Depression, as well opportunity to manage/modify
current interventions and improve client engagement in treatment
Mental Health Care System Challenges
• Wait times for counselling and therapy can be long, especially for children and youth
o In Ontario, wait times of 6 months to one year are common
• Psychiatric follow-up post initial assessment can be limiting
• Individuals may require more holistic approaches to treatment resulting in gaps in their
care plan
• Pressure to discharge from hospital to community may result in rushed/incorrect
diagnosis or lack of comprehensive treatment
• Longer wait times in treatment can lead to longer resistance in accepting treatment
Indigenous Population and Service Delivery
• It has been reported that when interacting with the healthcare system
o Indigenous people’s have encountered racism, sexism and stereotyping
o Additionally accessing service has often been reported as “alienating and
intimidating” (OFIC 2017)
• Barriers to accessing service often include:
o Pathologizing experiences of Indigenous peoples who may be responding to
colonization
o Health care services not reflective of traditional holistic and healing practices
o Workers with limited knowledge of Indigenous culture, traditions, beliefs and
history
o Lack of cultural safety and cultural humility from service providers leading to
breakdown in forming trusting relationships
Diversity and Mental Health Case Management
• Clients who come from ethnocultural, racialized and other diverse backgrounds my
experience even greater barriers to mental health treatment because of:
o Cultural taboos
o Higher degrees of distrust or even hostility toward mainstream health
institutions
o Restrictive treatment and eligibility requirements
• Care planning for new immigrants and refugees will often require interdisciplinary work
in order to meet complex needs
o Assessing unique to this population can involve gathering information on:
▪ Process of reaching new country
• Ex. Particularly important for refugees who have fled persecution
and forced displacement
▪ Living circumstances in country of origin
▪ Family separation
▪ Meaningful cultural considerations narrated by clients
Allyship
• How can case managers practice allyship:
o Advocate and promote cultural inclusion in care planning and coordinating
services
▪ Connecting with community leaders, cultural healers if aligned with client
goals/wishes
o Advocate for resources and culturally appropriate services
o Recognize continued need for learning
o Improve access to resources
▪ Coordination with primary care may involve advocating for space and
incorporation of traditional healing practices
o Historical and intergenerational trauma may result in certain triggers and
feelings of fear and mistrust
▪ Provide safe space and work with where the client is at
Service Coordination
• Care coordination around services is the organization of care between two or more
participants (including the individual in care) to ensure the appropriate delivery of care
that is person-centered and reflective of their needs/goals
Document Summary
Individuals may still require a diagnosis to access services. Depression, as well opportunity to manage/modify current interventions and improve client engagement in treatment. Mental health care system challenges: wait times for counselling and therapy can be long, especially for children and youth. In ontario, wait times of 6 months to one year are common: psychiatric follow-up post initial assessment can be limiting. It has been reported that when interacting with the healthcare system. Particularly important for refugees who have fled persecution and forced displacement: living circumstances in country of origin, family separation, meaningful cultural considerations narrated by clients. Eviction, job loss, sudden loss: crisis can be defined as perception or experiencing of an event or situation as an intolerable difficulty that exceeds that person"s current coping mechanisms and resources. Case management and crisis: case managers play a pivotal role in assessing the severity of the crisis.
