Applying a social justice lens to mental health

BY JIM MORTON, SOCIAL JUSTICE COMMITTEE CHAIR

We know that the first step toward change is speaking up.

In late 2017 and early 2018, many social workers from across Nova Scotia contacted the College to communicate concerns about the state of mental health and addiction services in our province. The issues they raised included an over-reliance on the medical model, underfunding, and an approach to services that largely ignores client-centred care and the context in which individuals live. Social workers also spoke with frustration about prioritizing late-stage treatment while downplaying critical issues like early childhood adversity, poverty, prevention and early intervention. They also expressed a sense of alienation.

Social workers know they have a vital perspective, and yet experience a sense of being devalued in the mental health workplace.

In response to these alarming concerns, the College asked the Social Justice Committee to take a close look at mental health, with a view to developing an advocacy strategy informed by social work values and focused on improving mental health in Nova Scotia.

The committee eagerly adopted the challenge. As a first step it organized a symposium in Halifax in April 2018. That event brought together about fifty people - social workers, those with first voice experience and other professionals - who were given the task of identifying what it would take to achieve optimal mental health in Nova Scotia. Their hard work surfaced five important principles:

1. Prioritize funding for mental wellness, bringing it without delay to 10% of overall health spending in Nova Scotia. This would bring investment in line with the recommendations of the World Health Organization.

2. Take action to address social inequities and the social determinants of health. Social workers know that mental health is about much more than medications, hospital beds and treatment sessions. It is sustained by access to nutritious food, family support, quality housing, adequate incomes and strong, healthy communities.

3. Found mental health and addictions programming and services on authentic community collaboration. People know what they need. Consultation must guide action, not platitudinous public relations exercises.

4. Ensure mental health policies, programs and services are client and family-centred. Health and illnesses are shaped by social context. Placing the client and family at the centre is good customer service, but is also the crucible for diagnostic work, treatment planning, and service development.

5. Understand mental wellness as a life-long journey, fostered by healthy communities. Wellness is not an end; there is never a fix. We need communities that sustain us as we draw our first breath and stand with us throughout the unpredictable ups and downs of life.

The College, guided by the symposium experience, prepared a working document on mental health and, with Social Justice Committee support, is using it to commission research designed to build foundational evidence for an advocacy strategy. This research will look at the need for strengthening investment in mental wellness. It will explore social work’s value in the planning and delivery of mental health and addiction services. The research will also offer insights on how the evidence of our systemic connections – our social, emotional and biological ties to families and communities – can be factored into clinical and community interventions.

In the meantime, the Social Justice Committee has begun to outline an advocacy strategy that responds to a vision of a “Nova Scotia where people are known for their integrity, confidence and capacity to live creative, productive, selfdirected lives; where the social determinants of health are widely understood and have the solid financial support of government; and where collaborative, respectful client-family centred mental health services are readily accessible to everyone.”

Our committee knows, as you do, that none of this will be possible without a serious investment from all of us.

We will need partners. We need to create an intensive, province-wide conversation that involves planning and organizing media and letter-writing campaigns, community meetings, and advocating for adjustments to social work education. We will need social workers to draft letters that link mental wellness with the social determinants of health; and to write articles that help readers understand that individuals can only be understood in the context of the families and communities in which they live.

We will need you.

By speaking up last year, social workers opened up a path that will help the College be a significant advocate for optimum mental health in Nova Scotia. Your voices have created a critically important goal, one that will take all of us to achieve. It will require drawing on our collaborative skills. It will challenge us to dig deeply into our understanding of systems and context, into our knowledge of the intersectionality of life. Speaking up has set the Social Justice Committee on a demanding expedition. In the months ahead, this voyage will undoubtedly require your voices again, along with your energy and courage… and your social work skills.

COMMITTEE MEMBERS:

Jim Morton(Chair), Annemieke Vink, (staff liaison), Harold Beals, Megan MacBride, Alexa MacLean, Maggie McCulloch, Haley McIntosh, Dermot Monaghan, Juanita Paris, Valerie White