Advocacy has been an integral part of the social work profession since its inception. Such advocacy efforts have usually occurred in response to the social needs of the time.
During the Civil War and World War I, for example, social work focused on responding to the major industrialization changes of this time period. Issues such as working hours, work condi- tions, and safety became the focus of the social workers’ advocacy efforts (Kirst-Ashman & Hull, 2009). The increased migration from rural areas all over the United States to larger cities was fu- eled by the hopes of prosperity through employment. Individuals came from these rural areas with dreams of finding work in cities, but instead were often met with overcrowded neighborhoods and living conditions that promoted health concerns for many (Kirst-Ashman & Hull, 2009). The set- tlement house movement of the 1880s represented a response to these poor inner-city living condi- tions. Settlement houses were places where religious leaders and others moved into neighborhoods to interact with the poor and “advocate for child labor laws, women’s suffrage, public housing, and public health” (Smith, 1995, p. 2130).
In contrast to the settlement movement, the Charity Organization Societies (COS) of the early 1900s focused on “curing individuals rather than on empowering communities” (Kirst-Ashman & Hull, 2009, p. 35). Faust (2008) observed that during the early period of the COS, at the turn of the 20th century, these “friendly visitors” were concerned with the current social conditions. Although their work sought to address what were perceived as “moral deficiencies” at that time, the ensuing activi- ties, discussions, and work focused on eradicating the wretched conditions that plagued urban cities (Faust, 2008; Miley, O’Melia, & DuBois, 2009). As Gilbert and Specht (1976) point out, this attention to therapeutic and clinical interventions prevailed as the major theme of social work from 1935 to 1960.
Although advocacy was a part of the profession long before this time, it became an especially prominent activity for social workers in the 1960s (Gilbert & Specht, 1976). The turbulent 1960s were the period of the civil rights movement, and the pressures for social justice exerted as part of that movement reaffirmed social workers’ need to focus on advocacy as a profession (Gilbert &
Review of the Social Work Literature 21
Specht, 1976). “The 1960s produced a new focus on social change versus individual pathology”
(Kirst-Ashman & Hull, 2009, p. 36), which required the social work profession to revisit its earlier days of working to empower clients and move beyond therapeutic interventions. In 1969, an Ad Hoc Committee on Advocacy publication included four major papers addressing the need for advocacy-related work in social work (Gilbert & Specht, 1976). The significance of this committee was that it was established by the national organization for the social work profession, the National Association of Social Workers (NASW) Task Force on the Urban Crisis and Public Welfare Prob- lems. “The Ad Hoc Committee of NASW reminded social workers of their social obligation [to advocacy]” (Faust, 2008, p. 293). The NASW has, throughout the years, continued to affirm the importance of advocacy for the social work profession. The NASW Code of Ethics (NASW, 1994) details the responsibilities of social workers, including the responsibility to work to “promote general welfare and social justice” (Lynch & Mitchell, 1995, p. 9).
Advocacy on behalf of clients has been an important role of social workers for more than 130 years. Advocating on behalf of clients has historically been the responsibility of social work- ers whether they are working as case workers, general practitioners, researchers, or clinical social workers. Advocacy has become something that all social workers are expected to incorporate into their professional role and identity (Gilbert & Specht, 1976, p. 288).
▸ Mental Health Advocacy: Successes and Shortcomings
There comes a time in everyone’s life when it feels like people are just not listening. From trying to get through to a parent to wanting to scream at political officials, everyone has experienced the frustration of being ignored. Mental health patients suffer this kind of dissatisfaction every day, and it is for this reason that mental health advocates have become vital to their well-being. Advocacy through legal, peer, and medical support is beneficial and necessary to the effective treatment and recovery of mental health patients by providing a voice for those who would otherwise be silenced, but it can also be counterproductive if not handled correctly.
Being an advocate has many different meanings, but the primary role of a person who holds this responsibility is to defend and support the decisions made by and the legal rights of the person they represent. It is easy to tread on the rights of individuals with mental illness because they may not feel capable of expressing their rights to certain people or they may not even be aware that they have rights at all. While it should be obvious that social workers, nurses, and other healthcare professionals should respect the rights of their patients, that is unfortunately not the case. In many instances, a lack of un- derstanding has proven to be detrimental to recovery for an individual with mental illness, while hav- ing empathy and consideration contributes greatly to a positive result (Stylianos & Kehyayan, 2012).
Because of this lack of understanding, maintaining the rights for those with disabilities is be- coming a pertinent issue. The Convention of the Rights of Persons with Disabilities began circulat- ing, and by 2010 had 146 signatories and 90 ratifiers. The basis of the Convention was to underscore self-determination, merit, and confidence for those with disabilities to make their own choices. It served as a form of advocacy for those with mental health issues by declaring that they deserve the same respect and the same rights as everyone else. Having a mental illness does not make a person incapable of functioning in society, and he or she should not be treated as such. In 1999, the U.S.
Supreme Court even determined that institutionalizing people with mental illness if they can be treated as a member of the community was a form of discrimination according to the Americans with Disabilities Act, and if possible, people should be placed back into society. This kind of legal advocacy, though effective, can easily become complex (Stylianos & Kehyayan, 2012).
22 Chapter 2 Advocacy Role of Providers
A less complex form of advocacy comes from those closest to the individual. Peers and men- tal health practitioners are always involved with people who have mental illnesses and can easily become a source of support. Having support from friends whether a person is mentally ill or not is always a source of comfort, which helps the individual to feel confident and empowered. Mental health practitioners can be a source of comfort as well, as their main interest involves seeing prog- ress in the individual, and they will help them reach that goal in the best ways possible (Stylianos
& Kehyayan, 2012).
Creating a world that advocates for all its people can be difficult when there are conflicts of interest involved. However, the World Health Organization (WHO) has been paving the road to a more equal society for a while. WHO’s purpose is to help advance world health, and it recognizes that people with mental disorders have become stigmatized and are viewed as inept at making deci- sions. They are vulnerable to abuse and mistreatment by people who should care about their safety.
The organization also recognizes barriers these individuals face daily, such as the inability to receive proper mental health services and information about these services, as well as poor treatment for those who do receive help, and WHO seeks to actively work to break down these walls between men- tal health patients and the rest of society. Because of these reasons, WHO promotes mental health advocacy to enact policies that protect the mentally disabled from harm and promote equality in a way that other organizations or individuals cannot (Funk, Minoletti, Drew, Taylor, & Saraceno, 2006).
By using government support, even though a variety of factors can influence governments, great strides can be made in mental health advocacy. Governments have access to resources that can open communication channels between advocacy groups and mental health providers, which will allow for greater cooperation between the two for better treatment of the mentally ill. Further, mental health advocacy groups can work with governments to improve existing legislation and enact new laws that will be beneficial to both the mental health patients and those who treat them. Government agencies also can communicate with the public. Educating the people becomes a catalyst for positive change even in small ways such as reducing the stigma of mental illness. Governments and advocacy groups such as WHO together are strong influencers of mental health advocacy movements, and with any hope will improve social attitudes toward people seeking mental health treatment (Funk et al., 2006).
Advocacy, although it sounds as straightforward as standing up for a person’s rights and passing laws, is not that simple. Mental health advocates are often the only professionals who are working to help the patients, which can lead to conflicts of interest if the patient has wants that conflict with the professional’s opinion. In addition, advocates may easily become caught up in the issues they are currently facing and forget to focus on long-term advocacy, such as policy reform, for future patients. Together, these issues lead to advocates’ failure to provide for patients to the fullest extent of their abilities. Placing policy change in a low priority position dwindles the availability of treat- ment for mental health patients, which is the exact opposite of the role advocates are meant to play.
Some characteristics of advocacy that should be present in all advocates are absent, which is also nonproductive. These characteristics include thinking of families as assets instead of hindrances, considering at-home treatment to be inadequate, and working jointly with the many people who have vested interests in the patient’s well-being. Advocacy, while it is undoubtedly a positive influ- ence for a patient, does not come unchallenged, and there is always work to be done (Knitzer, 2005).
Be it an individual, group, or government, mental health advocates have a difficult but cru- cial role to play in the lives of mental health patients. From acts as small as offering a source of emotional support to as big as working with leaders to pass legislation, advocates work tirelessly to improve the lives of those who need help most desperately. They have proven to be extremely ben- eficial to the health and recovery of their patients in the short term, while in the long term leading the way for a better future for patients to come.
Mental Health Advocacy: Successes and Shortcomings 23
▸ Interdisciplinary Benefits and Approach
In a world where social service organizations have seen their budgets shrink, staff diminished, and the ability to provide services cut due to difficult economic times, the interdisciplinary approach to providing services has become even more essential. Working to provide services in an era char- acterized by limited resources has resulted in clients working with multiple agencies and multiple professions. In this challenging environment, an interdisciplinary team approach to service provi- sion is the best approach.
Social work and the nursing profession are well suited to be in the forefront of the interdisci- plinary service provision movement. Clients’ compartmentalized problem focus is often a result of having to seek services from multiple organizations. The interdisciplinary team approach to ser- vice lessens compartmentalization of problems by clients and can be found in many mental health and medical settings (Johnson, 1995). “Medical settings also make use of the interdisciplinary team approach in providing for both the psychosocial and the physical needs of the patients; diagnostic centers also make considerable use of this type of team approach” (p. 119). When agencies work together and take an interdisciplinary team approach to helping, the client recognizes, respects, and benefits from this approach. Most importantly, the professions and social service community ensure the most effective and efficient use of public resources.