Professional dissonance among social workers: The collision between values and job tasks in mental health practice.

This study investigated the relationship between individual and job characteristics of mental health social workers and professional dissonance—an experienced conflict between values and job tasks. A 33-item questionnaire, designed specifically for the study’s purposes was utilized. A total of 320 usable study questionnaires were returned (44.5% response rate). The primary study hypothesis, that professional dissonance is related to individual and job characteristics, was partially supported by the data. While job characteristics appeared to have little influence on dissonance, several individual characteristics of the respondents were statistically related to level of dissonance. Specifically, men with the most years of experience and with lower reported attachment to self-determination reported higher levels of dissonance. Study participants affirmed the importance of life-long supervision in managing dissonance in practice

Unforeseen implications of regulation in clinical practice.

The authors, both long-time LCSWs, utilize an existential framework and postmodern lens to explore the implications of increased professional regulation in clinical practice. Specifically emphasized, are the themes of litigation-fear and the threat of license revocation that are prevalent in the field of clinical social work at this time. The authors argue that this “climate of fear” can lead to a slippery slope for a profession that has long valued the individual’s right (both client’s and practitioner’s) to self-determination, authenticity, and creativity and call for an increased conversation among practitioners about the desired role of regulation in the profession with the overall goal of protecting a true understanding of ethics in social work

Screening and access to services for individuals with serious mental illnesses in jails.

High rates of serious mental illnesses (SMI) among jail inmates pose challenges for the criminal justice system and risks for the individual with SMI. Research has identified actions to address these issues; it is unclear to what extent they have been operationalized. This study examines jails in one state, exploring how individuals with SMI are identified and treated, and comparing these with research-based recommendations. Results indicate that jails are not using evidence-based screenings, staff require training in SMI, access to services and medications for jailed individuals with SMI is often slow, and coordination between community providers and jails is limited

Experiences of consumers with mental illness in the jails of North Carolina: Lessons for policy change

This study aimed to explore the experiences of people with mental illnesses and their collaterals in the jails of North Carolina. Participants were interviewed by study personnel using semistructured interviews. Study recommendations that emerged for changes to increase the care that inmates with mental illnesses receive included: (1) conceptualizing care at all stages of incarceration process; (2) involving family when possible, reworking privacy procedures; and (3) increasing skills for working with treatment-resistant populations throughout the process. As part of a sister study, the authors were successful in stimulating policy change at the state level and describe this process

Negotiated coercion: Thoughts about Involuntary Treatment in Mental Health.

This article, written by a service user/mental health advocate and an academic/ practitioner, explores the concept of ‘negotiated coercion’ as a way to frame involuntary treatment that acknowledges its coercive essence, yet advances suggestions to maximize negotiation with consumers

Professional dissonance: A promising concept for clinical social work.

Social workers in mental health face a complex climate where they encounter value-laden intervention choices daily. Examples of these choices may include deciding to initiate treatment in spite of a client's wishes to the contrary, making a decision to break confidentiality, feeling pressured to diagnose a client with a reimbursable condition despite a treatment philosophy that may be to the contrary, or feeling the need to “pick and choose” therapy topics in light of severe shortages in benefit coverage. These and other scenarios put social work clinicians at risk for professional dissonance or what has been called a feeling of discomfort arising from the conflict between professional values and expected or required job tasks. The current article explores professional dissonance as a pertinent concept for social work in general, and mental health social work in particular. The theory base of the concept is explored as well as its utility for understanding burn-out in a deeper way

Ethical Dilemmas of Practicing Social Workers Around Psychiatric Medication: Results of a National Study.

It is acknowledged that social workers in mental health and other settings routinely experience client-related ethical dilemmas. Further, there is wide recognition of the potential impact of ethical dilemmas on social work practice with clients who use psychotropic medication. Little is know empirically, however, about the experiences of practitioners with these dilemmas. This article describes the results of a national survey of practicing social workers regarding the nature of ethical dilemmas they face related to their work with clients on medication issues. The results make it clear that social workers regularly confront a variety of ethical dilemmas in this type of practice. Many of these dilemmas are related to ambiguities around the knowledge base of practice, appropriate roles of providers, and basic personal and professional values. The authors present implications of these findings for social work practice and further research

Social workers and involuntary treatment in mental health.

Involuntary treatment is often a reality in mental health social work. The current research examined 330 mental health social workers' involvement in and opinions about involuntary treatment as part of their primary job functions. Varieties of involuntary intervention and typical frequency were investigated. The most often cited areas of involuntary treatment experience proved to be mandated outpatient counseling and emergency hospitalization. In general, participants reported a high level of support for the existence of involuntary intervention, both in "idea" and "implementation." The study also explored the attitudes social workers have about these sometimes "ethically-complex" social work interventions and how these attitudes may have changed over the life of their practice careers due to practice experience and personal growth, job changes, and exposure to the reality of mental illness

Screening for intellectual and developmental disabilities in jails: Are we there yet?

Early identification of intellectual and developmental disabilities in persons in the criminal justice system is essential to protect their rights during arrest and trial, ensure safety when incarcerated, and maximize the opportunities to receive services while incarcerated and postrelease. Using telephone interviews of jail administrators (N = 80) in 1 state, this study examined how people with intellectual and developmental disabilities were identified in jails. Findings indicated that administrators varied widely in awareness of individuals with intellectual and developmental disabilities in their jails. Few jails (6%) used formal screening instruments for intellectual and developmental disabilities, others relied on officer observation and self-report (53%), and some provided no screening at all; in addition, officers received little training in this regard. Findings suggest that few jails are operationalizing best-practice screening processes for intellectual and developmental disabilities

Is self-determination still important? What seasoned social workers are saying.

This study investigated the attitudes of 320 seasoned mental health social workers toward the social work value of self-determination. Social workers were asked to rate the importance of self-determination in their daily practice, both as a guiding value and in actual practice and were asked to describe, in relation to their practice history, any changes they had experienced in the importance of the value. The majority of participants responded that they thought more about self-determination now than in the past. Surprisingly, they also reported being relatively untroubled when practice situations conflicted with the value of self-determination, such as when a client was in need of involuntary treatment interventions. Participants provided rich information about why they believed changes had occurred in the way they thought of self-determination and how they implemented self-determination in practice with mental health clients