Mental health practice is inextricably linked to how this concept has been understood in a historical context from which policies and systems of care develop. How mental health is perceived has shaped policy, as much as policy has influenced how mental health has been defined and subsequently treated. Early frameworks evolved, furthering the multidisciplinary nature of policies and services highlighting social and environmental contributions. Holistic approaches that appreciate social determinants are a comparatively new way to understand and advance mental health policy that underlies access to insurance, programs, and services based on qualifications and eligibility. A chronological and historical overview highlights interconnectedness and provides context to the development of mental health policies, initiatives, and systems of care. Content specific to roles of the social work profession should be included.
Christine M. Rine
As technological advances continue to develop, delivering macro human service through social work innovations becomes a new priority for the discipline. Digital technologies offer potential applications using tablets, smartphones, cloud computing, artificial intelligence, and wearable technology to enable whole new possibilities for human services. As a result, policymakers and community organizers alike can access the existing information much faster, and potentially connect with hard-to-reach communities to make meaningful decisions. Incorporating the latest digital trends from business and industry settings to macro social work practice are highlighted. By utilizing digital technology, human service organizations can become more proactive and citizen-centered, potentially transforming personal and economic capacity.
Steven P. Segal
The deinstitutionalization policy sought to replace institutional care for populations in need of care and control with prosocial community-based alternatives. U.S. institutional populations, however, have increased since the policy’s inception by 205%. As implemented, with the assistance of advocacy and cost-cutting factions, it has succeeded only in enabling the divestiture of state responsibility for target groups. It sought to prevent unnecessary admission and retention in institutions. As implemented, deinstitutionalization initiated a process that involved a societal shift in the type of institutions and institutional alternatives used to house its target groups, often referred to as trans-institutionalization. For many in need of institutional placements, it has succeeded in preventing all admissions, expanding admissions for others. In seeking to develop community alternatives for housing, treating, and habilitating or rehabilitating its target groups, it has succeeded in establishing a variety of alternative living arrangements and showcase and model programs illustrating what can be done; yet, it has failed to deliver on investments in such programs to serve the majority of its target groups. It has resulted in the abandonment of substantial numbers to homelessness. It has been documented, from political, economic, legal, and social perspectives, how this policy has affected the care and control of populations such as older adults, children, people with mental illness or developmental disabilities, people under correctional-system supervision, and, more recently, individuals without a home. Suggestions for a truer implementation of deinstitutionalization’s initial aspirations are available.
Eva M. Moya, Amy Joyce-Ponder, Jacquelin I. Cordero, Silvia M. Chávez-Baray, and Margie Rodriguez LeSage
The emergence of social work and macro practice is often associated with the eradication of poverty and prevention of homelessness through the efforts of 19th century settlement houses. Structural violence and social determinants of homelessness are often grounded in unequal social, political, and economic conditions. Health and mental health were affected by the lack of stable housing, causing and increasing the complexity of health and human service needs and services. Furthermore, due to inequities, some populations are inadvertently more likely to face chronic homelessness, which can be mitigated through the role community-engagement and macro practice interventions.
After a period of mass incarceration that spanned the 1970s through the 2010s, the United States remains the leading incarcerator in the world. Incarceration rates in the United States outpace those of other countries by several hundred per 100,000. Incarceration rates began to decline slightly in 2009, when there was a loss of fiscal, political, and moral will for mass incarceration policy and practices. First, the onset of smart decarceration approaches, the historical context from which smart decarceration stems, and the societal momentum that led to the conceptualization of smart decarceration are described. Smart decarceration is a lead strategy in social work that has been adopted by the American Academy of Social Work and Social Welfare as one of the 12 Grand Challenges for Social Work for the decade 2015–2025. Finally, an overview of the current status of smart decarceration and details shifts and initiatives to pursue at the intersection of social work and smart decarceration is provided.
Sheila P. Vakharia
Social workers are uniquely qualified to be effective drug policy advocates for effective and equitable policies through their commitment to advancing social welfare and promoting social justice. The prohibitionist antidrug policies that began at the turn of the 20th century have been a key driver for the criminalization of millions of Americans over time, a disproportionate number of whom have been people of color. The period beginning with President Richard Nixon’s “War on Drugs,” in addition to contributing to inequality and marginalization, has exacerbated a number of public health and safety harms, suggesting that past policy approaches have not met their intended aims. The North American opioid overdose crisis in the early 21st century is presented as an illustrative case study because its persistence and mounting death toll exemplify the challenges with the current model of drug prohibition. Areas for macro social work interventions include legislative advocacy through lobbying, provision of expert testimony in legislative hearings, engagement in reform through litigation, involvement in social action, and performing policy analysis and research.
Janelle Stanley and Sarah Strole
The historical context of suicidal behavior and public policies addressing suicide arose simultaneously within the United States, and both reflect a culture of discrimination and economic disenfranchisement. Systems of oppression including anti-Black racism, restrictive immigration policy, displacement of American Indigenous communities, religious moralism, and the capitalist economic structure perpetuate high-risk categories of suicidality. Suicidal behavior, protective factors, and risk factors, including firearms, are examined in the context of twentieth and early twenty first century public policy. Recommendations for public policy will be discussed with consideration for policies that impact communities disproportionately and social work ethics, such as right to die laws and inconsistent standards of care.
Rhonda Wells-Wilbon, Rhea Porter, Taylor Geyton, and Anthony Estreet
Millions of Americans are affected by a mental illness or disorder each year. Given the prevalence, it is unfortunate that significant disparities exist within mental health care. Some of the most common reasons mental health disparities exist include stigma, previous negative experiences, limited mental health literacy, lack of culturally aware providers and services, language access, and lack of financial resources. Additionally, members of racial and ethnic, gender, and sexual orientation minority groups, who already encounter higher levels of bias, experience poorer mental health outcomes due to disparities than their counterparts. Grounded in the values and ethics of the profession, it is no surprise that social workers play a vital role in reducing mental health disparities.
Vadim Moldovan, Eugeniu Rotari, Vadim Tarna, and Alina Zagorodniuc
The Republic of Moldova is a small post-Soviet country that has been “transitioning” from a socialist to capitalist economy since the 1990s. Once a prosperous region of the Soviet Union, it is now among the poorest countries in Europe, facing many social problems that call for a strong social work profession. However, social work is new to the country and the profession is challenged by low societal status, meager resources, and lack of cohesion. Social work in Moldova is struggling to meet these challenges with the help from the West and the emergence of an indigenous model of professionalization. Child welfare, elder care, mental health, as well as the history of social work in Moldova, current state of social work education with its obstacles to and opportunities for progress will be discussed.
Hee Yun Lee, William Hasenbein, and Priscilla Gibson
As the older adult population continues to grow at a rapid rate, with an estimated 2.1 billion older adults in 2050, social welfare researchers are determined to fill the shortage of gerontological social workers and structural lag to best serve the baby boomers who are expected to need different services than previous generations. Mental illness impacts over 20% of older adults in the world and the United States. The major mental health issues in older adults include depression, anxiety, loneliness, and social isolation. Depression is considered one of the most common mental health issues among this population; however, the prevalence could be underestimated due to older adults linking relevant symptoms to other causes, such as old age, instead of as possible depression. Like depression, anxiety symptoms are often mistaken as results of aging. It is also difficult for providers to diagnose anxiety in this population due to anxiety frequently being coupled with other illnesses and the psychological stress that comes with old age. Because the presence of loneliness or social isolation can manifest depression and anxiety symptoms in older adults, it is also difficult to separate these two issues. With the anticipated increase of the older adult population within the next few years, measurement tools have been created to assess depression and anxiety specifically for older adults. In addition to adapting assessment tools, interventions tailored to older adults are essential to ensure treatment coherence, even though medications are the go-to treatment option.