By Poon Weng Cheong, Kong Lai Yee and Geraldine Wong
Medical Social Work in IMH started in the sixties at Woodbridge Hospital when the first social worker came from the United Kingdom to set up services for the poor in Singapore. Services then were naturally more inclined towards financial and welfare areas in view of the economic circumstances.
Over the decades, this role has evolved alongside the country’s progress economically. The MSW’s role in IMH has followed suit in its transformation. In the mental health setting, the MSW pays special attention to the social context of the person with mental illness (PMI), which entails the need to address social consequences arising as a result of the mental illness. The social context refers to the social environment of the individual and how it shapes the experiences of the mental illness. The social consequence refers to the impact of the mental illness on the person, family, and community (Bland 2001:147)
The social worker is an important member of the multi-disciplinary team (MDT) in mental health services, providing bio-psycho-social perspective and intervention to support patients and their families.
In general, the core functions of a Medical Social Worker are:
(1) Psychosocial Assessment, to assess strength and resilience of the patient, family, social support systems to help the individual functions within the community,
(2) Family Education and Mediation, to educate the family on the physical and psychosocial needs of its members and how they can access to internal and external resources; to mediate on the conflicts so as to strengthen their family relationship and aid in problem solving,
(3) Counselling for individual, couple and family, to provide counseling to clients presented with poor mental health issues (such as depression and anxiety) due to relationship problems and financial stress; clients facing adjustment difficulty due to illness and disability and clients with caregiving issues,
(4) Risk assessment, to assess and manage risk due to self-harm and harm to others,
(5) Financial assessment, to administer Medifund Assistance, identify and refer cases of financial hardship, administer other financial assistance,
(6) Discharge planning, to work with the MDT in formulating discharge plan and
(7) Information and referral services, to link patients and caregivers to necessary community resources.
In the mental health field, the social worker not only has to perform the core functions but often has to incorporate other roles to adequately meet the needs of someone affected by mental illness. The social worker needs to manage the psychiatric condition of the person by assessing the mental stability of the illness, monitoring the medication regime, providing psychosocial rehabilitation and working on improving PMI functioning in the community.
In the National Mental Health Blueprint, there are three community outreach teams. Each team deals with the unique needs of targeted client across the human lifespan of Singaporeans. Firstly, the Response Early intervention and Assessment in Community Mental Health (REACH) focuses on the needs of school going children. The Community Mental Health Team (CMHT) provides psychosocial rehabilitation of adult population with mental disorder. The Aged Psychiatry Community Assessment & Treatment Service (APCATS) is a community –oriented psychogeriatric outreach service.
Role of Medical Social Workers in REACH
The GP-school network was proposed by the Institute of Mental Health(Department of Child and Adolescent Psychiatry) where mobile multi-disciplinary clinical teams (i.e. REACH) were set up to provide mental health support for children and adolescents in the community involving schools, general practitioners (i.e. family doctors and community paediatricians) and voluntary welfare organisations. The REACH team comprises of Medical Social Workers, Doctors, Psychologists and Nurses.
The key objectives of this project are to:
(1) Improve the mental health of children and adolescents in schools
(2) Provide early interventions, support and training to school counsellors on mental health disorders
(3) Develop a mental health network for children and adolescents in the community involving
The role of the Medical Social Worker in the REACH team is to provide support and training to the school counselors, general practitioners and staff from the voluntary welfare organisations on ways to identify and assess children with mental health problems.
This is done through providing:
1) A helpline to consult and seek advice on strategies to help children with emotional, behavioural and/or developmental disorders,
2) Assessment, intervention and psychiatric treatment for children with mental health disorders when needed,
3) Case conferences, talks or workshops,
4) Individual and family therapy,
5) Group therapy,
6) Formulation and development of care management plans for referred students in collaboration with school counselors and the other community partners,
7) Appropriate referral and liaison with other healthcare professional and agencies and
8) A network of resources and information for dissemination to the referred student/ caregiver and FTSC.
Role of Medical Social Workers in CMHT
The Community Mental Health Team provides home-based psychosocial rehabilitation services and crisis interventions for persons with serious mental illness. The psychosocial rehabilitation services are based on the renowned Assertive Community Treatment Programme. The crisis interventions consist of helpline and mobile crisis team (Wei et al, 2005).
The major component of CMHT is clinical work. The second component is integration of care with the community through networking. The last component is providing training and support to the networking partners.
There are currently three Medical Social Workers in the team. Each Medical Social Worker provides social work services in respective zones namely, Eastern, Western and Central. He/she works with a multidisciplinary team consisting of doctors, psychologists, occupational therapists, nurses and social workers.
The six main roles of a Medical Social Worker in CMHT are:
1) To provide social work and psychosocial rehabilitation assessment and interventions to support the main case managers,
2) To provide care coordination by taking on the role of a case manager,
3) To provide clinical opinion in multidisciplinary team,
4) To spearhead networking efforts of CMHT,
5) To provide training to community partners and
6) To provide crisis interventions in mobile crisis team
Role of Medical Social Workers in APCATS
Aged Psychiatry Community Assessment & Treatment Service (APCATS) is a community –oriented psychogeriatric outreach service. APCATS started in January 2006 as a pilot project to provide psychogeriatric assessment and treatment for elderly in their own home if they are unable to access standard clinic-based mental health services due to frailty. APCATS aims to prevent unnecessary admission to inpatient mental health services and minimize the length of stay in hospital. APCATS also provides support for carers and reduces the burden of carers, hence allowing the elderly to remain longer in the community.
Medical Social Worker in APCATS works within a multi-disciplinary team to ensure the continuity of holistic patient care, by assessing and evaluating needs of the client and caregivers, and planning, coordinating, implementing and monitoring the interventions to address those needs.
APCATS Medical Social Worker’s Scope of Work Include:
1) Respond to inquiries on the referral to APCATS,
2) Conduct home visit after liaison and discussion with team members,
3) Establish rapport and build therapeutic alliance with client and family members,
4) Identify client’s/family’s need(s), formulate and develop appropriate individualised service plan in collaboration with other team members,
5) Case-manage patients that require more social work input,
6) Provide social and/ family support for caregivers within the boundaries of patient care,
7) Conduct bio-psycho-social assessment of clients including monitoring signs of relapse and caregiver stress (eg. administering the ZARIT Burden Scale with caregiver) (Generic skill),
8) Conduct social and family assessment for clients when necessary and to provide clinical services in terms of supportive counselling, family work, caregiver support, information and referral for services required, as well as work with and support family members in implementation of therapeutic care plans (Specific skill),
9) Provide psycho-education to client and family in response to needs assessment,
10) Provide assessment of patient’s financial status via means testing and render the necessary assistance if they meet the criteria,
11) Participate in APCATS multidisciplinary meetings and
12) Carry out duties as assigned by the Programme Director.
In conclusion, the roles of a Medical Social Worker may change over time depending on the needs of client and organisation. The training and education of social workers should equip entry social workers with a broad based knowledge and skills. In addition, for social workers who are interested to work with PMI, they must be further trained to function to meet the unique roles of Medical Social Workers in mental health field.
Wei KC, Lee C and Wong KE (2005), Community Psychiatry in Singapore: An Integration of Community Mental Health Services Towards Better Patient Care. Hong Kong Journal of Psychiatry, 15:132-137.
Bland R, (2001), The Social Worker in Meadows G. and Singh B (Eds), Mental Health in Australia: Collaborative Community Practice, Melbourne: Oxford University Press.