Report of the OASW Mental Health Survey:
Who We Are, Where We Work, and What We Do
Kimberly A. Calderwood, Ann-Marie O'Brien and Joan MacKenzie Davies
KIM A. CALDERWOOD
JOAN MACKENZIE DAVIES
The following report was published in April 2007.
The OASW Mental Health Advisory Task Force is a group of ten social workers from around the province with a range of expertise on mental health issues. The group was formed in October 2004 with a purpose of providing leadership and advice to OASW in order to advance the interests of social work in the mental health care sector in the areas of policy, practice, education and research.
To better understand the role of social workers in the mental health sector in the province, the group developed and distributed an electronic survey through Survey Monkey for completion by social workers who self-identified as working in the mental health field in Ontario. The overall intent was to survey generally and to ask broad open-ended questions. Findings from this survey were used to develop a role statement for social workers practising in this sector.
Members of OASW were notified through monthly E-Bulletins, the February 2006 issue of the OASW Newsmagazine and Branches. The link for the survey was posted on OCSWSSW’s website. Emails were sent to various service associations, mental health and addiction facilities, and other interest groups such as social work leaders in hospitals. All were asked to broadcast the link within their email networks in order to access a province-wide cross-section of social workers, both members and non-members of OASW. Between December 6, 2005 and April 8, 2006, surveys were completed online. Participants self-identified as working in the “mental health sector”.
This report focuses on the responses to the mental health survey: who we are in terms of gender, years of practice, and education; where we work in terms of both geographic area and area of practice; and what we do in terms of roles and responsibilities.
Who We Are
There were 339 respondents: 78 per cent female, 20 per cent male, and 2 per cent did not state their gender. Men more often reported being managers or directors and doing more administrative work in their jobs. Men reported using online/email services providing links to research relevant to social work and mental health practice. Also, men, more often than women, reported a higher level of comfort in formulating psychiatric diagnostic impressions based on the DSM-IV. Slightly more women than men reported being involved in education.
Almost a third (28 per cent) of respondents reported having five or fewer years of work experience. Slightly fewer (21 per cent) had six to ten years experience, and over half (51 per cent) had over ten years experience.
The majority of respondents (75 per cent) reported having an MSW as their highest social work degree, while 24 per cent reported having a BSW and less than one per cent reported having a doctorate degree in social work. Of note was that 193 out of the 339 respondents (60 per cent) had additional academic degrees from disciplines other than social work.
MSWs more often than BSWs reported feeling comfortable formulating psychiatric diagnostic impressions based on DSM-IV, and doing more psychotherapy, consultation, and private practice. They were less likely to be doing advocacy and more likely to meet with service users in formal settings, such as in their office. In contrast, BSWs most often reported working in the community and doing case management.
Respondents were asked to comment on the relevance of their social work education to their area of practice, mental health. Sixty-six per cent of respondents reported that some of their knowledge and skills were gained from their university curriculum or practicum while only 20 per cent reported that most of their learning came from their university education. Nine per cent said none of their learning was from university. Respondents were also asked what core skills should be taught in the university curriculum and in continuing education. These included areas such as mental illness, major diagnostic categories, current treatment models, pharmacotropic medications, legal issues and advocacy. Response rates were above 70 per cent for all of these options, suggesting that there is an expectation that the curriculum cover a wide range of core skills. Only 50 per cent responded that physiology/brain functioning should be taught.
Regarding concurrent disorders, 48 per cent of respondents reported that their social work education was somewhat useful in preparing them to work with people who have both addictions and mental health problems. MSWs rated the usefulness of education and training in helping people with addictions and mental health problems lower than BSWs. MSWs were also less likely to address addictions as part of their clients’ overall mental health treatment and recovery.
Where We Work
There was broad representation from across the province: 26 per cent of respondents were from Toronto; 24 per cent from Eastern Ontario; 27 per cent from Southwestern Ontario; 15 per cent from South-Central Ontario; and 9 per cent from Northern Ontario. Representation by community size was relatively consistent with census data and the results of another recent OASW survey: 57 per cent of respondents reported being from a large urban centre; 24 per cent from a mid-sized urban area (50,000-200,000); 12 per cent from a small urban area (under 50,000); and seven per cent of respondents reported working in a rural area.
Respondents from large urban centres more often reported meeting service recipients in formal settings such as their office, as opposed to meeting in informal settings. Use of online/email services, providing links to research relevant to social work and mental health practice, was most often reported in small urban centres.
Respondents from the north and rural areas most often reported having multiple roles, e.g. same frontline role as other regions but, in addition, more manager/director, more administration, higher numbers of community development, higher psychotherapy and case management. Respondents from the north and rural areas reported being more likely to address addictions as part of their clients’ overall mental health treatment and recovery. Respondents from the north and rural areas reported assigning less priority, in their own practice, to the need for specific practice knowledge and skills related to work with clients from culturally diverse backgrounds. These respondents also report having less comfort in formulating psychiatric diagnostic impressions on DSM-IV. Respondents from the north and rural areas were less likely to be engaged in private practice or education.
Respondents were asked to identify their area of practice. Twenty possible categories were given, including “other”. It is important to note that many respondents considered the service they provided to fit into more than one of these categories. The largest number of respondents identified community mental health as their area of practice (34 per cent). Approximately one quarter of the respondents selected adult psychiatry outpatient departments (25 per cent) and private practice (24 per cent). About 20 per cent ranked case management (19 per cent), adult psychiatry inpatient (18 per cent) and children’s mental health (18 per cent). It is also important to note that almost 50 per cent of respondents identified “other”, and the list they provided was varied.
What We Do
The most striking finding that influenced the development of a role statement for social work in mental health in Ontario was the diversity of roles, responsibilities, and focus of work across the province. In many instances, the same individual took on a wide range of social work roles within their position. Also showing diversity across the system, respondents reported using over 50 different assessment tools covering a very wide range of issues.
Respondents were asked to identify their responsibilities from 13 possible categories. They were invited to check all that applied. Five major responsibilities emerged. Fundamental to all social work practice are assessment and referral, and 87 per cent of respondents identified this responsibility. Providing supportive counselling (83 per cent), crisis intervention (73 per cent), advocacy (60 per cent) and psychotherapy (53 per cent) were also identified as major roles. Activities related to education, discharge planning, addictions counselling, outreach, administration, research, and teaching activities of daily living were also most often identified by respondents as roles, with each category receiving between 20 per cent and 50 per cent of responses.
Eighty-three per cent of respondents reported that they believe they are having a significant impact on the delivery of mental health services. However, they also identified some challenges. Seventy per cent reported that the greatest challenge in their work is the lack of resources. Thirty-nine per cent reported the devaluing of the profession as another challenge. Respondents also reported working outside traditional work hours: 61 per cent reported that they work in the evening, 30 per cent work on weekends, and 15 per cent work on major holidays.
It is important to consider our findings in the context of an evolving mental health system in Ontario. There has been in the past twenty years a significant shift from an institutionally based delivery system to a community-based one. Within the hospital system, there has been a shift from departmental structures of social work practice with a chief or director of social work and supervisors, to a program management model with professional practice leaders, who may or may not be managers, and no supervisors.
It is also significant to note that this is the first survey on this topic that has been conducted by OASW. We have learned a considerable amount through the process, and will be fine-tuning the wording of questions to enhance the validity of future questionnaires. As such, the findings are preliminary and may require further investigation.
It is noteworthy that many respondents felt much of their knowledge and skills came from learning on the job rather than from their university curriculum. The finding that MSWs provide more consultation, psychotherapy, and private practice, while BSWs provide more community-based case management, may shed some light on one of the much-debated issues about the differences between BSW and MSW graduates. The OASW Mental Health Advisory Task Group has decided to explore this question further.
Ongoing strategies need to be developed toward overcoming the many challenges that social workers face, such as lack of resources and devaluing of the profession. The fact that over half of respondents reported practising psychotherapy supports the need for social workers to be recognized as key providers of psychotherapy services by government, as they move forward with the regulation of psychotherapy as a controlled act and restrictions on access to the title “Psychotherapist” in the proposed Psychotherapy Act under the Regulated Health Professions Act.
In regard to workplace conditions, OASW has previously completed a Quality of Work Life Survey; the results are posted at http://www.oasw.org/en/membersite/pdfs/OASWQualityofWorkLifeSurvey-FinalReport.pdf.
The role statement of social workers in the mental health system in Ontario that arose from the findings of this survey can be viewed as well at http://www.oasw.org/en/membersite/pdfs/2006-Dec/MentalHealthRoleStatement2006.logo.pdf.
The survey affirms that social workers continue to play an important role in the delivery of mental health services across the province.
Task Group Members
Ann-Marie O’Brien, Chair (email@example.com) *
Brian Adams (firstname.lastname@example.org)
Kim Calderwood (email@example.com)
David Champagne (firstname.lastname@example.org)
Steve Lurie (email@example.com)
Deb Moskal (firstname.lastname@example.org)
John Ostrander (email@example.com)
Marilyn Parsons (deceased)
Charmaine Williams (firstname.lastname@example.org)
Joan MacKenzie Davies (email@example.com)
* In September 2007, Ann-Marie O’Brien replaced Steve Lurie as Chair. Steve had provided leadership since the Mental Health Advisory Task Force was established in October 2004. He was just appointed as Chair of the Service Providers Advisory Committee of the National Mental Health Commission, recently formed and announced by Prime Minister Stephen Harper.
Kimberly A. Calderwood, PhD, RSW, is Assistant Professor at the School of Social Work, University of Windsor. Ann-Marie O’Brien, MSW, RSW, is the Professional Practice Leader for Social Work at the Royal Ottawa Mental Health Centre, and is also an adjunct professor at Carleton University’s School of Social Work. Joan MacKenzie Davies, MSW, Res. Dip. S.W., RSW, is the Executive Director of OASW.