The International Journal of Psychosocial Rehabilitation

How New Zealand Community Mental Health Support Workers Perceive their Role

 

Barnaby D. M. Pace MNZPsS, Ass.MNZCMHN

BSocSc(Hons), MSocSc(Hons), PGDipCBT, PGDipEd(AdEd)

Academic – Mental Health Support

 Waikato Institute of Technology
Thames Campus
P.O. Box 713
Thames, New Zealand

 

Email Barnaby.Pace@wintec.ac.nz

 

Citation:
 Pace, B.  (2009). How New Zealand Community Mental Health Support Workers perceive
 their role. International Journal of Psychosocial Rehabilitation. Vol 13(2).   5-10

 



Abstract
As with all fledgling professions the role of the Community-based Mental Health Support Work is forging its own identity in New Zealand’s health care sector, with support workers struggling to fashion their own scope of practice. Through the uses of qualitative research methods support workers have been provided with the opportunity to share their perception of their role in community mental health and residential support services.   
Keywords: Mental Health Support Work, Residential Support Services, Role Perception, New Zealand

 

Introduction
Continual discussions with community support workers have provided the catalyst for the present research, with a focus on offering support workers with a sense of their own identity within mental health services. Currently community mental health workers are primarily defined by the support worker competencies identified by the Mental Health Commission (2001). The competencies guide support worker requirements such as attitudes, skills, knowledge and behaviour (Mental Health Commission, 2001, p. 3). The competence development process included reviews of international mental health recovery literature, a review of the training standards and requirements for support workers as well as other professional mental health bodies, and focus group consultations with services users, families, Maori (indigenous people) and other pre-dominate cultural groups. More recently the Ministry of Health (2007) has been giving further consideration to competences guiding best practice, focusing on what ‘real’ skills mental health support workers require. Additionally, recent funding developments in New Zealand have seen the inclusion of Addiction Services within the scope of mental health service provision. Additional support and training needs to be provided to mental health worker, as covered in the Ministry of Health (2007) documentation.    Definitions given through employment and associated contacts and the self perception of mental health support workers are not necessarily in alignment. The Ministerial documents discussed thus far offer guidance for behavioural conduct and the expectation regarding knowledge, attitudes and skills, but they do not define how support workers view themselves and their position within mental health service provision.
 
Two recent research papers (Barlow, 2006; Ryan, Garlick & Happell, 2006) have examined the role of community mental health nurses and their associated perception regarding their role within mental health service. Ryan et al. (2006) examined the role of mental health nursing with community based geriatric psychiatric services. Data analysis revealed two major themes, the role of the mental health nurse, and the specific function they carry out. Of particular interest to this paper is the role of the mental health nurse. Ryan offered discussion drawing on the narrative provided by the research participants. Central to the mental health nurses was their perceived practical “hands on” approach and their identified need to be a “Jack of all trades” (p. 97).  Barlow (2006) conducted a similar small-scale study to examine the perceived role of community mental health nurses and other members of multidisciplinary team for the elderly. The aim of the current paper is to determine the perceived role of the mental health support worker by those who are current employed in such roles.    
 
 
Methodology
A qualitative approach was used to conduct this research. The use of a qualitative methodology appeared particularly appropriate based on similar previous research (Ryan et al, 2006). Individual semi-structured interviews were conducted with mental health support workers from a variety of community based mental health services. All the services were located in the Waikato region of New Zealand’s North Island.
 
Semi-structured interviews are viewed as appropriate for the exploration of individuals’ perceptions, attitudes, values and beliefs (Richardson et al. 1965, Smith, 1975). This approach provide extensive, rich narratives and offers the opportunity for the researcher to clarify responses and follow-up with additional questions (Barriball & While, 1994). The interview consisted of twelve open-ended questions to guidance the research participants. The interview duration varied from 30 to 45 minutes depending on the responses given. Detailed interview notes were taken with some of the sessions being recorded with the approval of participants.
  
Participants
The research group consisted of 14 participants currently working as Mental Health Support Workers, and 1 participant currently employed as a mental health service manager with a support role built in. The research sample produced a mean age 49 (M = 49) and a gender spread of 4:1 (Female: Male). The mean time for employment as a mental health support worker was 2 year and 8 months (M = 2.8) with a range of 5 months to 6 years and 8 months (range = 6.3). Thirteen of the participants work directly with services users and two with the service user’s family. All participants worked for non-government mental health service provides.
 
Data Analysis
Major themes were identified through content analysis (Hsieh & Shannon, 2005; Berrios & Lucca, 2006) of the narrative notes and transcripts after multiple viewing. The first viewing was to gain a sense of familiarity with the information (Ryan, Garlick, & Happell, 2006). The interview notes and transcripts were then analysed for the identification and subsequent coding of major themes. A final reading of the information was made to test the accuracy of the coding in line with the identified themes.
 
Research Validity Measure
A focus group was formed to offer validation of the findings produced from semi-structured interviews. The focus group consisted of 4 participants who had been involved in the semi structured interviews. The mean time for employment as a mental health support worker was 4 years and 4 months (M = 4.4, range = 5.7). The focus group was directed to provide feedback on the researcher’s analysis of the narratives collected during the original interviews.
 

Results
The analysis of the data revealed the following themes as the perceived functions of a community based mental health support worker.
  1. Developing and maintaining a therapeutic relationship
  2. Working alongside the service users
  3. Skill development and training
  4. Community reintegration
  5. Administration
Each function is described and illustrated with participants’ quotes where appropriate.
 
1. Developing and maintaining a therapeutic relationship
The development and subsequent maintenance of the therapeutic relationship with consumers was identified by all participants as the single most important feature of their role. The therapeutic relationship was viewed as the overarching construct on which their role was created, being referred to as the philosophy behind their current practice. However, indirect references were made to strength based practice but not enough to suggest a theoretical underpinning.
 
Frequent references were made to the development and maintaining high levels of trust with their client group. Several statements indicating this level of trust required of the support worker in order to make it a meaningful relationship.    
 
“There is huge importance around gaining and maintaining trust. Without it the relationship is worthless.” [SW5]
 
“I think that a large part of the role is about the relationships you have with your clients. Without having that relationship you would not be able to work with them… help them on their journey… the road to a normal life.” [SW1]
 
2. Working alongside the service users
The concept of working alongside the service users featured frequently through the interviews, with a strong sense of partnership and collaborative practice. The general consensus across the participants was that in their role they were happy to support, encourage and engage in shared activities.
 
“It is really about working with our clients, providing the human connection in support of them and to be a partner in recovery … Encouraging them to find their own answers” [SW11]
 
 “I guess… for me… it’s about working with consumers and supporting them towards a better quality of life. That is our real job.” [SW1]
 
However, a strong sense of opposition was depicted around doing things for the service user. This particular concern was voice most clearly around cleaning duties. 
 
“I was not employed as a cleaner. I have no problem helping or working with a client, but I’m not doing all the cleaning for them. Cleaning flats is not in my job description. I mean, sometimes, I feeling like a motel cleaner not a support worker.” [SW3]    
 
3. Skill development, training and goal setting
A particularly strong emphasis was placed on the role of teaching and skill development by the support workers. The support workers interviewed considered that they spent a considerable amount of their time aiding service users learn simple day-to-day skills, and helping them set clear goals and future directions.
 
“I guess I view myself as a teacher of life skills, who offers guidance for the future.” [SW8]
 
 “Goal planning is important, particularly for day-to-day stuff like shaving and washing. For some clients it’s about showing them how to do it, n’ for others it’s about reminding them to do it.” [SW3]
 
4. Community reintegration
Inherent in the title of the community support worker is their role in supporting service user’s become reintegrated into the community. This element of their perceived role was strongly linked to both working alongside the service user and skill development.    
 
“To walk along side them” [SW8]
 
“Connectiveness to the community” [SW11]
 
5. Administration  
Administration was identified as a “necessary evil” of the support workers role. Over half of the participants identified an increase in the amount of time spent on administrative tasks over the duration of their employment. A number of participants viewed this increase in reporting to be detraction from their primary task of service user support.
 
“Lots of paper work, up to 40 percent of my time I have you know” [SW3]
 
“…satisfy reporting requirement for the job…” [SW7]
 
Research Validity Measure Results
Feedback received from the focus group validated the findings reported from the semi-structured interviews. The group endorsed the five identified roles for mental health support workers. The group commented on the accuracy of the comments drawn upon and their alignment with their own perceptions of the Mental Health Support Worker role in New Zealand. 
 

Discussion
The overarching purpose of this paper was to establish the perceived role of mental health support by workers currently employed in this position. Analysis of transcripts from the individual interviews revealed five predominant themes across all research participants. As a validity measure, a focus group of senior support workers was asked to offer their comments and endorsement of the identified themes.
 
As has been clearly identified within a large body of mental health literature the development and subsequent maintenance of a therapeutic relationship as paramount to the success of positive outcomes. This level of importance has been identified as no different in the role of the mental health support worker. Particularly strong emphasis was placed on the role of trust in the therapeutic relationship, with several references to how a high level of trust was required between the support workers and the service user in order to have a meaningful and effective relationship. Meaningful and effective relationships were viewed as therapeutic relationships that was both supportive and goal-orientation. Although the terms support or goal-orientated were not identified as clear roles of the work support, they are implied throughout four of the five roles articulated, with administration being the exception.
 
Goal planning and implementation are inherent features in the process of working along side services users, assisting their social skill development and as a part of community reintegration. In order to achieve successful outcomes the goals and associated processes need to be clearly identified by way of a comprehensive needs assessment. A function of the support workers role which was not identified by participants interviewed, which lends itself to warrant further investigation. Does the undertaking of service user assessment fall outside their scope of practice? Or is it not deemed as a critical feature of their current work. Either way, goal and support planning needs to be built on the foundation of a well constructed assessment.
 
Built on top of the therapeutic relationship and support/goal setting process, is the role of the support worker to work in collaboration with the service user. In effect they perceived their role as one of support and working alongside the service user. It was very clearly articulated that their role was one of collaboration and partnership, and not one of work for the service user. This concept in itself raised a number of philosophical conversations as to the degree of support and guidance one should offer. At what point do you start to withdraw support? How much guidance do you provide? Such questions are not easily answered, however a general consensus that all service users will vary in the degree of support and intervention required and, as such, need to be treated as individuals was concluded. Similarly the individuality of service users was referred to when considering skills development and training. The required level of support and training/education offered would be determined from a current assessment of service users needs, providing the foundation to tailor a package of support. In a circular fashion the individual approach reinforces the therapeutic relationship and strengthens the whole process increasing the likelihood of a successful outcome.       
 
Finally numerous comments were made regarding the time spend on administrative tasks and the perceived increase in the role over the past two year period. Various comments were made regarding the increase focus on quality reporting and documentation to meet sector standards and funding requirements. Interestingly the increase in Information Technology and the transition from paper to electronically based recording was viewed as problematic. Identified areas for consideration ranged from the time-consuming nature of IT based work, primarily due to limited staff skill, through to ethical issues that have been raised. Narratives of this nature clearly identify the need to up-skill the current workforce to match the present technological direction of mental health services.       
 
Based on the narratives obtained the group of support workers interviewed have a clear perception of their role as support worker in mental health services.  However, there is plenty of scope for further research such as the examination of allied mental health disciplines for instance community social workers and community mental health nurses, and how these roles compared to the role of the mental health support worker? What is the perception of the social workers and community mental health nurses of support workers? How can these disciplines compliment one another to best support service users? As such we have only scratched the surface in determining the role of the support worker in the provision of mental health services in New Zealand.  

References

Barlow, K. (2006). Perceptions of the role of the community psychiatric nurse. Nursing Times, 102, (9), 34-38.
 
Barriball, K. L., & While, A. (1994). Collecting data using a semi-structured interview: A discussion paper. Journal of Advanced Nursing, 19, (2), 328-335.
 
Berrios, R. & Lucca, N. (2006). Qualitative methodology in counselling research: Recent contributions and challenges for a new century. Journal of Counseling & Development, 84,174-186.
 
Hsieh, H., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative health research, 15, (9), 1277-1288.
 
Mental Health Commission. (March, 2001). Recovery competencies for New Zealand mental health workers. Mental Health Commission, Wellington: New Zealand.
 
Ministry of Health (March, 2007). Let’s get real: Real skills for people working in mental health and additions. Analysis of workshops and feedback November-December 2006. Ministry of Health, Wellington: New Zealand.
 
Richardson, S. A. Dohrenwend, B. S. & Klein, D. (1965). Interviewing. Basic Books, New York.
 
Ryan, R., Garlick, R., & Happell, B. (2006). Exploring the role of the mental health nurse in community mental health care for the aged. Issues in Mental Health Nursing, 27, (1), 91-105.
 
Smith, H. W. (1975). Strategies of social research methodological imagination. Prentice Hall International, London

 





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