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.
- Developing and maintaining a therapeutic relationship
- Working alongside the service users
- Skill development and training
- Community reintegration
- 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.
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