Conflictos derivados de la crisis hipotecaria: los lanzamientos y

By presenting an apparently authoritative, generalisable model based on a narrow range of settings, the GMH recommendations potentially lend themselves to practice and policy that override local meanings, initiatives and contextual factors (Orr & Jain, 2014). Social work’s distinctive theoretical focus on socioeconomic and cultural context could provide a valuable antidote to this concern. Although the features of social work vary hugely across the world, social work’s theoretical propensity for psychosocial informed knowledge, service user rights and participation, as well as the strong values-based commitment to

empowerment, are consistent strengths of the profession which may offer correctives to the “one-size-fits-all” prescription of GMH. The following sections describe features of social work that may play an important role in addressing the mental health treatment gap in low- resource settings.

2.5.1 Promoting wellbeing and equality

The WHO definition of health encompasses the concept of wellness, noting that health is “a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity” (1946). While there is increasingly good data on certain interventions for psychiatric disorders (for example, antidepressants for severe depression), there is a paucity of data on the efficacy and effectiveness of interventions for wellbeing (Stein & Giordano, 2015). GMH is likely to focus initial research efforts on the prevention and treatment of diagnosable disorders, rather than on maximising wellbeing in the community (Collins et al., 2011).

Contrastingly, social work reflects the promotion of social and economic equalities. Ruth Allen, in her position paper, The Role of the Social Worker in Adult Mental Health Services (2014) describes social work as focusing on the “person as a whole – their

fundamental human potential and the opportunities they could access to bring about change” (p. 39). The importance of the social determinants of mental distress throughout the life course that are often missed in purely medical, illness approaches (e.g., trauma, loss and abuse, experiences in childhood) are more prominent in the social work discipline. Working daily with life at its extremes, social workers are witnessing the highs and lows of human capabilities and behaviour. For many people, the opportunities for—family inheritance and place of birth (i.e., locality, community or country) and access to resources—are determining factors for mental health and wellbeing.

2.5.2 Human rights and social justice

In December 2006, the United Nations adopted the Convention on the Rights of Persons with Disabilities (UN General Assembly, 2007). Its purpose is to “promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity” (p. 2). A general principle of the document is that persons with disabilities, including those with mental health conditions, have a right to full and effective participation and inclusion in society. Therefore, it showed that changing attitudes towards—and practices—in mental health care is not only a necessity, but also an obligation under international human rights law. The inclusion of mental health in the landmark SDGs to ensure that, by 2030, there is a reduction by one third of premature mortality through prevention and treatment and promotion of mental health and wellbeing (United Nations, 2015). The WHO has also endorsed the need to promote human rights and quality of mental health services globally, with the development of the

QualityRights initiative (Funk & Drew, 2017). Freedom from coercive interventions and promotion of those that respect the right to legal capacity, choice, community inclusion and recovery are at the core of the QualityRights initiative.

As a reflection of these policy directives, social inclusion is now considered a key principle of mental health service provision in many countries (Coombs, Nicholas, & Pirkis, 2013; Department of Health, 2011), the aim of which is to improve the opportunities for people with mental health conditions to engage in society equally to others. Indeed, the global commitment to respect human rights and support social inclusion is at the centre of social work, promoting the dignity and worth of people (Allen, Balfour, Bell, & Marmot, 2014). Trained to work in partnership with people using mental health services, their families, and caregivers, social work practitioners support social inclusion through their advanced

communities to enhance participation of people with mental health conditions (Baumgartner & Susser, 2013).

2.5.3 Values based commitment to empowerment

A recurring anecdote to the GMH movement has been “nothing for us, without us”, coming out of the social activist era of the 1960’s United States to include service users with disabilities in decision making about their care (Beresford & Croft, 2001). The voice of the consumer and user involvement movements in mental health social work has played a crucial role in disability studies in general and is particularly relevant to mental health concerns. Social perspectives are rooted in acknowledging the importance of peoples’ own expertise about their care needs. This reflects the increasingly influential consumer-oriented perspective of the mental health recovery movement that seeks to establish and enhance patient

empowerment (Frost et al., 2017). Social work practice often involves working alongside people closely, using empathy and relationship-building skills to hear and see through the eyes of the service user, their family and friends.

2.5.4 Working towards development and community sustainability

Social work actions may be with individuals, groups and communities in policy, advocacy and social change. In the Global Agenda for Social Work and Social Development Commitment to Action, the International Federation of Social Workers (IFSW) and the International Association of Schools of Social Work (IASSW) have committed members “to supporting, influencing and enabling structures and systems that positively address the root causes of oppression and inequality” (2012, p. 1). Initiatives as the IASSW Global Agenda (International Federation of Social Workers, 2012), social work practice is now also

unavoidably both local and global. Social workers must be cognisant of globalisation trends in their practice, trends that provide a way of understanding the social circumstances of

peoples’ lives on a day to day basis, and a context within which to act (Pockett & Beddoe, 2015).

Social indicators of development, including gains in literacy, health conditions and services, and provision of housing are fundamental to the professional intervention of social workers. Social workers can generally mediate the process of development through enabling individuals and the society to mobilise and deliver a wide range of services, drawing upon the existing resources available in the community. For example, social workers are expected to assist in restoring, maintaining and enhancing the social functioning of individuals and the society; this responsibility entails the development, procurement and/or delivery of resources and services to meet the many and varied needs of the people. The role of social workers in helping people to build relationships and strengthen their connections with their local

community has also been emphasised (Huxley, Evans, Beresford, Davidson, & King, 2009). It is through these features, promotion of wellbeing and quality, human rights and social justice, empowerment of service users and integration with the wider social

environment that the field of social work may be particularly suited to addressing the current limitations of GMH. The following sections illustrate the critical need to address the social factors involved in mental health, and how existing theories may be used to develop social interventions in LMIC.