In considering mental health support work and the staff that undertake these role thought needs to be given to the shadow of neoliberalism which exists when examining mental health services. A humanistic public and social good approach is in tension with the neoliberalism philosophy. The tension plays out in the fundamental questioning of the rights and responsibilities of the state for people with mental illness versus the rights and responsibilities of the individual to provide for their own health and social service care. These tensions become magnified in the mental health sector due to the “clash of ideologies” (Carney, p. 105) between medicalisation and therapeutic interventions. Neoliberalism ideology has been discussed in Chapter Two through examining aspects of health policy and health reforms of early 1990s. It was this period of New Zealand’s health reforms that witnessed the growth of the non-government organisations in providing services for mental health consumers, but also saw a move away from state control of services to private service providers. Esposito and Perez (2014) support the view that neo- liberalism reaches far beyond policies and regulations it is a“ vision of the world in which all aspects of social, cultural, and economic life are shaped” (p. 416). Resulting from such views is the assumption is that there are inefficiencies in the state system which are not found in the private system and that “free functioning of the market forces leads to a better utilization and allocation of resources” (McGregor, 2001, p. 83). This approach suggests that “social equity, participative democracy, sustainability and economic growth” (p. 83) are not interconnected but that economic growth should be the overarching driver for policies. The conflict which then exists between the ideology of mental health services and mental health support work if taken from a neoliberalism view is the challenge to place a value on mental health support work. This challenge is highlighted by John in Chapter Seven when he suggests that there has to be a new way of accounting the value of mental health support work and that this needs to move from the current output approach to a more humanistic evaluative framework.
It could be viewed that if it were not the low wages of mental health support workers they would become an unaffordable commodity due to the amount of time that they spend with clients. Further there is the issue of what they do with mental health consumers. From a neoliberalism approach individuals are responsible in finding “their own solutions to their lack of health care” (McGregor, 2001, p. 84). From such a perspective it could be argued that clients need to find their own support people from within their own family and social circles. Ramon (2008) suggests that the neoliberalism movement takes away the collective responsibility towards the individual and has contributed “to the continuation of perceiving mental health service users as social and personal failures in the twenty-first century” (p. 121).
Generally governments in first world countries continue to maintain control of individuals through legislation while rationing resources thereby preventing “clinicians, consumers and carer interests to win the sufficient share of resources needed to realize the promise of dignified community based care of the mentally ill” (Carney, 2008, p. 111). This goes back to the heart of mental health consumers having the rights of citizenship. While research findings tend to address questions of role and function, it is important to remember that mental health support work is enabled or constrained by political ideology.
SUMMARY
The complexities of workforce planning require scrutinizing when undertaking mental health service reconfiguration. Some members of our most vulnerable population are placed at risk if this is not performed. New Zealand looked at de-institutionalisation and took future workforce requirements into consideration. Like many other Western countries, New Zealand has made a conscious attempt to adopt a recovery philosophy when developing policy for services. The concepts of recovery are possible for countries to use and develop into a model that suits their environment. It is evident that many of the earlier philosophies about what makes human beings feel valued such as hope, faith, care and trust, positive relationships, and happiness are aspirational concepts. When these are considered in the relationship between the mental health support worker and the mental health consumer, recovery becomes a reality.
Changes in the workforce have seen the introduction of mental health support workers as well as peer support workers. Many overseas countries (in particular England) have seen the introduction of the STR workers who undertake a role that is very similar to the mental health support worker in New Zealand.
The literature in relation to characteristics identified by mental health consumers as important in assisting with recovery are characteristics which have been identified as belonging to mental health support workers and the STR workers. While competencies for the mental health workforce have been identified, it is the nature of the relationship that mental health consumers value the most. It is the ordinariness, the non-judgement and the non-clinical and non-labelling approach that mental health consumers believe is the most helpful in their recovery. It is these characteristics that they see in the mental health support worker.
The literature revealed that there are limited studies about the role of mental health support workers within mental health services and about how that role is perceived and understood by others within mental health services. Since the formal introduction of the mental health support worker role in New Zealand in 1998, other countries such as Britain and Australia have introduced similar roles under different titles. Since the 1990s New Zealand has also seen the introduction of the peer support worker into mental health services. The available literature contained in policy documents suggest that the mental health support worker’s role has not been fully realised within the New Zealand health context. This study illuminates the work being undertaken by the mental health support worker and describes an aspirational future for this workforce. The literature also highlighted the shadow of competing tension between opposing ideologies that of ‘public good’ versus individual responsibilities.