Lisa is employed as an educator of mental health support workers. She spoke with passion about the work she undertakes, and also expressed strong views that related to public safety.
Lisa is a registered health professional. As such Lisa has a scope of practice under the Health Practitioners Competence Assurance Act (2003) and therefore has a regulatory authority which regulates practice through attestation of continuing competency.
Cheap labour, my memory of the time when we moved quickly to community support, neglect, was the consumer movement wanting support but not professional support –meaning not wanting clinical support. But this was misconstrued as meaning cheap labour, unskilled support people with good hearts which is fabulous but is not enough.
Danger of it going under another health professional group as it is a role that has strong similarities to all of the professional groups above, but not one of them.
More acknowledgement and valued, career path, accountability, for mental health support workers for people receiving the support needed for regulations under scrutiny such as HPCA (Health Practitioners Competence Assurance Act. 2003) so that there is accountability for mental health support workers and they can be supervised or even forbidden from being employed as are other professionals. But we have many professional groupings at one level; we need another health profession like a hole in the foot. But we have got this situation now of “someone being dismissed and then getting a job down the road”. But now that we have mental health support workers I think they need to be regulated for the benefit of people using the services. Self-regulation is not widely carried by the group. Second level social worker. Employer/employee regulations are not enough. Interrupted biography, times in people lives when they are diagnosed with a mental illness, then that is where the support worker role comes in to assist the person to find their way through the effects of the illness, what happened in the lead up to using the services, to make sense of their life experience, work through the issues of medications, self-stigma, how to use the services. Some of this is done by nursing OT and social workers in particular. I do believe that is happening, but not as strongly as it should. It is a significant part of helping people back into their life and community and therefore the role of the mental health support worker.
Lisa exposes the issue of the development of the mental health support worker workforce as being undertaken with haste as a result of government policy which saw people with long term mental illness being moved from a hospital setting into the community. While she does not offer an opinion on this policy what she does ask is has sufficient emphasis been placed on what the consumer wants. She describes this in terms of what the consumer did not want; they did not want more clinical support; what they wanted was more appropriate support. Lisa feels that instead what happened was the development of a cheap labour force created
from the people with the hearts of gold but generally unskilled, the people that are referred to as mental health support workers. Lisa recognises the need for mental health support workers to have a good heart, this I re-interpret as being a caring person, but Lisa suggests this alone is not adequate. Having a good heart is not a quality that generally has high value in our society, although it is a value that many of us would like to be labelled with along with our other skills and qualities. The level of remuneration is one way in which skills are valued, yet Lisa suggests that while the mental health support worker has well-meaning and well intentioned qualities these skills are not the skills that command high salaries. She continues with this thread when she expresses the view that she does not believe that mental health support workers are not seen as a valued part of the mental health workforce. This lack of valuing is a complicated position to untangle. Consumers wanted to be able to have support provided by a group of workers that were non-clinical in nature i.e. not a duplication of existing health professionals. This she suggests has been through economic imperatives translated to mean an unskilled and poorly paid and undervalued health sector worker. A good heart is not sufficient to secure a good salary.
Lisa expresses concerns about the lack of regulation within the sphere of the mental health support worker related to:
• Lack of regulation of mental health support workers
• The lack of self-regulation of mental health support workers • Limited accountability of mental health support workers
She poses what is for her a dilemma as to how mental health support workers can be seen as professional if they are not a regulated group of health professionals but argues the sector does not want or need another regulated health professional. The question she poses is around how the mental health support worker can be viewed as professional for the work they undertake without being regulated. She recognises that the act of regulation in itself poses issues, adding yet another group of health workers to the health professional arena. Would the regulation of this workforce pose greater risks? To regulate is likely to mean a clearer definition and monitoring of the scope of the work against the risk to the public of receiving care from non-regulated health professionals. The Health Practitioners Competence Assurance Act (2003) provides protection for the public for those
professionals whose scope of practice sits under this act by way of a regulatory authority. Section 3 of the Health and Disability Commissioners Act (1994) provides a definition of health care provider by way of section 5 (a) i or iii. The other relevant Act is the Health and Disability Services (Safety) Act 2001. It is of note that this Act provides references to service providers only, not individual practitioners. The more substantive analysis of this matter will be examined in more depth in Chapter 10. The area of regulation poses a Shadow for support workers. O'Brien (2005) suggests that it is the knowledge and power which is held by professional groups that provide them with the ability to develop professionally and to have their profession legitimised. The unexamined issue is whether the public is better protected through regulation. The purpose of the Health Practitioners Competence Assurance Act (2003) was to provide public protection in high risk health occupational groups. Vernon, Chiarella, and Papps (2011) discuss the complexities within the regulated health sector through evidence of current competence and regulation with each part of the sector including regulatory authorities, individuals and employees having a part to play with the ultimate aim being to ensure public safety. Vernon et al. (2011) poses the question as to whether all the requirements for regulated health professionals in place has just shifted responsibilities from individuals to service providers.