UNIT I

Psychiatric social work is the application of social work methods and practices in
the field of psychiatry. It is the social work practiced in psychiatric settings, de addiction
centers etc. It is both a science and art as the social work belongs to discipline of art and
psychiatry belongs to discipline of science. Psychiatric patients cannot be treated by
medicines alone. He needs both psychological and social treatment. Social treatment is
necessary because a person’s social conditions get disturbed due to psychiatric illness.
Psychiatric social worker needs knowledge in both the fields of psychiatry and social
work.

HISTORICAL DEVELOPMENT OF PSW

In the beginning the psychiatrists were interested to understand the personality of

the patients in relation to their social environment. They appointed some agents for
collecting the family back ground of the patients. These agents collected case histories
from the patients and acted as an intermediate between the patient and the family
members. They were the pioneer social workers in the field of psychiatry. In 1905,
Massachusetts General Hospital established social service department. Dr. Putam who
was in charge of the neurological clinic appointed a full time social worker in his clinic
under his personal supervision.

In 1906, psychiatric social work was initiated at the Manhattan State Hospital in
New York City, by the New York State Charities Aid Association. Here, the psychiatric
social worker visited patients' families to obtain collateral information needed by
psychiatrists, relative to family background and past life experiences. They just acted as
after care agents and clinics in United States began to employ social workers. The
pioneer social workers and the aftercare agents inspired many people to act as social
workers in the field of psychiatry.
 In 1913, Boston psychopathic hospital established as social service department
under the leadership of Dr. Ernest Sutherland and Dr. Mary C Jarret, who was appointed
as the head of the social service department. The social service department aim to assist
in the study and treatment of mental disorders and aid patients in regaining their normal
living. In addition, the social workers took the responsibility of educating the public in
promoting the understanding of mental illness, as well as in research to understand the
causes for mental disorders. The term ‘psychiatric social work’ was first used in the
book “The kingdom of evils” by Dr. Ernest Sutherland and Dr. Mary C Jarret. The book
reveals the scope and importance of psychiatric social work.

In 1917 Mary Richmond in her book “Social Diagnosis” emphasized on the role
of personality and society in influencing mental health of the people.

When the United States entered World War I, leaders of the psychiatric social
work profession foresaw the need for providing care for the mentally ill in Army and
Navy hospitals and, in 1918, initiated a training course for psychiatric social work at
Smith College, Northampton, Mass. As the flow of neuropsychiatric casualties
increased, the Army Medical Department requested the American Red Cross to supply
psychiatric social work personnel to military hospitals.

The first trained worker was assigned on 1 September 1918, to the U.S. Army
General Hospital This worker's duties were to assist the medical officers by obtaining
information regarding the personal, family, and community background of the soldiers
under treatment, as an aid in diagnosis, treatment, and plans for aftercare.

After the war, in March 1919, the Surgeon General of the U.S. Public Health
Service requested the American Red Cross to organize a social service program within
Federal hospitals. The Red Cross assumed full responsibility for outlining the social
service program, formulating policies, recruiting personnel, and assisting in the
organization of the work. Because Federal hospitals served large areas, it was essential
that the worker be equipped not only to give aid to the psychiatric staff but also to assist
local Red Cross chapters in assembling social data, interpreting recommendations for
treatment, and helping the discharged patient accomplish the necessary social and other
rehabilitative measures for his recovery. Because there was a serious dearth of trained
personnel, the Red Cross offered special scholarships and cooperated with existing
schools of social work in a program of training. By January 1920, there were social
service departments in 42 Federal hospitals. 

Another major vehicle that helped push psychiatric social work into a prominent
position was the development of child guidance clinics. Early child guidance clinics
were initially created out of a concern about juvenile delinquents. Through this work
early clinic professions became concerned over the lack of social and psychological
services for all children. As a consequence, child guidance clinics rapidly broadened
their mission to include children with mental and emotional problems. In 1920, William
Haley started a child guidance clinic and he emphasized in the scope of psychiatric
social workers. In child guidance settings, social workers begin to enjoy greater freedom
of working. They gained more preference in child guidance.

In 1922, the American Association of social workers was formed. Initially they
were part of American Association of hospital workers. In 1926 they separated from the
association and considered as an independent body. From 1930 a new emphasis
appeared within the family welfare agencies in account of families presenting with
problems of emotional mal adjustments, in addition to financial needs. Thus a large
number of workers in the field of family welfare began to utilize knowledge form field
of psychiatry, to work as therapists to client with psychiatric problems. Most family
welfare agencies started to employee psychiatric social workers and they started to give
training to their staffs in mental hygiene and social psychiatry.

Around 1936, progress in the shared responsibilities for treatment in relation to

psychiatry was obscured by the independent role of the social worker as a therapist,
thereby making the activities of the social workers wide spread. In fact the boundary
lines between fields that deal with human relationship started steadily breaking down.
Thus psychiatric social work became alive with most of the disciplines such as
psychology and psychiatry, psychology and sociology, mental hygiene and public
health education.

In September 1942, the Association requested a grant from the Rockefeller

Foundation in order to accomplish two major objectives: (1) To centralize data on
personnel and vacancies in psychiatric social work and (2) to establish a more vital and
immediate relationship with professional education for psychiatric social work. This
involved plans for recruiting students for psychiatric social work, for developing
scholarship plans to finance students, and for channeling new materials and areas of
practice to the schools of social work.

As early as mid-1942, in at least two centers, unofficial but active outpatient

neuropsychiatric clinics were functioning with social workers. The first formal and
completely staffed mental health clinic was developed at Fort Monmouth, where the
usual team of psychiatrist, clinical psychologist, and psychiatric social workers
functioned in a most effective way and set a pattern for the development of consultation
services throughout the Army. This unit was established on 4 March 1942.

The role of psychiatric social workers extended beyond case work. These include
creating general public awareness about mental health, and the cause and need to
prevent it. They also helped in the development of psychiatric social work. Gradually
the psychiatric social workers were employed in psychiatric hospitals and clinics and
they were considered as an important part of psychiatric team.
HISTORY OF PSYCHIATRIC SOCIAL WORK IN INDIA
The history of psychiatric social work in India began with the establishment of
child guidance clinics by sir Dorabji Tata Graduate School, Bombay in 1937. The clinic
was established to provide training facilities for postgraduate social work students. In
1938 a trained social worker was employed on a full time basis. In 1948 the BHORE
committee recommended for the appointment of medical and psychiatric social workers.
In 1948 YERVADA medical hospital appointed a psychiatric social worker named
Malathy Renade under the guidance of DR. G.R Banarjee. After that JJ hospital in
Bombay employed a psychiatric social worker in 1950. In 1952 a specialized course in
psychiatric social work was established. This was combined with medical social work
and it was called medical and social work. DR. Sharadha Menon who was the
superindent of Madras Mental Hospital helped the growth of psychiatric social work in
South India. The Delhi School of social Work introduce specialization in psychiatric
social work in the post graduate training in social work in the year 1962.

CASE WORK GROUP WORK AND COMMUNITY ORGANIZATION IN

THE PSYCHIATRIC SERVICES
In the psychiatric setting the social work methods such as case work, group work and
community organization are important because through this practice the psychiatric
patients and the family members can be helped to a greater extent.

Case work
Social case work, a primary method of social work, is concerned with the
adjustment and development of individuals towards more satisfying human relations. It is
a social treatment of maladjusted individual, involving an attempt to understand his
personality, behaviour, and social relationships, and to assist him in working out a better
social and personal adjustment. It seeks to help individual to solve their problems in a
systematic way based on knowledge of human behaviour and various tested approaches.
Thus social case work is a one to one relationship which works in helping the individual
for his adjustment and development.

Mary Richmond (1915) defines social work “as the art of doing different things
for and with different people by cooperating with them to achieve at one and the same
time their own and society’s betterment”.

Case history collection in psychiatry is now termed as case work. Case history is
the collection of detailed information about the patient. Case work is the process of
collecting detailed history about the patient and making a social diagnosis of the problem
faced by the patient. So case work in psychiatry includes

Case history + psycho social diagnosis + intervention = psychiatric case work

The case history is analyzed for any psychosocial problem on the basis of which psycho
social diagnosis is made and treatment is provided.
The main advantages of practicing case work in psychiatric settings are:
1. It deals with single individual
2. It is better practiced and it is result oriented.
3. The personal and social disorientation of the mentally ill people can be
easily understood by this method.
4. It helps the patient to cooperate and adjust with the problems through
some interventions, referrals and resource mobilization.
5. It is considered as a part of treatment in psychiatric social work.

Group work
It is the methods of social work that develops the ability of establishing
constructive relationship in the individual through group activities. It enhances the social
functioning of the people by purposeful sharing of their experiences. According to
konopka, “Social group work is a method of social work which he helps the individuals
to enhance their social functioning through purposeful group experiences and to cope
more effectively with their personal, group or community problem”. The group work can
be educational or recreational.
The main advantages of practicing group work in psychiatric settings are:
1. It fulfills human needs such as need of love, affection, feeling security,
to have enjoyment etc.
2. It is a unique mean of solving isolation problem among people.
3. Self reliance is developed through group activity.
4. The feeling of being accepted is satisfied with the help of group work
activities.
5. The group worker by practicing social group work in psychiatric setting
is enhancing the confidence of the patient.
6. Psycho social problems are solved and manage through group
experience.
7. It is the best method for the proper development of personality.
8. The main aim of the group is to enhance the problem solving capacity of
the patient.
9. A problem which was considered unique is generalized by meeting
people who are facing the same problem and by sharing their
experiences the patient can model them to find solutions to their
problem.
10. People in one group motivate and helps others to overcome their
problems.

Community organization
It is an indirect form of social work process distinct from case work and group
work. It is directed to provide service for people with special needs. It is process in which
efforts are directed towards meeting the community needs and developing integration
within the community. According to Ross “Community organization is a process by
which a community identifies its needs or objectives, orders (or ranks) these needs or
objectives, develops the confidence and will to work at those needs or objectives, finds
the resources (internal, and / external) to deal with these needs or objectives, takes action
in respect of them, and in so doing extends and develops cooperative and collaborative
attitudes and practices in the community’.
The main aims of practicing community organization in psychiatric settings are:
1. Through community organization, the common needs of the people are
identified, and the people made to understand about their basic needs.
2. After identification of the need, the community is helped by a
community organizer to establish some order of priority among these
needs so that efforts may be taken accordingly to fulfill these needs.
3. Community organizer helps the community to locate the resources in
the society through which the needs may be fulfilled. There are certain
agencies in the community which works for the betterment of the life of
the people, but people are generally ignorant about these agencies.
Community workers make the community to use these resources.
4. The community worker motivates the community to take actions to
solve their problems.
5. It is the application of theoretical social work practices into practice.
Eg: The community organization in psychiatric setting may be used for creating
awareness about various psychiatric illness, alleviating stigmas about mental illness
among people, educating the people about the importance of family, educating on various
symptoms of various illness etc.

LIMITATIONS AND DIFFICULTIES FACED IN PSYCHIATRIC SOCIAL

WORK PRACTICE

The importance of medical and psychiatric social work can be well understood
from the WHO definition of health which states that “Health is a complete state of
physical, psychological and social well being and not merely the absence of any disease
or infirmity”. The social wellbeing of an individual can be well handled by medical and
psychiatric social workers. The objective of any hospitals is the restoration of health
which includes all the dimensions and a complete treatment can be provided only if we
look into the social dimension also.

But the main limitation of Psychiatric social work in India is that it is brought
from west and slowly entering India. The curriculum of psychiatric social work is based
on western pattern. In certain situations it does not suit for Indian situations. The scope
for psychiatric social work is poor in India. Most of the psychiatrists and general doctors
are not aware about the importance and need of social workers. In a psychiatric setting
the duties of doctors, nurses and other professionals are identified. But in case of
psychiatric social work, no functions are identified yet. Even after 70 years of functioning
of social workers in psychiatric settings, the doctors, nursed, patients or the social
workers are not able to identify the role of psychiatric social workers in the team and his
contribution to the care of patients. There is a problem of role ambiguity.

The psychiatric social workers are not able to get the professional supervision and
guidance at the needed time. It lacks a professional body and there is absence of
regulatory board which leads to absence of quality of the profession. The salary scale of
psychiatric social work is very low and they are facing very low recognition from the
society. In most of the psychiatric hospital, social workers are facing very heavy work
load and there is no proper work boundary for their field.

PROBLEMS IN MENTAL HEALTH FIELD

The problems still faced in mental health field are
1. There is a problem of stigma. The mentally ill people are not treated at
par with the so called normal people.
 2. Still a greater part of the population believes in faith healing and
traditional treatment. In some area of the country the clergymen is
considered as the physician.
3. The no of institutions specialized in psychiatry is less.
4. Absence of multidisciplinary team in big hospital poses another
problem.
5. No of professionals specialized in dealing with mental illness is less.

The low priority to mental health is evidence from the fact that there were only 42
mental hospitals with the total of 20,000 beds in 1981. There were only 1,100 physiatrist
of whom 200 were in private practice, approximately 400 to 500 clinical psychologists
and 200 to 300 psychiatric social workers.

Man power requirement

In India for psychiatric social workers are required to go through a post graduate
course in social work with specialization in psychiatric social work. During the two years
they should have practical training in psychiatric setting for at least one year. They
should have been exposed to all type of mental illness, and should know how to diagnose
their psycho social problems under the guidance of psychiatric social workers. The man
power requirements may be worked out in the following manner.
1. 6 psychiatric social workers for mental health hospitals with 500 beds
(2 inpatients, 2 out patients, and 2 for community health services)
2. A minimum of 2 social workers will be required for not only taking down
detail case history but also to take up at least 3 – 4 patients for counseling and
psychotherapy.
 UNIT IV

ROLES AND FUNCTIONS OF PSYCHIATRIC SOCIAL WORKERS

Psychiatric OPD’s
Psychiatric OPD is a very important department in a hospital. All the patients
suffering from psychiatric complaints of minor, major, chronic are examined here. OPD
of a psychiatric hospital provide diagnostic, curative, preventive and rehabilitation
services. The roles of psychiatric social worker in psychiatric OPD are as follows:
1. Intake of the patient: The basic work of any psychiatric social worker is to accept
the client and get the basic information from them.
2. Mental status examination is done by the psychiatric social workers.
3. They provide psycho social education to the family members about the nature of
illness, explain the causative factors for the illness, explaining the need of support to the
patients by the family members and making the family members accept the reality.
4. Referral services: They refer the patients to other agencies where specialized
treatment is given. Sometimes the mental illness is associated with physical illness, so the
clients are also referred to physicians. Referral services are done according to the actual
need of the client and depending on the financial situation of the client.
5. Resource mobilization: The psychiatric social worker uses the available resources
for the betterment of the client. Resource mobilization forms a part of the referral services
which aims at enabling the client avail their rights.
6. Motivating the client and the family: The psychiatric social worker motivate the
client for treatment and regular intake of medicines. He also motivates the client’s family
for further follow ups.
7. Record maintenance
8. Individual psychotherapy
Psychiatry specialty clinics
The psychiatric specialty clinic is a second area in which the psychiatrist and the
psychiatric social workers are associated. It includes the neurological clinic,
neuropsychiatric clinics, mental hygiene clinics and psychiatric clinics. Some of them are
connected with general hospitals and some with mental hospitals. It includes both the OP
and the IP departments to treat people with psychiatric illness. The roles of social
workers in psychiatric specialty clinic are:
1. Conducting case work
2. Conducting group work
3. Conducting awareness programmes
4. Counseling to patients and family members
5. Giving psychological support to patients and family members
6. Conducting research
7. Financial assistance with other agencies for helping the patients
8. Conducting camps
9. Resource mobilization
10. Providing psycho education

De addiction centers
Addiction is the craving or dependence on any substance and the absence may
cause anxiety. The dependence may be both physical and psychological. De addiction
center is where the people who are addicted to alcohol or other drugs come for treatment
to recover from their addiction or to take treatment for their relapse. The role of social
worker in such de addiction center includes:
1. Assessment of the extent of the problem which include the family, background,
health condition and the assessment of current position of the client.
2. Motivating the client for regular treatment.
3. Giving awareness about the ill effects of drugs
4. Conducting group meeting
 5. Restoration of the client in the family
6. Help the client to quit smoking and drinking by conducting individual therapy,
group therapy and family therapy.

Child guidance clinic

Children with behavior, conduct, emotional and psychiatric problem are treated.
The children below the age of 16 are admitted for treatment. The roles of social workers
in child guidance clinic are:
1. Intake process
2. Family history taking
3. Conducting parent group meeting
4. Diagnosis
5. Treatment plan
6. Modifying the life style
7. Training for parents to bring their child
8. Referral
9. Resource mobilization

UNIT V

REHABILITATION OF PSYCHIATRIC PATIENTS

Psychiatric rehabilitation

Rehabilitation may be defined as the combined and the coordinated use of

medical, social, educational and occupational measures for training and retraining the
individual for the highest possible level of functional ability.
Role of social worker in rehabilitation
The current view is that the responsibility of a psychiatric hospital dies not end
when the treatment is over. The purpose of psychiatric rehabilitation is to make
productive people from non productive people. The roles of social worker in
rehabilitation are:
1. Planning the assessment
2. Planning the use of resource mobilization
3. Planning for training
4. Provide placement services
5. Provide referral services
6. Engaging the patients in different activities.

Reintegration of the patient in the family and the community

In case of mental illness the client’s family is not ready to accept the client. The
client’s parents may accept the client but the client’s spouse and the in laws family may
not accept them. This may be due to many reasons like:
1. Though the patient is recovered completely there is greater suspicion and doubt on
the client. This is so because, due to mental illness and the impact of auditory
hallucination the client may have uttered some girls or boys name, or have spoken
ill of someone in the family. This may be taken seriously by the spouse and harm
the relationship.
2. During the course of illness the client might have used abusive words and this may
be remembered by the family members even after the cure of the client.
3. Due to social status the family may be reluctant to accept the client even if the
client is fully recovered.
4. Sometimes the client may be a wandering mentally ill and finding the details about
the family is the biggest problem.
These factors may make the process of reintegration difficult. It is the duty of the social
workers to integrate the client and the family. The social worker should provide psycho
social education to the family members and explain the impact of illness so that the
family members understand the client and his problems.

Role of psychiatric social worker in team work

The mail main purpose of psychiatric care is restoration and promotion of mental
health and prevention of mental illness. For the achievement of this purpose, several
professionals such as the psychiatrists, psychologists, psychotherapists, psychiatric
nurses, and psychiatric social workers are working together as a team. The services of
each professional are equally important and necessary for a effective team work. A
proper understanding and mutual respect for each others are needed for better services for
the patients. The roles of social workers in team are:
1. Providing case work and group work services to the patient and family
members for the purpose of diagnosis and treatment.
2. Assisting the individual to determine and resolve specific problems in his
environment and interpersonal relationship.
3. Helping the team for providing a humanistic approach to the patient
4. Act as intermediate between other professionals and patients.

Partial hospitalization
According to American Association of Partial Hospitalization, “Partial
hospitalization is defined as a time limited ambulatory, active treatment programme that
offers therapeutically coordinated and structured clinical services within a stable
therapeutic environment”. The term partial hospitalization may include:
Day hospitalization: It is a psychiatric treatment program that patients attend 5 days a
week from 8.30 am to 5.00 pm. The patients have breakfast and dinner at home and have
lunch at hospital.
Night hospitalization: A program in which patient usually work or goes to school and
return to hospital for dinner and they sleep in the hospital.
Evening and weekend hospital care: A programme in which patient functions in job or
at school and return to the hospital for evening and weekend programs.

Therapeutic community
It is defined as hospital environment used for therapeutic procedures. It provides
responsibility to a population for mental health delivery. In this method the treatment is
given to the client in community based centers. It avoids the unnecessary hospitalizations
and focuses on prevention and promotion of health. Continuous care is provided with the
help of multidisciplinary team approach.

Day care centers

The day care should be located outside the hospitals and in the community. It
should be attached to the outpatient service rather than the inpatient service. They look
after the client during the day time and in the night they go back to their own homes.

Half way homes

They provide accommodation for a short period of time to stabilize and correct the
patients during the crisis period where they learn certain skills for their own betterment.

Sheltered homes
It is a homogenous setting in which people with particular disability or illnesses
are work together.

Transitory homes
They provide training to the patient for certain skill where the inmates are
transferred from one house to another based on their skill training and skill progress.