11 The role of Social Work, Counsellor, Peer Worker in Mental Health Care

Background: Sarah is a 35-year-old woman who has been admitted to a general hospital due to severe anxiety and panic attacks. She has a history of depression and has experienced recent stressors related to work and family issues. Sarah’s symptoms include insomnia, loss of appetite, and difficulty concentrating. Her primary care physician has referred her to the hospital’s psychiatric unit for further evaluation and treatment.

Role of the Social Worker: As part of the hospital’s multidisciplinary team, the social worker plays a crucial role in Sarah’s care:

• Assessment and Planning:
• Upon admission, the social worker conducts a thorough psychosocial assessment of Sarah’s current situation, including her support system, living arrangements, and any stressors contributing to her mental health issues.
• Collaborates with Sarah, her family (with consent), and other healthcare professionals to develop a comprehensive care plan that addresses her immediate needs and long-term goals.
• Support and Counselling:
• Provides emotional support and counselling to Sarah to help her cope with the stress of hospitalization and her mental health symptoms.
• Uses therapeutic techniques such as cognitive-behavioural strategies to address Sarah’s anxiety and panic attacks.
• Advocacy:
• Advocates for Sarah’s rights and needs within the hospital setting, ensuring that she receives appropriate treatment and care.
• Assists Sarah in navigating the healthcare system, including understanding her treatment options and advocating for her preferences.
• Coordination of Care:
• Collaborates closely with the psychiatric team, nurses, and other healthcare providers to ensure a coordinated approach to Sarah’s treatment.
• Facilitates communication between Sarah and her treatment team, ensuring that everyone is informed and involved in her care plan.
• Discharge Planning and Aftercare:
• Works on discharge planning from the early stages of Sarah’s hospitalization, ensuring that she has a safe and supportive environment to return to.
• Arranges follow-up appointments with outpatient mental health services, supports Sarah in accessing community resources, and provides referrals for ongoing therapy or support groups.

Challenges and Considerations:

• Stigma: Addressing stigma associated with mental health issues both within the hospital and in Sarah’s social environment.

Complex Family Dynamics: Managing family dynamics and involving them appropriately in Sarah’s care while respecting her privacy and preferences.

• Resource Limitations: Navigating resource constraints and advocating for additional support services as needed for Sarah’s recovery.

Outcome: Through the coordinated efforts of the multidisciplinary team, including the social worker’s support, Sarah’s condition stabilizes during her hospitalization. She gains skills in managing her anxiety and panic attacks, and her family becomes more involved in her ongoing care and support. Upon discharge, Sarah has a comprehensive aftercare plan in place, which includes regular therapy sessions and support groups to continue her recovery journey effectively.

Conclusion: In this case study, the social worker’s role is pivotal in providing holistic support to Sarah, addressing not only her mental health symptoms but also her broader psychosocial needs. By collaborating with the healthcare team and advocating for Sarah’s best interests, the social worker enhances her overall well-being and supports her successful transition from hospitalization to community-based care.

Background: John is a 25-year-old man who has recently graduated from college and is struggling with severe anxiety. He lives alone in an apartment in a bustling city. He describes feeling overwhelmed by simple tasks like grocery shopping or attending social events. His anxiety has worsened since he lost his job six months ago, and he has been avoiding applying for new positions due to fear of rejection.

Initial Assessment: John was referred to the community counselling centre by his former college advisor, who noticed a decline in his academic performance and social interactions during his last semester. In the initial assessment, John expresses feelings of constant worry, tension, and fear of embarrassing himself in public. He reports difficulty sleeping and a loss of appetite.

Treatment Plan:

Psychoeducation: The counsellor starts by educating John about anxiety disorders, explaining the physiological and psychological components of anxiety. They discuss how anxiety can manifest differently in individuals and the role of cognitive-behavioural techniques in managing anxiety symptoms.

Cognitive-Behavioural Therapy (CBT): The counsellor introduces CBT techniques such as cognitive restructuring and exposure therapy. They work on identifying and challenging John’s negative thought patterns, teaching him relaxation techniques, and gradually exposing him to anxiety-provoking situations in a controlled manner.

Social Skills Training: Recognizing John’s social withdrawal, the counsellor includes social skills training sessions. They practice assertiveness, active listening, and conflict resolution techniques to help John feel more confident in social settings.

Medication Evaluation: Given the severity of John’s symptoms, the counsellor suggests consulting with a psychiatrist for a medication evaluation. They explain the potential benefits and side effects of medication, emphasising that it can be used in conjunction with therapy to alleviate symptoms.

Support Network Enhancement: The counsellor encourages John to reconnect with supportive friends and family members. They discuss the importance of having a strong support network and identify local community resources, such as support groups or recreational activities, that John can participate in to reduce isolation.

Progress and Challenges:

Progress: Over the course of several months, John shows improvement in managing his anxiety symptoms. He becomes more proactive in challenging his negative thoughts, uses relaxation techniques to cope with stress, and starts attending weekly support group meetings for individuals with anxiety disorders.
Challenges: John experiences setbacks, especially during job interviews, where he still struggles with intense anxiety. The counsellor continues to work with him on developing coping strategies and maintaining motivation to pursue employment opportunities.

Community Integration: The counsellor collaborates with John to develop a plan for gradually reintegrating into the community. They explore volunteer opportunities related to John’s interests, such as assisting at local events or participating in community gardening projects. This helps John regain a sense of purpose and achievement outside of therapy sessions.

Conclusion: Through ongoing counselling, medication management, and community engagement, John makes significant strides in managing his anxiety and rebuilding his life post-graduation. The counsellor continues to monitor John’s progress, adjust treatment strategies as needed, and reinforce positive coping skills to promote long-term mental health and well-being.

This case study highlights the comprehensive approach of a counsellor in supporting an individual with mental health concerns in the community, addressing both clinical symptoms and practical challenges to foster recovery and resilience.

Background: John is a 30-year-old man who has been diagnosed with bipolar disorder. He has had several hospitalizations due to manic episodes but has been stable with medication for the past year. He struggles with low self-esteem and fears relapsing into another episode.

Role of the Case Study Peer Worker:

Building Rapport:

• Initial Meetings: The peer worker, let’s call her Sarah, meets with John regularly to establish trust and rapport. Sarah shares her own experiences with bipolar disorder, which helps John feel understood and less alone in his struggles.

Support and Empowerment:

• Setting Realistic Goals: Sarah helps John identify his goals, such as improving self-esteem and maintaining stability. They break these goals down into manageable steps.
• Encouragement: Sarah consistently encourages John, reminding him of his strengths and progress made so far.

Advocacy and Navigation:

• Navigating Services: Sarah assists John in understanding his treatment plan, medication regimen, and how to access community resources such as support groups or therapy.
• Advocacy: When John faces challenges with medication side effects or misunderstandings with healthcare providers, Sarah advocates on his behalf, ensuring his concerns are addressed.

Education and Information:

• Psychoeducation: Sarah educates John about bipolar disorder, explaining symptoms, triggers, and coping strategies.
• Skill Building: They work on skills like mindfulness techniques and recognising early warning signs of mood changes.

Supportive Relationships:

• Regular Check-ins: Sarah meets with John weekly for one-on-one sessions, where they discuss his mood, any stressors, and strategies for managing them.
• Peer Support Group: Sarah encourages John to attend a bipolar support group she facilitates at the mental health unit, where he connects with others who understand his experiences.

Outcome: Over several months of working with Sarah, John experiences significant improvements in his self-esteem and stability. He learns to recognize triggers and manage stress effectively. With Sarah’s support, he feels more confident in his ability to maintain his mental health and prevent relapses.

Conclusion: The case study peer worker role in John’s journey illustrates the vital support and guidance provided by someone with shared lived experiences. By offering empathy, practical assistance, and advocacy, peer workers like Sarah play a crucial role in enhancing the overall well-being and recovery of individuals in mental health units.