Sunteți pe pagina 1din 18

Introductory Guide to Psychiatric Social Work

By Kaitlin Louie

Psychiatric social work is a specialized type of medical social work that involves supporting,
providing therapy to, and coordinating the care of individuals who are severely mentally ill and
who require hospitalization or other types of intensive psychiatric help. Psychiatric social
workers complete a variety of tasks when working with clients, including but not limited to
psychosocial and risk assessments, individualized and group psychotherapy, crisis intervention
and support, care coordination, and discharge planning services. Psychiatric social workers are
employed in a wide range of settings, ranging from intensive inpatient wards to outpatient
psychiatric clinics.

Psychiatric social work is a challenging and very demanding profession. Social workers in this
field must work closely with individuals suffering from complex and hard to manage conditions,
who are in deep emotional distress and/or who may be a danger to themselves or others.
Psychiatric social workers may also encounter difficulties in getting clients the resources and
support they need to fully address their problems. However, some individuals gravitate to this
work for its constant intellectual and professional challenges, and for the opportunity to help
deeply vulnerable populations.

Due to their intensive work with clients’ severe mental health and behavioral issues, psychiatric
social workers often need graduate-level training in clinical social work methods, including
psychotherapy, crisis interventions, group therapy, and developing sound treatment plans in
collaboration with mental health and medical staff. Therefore, individuals interested in this field
of work should strongly consider earning a Master’s in Social Work with a concentration in
clinical or psychiatric social work from a CSWE-accredited institution.

Types of Psychiatric Social Workers


Psychiatric social workers’ responsibilities and client populations will vary significantly
depending on their work setting, and the teams to which they are assigned at their place of
employment. For example, some social workers within the psychiatric departments of hospitals
will specifically support severely mentally ill individuals who are involved in the criminal justice
system, or work exclusively with children who are victims of trauma.

In general, types of psychiatric social workers include inpatient psychiatric social workers,
emergency and crisis services psychiatric social workers, and outpatient psychiatric social
workers. Depending on their work setting and specific role, some psychiatric social workers may
fulfill tasks in all three areas–inpatient, outpatient, and emergency services.

Inpatient Psychiatric Social Workers


Inpatient psychiatric social workers work in the psychiatry departments of hospitals and medical
centers with patients who have been hospitalized for debilitating or dangerous psychological
and/or behavioral issues, such as severe substance abuse, psychosis, bipolar disorder,
schizophrenia, and other conditions. Psychiatric social workers in inpatient hospital settings
complete many different tasks to support patients, including conducting psychosocial
assessments to determine patients’ mental health status and needs; providing psychotherapy and
other clinical services to help clients address their emotional, behavioral, and mental health
challenges; communicating and coordinating with the larger treatment team to optimize clients’
physical and mental health care; connecting clients with relevant resources and services; and
facilitating clients’ transition to other care facilities or back to daily life through discharge
planning and follow-ups.

Psychiatric departments in hospitals tend to have several units that treat different mental health
or behavioral problems. Anne Friedman, ASW, who works as an Associate Clinical Social
Worker Fellow in Kaiser Permanente’s Psychiatry Department, explained to
OnlineMSWPrograms.com how she works on multiple teams to serve the diverse patient
population at Kaiser. “Within the Psychiatry department I’m on two teams, Chemical
Dependency (CD) and Adult Mental Health. CD is an entirely group-based program, and I help
facilitate an early recovery group two days a week and a drop in support group for dually-
diagnosed (substance use and mental illness) patients once a week. Within the adult team, I do
intakes for new patients, see a caseload of individuals, and run groups,” she explained.

In hospital settings, inpatient psychiatric social workers play a very important role in identifying
and advocating for patients’ needs as part of a larger medical team. “In hospital settings
psychiatric social workers are an integral part of the multi-disciplinary team, making
recommendations for treatment, rehabilitation, and social service connections,” Lynsey Clark,
MSW, who works as a psychiatric social worker at San Francisco General Hospital, in their
Inpatient Psychiatric Unit, told OnlineMSWPrograms.com. “Within the hospital setting
psychiatric social workers can make an enormous difference in the patients’ material reality
through therapeutic interventions and by connecting them with valuable social services, which
has the potential to improve their circumstances. We are also advocates for the patient, pushing
for more time when needed and better placements.”

In addition to daily communications with the treatment team for a given client or group of
clients, inpatient psychiatric social workers meet regularly with medical staff to develop and alter
a client’s treatment plan as needed. “I work with psychiatrists (MD’s), nurses (RN’s, LVN’s and
Psyche Techs) Occupational Therapists (OT’s), and other social workers (LCSW and MSW’s),”
Ms. Clark explained, “Treatment for all patients is team based and all the disciplines meet four
times a week in order to discuss the most appropriate treatment and care for the patient.”

Psychiatric Emergency Services and Crisis Response Social Workers


For patients who are undergoing acute crises or are in danger of hurting themselves or others,
psychiatric social workers conduct psychiatric assessments, short term crisis support, and care
coordination as part of a crisis or emergency services team. Environments that employ crisis
service psychiatric social workers include emergency care teams that work as part of a larger
medical center and crisis services at public health departments.

Crisis and emergency services psychiatric social workers work with clients for a brief period of
time to assess their needs, help them obtain the intensive care they require, and possibly
recommend them for involuntary hospitalization. Crisis service environments tend to be more
short-term than inpatient hospital psychiatric settings, as patients are generally directed to
hospitals and/or intensive care facilities where they can receive longer-term and more
comprehensive care.

Hillary Paffenroth, LCSW, who works as a psychiatric social worker for Comprehensive Crisis
Services of the City and County of San Francisco, explained how one of her main responsibilities
is determining if patients need to be placed on a psychiatric hold, and how the types of clients
she serves tend to be severely ill and in need of immediate assistance and supervision.

“The reasons that an individual would be placed on a hold are that they are currently: a danger to
self, a danger to others, or gravely disabled,” Ms. Paffenroth explained, “The first two categories
are fairly straightforward, if someone is suicidal or homicidal, or if their actions are placing
themselves or others at significant risk of danger, they would meet criteria. The third category,
gravely disabled, means that an individual cannot take care of their most basic needs such as
eating, bathing, having a place to live, attending to a serious medical condition, etc.”

In her interview with OnlineMSWPrograms.com, Ms. Clark described her work in an emergency
psychiatric setting, specifically Psychiatric Emergency Services (PES) at Contra Costa County
Regional Medical Center. “At PES in Contra Costa County my patients were often experiencing
psychotic episodes, mania, depression, suicidal ideation, homicidal ideation and self-harming
behaviors,” she said, “The work is extremely fast paced and demanding, [as we are] working
with patients who have a very high acuity. Professional expectations included assessing the
patient for risk, brief therapy, family reunification and assisting in the transfer or discharge of the
patient.”

Outpatient Psychiatric Social Workers

Outpatient psychiatric social workers provide therapy and care coordination services to
individuals who do not require immediate hospitalization, but who still struggle with severe
mental illness and debilitating emotional and/or behavioral issues; oftentimes patients in
outpatient psychiatric settings are at risk of needing hospitalization, or have been recently
discharged from an inpatient setting.

In her work at Kaiser Permanente, Anne Friedman, ASW also has experience working with
clients in outpatient settings. “I also spend two mornings in the Intensive Outpatient Program, for
patients who are at risk of psychiatric hospitalization or who have just been discharged from a
higher level of care. My patients are ages 18-70+ and come in with a pretty wide range of
presenting problems–from heroin addiction to bipolar disorder to postpartum depression,” she
said.

Outpatient psychiatric social workers tend to work for a longer period of time with patients, and
can even follow them through multiple systems to help support them as they transition from
intensive care back home or to another facility.

Charles Berman, MSW is an Intensive Outpatient Psychiatric Social Worker at the University of
California, San Francisco’s (UCSF) Citywide Case Management – Forensic Team, where he
supports and provides therapy to severely mentally ill adults who are also involved in the
criminal justice system. “[My colleagues and I provide] intensive wraparound services to clients
as they cycle in and out of the jail, the state hospitals, local hospitals, and the community,” he
told OnlineMSWPrograms.com.

In addition to her work in inpatient psychiatric settings, Ms. Clark worked for a period of time in
an outpatient psychiatric setting, and described her daily responsibilities to
OnlineMSWPrograms.com. “As an outpatient psychiatric social worker I provided individual
therapy for patients with a variety of mental health needs including depression, anxiety, and
PTSD,” she said, “At an outpatient psychiatric setting social workers are employed as therapists
and they perform the same duties as MFTs, PsyDs and PhDs. They conduct various groups
including Dialectical Behavioral Therapy, Cognitive Behavioral Therapy, and Seeking Safety,
among others.”

What Psychiatric Social Workers Do

As mentioned previously, psychiatric social workers’ main goal is to stabilize and support people
experiencing intense psychological distress or behavioral issues that are threatening their safety
and well-being, or the safety and well-being of others. Psychiatric social workers accomplish this
goal through a combination of diagnostic assessments (ex. psychosocial assessments and risk
assessments), individual and group therapy, and care coordination/case management services.

Diagnostic Assessments

One of the most important tasks that psychiatric social workers have is conducting different
diagnostic assessments of patients’ mental health in order to determine their specific
psychological issues and needs. The main assessment that psychiatric social workers conduct is
the psychosocial assessment, which requires that the psychiatric social worker gather the
following information:

 Primary and secondary psychological conditions (ex. depression, severe anxiety, PTSD,
schizophrenia, bipolar disorder, etc.)
 Behavioral issues (substance abuse, violence, problems with emotional regulation, etc.)
 Familial, social, cultural, and occupational background
 Physical health status and medical treatment history
 Mental health status (as measured by tests that measure mood, cognition, motor skills,
perception, etc.)
 Mental health treatment history
 Current medications and treatment support systems

Psychiatric social workers may use information gained from the psychosocial assessment to also
complete risk assessments, which are targeted evaluations of whether an individual may
experience an adverse outcome in their current state and situation. Psychiatric social workers use
risk assessments to determine the level of care that a patient needs (ex. hospitalization, an
inpatient psychiatric hold, or intensive outpatient psychotherapy).

Care Coordination (Case Management)

Once they have determined the mental health status and treatment history of their patients,
psychiatric social workers are responsible for ensuring that their patients receive the mental
health support they need. They accomplish this goal by:

 Developing a patient treatment plan in collaboration with medical and mental health staff,
using information from the psychosocial assessment
 Monitoring a patient’s progress throughout his or her treatment
 Communicating with the treatment team as needed regarding developments in a patient’s
mental health status
 Explaining different treatment options and plans to patients
 Connecting patients to relevant resources within and outside the treatment facility
 Coordinating safe and effective discharges when the time comes for patients to transition
to a different treatment facility or back home

Psychiatric social workers are also often responsible for keeping medical and mental health
treatment records to ensure continuity of care if/when patients transition to different psychiatric
settings or providers.

Individual and Group Psychotherapy

Depending on their work setting, psychiatric social workers may deliver short-term or long-term
psychotherapy to patients, utilizing different clinical social work methods according to each
patient’s individual psychological situation and needs. Psychotherapeutic methods that they may
use include but are not limited to cognitive behavioral therapy, harm reduction techniques (for
behavioral issues such as chemical dependency), motivational interviewing, dialectical
behavioral therapy, mindfulness training, and experiential therapy.
For more information on psychotherapeutic methods, please refer to our Clinical Social Work
Guide.

Challenges of Psychiatric Social Work

Psychiatric social work is a very demanding and difficult profession. Psychiatric social workers
must provide intensive and at times holistic support to people who are suffering from incredibly
severe, complex, and multifaceted mental health and behavioral issues. In addition, seeing
individuals in acute suffering, and who may pose a danger to themselves and/or others, on a daily
basis can prove disconcerting and draining for some professionals in the field.

“It’s hard to describe how to prepare for watching a patient be restrained, a child receive
sedation, the assaults that can be witnessed that make the job hazardous,” Ms. Clark said, “Being
aware, knowing safety precautions is vital for keeping safe and keeping the unit safe for others.”

Psychiatric social work can be unpredictable and dangerous, as Ms. Paffenroth explained to
OnlineMSWPrograms.com. “One of the most challenging aspects of my job is the potential
danger. When going out into the community to do evaluations I do not know what to expect,”
she said, “I try to gather as much collateral information as possible before going, however you
still do not know what you are walking into much of the time.”

The hazards of the job are not the only challenge that psychiatric social workers encounter. “For
me I have never found the needs of my patients to be the challenge; rather, connecting my
patients with a finite amount of resources has always been the most frustrating part of my work,”
Ms. Clark noted, “Additionally, process and structural problems of the way social and mental
health services are distributed, managed and funded are equally as frustrating.”

The psychiatric social workers whom we interviewed encouraged professionals in the field to
develop a plan for strong and consistent self-care. “I believe the largest asset a student can
possess is a commitment to the patients and really good self care,” Ms. Clark said.

Mr. Berman described the importance of establishing boundaries between one’s professional and
personal life, and engaging in self-care practices in order to stay balanced and energized at work.
“It has been challenging to set boundaries between my work and personal life that will allow this
career to be sustainable in the long-term. I have started forcing myself to leave work on time, no
matter if not everything is done,” he said, “Because the truth is no matter how hard you work, it
will never be enough. I have also become more committed to my own weekly therapy, which is
important for self-care and professional development.”

Ms. Paffenroth also explained how, on the job, awareness and caution are extremely important.
“The best way to address the safety challenges is to be very aware,” she advised, “This starts by
asking the referring party if the individual has a history of violence or has made any threats of
violence, gathering as much about the individuals history as possible. Once on scene, continue to
be aware of your surroundings, do not enter someone’s home if you feel threatened or unsafe.
We always go out in teams of two and we always make safety a priority.”

Why People Become Psychiatric Social Workers

For individuals who are drawn to a fast-paced and constantly challenging environment, and to
responsibilities that are both intellectually engaging and socially impactful, psychiatric social
work may be a rewarding field.

“I decided to become a psychiatric social worker partly because it is a way to combine my


interest in the law with my interest in mental health and helping people,” Ms. Paffenroth told
OnlineMSWPrograms.com, “I’m very happy where I ended up professionally.”

“I wanted to pursue psychiatric social work because I’m really interested in mental health and,
personally, love thinking about how social, political, economic, and historical (ie macro) factors
affect people’s wellbeing, and vice versa,” Ms. Friedman said. She also noted how the
populations with which she works offer constant opportunities for personal growth and
professional development. “One of the things I’ve loved most, but has also been difficult, about
this training year is the diversity of my patient population,” she said.

Ms. Paffenroth cited the gratitude of her patients’ families as a main source of professional
energy. “One area I would like to highlight about this work is the way we help the people who
are not the direct client. For example, family members, friends and even experienced clinicians
call us when they have encountered a serious crisis or when they do not know what to do and
need help,” she noted. The unique expertise and services that psychiatric social workers provide
mean that they can assist patients and their families in ways that other mental health
professionals are unable to do. “It is extremely rewarding to offer these people help in their time
of need. Family, friends and providers are often profusely thankful and tell us that they do not
know what they would have done without our help,” Ms. Paffenroth continued, “Through this
kind of feedback it is clear that the impact of our service goes beyond just helping the client get
to the hospital. We can start someone on the road to help and recovery in a way that most other
providers cannot. That makes my job pretty special.”

Ms. Clark told OnlineMSWPrograms.com how, in addition to the knowledge of the large scale
impact of her work, the daily successes and impact she has with clients are also deeply
rewarding. “The highlights are harder to measure because the successes can sometimes occur on
a small scale,” she noted, “On any given day the highlights of my job could be filing a police
report, having a meaningful conversation, or transferring a patient with chronic schizophrenia to
an appropriate facility.” She also noted how one’s professional team can make a huge difference.
“Working on a collaborative team of professionals continues to be one of the best parts of the
job,” she said.

Advice on How to Become a Psychiatric Social Worker


The complexities, difficulties, and potential dangers of psychiatric social work mean that
individuals generally need graduate-level training and internship and/or professional experience
in medical or psychiatric settings in order to qualify for roles in this field.

In order to sufficiently address patients’ conditions, and to provide them with effective therapy
as needed, students who wish to become psychiatric social workers should obtain a solid
foundation in clinical social work modalities. “I recommend taking classes on therapeutic
modalities you’re interested in (psychodynamic work, CBT, family systems, etc),” Ms. Friedman
advised. Classes in trauma, family dynamics, and the Diagnostic Statistical Manual of Mental
Disorders (DSM-IV) may also be useful. “[I]f your program offers elective classes on clinical
diagnosis and the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), take as many
as you can!” Ms. Paffenroth said, “I have become a strong clinician in this area due to the nature
of my internships and jobs, however feel this was lacking in my overall academic work.”

Mr. Berman encouraged students to identify the populations they would like to work with, and
take classes that are relevant to those populations. “Get training in substance abuse, therapy for
borderline and psychotic clients, trauma work, and case management experience for homeless
adults,” he advised.

Ms. Friedman recommended that students actively seek field placements in medical and/or
psychiatric settings. “One of the reasons I’m doing a post-master’s training year in mental health
is that I felt like my internships weren’t especially clinical,” she explained, “I think it can be hard
to enter psychiatric social work after grad school if your internships haven’t been in this field, so
I would encourage MSW students to pursue internships in agencies or organizations doing
mental health work if this is an area they’d like to go into. Different settings provide different
experiences in terms of duration of treatment – psychiatric ER will be short-term and crisis-
focused, versus an agency providing long-term therapy to trauma survivors, for example.”

“I believe that having internships in medical facilities is the best advantage for selling oneself
during interviews first out of school. Advocating for yourself while you are in school to get those
internships is important,” Ms. Clark agreed.

Ms. Paffenroth encouraged social work students to be open to different concentrations going into
the MSW program, citing her own experience changing concentrations after completing an
employer-based internship with the Berkley Mobile Crisis Team. “I was initially enrolled in the
Child Youth and Families concentration, however this limited my internship options and
ultimately would have limited my career options if I had stayed within that concentration.
Changing to Community Mental Health felt like a big step and was somewhat scary at the time,”
she recalled, “In hindsight it was a very wise choice. So my advice is to be flexible and don’t
limit your possibilities just because you have a certain mindset going in.”
Even after obtaining a job in psychiatric social work, students should continually seek to gain
more information about the field and stay updated on ways they can improve their work with
clients and colleagues in psychiatric settings. “Participate in lots of continuing education once
you graduate! These courses will help you continue building your skills, allowing you to focus
on a particular area that most interests you and is relevant to your clients. They are also great for
networking,” Mr. Berman said.

Through careful preparation, continual self-evaluation, a solid self-care plan, and consistent
efforts to learn more and contribute more on the job, social workers in psychiatric settings can
enter and even excel in a field that offers unique opportunities to make a profound difference in
the lives of patients and families who would otherwise be unable to find the help and support
they need.

Medical Social Work: Connotation, Challenges and Prospects

Abstract
Social work as a specialized field, grounded in scientific knowledge and skills, is more inclined
towards problem solving process rather than charity focused approach. Medical social work, as a
primary method, deals with the bio-psychosocial-spiritual elements of an individual with a
problem and assesses the pliability and strength of the patients, social support systems and their
families, to assist the patients resolve their problems independently. Medical social worker
(MSW), also known as case-worker or care-worker, has to play a substantial role in the
rehabilitation and retrieval of a person. This paper examines the roles played and responsibilities
discharged by the Medical Social Workers internationally and specifically with reference to
Pakistan. The capacity constraints and challenges confronted by MSWs in hospitals have also
been highlighted and some policy implications have been suggested to enhance the capabilities
of Medical Social Workers for serving the patients in a befitting manner.

I. Introduction
Social work, as a professional domain of social sciences, deals with the systematic
treatment and solution of psycho-social problems of individuals, groups and community.
Social work has its roots in society to deal with social problems. Hence, it is inclined to
achieve two major objectives; the formation of such an environment which assists in making a
more satiating system of living and the creation of welfare systems which help the individuals
and community to live more creatively and adequately. Medical social work came into being
because some doctors and some nurses wanted more far reaching ways of making the sick well
and keeping them well. Medical Social Work, a major domain of social work, is also called
Hospital Social Work.
Medical Social Workers (MSWs) typically work in hospitals and facilitate those patients who
need psycho-social assistance. MSWs assess bio-psycho-social and spiritual requirements of the
patients and their families and intercede for linking patients and their families to required
resources and recuperation in the community; do supportive counseling and psychotherapy of
patients to strengthen their social functioning in society.
According to Parmar (2014), “Social case work is a process, which develops personality through
adjustments consciously affected, individual by individual, between men and their social
environment with their problems.” Cobat (2010) defined medical in diagnosis and treatment of
patient through study of the patient in his social situation and by understanding the patient and
his environment. In addition, the medical social work is support by organized sources in making
medical treatment more effective.” According to Association of American Medical Colleges
(1977), “medical social work is a method which is centered on one to one relationship. It’s a
primary technique that supports in social functioning of individuals. The primary function of
hospital social work was teaching doctors and nurses about social and psychological aspects of
disease and to liaison or act as a bridge between hospital and the social environment and
community resources of the patients”.
“Case work or medical social work in the hospitals is for ensuring healthy
conditions in his or her home in preparation for the patient’s return at home” (Maijor, 2011).
Cannon (2010) defined medical social work as, “Hospital social worker’s role includes the direct
treatment of the patient’s social and psychological problems which were among the causes or
effects of their health problems or which acted as barriers to
cooperation with the medical treatment plan”. “A Medical Social Worker is a social worker who
works in a medical setting such as a hospice, outpatient clinic, hospital, community health
agency, or long-term care facility. MSWs are most often referred as “social workers,” and
sporadically may have other titles, such as Case/Care Manager.” (Morrow, 2014)
Many types of patients could benefit from the care of a MSW. Specifically, individuals with
mental illness; homeless individuals; the terminally ill; transplant
patients; individuals with chronic degenerative illnesses; and individuals with numerous
emotional, financial, social or housing problems.
II. What does MSWs do?
Being a member of a multi-disciplinary healthcare squad, the MSW provides
mediations to facilitate patients during recovery process and their families in adjusting to
grave and protracted medical conditions. The recovery of patient and his life’s quality
depends on his ability and his family’s will to adjust and cope with the effect of medical
conditions and subsequent infirmity on their finances, relationships, employment and
lifestyle. They support patients and their families to understand to manage life
emergencies resulting from chronic or acute medical situations, and emphasize on
improving their physical and mental comfort to attain self-confidence. They also assist in
reducing the liability of patients and their families from sustained healthcare and social
expenses.
MSWs succor patients and their families regarding health-related glitches and
trepidations. They perform complete assessment of a patient’s financial, emotional, social
and environmental support requirements and intimate other health-care team members
about these aspects, which may have an impact on the patient’s well-being and health.
They work with the patient’s support systems or family along with other agencies to
make a plan for patient’s care in his house.
Syeda Mahnaz Hassan 497
The most important role played by MSWs is patient’s counseling. MSWs assist
patients decide about appropriate health-care and other health services, initiate support
group discussions, provide support to patients with severe or protracted illnesses and
provide individual counseling.
MSWs effectively coordinate patient’s discharge planning in hospital settings.
They facilitate patients and their families in making arrangements for in-home medical
equipment, accessing in-home health-care services, coordinating follow-up treatments,
providing transportation and referring patients to social service agencies working in the
community. They are every so often assisting patients in health insurance coverage and
accessing financial support. In some cases, they also closely work with health insurance
companies to decide about the patient’s remunerations and support for the patient.
The basic functions of MSWs (Parmar, 2014) are;
 Psycho-social, physical and spiritual assessment for determining the resilience and
strength of the patients, their families and community support systems to assist the
people function within the society.
 Educating the patient’s family on bio-psycho-social requirements of the patients
and how they can acquire resources; and mediating familial skirmishes.
 Counseling patients and their families.
 Risk assessment of patients (self-harm like suicide or others such as child abuse, family
violence).
 Funds management and providing financial assistance to deserving cases.
 Discharge planning of patients.
 Referring services for associating patients to available community resources.
A. Fields of Practice for MSWs
The MSWs have opportunities to work in the specialized fields as well as in
different medical disciplines, like psychiatry, nephrology, geriatrics and oncology. The
specialized field include trauma work, community network and advocacy, case
management, group work, research and teaching, marital counseling, individual
psychotherapy, family mediation and therapy, domiciliary care, palliative care,
bereavement and grief counseling.
B. Origin of Medical Social Work
The professional method of social case work originated in USA in the second
decade of the century. One of the earliest organized efforts in USA to help poor was the
establishment of “American Charity Organization Society” in 1877. On the pattern of
charity, their collective experience of knowing the poor families and their problems by
social scientists broadens the understanding of human behavior. There was growing
recognition that there are internal and external forces within the individual which
influence his behavior and the nature of his existence in the society. In the course of time
the term “paid agents” or the “poor” were supplanted by “case workers” and the “client”
respectively. In the terminology of help giving organizations and the office of
organization came to be known as “agency”.

Mary Richmond made a significant contribution to social case work. Mary


Richmond used the word “social diagnosis” in his book which published in 1877 may be
considered as the first book in social case work. It set forth the methodology of helping
client through systematic way of assessing their problems and handling them. In the
1890’s in London, on the initiative of Sir Charles S. Loch, MSWs were organized and
they worked as volunteer greeters in hospitals. They used to make social investigations
and decide whether to admit the patient for free treatment in the hospital or ask from
community organizations for financial support of the patient. Formerly, MSWs were
known as Almoners, Lady Almoners or Hospital Almoners in Ireland and UK.
In early 1900s, the professional social workers were appointed in the
Massachusetts General Hospital in America. Richard Clarke Cabot created this position
to assist patients to cope with those arenas of life which had made their cure problematic.
In 1905, Cabot appointed Garmet I. Pelton, a nurse, as hospital social worker at
Massachusetts General Hospital. Dr. Ella Webb established a medical dispensary for sick
children in Ireland in 1918 which became the initiation of medical social work in Ireland.
In 1945, the Institute of Almoners in Britain was formed, which was renamed in 1946 as
the Institute of Medical Social Work.
Social Work in health care was eventually divided into medical and psychiatric
social work, a division stimulated by the introduction of Freudian Psychoanalytic Theory
around 1920. Since 1905, in hospital setting, medical social work in the health-care field
has extended to various health care settings, like, community based clinics, nursing
homes, psychiatric and other hospitals, public health agencies, rehabilitation services
centers, home care agencies and private medical practice.
American Association of Medical Social Workers and American Hospital
Association published major studies of Medical social practice in the form of pamphlets
and books in the period from 1925 through 1940. Although the most striking
characteristics of the case work literature of this period was its growing recognition of
psychodynamics but it is unfortunately true that the major parts of such writing tends to
be descriptive rather than analytical. The literature on case work in medical setting is
filled with articles that describe in detail the work of the writer in few cases or his
experience in specific kind of emergency, such articles offer generalization regarding the
range of social needs which reveal little of treatment’s method or diagnostic thinking.
III. Medical Social Work in Pakistan
On the request of Pakistan’s Government to UNO, a Swedish medical social
worker, Miss Anna Mo Toll, visited Karachi in 1953. Then, the term ‘Medical Social
Work’ was unfamiliar in general, rather few bureaucrats in health department commented
that there was no need for personnel training for medical social work. Some doctors, who
were trained from foreign countries, were aware of this field.
In 1953, first MSW was employed at Tuberculosis control and training center. The
patient needs were of basic nature, those were raised out of the incapacity to purchase
drugs, assistance for recuperation, resolution of family glitches, instability in performing
social roles, health, education and so on. Afterwards, Zakat was withheld from the
Syeda Mahnaz Hassan 499
individual’s bank accounts and some of the money collected through Zakat was
earmarked for the patients under treatment in the hospitals in 1980s. This was how public
assistance program was initiated in Pakistan. The ‘Patient Welfare Association’ in
hospital managed these funds and the hospital administrator is selected as Chairman and
medical social workers as the secretary of this association.
Later on, Bait-ul-Maal’s system was announced from transfer of receipt from
grants and taxes from local, provincial and federal authorities, voluntary agencies
including Khairat and Sadaqat and donations from international organizations. It
delivered much needed financial assistance to medical social work in Pakistan as it was a
well-organized infrastructure based on Islamic philanthropic public assistance system.
Formerly, medical social welfare’s service was working under the auspices of ‘National
Council of Social Welfare’. Now, there are about 100 MSW units in Punjab, 30 in
province Sindh, four in Baluchistan and four in Khyber Pakhtunkhwa. A MSW is hired
and managed by the Directorate of Social Welfare of the respective province (Malik &
Sarfraz, 2012).
A. Organizational Hierarchy and Funding Sources
In most of the cases, a Medical Social Welfare Officer is appointed in MSSPs in
hospitals assisted by a clerk and an office attendant. A medical social welfare officer gets
funding from three sources for needy patients (Khalid, 2009).
 Zakat Department
 Bait-ul-Maal Department
 Non-Governmental Organization’s (NGO) donations
B. Practice of Medical Social Work in Pakistan
The role of medical social services is to help individuals, by assisting in the
remediation of problems aggravated by social, emotional, physical, psychological or
economic problems, such as, the inability of the parents to accept the handicapped child
or face the situation like hospitalization of a bread-earner of the family. Medical social
workers are working in different areas of Pakistan. The following 18 Medical Social
Services Projects (MSSPs) are providing medical assistance to needy in Lahore city.
 Nawaz Sharif Hospital
 Kot Khawaja Saeed Hospital
 Mayo Hospital
 King Edward Medical University
 Lady Willington Hospital
 Mian Munshi Hospital
 Punjab Institute of Public Health
 Fatima Memorial Hospital
 Services Hospital
 Punjab Institute of Cardiology
 Institute of Mental Health
 Children Hospital
 Anmol Hospital
 General Hospital
 Shaukat Khanam Hospital
 Ghulab Devi Hospital
 Jinnah Hospital
 Sir Ganga Ram Hospital
500 Pakistan Journal of Social Sciences Vol. 36, No. 1
C. Role of Medical Social Workers and Services Provision
The MSW is concerned about his patient’s personality and his environment’s
social factors, which have numerous effects on the mental and emotional condition of his
patient. A medical social worker through building a strong trustworthy relationship with
his patient (client) tries to improve the mental and emotional condition of his patient in
order to reduce the stress, strain or pressure, for his environmental modification or
manipulation. MSW supervises the measures taken for the patient’s treatment and makes
necessary arrangements for their social adjustment and recuperation in society. MSWs
also work cooperatively as a team member in the multidisciplinary health-care team
which is directly embroiled in the patient’s care. MSWs also need to possess good
assessment and analytical skills along with a knack to converse effectively with staff and
patients and a capability to build a therapeutic relationship with patients.
Medical social worker values the ethical concepts of self-determination of the
patients. He strives to ensure the right of the patient to make his/her own choice about
treatment, planning, care and discharge. In numerous cases, expensive drugs may be
advised and poor patients cannot purchase them. An MSW provides medicines and
needed help for the patients. Sometime a medical social worker plays a role of motivator
by explaining the nature of disease to the patient and importance of its treatment as well.
In many cases, treatment of the patient required past history and family background of
the patient, at that time a medical social worker provide the case history of the patients
under treatment (Ali & Rafi, 2013).
D. Services provision by Department of Social Welfare and Bait-ul-Maal, Punjab
Department of Social Welfare and Bait-ul-Maal has initiated 100 Medical Social
Services projects in different hospitals for the provision of medical social services to the
person with problem. It not only covers the medical and social problems of the
individuals but also assist the individuals with Functional limitations (disable person) and
mental illness in dealing with their psychological problems. Along with that there is also
a project in Punjab Institute for Mental Health which is also providing services to
physically and mentally disabled persons through medical social worker.
E. Activities of Medical Social Worker in Hospitals
Activities of MSWs in hospitals regarding patients are:
 Preparation of case history
 Counseling of patient and his family
 Follow up and Rehabilitation of patient
 Provision of medicine
 Adjustment of patient activities regarding Patient Welfare Society (PWS)
 To establish and facilitate the PWS
 To arrange medical camp through PWS activities regarding Blood Bank
 To establish Blood Bank through PWS
 To arrange Blood camp through PWS
 Registration of Blood donors activities regarding Zakat department
 Maintain the record of Health welfare committee Syeda Mahnaz Hassan 501
 Utilization of Zakat fund for needy patient activities regarding hospital staff
 Coordination with Medical Superintendent, Doctors and paramedical staff
 To establish healthy relation between Doctor and Patient
 To visit the wards with hospital staff and locate the deserving patient who needs the assistance
F. Blemishes in Medical Social Work in Hospital
MSWs are not working independently in Pakistan. He/she is dependent on the
funding department, that is, Zakat Department, which is entirely different from his/her
parent department; Social Welfare and Bait-ul-Maal Department. Political pressure also
creates hurdle for impartial working of MSWs. There is a need of training for effective
working of MSWs which are not considered seriously by the Government. Limited
resources and limited funds also affect the working of medical social services. The
process of getting services is exhaustive. Follow-up of patients is very weak. Family
counseling is not being practiced properly in hospitals.
Pakistan is a developing country, having limited recourses for funding to Medical
Social Services Projects. It is also a fact that public health is not a priority of our
politicians. There must be at least one project in every public and private hospital in
Pakistan but because of improper Government policies, the MSSPs have not been
established. Pakistan’s Government, its politicians and bureaucrats do not understand the
true spirit and sense of medical social work. Patient Welfare Societies become
politicized. Donors do not have trust on Government Policies.
After discharge from hospital, many patients are unable to work or continue their
job to earn some money; they are provided neither physical help nor technical help for
reacquiring their sustainable position in society. This is a chronic condition especially in
the cases of disabled. Medical social workers report an increase in the severity in client’s
problems, caseload size, paperwork and waiting lists for services. (NASW, 2006)
IV. Challenges to Medical Social Work in Pakistan
The below given table presents the details of beneficiaries of MSSPs working in
35 districts of Punjab province. The last six years report, from 2010 to 2015 depicts a
very grim state of affairs that in a total population of 180 million people in Pakistan, only
1.08 million people per year, on an average, are able to get benefit from the MSSPs in
Punjab province, which is the most populated province of the country. This bleak picture
shows a dire need for increasing the awareness regarding MSSPs to the general public
and, concomitantly, demands for improving the infrastructure and financial needs of
these MSSPs. In a country where more than 60% of the population lives below the
poverty line (Kakakhel, 2014), only 2.8% of the GDP is extremely insufficient to cater
the health needs of the humongous population.
According to the available statistics from Economic Survey of Pakistan (2014-15),
there are only 118041 hospital beds available for the patients which give a ratio of 1593
patients per bed. The doctor to patient ratio is 1:1073 and dentist to patient ratio is
1:12447. On an average, for the last 03 years, PKR 0.55 billion are spent on health in
Pakistan which depicts a very disconsolate picture. The rural population has much lower
health facilities since majority of hospitals and doctors are located in big cities.
Table 1: Six Years (2010-2015) Beneficiaries Report of Medical Social Services
Project working under Social Welfare and Bait-ul-Maal Department,
Government of Punjab

V. Conclusion
In a developing country like Pakistan, among poor people the delay in approaching
any hospital or clinic for help is frequent, fear of loss of the source of income during
treatment often inhibit a bread-winner from looking for diagnosis and treatment in time.
Crowded living conditions, undernourishment, unhygienic environment, ignorance are
the grounded reasons for the budding of diseases. In this regard, the instructions given by
the doctors and medical social officer are seldom carried out because of limited financial
resources and ignorance about the severity of the condition. Thus, considerably medical
care given remains unproductive.
Medical social work is extremely challenging work and MSW has to manage the
deadlines, caseloads and ensure the provision of services. The medical social workers
often face complex challenging cases involving patients with multiple psycho-social
problems, all of which demand involvement of a case-worker to deal with their problem
effectively. Therefore, a comprehensive and timely assessment of a “person in problem”
is crucial. Concomitantly, there are various factors at societal level which hinder the
effective functioning of medial social work in hospitals, such as, lack of fund’s provision,
indistinct or vague concept of a Medical Social Welfare Officer by a lay-man and his
roles and services which he can provide, lack of team work and centralized decision
making. Although the medical social services were initiated almost 60 years back in
Pakistan, but due to the reasons mentioned above and the challenges which they face,
these services are still in preliminary stages and have not attained their effective level in
Pakistan. Strong policy implications are required to enhance the productivity of MSWs
for rehabilitating patients.
References
Ali, M., & Rafi, S. (2013). Medical Social Work in Pakistan. Journal of Social Sciences
and Humanities, 4(4), 4-38.
Association of American Medical Colleges (1977). Medical School Admission
Requirements: Washington, D.C.: AAMC.
Kakakhel, M. (03 October 2014). The Poverty Position in Pakistan. The Nation. Lahore
1. ROLE OF SOCIAL WORKER IN A HOSPITAL
2. INTRODUCTION The important areas of medical social workers are in hospitals, drug
rehabilitation centres, community health agencies, nursing homes, mental health facilities
and clinics. Most importantly a medical social worker works to assure that the best interests
of the patient are being met.
3. ROLE OF MSW IN HOSPITALS  COUNSELING  CARE PLANNING 
FINANCIAL ASSISTANCE  ASSESSMENT  ADVOCACY  LEGAL ASSISTANCE
4. COUNSELING  MSWs advise and counsel patients and their families .  MSWs
explain the nature of an illness to them  The MSWs advise them how to effectively deal
with symptoms and treatment.  The MSW serves as a grief counselor to help them deal
with the trauma of experiencing a chronic or an acute illness.
5. 2.CARE PLANNING  Families and patients often don’t know where to turn to get medical
care.  A MSW assists patients and families in finding and arranging services such as in home
care , nursing home care and counseling  The MSWs work with the medical team and discuss
about care planning.
6. 3.FINANCIAL ASSISTANCE  As the expense for an acute and chronic illness is very high,
families may not be able to financially provide for the care of an ill family member  If the ill
person is a parent , financial support for the care of dependents must also be dealt with.  MSWs
refer and assist the patients in obtaining financial assistance , food assistance and health care
coverage through city, state and federal programmes
7. 4.ASSESSMENT  The MSWs assess a patient whether he is severely mentally ill ,is a drug
addict or is a victim of abuse with the requirement of doctors or nurses.  The experienced
opinion of a MSW is highly regarded by hospital staff.  The MSW evaluates the patient and
reports back to the hospital staff.  Together hospital staff and MSW collaborate to find the best
approach to help mentally ill, mentally in competent, drug addicted or abused patients.
8. 5.ADVOCACY  A MSW acts as a patient advocate  The MSW acts as an intermediatory
between patients and the medical community  They are the voice for people who have
communication barriers or cultural differences that make effective communication challenging .
 Without the MSWs this type of patients often fall between the cracks-their health and
emotional needs unknown
9. 6.LEGAL ASSISTANCE  MSWs must take legal action to protect the patient. 
MSWsshould take legal actions in the following situations, 1.Parents are unable to take care for
their sick child 2.Accident cases 4.Abuse cases 3. Encounter cases . In these cases a conservator,
a power of attorney or a public guardian may need to be appointed.
10. MSWs DEALING WITH EMOTIONAL AND SOCIAL COMPONENTS OF ILLNESS
BOTH IN RURAL AND URBAN SETTINGS
11. EMOTIONAL COMPONENTS 1. Stigma 2. Stress 3. Anxiety 4. Depression 5. Abuse
6.Confusion and memory problems 7. Self devaluation
12. SOCIAL COMPONENTS  Social isolation  Break in social relationship  Loss of family
and social support.  Inability to perform social roles.  Financial problems
13.  Avail good support from the family friends relatives and society.  Save the patient and
his families from surrendering control of the future.  MSWs perform their roles perfectly to
manage the social and emotional consequenses of the illness.  MSWs apply the needed
methods of social work and different therapies to deal with the socio –emotional aspects of
illness both in rural and in urban settings  Mobilize community resources of the patients.
Psychiatric social work has been defined as social work practiced in relation topsychiatry. It
signifies the use of social work knowledge, skills and methods inthe practice of psychiatry which, in turn,
has enriched the field of social workby throwing light on psychiatric implications of personal and
social problems.In psychiatric social work, social case work and psychiatric services
arecombined for the purpose of treating mental or emotional disturbances. It alsohelps those patients
who, due to emotional disturbance, feel difficulty inadjustment within the society. Thus, psychiatric
social work is orientedtowards the welfare of patients suffering from emotional or mental disorders.The causes
of mental disorders have been shrouded in mystery andmisgivings. In ancient times, mental disorders
were not considered asdiseases. Their causation was linked with the evil influence of demons. In thename of
medical treatment, very inhuman treatment was meted out to theseunfortunate people in order to drive
away the evil spirits. This notion wasprevalent up to the medieval period. The eighteenth century saw
thebeginning of medical attention and more humane treatment of the mentally illpeople. This
gathered greater momentum in the nineteenth century followingstudies which highlighted the
interdependence of the mind and body,culminating in Sigmund Freud’s theories of the
unconscious and his method ofpsychoanalysis for resolving mental derangements. The overall
result of theseresearches, in the study of the nature and cure of mental illness, was theconviction that social
factors and environmental conditions are as potent asbiological, organic and hereditary factors. Hence the
treatment has to bebroad based, including, in addition to the administration of
medicines,psychological treatment to tackle personality and behavior problems andsocial treatment for
effecting changes in the environment. Thesedevelopments have led to more humane and scientific
treatment of patients ofmental ailments.

S-ar putea să vă placă și