REFLECTIONS OF A CLINICAL SOCIAL WORKER IN AUSTRALIA
by Mickey Skidmore, AMHSW, ACSW, MACSW
When I left the United States nearly 10 years ago, it was estimated that nearly 65% of all mental health treatment was being provided by Clinical Social Workers. Not psychiatrist, not psychologist nor counsellors. Moreover, clinical Social Workers were highly desired in the work force due to their broader focus of the client in the context of their environment (thereby being more inclusive of their family and other social networks associated with their day-to-day interactions). Psychologist’s had priced themselves out of the market in many respects. Psychiatric in-patient wards no longer found it cost effective to have both clinical Social Workers and Psychologist on staff when clinical Social Workers not only provided clinical interventions with individuals, but also provided group therapy, family therapy and case management functions in addition to comprehensive Psychosocial Assessments. In short, Social Work was king.
Translating this experience to Australia has been, and continues to be a persistent uphill battle. When I mention my considerable experience as a clinical Social Worker people in Australia often look at me as if I have three heads. The notion of “clinical” Social Worker is foreign to them. There is a deeply entrenched (and incorrect) mindset in Australia, that a Psychologist — and only a Psychologist is the only suitable or appropriate professional to provide counselling or mental health treatment. I would also point out that this false belief endures both with professionals and the general public.
On more than one occasion, once my MSW students become familiar with my professional background, they have conveyed to me that they want to do what I do. However, in their assignments or during their comments they routinely mention referring a client to a psychologist for counselling. And I take the opportunity to challenge them by inquiring why they wouldn’t consider referring them to a clinical Social Worker?
Despite the fact that Medicare has recognised Accredited Mental Health Social Workers as providers under the national Medicare scheme, this mistakenly entrenched mindset remains generally pervasive. While I go out of my way to distinguish myself as a Clinical Social Workers, I still receive referrals and correspondence referring to me as a Psychologist. Even my own clients often refer to me as a Psychologist, despite my complete and transparent disclosure that I am not a Psychologist.
In my view, the lack of national or even state registration indirectly supports this view. Despite the passage of legislation in SA last year in response to a Royal Commission recommendation for Social Work registration, moving forward in this regard has been painstakingly slow (and very much under most people’s radar). AASW has opted for micro-credentialing program to highlight and bolster the expertise of an individual’s Social Work expertise. However, there seems to be very little tangible benefit from any of these credentials other than the Accredited Mental Health Social Worker — which enables clinical Social Workers access to the Medicare scheme. While the AASW collects handsome fees for the application process and maintaining the yearly renewal of each credential, other than a personal sense of pride and accomplishment there is little if any tangible benefit from them. In my estimation, they simply have not gained the traction AASW had once envisioned — yet.
One need look no further than the NSW State government system. Social Workers applying for positions in this system must be eligible for membership in AASW. Any successful graduate from an accredited University Social Work program is “eligible” for AASW membership. Once employed however, rarely is obtaining subsequent credentials a point of emphasis in the promotion, advancement or professional development of the employee. To the best of my knowledge, there is little to no influence or emphasis from the unions to incorporate or integrate these credentials to be recognised in the HR system of NSW State Government.
In my own experience, I was unable to simply discontinue my own standards of professional practice. Rather that passively waiting for referrals from others around what they thought Social Workers should do to assist clients/patients; my view was that every individual on the ward was my client. I would undergo some form of psychosocial assessment for every client to determine my own Social Work recommendations. However, this did not seem to be standard practice for other Social Workers in the in-patient service.
Despite the pressures to escort patients off the ward (after many of them had been scheduled) alone, in violation of ward and hospital policy; I opted to model clinical Social Work practice whenever possible — providing assessments; limited case management (linking with external stakeholders); discharge planning; collaborating with families; and advocating for disenfranchised clients. I would also clearly temper and advocate for realistic limits of things that Social Workers were not realistically able to do within a medical model. Perhaps the most pressing dissonance is impressing upon the system, that homelessness is never adequately addressed or resolved from a hospital — whether that was in the ED or a psychiatric ward. Housing is a political quagmire that is addressed with the DOH, with real estate agents or in conjunction with an individual’s family. There are no houses, units or apartments at the hospital. And all Social Workers can realistically do is refer, link and/or advocate with housing authorities and resources.
I have previously written about the “professional racism” that underscores the reality of clinical Social Workers in Australia. While Medicare recognises AMHSW’s to have access to their scheme, the payment schedule is considerably less for Social Workers compared to Psychologists — even though they may work side by side in the same practice, essentially navigating similar risks and complexity. Moreover, while a Social Worker’s training in system’s theory naturally lends itself to family work, Medicare will not reimburse for family therapy or marital therapy in Australia, leaving people seeking these services to endure the waiting list of Relationships Australia, or paying privately out of pocket.
We are a long way from clinical Social Work practice to becoming more recognised and respected in Australia. Registration at the national level in my view would be significant accomplishment. However, further integration from AASW regarding credentialing; greater influence from Unions with State Governments; further lobbying with Medicare regarding fee structure and advocating for inclusion of family therapy would all go a long way to begin to dissolve the entrench attitude that Psychologist have a monopoly on the clinical realm of mental health service delivery.