Mickey Skidmore, AMHSW, ACSW, MACSW
Social Work is widely recognised as a helping profession. Perhaps more importantly however, is the manner in which Social Workers attempt to provide assistance. Engagement emphasises the identification of strengths; cultural awareness; sensitivity to the potential role of traumatic experiences; and recognition of the environmental context in which they live (hopefully) resulting in empowering people to help themselves. The profession has long valued the principle of self-determination and acknowledged that individuals and families often have clear views about the solutions that works best for them.
A bio-psycho-social emphasis coupled with this broader context to better understand clients is a unique perspective that the Social Work profession offers that other professional disciplines do not. Despite the advantages of such an approach, it is not generally accepted or well received in the NSW governmental healthcare systems overall (which continues to be dominated by medical model approaches). Rather, it is widely misunderstood, devalued, disrespected and often disregarded.
While it is frustrating that other disciplines do not seem to have a grasp of what Social Workers do, it is perhaps more disturbing that they seem disinterested in learning about it. In my view, this contributes to false and misinformed expectations that results in setting the stage for false hope — and setting up Social Workers as systemic scapegoats when this is ultimately exposed. Below are only a few of the issues that are systemically out-of-whack and dysfunctional that contributes to the perpetuation of false hope with disenfranchised clients seeking assistance in a range of systems.
Clients are admitted to the hospital everyday who are homeless. They were homeless before being admitted for whatever their medical issues might be, yet too often there is an unreasonable expectation that such clients accommodation should be resolved before being discharged. Regardless of what one’s view’s about this might be, it is simply beyond the scope of what hospital’s can realistically provide. While it requires no special skills or training to provide a phone number or address for the nearest DOH office, such clients are often referred to Social Worker’s in the hospital. And, even if the Social Worker wanted to resolve these referrals for being homeless there are no houses, units, apartments or granny flats at hospitals to offer or hand out. There is however, an entire Governmental agency developed and devoted entirely to address this issue — The Department of Housing (DOH). Many of these clients are attempting to have their needs met through the hospital or by other governmental organisations, suggesting disenchantment with systemic challenges and short-comings that do not work in their favour.
During my time at Liverpool hospital, clients were frequently encouraged and instructed to engage the Social Worker to liaise with DOH in order to classify their application as “priority” status. The implication for clients was this would expedite their application or shorten the wait time for DOH allocation. Such a classification only held a distinction with DOH management. It made absolutely no practical difference for the clients who could still expect wait times of 10-15+years for a property in the Liverpool area and 20+ for Fairfield. Ultimately, in my view all this manoeuvring accomplished was contributing to an underlying sense of false hope for clients.
The issue of domestic violence is a particularly difficult and complex issue that many find to be a vexing social problem. Such a circumstance does not fall neatly within a medical model framework. Thus, Social Worker’s are often called upon to intervene. Yet, in most situations the realistic options available for a person in such circumstances are extremely limited — with nearly all of the options being (largely) undesirable. Even if they are compelled to flee their homes, shelters often present another range of concerns for them or their young children that only serve to complicate their circumstances. No magic options are readily available for most confronted with this misfortune. Once again, the notion of false hope is often unintentionally conveyed or implied in the context of exploring immediate safety.
As a Social Worker I have often heard a range of explanations to somehow justify the current state of the foster system. Often FACS will not even pretend to investigate questionable or concerning circumstances of children older than 14 years of age due to the overwhelming numbers of younger children being removed from their family of origin. The system is simply overwhelmed. Children older than 14 who find themselves in abusive or neglectful family circumstances are apparently left to fend for themselves. When I first came to Australia, it was common place for hospitals to discharge minors to refuges unaccompanied by an adult or guardian. FACS departments regularly are slow to respond (if they respond at all) to a Social Workers call in a hospital under these circumstances, as in the view of FACS the child is not in immediate danger while in the duty of care while in the hospital.
If the numbers are so pervasive that the system’s in place are overwhelmed, what does that say about how family systems are managing in NSW? What does it say about how people are raising and parenting their children in NSW? What is it about our society that is so dysfunctional that we remove so many children from their family of origin? When looking at this issue from a macro perspective, the notion of providing limited foster placements to children in a system that is completely overwhelmed is type of assistance that seems inadequate.
If we are being genuine, realistic and completely transparent, homeless (or inadequate accommodation) is never satisfactorily addressed or resolved from a hospital. The best resources for accommodation are a real estate agent; family/friends; or DOH — not a hospital, which addresses medical concerns. When such referrals are made to a hospital Social Worker you might as well ask them to solve the issue of homelessness throughout NSW. To suggest, imply or infer that a Social Worker could do anything other than described in this essay only serves as an example of how the system set’s up Social Worker’s as scapegoats.
Moreover, addressing larger more complex issues such as domestic violence and child protection and foster care might as well be on par with suggesting the Social Worker solve the issues of poverty, hunger, or world peace — from a hospital no less.
Rather than embrace the unique skill set and broad knowledge base that could offer worthwhile contributions to a medical model; too often interdisciplinary teams are threatened by what Social Work offers suggest or offer. They take offence to attempting of offer systemic changes from within that would benefit both the organisation and the clients being served. Because of our slant for social justice, we are often viewed as agitators. I have even undergone a formal complaint process in the past for simply doing what I was trained to do as a Social Worker, for a system that was clearly disinterested in what I was offering.
Rather than being recognised and respected as clinicians, in inpatient hospital settings Social Workers are often reduced to “gophers” (go for this … go for that). Conversely, in community settings Social Workers are often reduced to “chasers” to clients that are often not interested in what is being offered to them (primarily medication). Again rather than acknowledging that our skill set could be utilised in a medical model, we are instead asked to walk clients to the bank or escort (babysit) them while on leave during their admission. And when there is persistent push back from enough Social Workers, the system responds by hiring a new (less expensive) category of employee emphasising their own lived experience over a formal tertiary qualification to do what they really want us to do in the first place.
In the meantime, the Healthcare Unions supposedly representing the interests of the Social Work profession are largely silent on these issues, focusing instead on membership drives rather than supporting the profession on relevant practice issues within these beauracratic systems.