ACCEPTANCE AND THE HOPE IN DIALECTICS

By Mickey Skidmore, AMHSW, ACSW, FAASW

As I sat down to write this month’s “perspective”, I felt after 14 years I was ready to publicly express my overall professional disappointment as a Social Worker practitioner in Australia. I have had numerous clients and supervises lament about their vocational experiences which has contributed to my own conclusion that there are a range of factors that have led to me to believe that the work culture in Australia seems inherently dysfunctional — if not  toxic.

I have previously written about my Reflections of a Clinical Social Worker in Australia (June 2021). In this editorial I’d like to broaden the scope to a broader, more generalised landscape of Social Work practice in Australia. To be clear, the scope of Social Work practice in the United States is profoundly different from Social Work practice in Australia. So, I will explore a few significant areas that highlight and illustrate these distinctions.

Language Role Clarity & Professional Identity

Perhaps the most obvious difference is the significant lack of consensus (even among AASW members) of how Social Work is defined and understood. What constitutes Social Work practice in Australia? What is it that Social Workers do (besides remove children from unsafe home environments)? And given this lack of clarity, how does that underscore the professional identity of Social Workers in Australia.

Many people are unable to distinguish the difference between Welfare Officers and Social Workers. Although they are related, the education, training and qualifications for each are distinctly different — as are their roles, purpose and function. I would argue that the overwhelming majority of people’s understanding of these issues is based on social construction rather than on clear, statutory definitions. 

Just as most Australian’s hold the view that winter begins on June 1st rather than rely on the science of the solstice (the shortest day of the year) to mark the onset of this season; the widely accepted consensus of Australian’s (both lay people and professional communities) is that only Psychologists are qualified to treat mental health afflictions. A colleague recently shared an anecdote of being in court, and the lawyer publicly stating he was not qualified to do psychotherapy.

Despite the recognition of Accredited Mental Health Social Workers as being qualified to access the Medicare scheme for some time now, this outdated and inaccurate socially constructed viewpoint persists. I have also previously written about “professional racism” (November 2019) in this regard. While some organisations (VA; Open Arms; etc) have embraced AMHSW’s to provide services; working side by side, essentially managing the same risks and providing the same services as their Psychology colleagues, SW’ers are compensated substantially less. Recently, one of my students (from a prior Counselling background) even suggested that SW’ers were not qualified to make referrals to other professionals.

In contrast, I offer some statutory definitions (effective as of January 1, 2021) from the Licensure legislation in North Carolina (USA).

Clinical social work practice. —  The professional application of social work theory and methods to the biopsychosocial diagnosis, treatment, or prevention, of emotional and mental disorders. Practice includes, by whatever means of communications, the treatment of individuals, couples, families, and groups, including the use of psychotherapy and referrals to and collaboration with other health professionals when appropriate. Clinical social work practice shall not include the provision of supportive daily living services to persons with severe and persistent mental illness as defined in G.S. 122C-3(33a).  

Licensed clinical social worker. —  A person who is competent to function independently, who holds himself or herself out to the public as a social worker, and who offers or provides clinical social work services or supervises others engaging in clinical social work practice.   

Practice of social work. —  To perform or offer to perform services, by whatever means of communications, for other people that involve the application of social work values, principles, and techniques in areas such as social work services, consultation and administration, and social work planning and research.

The specificity of this language; the clarity of the roles, purpose/function and definitions of service has been the framework of my professional Social Work identity for decades. Even though the AASW Code of Conduct does not afford such clarity for Social Work practice in Australia I have maintained the incorporation of these standards to my practice in Australia.

Organisational Frameworks Bureaucracy and Duty of Care

When it comes to issues of Duty of Care, there are contrasts between ideological principles versus pragmatic realism. For example, consider that an established client suffering from a head-trauma was denied admission to the hospital’s brain injury unit and was subsequently admitted to the psychiatric ward instead. During the obvious discussion among the interdisciplinary team regarding the appropriateness of this admission the attending physician conveyed that “the patient is here now … it is now our duty of care.” My response to this is, who had duty of care prior to this admission? And why would they be refused admission to the brain injury unit — seemingly designed and intend for such a presenting circumstance — especially an already established client?

Another example is more straight-forward in that the client in question is a mental health client. The only distinction is between inpatient and outpatient (community) levels of care or services. This established mental health client for the past 6 months required inpatient hospitalisation. The Case Mgr overseeing her case forwarded a list of upwards of a dozen tasks that was being demanded be addressed prior to her discharge. Yet a review of documentation from the past 6 months reflected zero efforts on the part of this Case Mgr or the community service to address any of these issues. Once again the question can be raised why is the duty of care card seemingly only played in an inpatient setting? Where was the demonstration of duty of care prior to this admission? On a pragmatic level, this commonly referred to as a professional “dump.”

In my view, the evasion of professional responsibility (duty of care) occurs in part due to the bureaucratic and organisational structure of the hospital — specifically, operating on a “consulting” model. Rather than each respective service (mental health; aged care; youth; brain-injury; AOD; etc) maintaining oversight and responsibility for their client’s care (continuity of care); they are admitted to a psychiatric service where the responsibility of care is handed over to the another psychiatrist. Either there is little to no contribution regarding their care until discharged back to their service; or they will make consulting recommendations for the psychiatric team to undertake that they often would not bother to undertake themselves.

Perhaps the biggest quagmire eventuates when inpatient psychiatric wards evolve into psychiatric hotels, where clients reside for years on end because the broader systems evade responsibility for their duty of care due to inadequate resources and policies.

Social Work Educational Structure

Perhaps the most fundamental contributor to the contextual difference in Social Work practice is the Social Work educational structure in Australia. Simply put, the Australian educational framework for Social Work practice is based upon a bachelorette preparation. In most parts of the world, the MSW is both the terminal and working degree. It is similar to a PhD in Psychology minus the dissertation. The MSW in the United States includes a thesis component and may be more similar in comparison to a Psy D. In the United States the BSW is the foundational preparation enabling one to begin their professional practice (in limited capacity). However, the advanced education, training and skills are developed in the MSW curriculum. For the most part, the Australian educational framework is limited to the foundational level. 

Many have come to accept that the financial framework of International students is “baked in” to the Australian economy. In the United States, out-of-state students fees are two to three times as much as in-state students. For public Universities, international students are charged the same out-of-state fees; whereas private Universities often charge the same higher rate to all students across the board. To be clear, an MSWQ is not a real “masters degree”, but rather a repackaged bachelor’s degreed condensed from a four year program to a two year program that is recognised by the Australian government as pathway to pursue permanent residence and practice in Australia.

Genuine MSW programs in Australia are limited, rare and often emphasise policy or academic focus. It is unfortunate and sad from my perspective that Social Work students wishing to build upon and enhance their foundational preparation with advanced Social Work skill and knowledge often are forced to pursue masters degrees in other disciplines (i.e. Masters of Counselling) rather than a graduate focus underscoring and further enhancing Social Work principles. 

Additional speculation may also suggest that this limited educational structure contributes to the imprecise language that employers use with recruiting social workers; the uncertainty around the role or function of Social Workers in the work place; and lack of clear professional identity for the Social Work profession. It may also contribute to the ambivalence within the profession regarding the need for professional registration or licensure.

AASW

Considering that the membership fees of the ASSW far exceeds that of Psychologists, Counsellors, Occupational Therapists and others, why hasn’t the AASW done more to address some of these issues? The NASW in the United States is a highly respected national organisation that carries significant political weight in service of the Social Work profession and the public it serves.

While the AASW is the largest independent professional body in Australia it is far from consensus or uniformity around several issues facing the Social Work profession — including the fundamental issue of registration (or licensure) — which I understand has now been debated for decades. When I came to Australia there were regional offices and boards and staff for each office. Since COVID however, from my perspective, the AASW has largely become an online endeavour, with limited face-to-face training events or opportunities. The growing number of micro-credentials it offers is more of a money making revenue stream that provides limited practical or pragmatic value (other than the AMHSW credential) and looming bureaucratic intrusion. The recent internal upheaval of AASW leadership has resulted in decreased notices and clear information.

I hear many within the AASW express displeasure and uncertainty regarding if this organisation is meeting the needs of it’s members, or have them wondering if the exorbitant fees are worth it. In contrast to when I left the United States there was no such ambivalence or uncertainty around the NASW.

ACCEPTANCE & HOPE

I have reflected on this for some time now and struggled with how to acknowledge this in a genuine and constructive way. I find some solace in the principles of critical realism. I can accept the cultural limitations of the Social Work profession and the realities of a dysfunctional work culture in Australia. I can also accept that as a result, my professional experiences have been disappointing (especially when contrasted with my experiences in America). Yet, this is not an admission of defeat or even surrender. More than one thing can be true at the same time. The hope that is offered from cultural realism is that at some point a new dialect can emerge from these truths that offers an alternative path forward.

For now, I find some hope in academia — preparing future students for Social Work practice. I find passing some of my knowledge and experience to the next generation to be generative and hopeful. My students see me and recognise that I am a living example that defies many of the conventional socially constructed misrepresentations in Australian society. I suppose I can also accept that these issues may not be resolved in my lifetime. Even if I never achieve my long desire for some type of peace in this regard, I am satisfied that I have consistently advocated for principles that were instilled in me as values aligned with the Social Work profession.

References

  1. Skidmore, M. Reflections of a Clinical Social Worker in Australia (June 2021).
  2. Skidmore, M. Professional Racism (November 2019).