Introduction

There are many reasons why people entitled to use health and social work services do not use them. Service design may preclude even those with the most complex and greatest needs. Some may be excluded because services are not acceptable, adequate or appropriate. Others may place themselves out of the reach of services, for instance because of the stigma attached to their illness. This chapter shows how social work can be a prime mover in reviewing and reshaping health and social work service provision.

Section 12.1 describes an action research project conducted in Glasgow, Scotland, with black and minority ethnic populations whose reluctance to use mental health services has been compounded by their ongoing experience of racism and isolation. Willingness to disclose illness required changes in beliefs and attitudes within communities and changes to the ways that providers approached planning and delivery processes. The authors describe the ‘community conversations’ that acted as the crucial vehicle for creating greater acceptance of mental distress and more appropriate services.

The setting for the changes described in Section 12.2 is an oncology social work service of a large metropolitan hospital in Melbourne, Australia. Social workers were traditionally assigned to treatment units rather than disease streams, resulting in unequal access to services, insufficient continuity of care and inadequate identification of and responsiveness to patients in greatest personal and social distress. The authors outline the changes they instituted to provide universal access to basic services, improve continuity of care and introduce a screening model to identify those most at risk of distress, while addressing the demand for evidence-based practice and the limits of resource constraints.

These accounts demonstrate how alliances with like-minded colleagues and organisations, and in partnership with potential users of services are essential for effecting change towards greater equality.

Addressing mental health inequalities in Scotland through community conversation

Introduction

Mental health problems are increasingly recognised as a global health issue. The associated stigma and discrimination result in social exclusion and inhibit help-seeking and recovery (WHO, 2002). Stigma involves a combination of ignorance, stigmatising attitudes and discriminatory behaviour, and operates at the level of self, family, community and society. Biomedical perspectives that are often used to understand and frame mental health issues offer little evidence about what works in addressing stigma and discrimination.