You’ve got to move past the ‘fluffiness’ of heart and soul to recognise that social change occurs through love in action! My favouritism for Social Workers among all mental health professionals lends itself to their day-in-day-out, tireless work supporting the recovery journey of people experiencing mental health issues.
Like mama’s milk to our society and rarely praised enough, Social Workers are the patient yet pro-active people who outreach to homes, 24/7 when we roost in a rut. They are hand-holding, strength-building, no-nonsense heroes, and what a stellar role they play placating social malaise.
I spoke with Ava Freeland, a Partners in Recovery Support facilitator and undercover art therapist, advocate, meditation guide, counsellor, youth/drug/alcohol worker, and friend to many people in the community. Ava epitomises support. Her grasp of the ‘clinical vs community’ model debate is insightful.
She upholds progressive attitudes about voice-hearers, traumatised poets and recovery journeys for the deemed unwell. She makes you wanna say, ‘Social Workers, we salute you!’ just by being Ava and just by doing her part in the mental health of the community.
BFA: What role/s have you performed in community mental health settings and what inspires you to be of service in this way?
AVA: I first started my career in youth alcohol and other drug (AOD) work. For me, the AOD use was on the surface of what was going on for all the young people I came into contact with. Underneath it all was how they were coping with their emotional and mental health. I think having the foundation of working with youth in such a high risk area has always been a really positive influence on my work with adults who struggle with mental health. It taught me to be flexible, have fun and that a good relationship is the most effective intervention
After this role I became a community mental health practitioner. I worked at a community health center in the inner suburbs of Melbourne. I had about eight people I worked with, everybody I worked with struggled with a severe and persistent mental health issue such as hearing voices, or experiencing major highs and low. I would have weekly to fortnightly contact with them. My role was to support people in their recovery through a psychosocial model.
The psychosocial model recognises the impact that a persons connection to social supports has on their mental health.
My role here was very varied. For one client I would support her by attending sewing classes at a local neighborhood house and for another client we did a lot of work in preparing for and eventually having a coffee at a local café. This was something he had never been able to do previously due to debilitating anxiety. I also ran a hearing voices group.
I loved this role. I found it so effective, I would be able to walk along side a person and see how they negotiate the world around them. Some of the most therapeutic conversations would happen in the car on the way to and from a social activity.
Now I work as a Support Facilitator in a program called Partners In Recovery. We work with people who have similar severe and persistent mental health issues and range of other complex needs. My role is to make sure that they have the right supports in place, for instance, housing, AOD workers and community mental health workers. I encourage a collaborative approach amongst all these services. It’s a great program and I find we end up working with a lot of people who would previously have fallen between the gaps.
BFA: What are the 3 common issues you witness people struggle with? eg. depression, drug and alcohol, low self-esteem, homelessness, self-harm.
AVA: The common thread that I see in the work I do is that everybody has experienced some kind of trauma. I did some great training through an organisation called Voices Vic. It is an organisation that are leading the way in changing the approach to working with people who hear voices in Victoria.
Voices Vic believed that there is some kind of un-resolved trauma underpinning the voice hearers experience. Doing this training revolutionised the way I work with people and Voices Vic are making a huge change in the world of mental health. They talk about getting to the roots of the problem rather than looking at medication being the only option for someone who is experiencing voices.
Often in this field we hear people say we don’t want to explore a persons trauma with them as it is opening a can of worms and it needs to be qualified professional having those conversations. Whilst I agree a practitioner needs to be aware of their limitations and abilities we also need to recognize that for that person the “can” is often already open and worms are flying all over the place. Being able to sit with a person as they process their trauma and being able to listen is so important.
Whilst mental health issues are certainly non-discriminate and can affect people from all walks of life, the demographic I work with are people who are often severely affected by adverse poverty. This affects everything from housing, education and diet and nutrition. One of the first things a social worker learns about is Maslow’s hierarchy of needs. It basically means that people need to have access to housing and these other basic needs before they can move through and address other areas in their life eventually coming to a point of self-actualization.
Again, this is why working on the practical areas as a worker can be so beneficial and effect actual change. But when we’re talking about issues such as income and housing, services and workers can only do so much. It’s really a much bigger social issue that needs to be addressed in the political arena.
BFA: How has your approach as a Support Facilitator clashed with a clinical mental health worker’s model and can you tell us about a time when this happened?
Understandably there’s often very different approaches and opinions between the two regarding causes and possible outcomes for clients. I have found the clinical model often comes from a place of seeing people as being “ill” and needing medication to fix this. It can be very disempowering for the person and lose sight of the individual and their journey.
One scenario comes to mind. I feel it really points out the differences in approach but also shows how through these situations we can affect change:
I was in a workplace alongside clinical workers from a different program. A client who was experiencing homelessness and other complex issues presented. At the time he was elevated and spoke in a very aggressive way and was presenting with some delusional beliefs. A hospital stay was needed and the clinical staff at my work supported him with this admission. During this time he gave the workers an artwork that had a poem he had written onto canvas with a permanent marker. You could say his handwriting reflected his state of mind with jagged edges, nonsensical phrases and words, and a very fast pace to it. It was placed in the store room.
He came back to our service and I was assigned to work with him. He still often presented as elevated and his trauma was so present for him he would often speak loudly and aggressively. I was once speaking with him about this and I wanted to guide the conversation in a way that recognised his strengths so I asked him “How did you get through it?” The next day he delivered an artwork to my work. It was another one of his poems written in a frame. This one still had the fast pace with jagged handwriting. There were still some made up words but the focus of the poem was on his strengths and reflections on what he felt had brought him through the trials in his life.
I had begun to realise that this clients presentation, even when he was in a good frame of mind, was always going to be elevated. Therefore his art, no matter how confronting, was an important part of his expression and recovery. I put the art work on the wall. The artwork lasted a day before it was taken down off the wall. Some of the clinical staff saw it as “inappropriate” which really made me question a number of things. Just because something doesn’t fit into our idea of what “normal” is, is it necessarily a symptom of an “illness”? Where do we draw these lines?
This situation meant that we were able to address this and start having these conversations.
BFA: How do social and clinical supports work in harmony? Do you think this is optimal or is one more suitable than the other, in your experience?
AVA: Above is one example where there was a clash but there are many other situations where I have worked really well and effectively with clinical services.
I’m noticing more frequently that the clinical services are taking on a community mental health model. The new Mental Health Act is reflecting this with the compulsory introduction to Advanced Statements of Care that give a person the opportunity to make a plan as to what they would like to have happen should they become unwell and not be able to make safe decisions for themselves.
I’m seeing clinical case managers embrace this and a shift towards a client led way of working. With this mindset I’ve had great experiences working on care teams with clinical workers. Recently I experienced a good example of how this collaborative approach can benefit a client. I was concerned that a client was becoming increasingly elevated and showing signs of paranoia. I was able to contact their clinical case manager directly and talk about my concerns. As a result the clinical case manager was able to see this client earlier and their medication was reviewed and adjusted. Having this relationship with clinical services and a good support team helped this client to avoid becoming increasingly unwell and experience a potential hospital admission.
I think traditionally there has been a power imbalance between community services and clinical services. This is because ultimately clinical services often have the power, particularly if a person is on a Community Treatment Order.
Community workers see the client regularly and can have some really valuable insight as to how they are travelling.
BFA: What satisfies you about your work in the community and how does it enrich your life, your wellbeing and/or personal development?
AVA: I derive huge satisfaction from being creative in my job. I’ve sat with clients and made collages, facilitated guided meditations, taken walks in the forest and advocated for them in the law courts. I enjoy having the opportunity to see what might support an individual and being able to respond accordingly.
The biggest thing that inspires me is seeing change. I wholeheartedly believe in recovery for every person, I’ve seen it happen for some of the most unwell people you can imagine.
The change that is made doesn’t have to be a huge thing either. I mentioned sitting in a café with my client who had never done so before and that was a huge moment. Recently I was with a client who was living in supported accommodation in a very institutionalised setting. After he paid the rent and expenses of the residential service he lived at, he was left with only $20 a fortnight. He also worked at a sheltered workplace receiving $2 an hour. We supported him to move into a shared boarding house and linked him in with some employment services. All this was very satisfying but the most rewarding part was seeing him make more eye contact and engage in conversation with me. He smiled when I bought him a coffee, which was the first time I had ever seen him smile. That was a wonderful feeling.
I think my personal life is constantly enriched by these human experiences. The people I work with are part of the community that we are in. We’re not separate, we’re all part of the same.
Thank you Ava and all Social Workers for the remarkable service you provide in our communities. Your fortifying efforts do not go unnoticed.