10 Years Later: Is Graduate Social Work Education Promoting a Critical Approach to Mental Health Practice?

Background:The present study is a 10-year follow up to one conducted in 2003 (Lacasse & Gomory) examining the content of graduate social work psychopathology class syllabi. Like the previous effort, the current study is seeking to evaluate whether graduate students are being taught the latest scientific knowledge regarding mental health practice as they prepare to enter the field. The former study found little evidence that graduate level social work education was providing content aside from only that of the most conventional and institutional--- the biomedical model. In light of the contentious debate surrounding the, then, soon-to-be-published DSM 5, the purpose of this study was to reassess the state of graduate level social work mental health education, ten years after the original, to see if these findings were still the case.

Methods: We attempted to replicate the original study’s methodology in its entirety. In the Fall of 2010, we identified graduate schools of social work where psychopathology courses were taught, and solicited syllabi from the top 82 ranked programs (U.S. News  rankings). From the Fall of 2011 until the Spring of 2012, syllabi were collected through email to program administration and faculty members, as well as through searching online for publically available copies. In keeping with the previous study, a content analysis of each syllabi was undertaken, evaluating both course descriptions, course readings, and assigned reading. Each required textbook and article were collected and analyzed for information regarding four themes: 1) The conceptualization of mental disorders; 2) The reliability and validity of psychiatric diagnoses; 3) The etiology of mental disorders; and 4) The use of psychiatric medications in mental health practice. Syllabi content was coded and entered into a database for analysis.

Results: We collected 90 syllabi from 57 different schools, including 39 of the top 50 ranked schools. While a majority of courses were arranged by DSM categories (n=82; 88.2%) and approximately 2/3 required the DSM as a course textbook, (n=62; 66.7%), only 14% of syllabi mentioned (n=13) this issue of diagnostic reliability; 16.1% mentioned the issue of diagnostic validity (n=15). Further contemporary critics of mental health were mentioned only sparingly (e.g. Kirk, n=27; 29%; Wakefield, n=9; 9.7%; Szasz, 9; 9.7%). Of required textbooks, only 3 of 99 different texts were found to have offered critical content related to the four themes described above. Initial results surrounding the content of readings regarding etiology and medications found only limited content questioning the validity of dominant claims.

Conclusions: The results of this follow-up study indicate that graduate mental health education in the field of social work has remained fixed on a biomedical framework, despite the existence of numerous alternative frameworks and practices. Since the start of this study the received view of mental disorder as medical illness has sustained an unprecedented amount of criticism, both among professionals and the public media. It would appear that the time is ripe for social work and its central presence in the mental healthcare arena to cultivate an alternative and independent knowledge-base from which to practice.