Professionalizing Everyday Life: How Frontline Social Workers Negotiate Professional Identities in Community-Based Mental Health Services in Mainland China

Background and Purpose In contemporary China, more than 70% of the individuals with severe mental illness (SMI) are cared by family in community settings due to the scarcity and unequal distribution of hospital-based treatment resources. In the mid 2000s, government-run mental hospitals started to incorporate community services into their existing systems. Social work, an emerging profession in China, has been brought into mental hospitals for this experimentation. Investigating one case example – the localization of the Assertive Community Treatment (ACT) model in an urban mental hospital in Southeast China – this preliminary study discusses 1) how frontline social workers make efforts to simultaneously negotiate a space in mental healthcare, justify the necessity and uniqueness of their roles in relation to other professionals, and establish a professional identity for public recognition; and 2) how everyday (inter)actions between social workers and their client families reconfigure the perceptions and conceptions of social work professionalization in China.

Methods A 2-month ethnographic study was conducted in Spring 2017 at an urban mental hospital social service department in Southeast China. The author conducted participant observation mainly by shadowing frontline social workers in their daily routine, including activities such as home/community visits, record-keeping, staff meetings, and so forth. During the ethnographic study, 6 semi-structured interviews with 3 social workers, 1 supervisor, and 2 psychiatrists were conducted. Besides, the author helped the department draft a service manual for distilling and disseminating their experiences of localizing ACT, which revealed the discursive strategies of professionalization deployed by these social workers.

Results Instead of building a holistic service package by a non-hierarchical multidisciplinary team at the need of the client, ACT provision in China has become the job of social workers alone (under the psychiatrists’ administrative supervision) whose tasks were largely helping clients and family caregivers with mundane daily-living activities and handling family conflicts. In this process, not only were boundaries between professional and personal relationships constantly challenged, social workers also experienced tensions between keeping a professional status and following traditional care ethics. As patients of mental illness and their families have been excluded as “nonperson” by the Chinese state and society at large, this style of social work practice has also been marginalized by other mental health professionals and social workers in other fields.

Through discursive strategies of professionalizing everyday life, frontline social workers have been simultaneously negotiating a space for daily practice and advocating for professional legitimacy. Embracing mundane daily-living activities and familial relationships into the scope of formal expertise, frontline social workers are reconceptualizing the notion of social work professionality in China – a bottom-up, locally-oriented approach of knowledge production. Emphasizing everyday life and relationship-building, this practice modality could potentially bring the focus of mental health service from managing a population back to caring for persons.

Conclusions and Implications In China, social work is a profession in-the-making. Findings highlight the importance of ground-level social workers’ everyday experiences in the conceptualization and construction of social work knowledge and expertise – a bottom-up knowledge and reality making process in response to China’s sociopolitical contexts.