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Holistic approaches, such as the biopsychosocial (BPS) model, seek to address biological reductionism by incorporating multiple dimensions (e.g. psychological and sociological perspectives) in understanding and working with health issues. In recent decades, the BPS model has gradually grown into a mainstream conceptual and practice framework used to inform public research and health policy in the mental health field. However, a critical stance has garnered increasing attention with discussions focusing on the vague inclusivity of holistic models and their implementation in practice.
In social work, while our practitioners are often positioned hypothetically as the most suitable profession to implement holistic models in mental health care, little empirical research enquiries how practitioners navigate competing mental health discourses and form their holistic understandings in the different contexts of practice-base knowledge. This paper aims to fill this gap through a qualitative exploration of the accounts of frontline mental health social workers in two different cultural contexts (i.e., Hong Kong and Sydney).
Methods
Twenty-six individual semi-structured interviews with social work practitioners were conducted in two geographically and culturally distinctive settings (14 in Hong Kong and 12 in Sydney). Participants were recruited with the support of major mental health organizations and social worker professional bodies. Thematic analysis was employed as the main approach to analyze the interview data.
Findings
Three themes were identified in participant accounts. First, in both settings, the majority of the social work participants tended to distance themselves from a pure, explicit illness-focused conceptualization of mental health issues (MHIs) through deliberate discussions regarding the importance of broader, psychosocial dimensions in their understandings. Nevertheless, these dimensions were organized and navigated in distinctive ways, with some participants emphasized brain dysfunction or vulnerability exists as the most direct, true cause of MHIs, and others oriented their understandings of the holistic approach to MHIs around challenging the factual status of mental ‘illness’. Second, these practitioner understandings of MHIs were reported to be shaped by social work education, and more importantly, one’s own practice experience with mental health consumers. Critical thinking of the concept of mental ‘illness’ was more commonly expressed among participants who had lived experience of mental health issues. Comparing participant accounts in the two contexts, Sydney participants tended to take a more fluid and flexible approach to conceptualize MHIs in practice. Facilitating a person-centered understanding of MHIs is believed to be most effectively based in a flexible approach that remains able to adapt to diverse situations and presentations in mental health contexts.
Implications and conclusions
The study reveals the varying principles and contextual influences that impact on social workers’ practice-based conceptualizations of MHIs, offering offers a promising arena in which to contemplate questions regarding the construction of holistic approaches to health. We suggest that a pedagogical emphasis needs to be directed towards showcasing how professional fluidity can be created and managed in the contemporary mental health context, underpinned by consumer accounts, competing theories and perspectives and broader sociopolitical and cultural forces.