Collaboratively Embedding Social Work Advocacy to Support Client Mental Health Recovery: A Partnership-Based Mixed Methods Study

Background and Purpose: Social workers are well-positioned to engage in advocacy to address equity issues related to the social determinants of health (SDH) which impact health and mental health for clients experiencing serious mental illness. While there is a longstanding history of social workers engaging in advocacy practices on behalf of clients, families, and communities, there is little research available considering social work advocacy in Canadian mental health settings to guide practice. Needed is local collaboration to generate knowledge in partnership. To enhance advocacy practices that address SDH to support client recovery, we developed a partnership between a Canadian school of social work and a tertiary-level mental health organization providing inpatient, outpatient, and community outreach services for individuals experiencing serious mental illness and their families.

Methods: Situated within a classic pragmatist epistemology, our exploratory mixed-methods project used quantitative and qualitative methods aimed to: (1) understand the barriers to effective advocacy practices used by social workers supporting clients with serious mental illness; (2) comprehensively understand advocacy practices and competencies that successfully overcome these advocacy barriers; and (3) disseminate knowledge gained to embed practices within an organizational advocacy approach.

We recruited social workers employed at our partnered organization to complete an online survey about social work advocacy. The survey was based on SDH research and recovery theory, and was informed by the research team’s collaborative, team-based approach to constructing survey questions. Quantitative survey data were analyzed using descriptive analyses.

The survey captured the broader insights of social workers regarding advocacy practices at this organization and findings were used to inform the next phase of the study which directed practitioner interviews during Winter 2023. Of those who completed the survey and expressed interest in the next phase, social workers from the organization were invited to engage in a 60–90-minute audio-recorded semi-structured interview to elicit a more in-depth and comprehensive understanding of advocacy practices, processes, and competencies at the partnership organization. Interview data were transcribed and analyzed using Braun and Clarke’s (2022) six steps of Reflexive Thematic Analysis, with methods used to enhance trustworthiness and credibility.

Results: Survey results of practicing social workers (n=43) were further understood and enriched through interviews (n=12). Most (88%) participants conducted individual/family advocacy centered on accessing resources (e.g., income, health care), whereas 51% were engaging in systems-level advocacy related to housing. Interviews revealed more nuanced findings about participants’ (1) advocacy strategies (e.g., initiating campaigns, harnessing community partnerships to secure client services), (2) advocacy knowledges (e.g., awareness of available services and political processes), (3) advocacy skills (e.g., collaboration and diplomacy), and (4) cognitive and affective processes (e.g., emotional regulation).

Conclusion: Through our research partnership, study findings codified tacit practitioner knowledge by identifying key advocacy practices and competencies to create an organization-wide approach to SDH advocacy toward client recovery. Next steps in our partnership, and implications for practice, policy, and research will be shared.