Students learning in institutions of higher education normally have a work placement opportunity to learn from the practical work experience along with the respect to the formal diploma or degree courses in order to put the theory into practice. A work placement is necessary, when one is leaving University, since it will provide numerous opportunities for the fulfilment of career dreams in addition to getting a job. During the work placement, one is expected to behave in the same manner as the staff in the organisation. The experience in this job may turn out to be an interesting or more dissatisfying one, but both cases are crucial. There are different levels of support that may be provided by different organisations. In any situation within an organisation, it is essential to stick to guidelines that will enable one to achieve the most out of a placement experience. A record of all the activities done is written down by using a diary, from which a full report will be developed and presented for the assessment. The main objective of this paper is to critically evaluate African and Caribbean Mental Health Services, show application of theoretical frameworks and concepts in this work setting and develop skills that will increase my employability after graduation.
A Brief Overview of African and Caribbean Mental Health Services
African and Caribbean Mental Health Services (ACMHS) is a voluntary organisation, founded in 1989 as a result of frequent cases of admission of the second generation of African and African Caribbean youths into psychiatric hospitals based in Manchester. It later led to the formation of African and Caribbean Mental Health Commission (ACMHC) in 2002. Additionally, their caregivers and families were benefitting from these services. During the year ACMHS can support over 350 clients in addition to supporting socially and economically disadvantaged areas not only of Manchester, but also its environs.
The main objective of ACMHS is to provide a culturally appropriate and confidential mental health services predominantly to the African Caribbean as well as African people, who may be suffering from mental illnesses. Taking a holistic approach to mental health, ACMHC links mental illnesses to both internal, such as psychological genetics, as well as external factors, namely exclusion and isolation (African and Caribbean Mental Health Services n.d.).
Structurally, ACMHS is under the management of Board of Trustees that consists of twelve members and three-co-opted members, who have a wide experience and in possession of a variety of skills that are widely utilized. For instance, volunteer, Commissioning Lead, Social Worker, Solicitor, Finance Manager, Retired HR Manager, Accountant, Lecturer, careers, two service user representatives, Psychiatric Nurse and Child Care Inspector make up the Board of Trustees. Therefore, the staff with these appropriate skills and experiences, who manage the operations of ACMHS, are of either African or Caribbean descent. There is also a multi disciplinary team, which ensures that comprehensive services are delivered to the members of the community, careers and their families, secure units and their homes and also hospitals (African and Caribbean Mental Health Services n.d.).
The main clients of African and Caribbean Mental Health Services are predominantly black people, but non-black volunteers as well as service users can be accepted because of the nature of activities. The black people were found to face discrimination in the provision of mental health services. They had been initially diagnosed and apprehended as schizophrenic. Therefore, the services provided to them are based on the five year programme that was established by the British Government. Its objective is to address the issue of racism affecting mental health service provision to people of the African Caribbean descent and other minority patients. The African and Caribbean Mental Health Commission (ACMHC) works as an independent organisation and London-wide strategic forum; thus, it is a national network, which only targets to ensure of the implementation of mental health policy. The policy will address the inequality observed in the provision of mental health services, specifically to the African and African Caribbean Communities. The organisation provides a wide range of services such as information and advice, student placements, training, therapy taking, research, person centred counselling and volunteer programmes among others. ACMHC also gives them primary mental health care, which is targeted to help the people with common mental health problems, ranging from mild to anxiety disorders. It also attends to referrals such as from Mental Health Primary Care Teams (Primary Care Mental Health Team n.d.). The services are free of charge for people living in Manchester and Trafford, but those, who live outside these areas, have some charges to pay. People that predominantly benefit are men and women above 16 years of age, those who are in hospitals, prisons, secure units, hostels and their own homes, where they are taken care of by relatives and friends, carers, students, such as occupational therapists, NHS professionals, representatives of Statutory agencies and Community organisations.
Despite its influence on the creation of awareness of various mental health and cultural issues, ACMHS has managed to bring about change with the support of practitioners, policy decision makers and also ensure the promotion of good community health. During service provision, ACMHS assesses and manages individuals, such as patients with drop-ins, mental health, advocacy, medications and side effects, as well as budgeting as part of the practical support. The integral part of these services is the drop-in activities, such as black literature, trips, music and cultural studies, which are quite essential as they provide forum for new skills to be gained by members (African and Caribbean Mental Health Services n. d.).
The ACMHS staffs consist of appropriately qualified members, who carry out the operations of this organisation. The management team is well established and comprise of the Chairman, Vice Chairman, Secretary, treasurer, and volunteers as well. Under this leadership, the staff works hard to provide services under four categories. The first category involves specialist hospital services, which are a befriending service, while the psychiatric patients are in hospital, and it also deals with psychiatric reports. The second consists of secondary and primary care, where a key worker accompanies drop-in attendees. In this category, a colleague accompanies service users to various appointments, which are organised under different settings. Moreover, at this level, the staff shares information with clients and professionals concerning the promotion of mental health.
The third category is the community care, which addresses the drop-ins such as music, sports and art. I found drop-ins very interesting; therefore I participated in all of those activities that most appealed to me. For instance, in music drop-ins, I was able to sing with the clients, and I also helped them fill the questionnaire that the clients were requested to fill in the art drop-ins. Moreover, it was encouraging to the clients in terms of my intervention in the life skill drop-ins, in which I took time to listen to the clients’ complains and find the best way of reassuring them. The staff in charge has to identify women and their groups, volunteer and user groups. Volunteers in the organisation play a vital role in this category. The primary care team provides a 10-week counselling. The staff involved here aims at getting enough support from the organisation to move from incapacity befits to job-seekers.
The fourth category are services, in which the staff helps to form new social networks and improve those, which are already present, ensures that there is no social isolation for those undergoing therapy on mental illness. Lastly, some sections of the staff provide preventive services of ensuring that the initial risk assessment is done. They also ensure that relaxation techniques are in place as well as therapy, monitoring and evaluation measures. Therefore, at this level of my placement, I was able to answer calls from different points of the hospital such as from other staff members or from some clients requiring various types of help. I also appealed to the staffs one by one, so that they could discuss with me the role, which each of them performed in the institution. The staff members discussed the role, which the institution was playing, mainly dealing with mental health problems.
In the African and Caribbean Mental Health Services, the staff is made up of a majority of black or those coming from the minority ethnic groups. My initial worry was whether the patients looked at this with a positive mind and hence an empowering factor, since they can now easily identify with fellow black nurses, social workers and numerous black people, who were working within the hospital. The other question was what patients thought about the key decision makers for their treatment being the white, while the rest of the staff were women from the ethnic minority. However, through the placement and with time, I realized that the entire staff worked cohesively, and decisions were made by the team of multi-professionals. It is argued that negative attitudes towards mental distress that are normally or easily observable can be shaped by some forms of discrimination such as race. For example, there is a belief that in many cases, black people are more violent than white people (Harrison 2002).
Influence of Career Choice
The placement has totally changed my perspective on the actual meaning of being emotionally intelligent, an experience, which I have gained from my placement in ACMHS. In my future career, it will be possible not only to reflect upon my emotions, but also manage them, since they play a vital role during the interaction with both my future work colleagues and patients. I am now aware of my own emotions, and this has reframed my negative stereotypes about schizophrenics as I was worried on how to work with them. This stereotype was tested, when I was involved in row with a lady, who put on badly always; an instance I thought it would make her vulnerable to be raped by other male patients around. I became so watchful on her, especially when it was my duty that some other things would sometimes go wrong. This made it difficult for me to manage my emotions and that of the lady, until I turned to other professionals and explained what was bothering me. That is when I learnt that there are specialized professionals, who deal with that behaviour, even when I am not watching (Healey & Spencer 2007, pp. 14-16).
Developing Ideas about Professional Practice
Through the placement I learnt that African and Caribbean Mental Health Services rely heavily on the highly effective staff from multi-professional backgrounds. I learnt that multi-professional work and agency work is very essential in producing care and assessments, which are comprehensive. This is because a number of professions are brought together to work on a particular problem; thus, different perspectives regarding mental illnesses and other associated issues are brought on board (Davenport n.d).
Professionally, I have learnt that ACMHS operates on a policy that requires everybody to be treated equally, and nobody is discriminated, irrespective of sex or age as long as one is above 16 years, sexual orientations, religion, employment status, physical fitness or cultural background, although the main target clients are those from the African descent (Equality and diversity monitoring form n.d.).
My placement supervision played a significant role in the success of my work. It purely involved a shared commitment in a learning centred partnership, which later became an essential part of developing professional relationships. The supervisor, to whom I was attached, helped me in being reflective on the essence of the placement and also in developing a reflexive practice. For instance, this supervision introduced and took me through mental illnesses, in addition to other related areas such as financial expenditure. Moreover, it is through supervision that I learnt how to maintain professional boundaries, while interacting with patients and at the same time ensuring that I am aware of risk and safety procedures. However, due to the supervision, I was able to establish a good rapport with patients. Finally, the supervision got me an opportunity to reflect on some ethical issues, associated with some patients I worked with, such as the feelings towards the crimes, which some patients committed as well as ensuring that this case did not interfere with the patient (Healey & Spencer 2007, p. 95).
Thus, this supervision was more beneficial for the reason that it was based on a focused learning as it requires a practice of creative thinking, which many people use in their social care practices. The main problem that can occur to vulnerable learners is when the criteria and concepts of the assessors fail to agree with those of the learners. It is argued that social caring, such as the one I was doing in my placement, requires one to be a reflective practitioner, who should be able to tell using research results the interventions that are likely to lead to the best targeted result (Knott & Scragg 2010).
Opportunities for Developing Work-Related Skills
It is crucial that a lot of skills and experience were achieved in my placement time in ACMHS, but this also became an opportunity for me to discover some of my talents, which will closely suit my personal practice. I have learnt that I have a special interest taking record of assignments and executing them in such a quick and successful way, whereas my supervisor still thinks I have not began. I have learnt a lot of new skills related to the courses I did in campus together with completely other new ones that are specifically applicable to the work environment. Similarly to what happens at Nyabingi, an organisation, which gives black people a sense of belonging, I also felt a sense of professional belonging, while working in ACMHS. Some of the activities I learnt are study skills, support, consultations and research, counselling, therapy processes and efficiency in teamwork (Nyabingi n.d., pp.2-5).
Internal Policy of the Organisation
All the practices in the African and Caribbean Mental Health Services are directed by the legal and policy requirements. The main document used currently is based on the three suggested policy decisions, which have been made regarding the problem that relates to detaining people from the African and African Caribbean descent diagnosed with psychotic disorders under part II of the MHA (Harrison n.d.) The Mental Health Act, which was amended last in 2007, contributes towards the introduction of Independent Mental Health Advocate (IMHA), which will play the role of helping patients in understanding their legal rights as stipulated in the 983 MH Act (Detention under the Mental Health Act n.d.). It is hoped that by 2013, the commissioning of IMHA services will be accessible by the local authorities and hence ensuring that qualifying patients will benefit from highly effective and quality IMHA services (The right to be heard: review of Independent Mental Health Advocate (IMHA) services in England n.d.).
In the Act, a legal framework is set on the manner of treatment and care of people with mental disorders through the provision of legislation. It dictates the events, in which a mentally disordered people may be detained without their consent in a hospital for the assessment of the disorder. There is also a restriction order, which restricts the movement of patients or their discharge, until there is an agreement from the Ministry in charge of justice. The Magistrates Courts are given powers by this Act to have an accused person to be remanded to hospital with the purpose of being treated or diagnosed.
The patients’ handle by African and Caribbean Mental Health Services can result in making an application to the First Tier Tribunals in order to evaluate the extent of the available conditions that require them to continue being in detention. These are given authority by the Act to order an absolute or a conditional discharge of the patient. Alternatively, they may apply for the reviewing of their cases by the hospital managers. Due to this crucial role played by the Mental Health Act, I committed my time throughout this work placement to comprehend its application. The section 41 of the Act, which provided the patients with the impulsion to work out their own recovery process and later discharge, was of a particular interest to me. The mentally ill patients follow their personal care plans by partaking in group therapy, avoiding not only to use the outlawed substances, but also to be identified as problem patients by the management. Their main objective is to blindfold the Ministry of Justice that their mental disorder risks have evidently decreased. Some become hospital mongers, and since they seem satisfied with the life in the hospital, they do not join the rest in chatting their way out (Being discharged from a section n.d.).
The Understanding of How the Organisation Is Affected by Policy and Legislation
As a result of my placement, I have come to learn that the British government is dedicated to handling problems that arise in the inequality, observed in the mental health service provision between the majority white population and black people, who are referred to as Black and Minority Ethnic (BME). There are also legal factors, which determine the provision of mental health care not only to the BME, but also to the asylum seekers in the UK. The government has established EU’s strategic policy, which is termed as the Green Paper; in the clause, the section 2 stipulates the centrality of mental health for citizens and societies. African and Caribbean Mental Health Commission (ACMHC) is a signatory to this provision and states that mental health has implications on the GDP of the UK.
The ACMHC aims at seeing the improved work of the different ways, in which the hospital had failed, namely caring for people from BME communities. The commission will ensure that this is done through the introduction of a tool for monitoring of mental health services in ethnic groups across all EU states in order to monitor and address ethnic health inequalities. It feels that this has to be done despite the awareness that this monitoring is illegal in many EU states, since that would be a significant step in measuring rate of achieving the strategies outlined in the Green Paper. The strategy is also expected to address the excessive use of ‘schizophrenia’ diagnosis, which then leads to over representation of this particular client group and their subsequent sectioning.
The black service users have always felt racial injustices as well as cultural oppression, but The Black Voluntary Community Sector (BVCS) has played a vital role in the provision of mental health services to the ethnic minorities and thus bridging the gap that exists. The ACMHC believes that public health medicine has a major responsibility of nurturing policies that enhance health. The expenditure on mental health is the second highest in the UK, and it views this as an unavoidable burden, just as it is viewed by individuals, carers and families. The commission agrees with the fact that the member states have an existing scope of cooperation within and between them, which should provide an advantageous ground in helping to alleviate mental health inequalities as well as disparities associated with it. Therefore, it calls upon everybody, and the organisation supports BVCS in addressing institutional racism and discrimination (Improving the mental health of the population 2006).
The programmes at placement helped me in understanding how to assess myself on the basis of, for instance, competence, accuracy, problem solving skills, personal learning management and ability to work well with fellow staff members. This placement not only provided me with an opportunity to learn better communication skills, but also presented me with a suitable environment to apply the various skills that were learnt. In many occasions, I faced communication problems with not only my work colleagues, but also with my supervisor and in more frequent cases with my clients. For example, daily routine procedures, instructions on handling a given patient or step by step instructions on how to carry out drop-in activities, required a great listening skill to execute.
Monitoring and evaluation of the provided services required an effective application of SWOT analysis in order to use questionnaires, interviews and group discussions properly. I was able to learn all this during my placement (Flexible Combined Honours, n.d.). My placement in a hospital set up, in which mental illness is treated exactly as a normal illness, provided me with the best medical model that will be applicable in my future career of a medical professional.
In terms of the significant factor on illness and recovery, I managed to learn that social exclusion and stigma are the major barriers for social inclusion and the recovery process. When people are labelled as being dangerous or violent by the society, just as I held the same thought for the people with mental health problems, they end up suffering from stigma. Now that I have worked in my ward, closer to the same patients, and the time spent together with them in community mental teams as well as community hostels, I have obtained a substantial experience, which taught me that patients normally find it difficult reintegrating to the society again, and the anxiety they face just before they are discharged.
The National Service Framework for Mental Health is one of the bodies that are fighting to ensure social services as well as health services promote mental health and set objectives that imply the substantial reduction of discrimination of whatever manner as well as social exclusion. This campaign must be vigorous in nature, although it sometimes requires being effective in terms of funding and targeting. Stigma and discrimination are difficult to end as they are widespread; hence, they defied the call to end them through campaigns. Moreover, stigma and discrimination are said to more problematic than the mental health problems (Social exclusion in Unit Report, n.d.).
According to the information of the assessment of my work placement, I preferred a systematic approach, which implies that individuals need to be understood, the way they interact with their family, community, while the general social and political environment is being assessed. For instance, most of the patients fit into a particular demographic group, which predominantly consists of people from an ethnic minority. Most of these people are believed to have gone through disruptive and disadvantaged family backgrounds. The theory of attachment and loss also explains this scenario; therefore, it is also very effective in assessing the information. In addition, another pivotal basis for the formation of understanding, management and treatment of mental illness are the biological and psychological models. Therefore, for a comprehensive assessment to be obtained, I found it essential to have a combination of knowledge from these theoretical perspectives (Healey & Spencer 2007, p.49).
In addition to assessment theories, biological and psychological models, applied through the use of medication and also the administration of both individual and group therapies, are used to intervene in a practice. In my placement, I chose to work with an individual patient, where I tried to know what the patient valued most based on their own perspective, and then I searched for the right solutions for them (Collingwood 1993). This is also known as a task centred practice. In this case, problems are referred to as identifiable sources of behaviour, setting of goals and mutual agreements with service users; thus, their involvement proceeds in terms of small sequential, manageable steps. In this practice, a social care provider works hand in hand with a client to solve problems, while utilizing, extending and consolidating their strength and abilities. For example, after the assessment of a patient has been undertaken, they are then given a task to read, which they have to do within a given time frame. After this they are asked to note any errors or questions that were possibly heard about the assessment. In my case, I learnt that the assessment process is an intervention in the process, since I was able to challenge mentally ill patients to think, examine their overall progress as well as specific behaviour and look into their insight, mental illnesses and index offenses (Madoc-Jones 2008, pp.130-134).
The work placement period has been a very enriching experience, connecting my theoretical studies with work practice. The termination of this placement makes me reflect back on the progress that I have made in terms of the accumulated skills, the experience on handling of clients. In terms of the mental illness that I was dealing with, I feel that the knowledge and understanding has enabled me to change my stereotypes concerning the mentally disordered individuals. This placement allowed me to achieve many positive changes, refine my skills, which were exceptionally helpful during the information presentation and team work activities. Through these skills I learnt how to manage stress and emotions as well as proper ways of communication. Additionally, the drip-in activities, therapy and counselling programmes were scheduled in such a systematic manner that it became a factor, which helped in learning how to prioritize my work as well as manage time properly. I was able to achieve this not only with the support of practice teacher, but mostly with the help of the multi-professional team.
In this placement, I felt more motivated, since I was able to interact with the multi-professional team, who were able to guide me not only on every area, which I was scheduled to learn, but also any other areas, in which I developed interest. I was also able to be a part of the decision making process such as in meetings held by Mental Health Review Tribunals and also those held by hospital managers. In addition, I am reaching the end of the placement as an experienced reflective and reflexive practitioner, whom I will strive to be as long as I continue being a social care giver now qualified to promote the best social care practice. The placement has generally been a lively and enjoyable experience, and I feel that it has given me varied and interesting learning opportunities through the guidance of my practice teacher. These are the opportunities, which enabled me to understand comprehensively and attain the experience of the mental health social work. Furthermore, I appreciate the positive relationships with my clients, patients and staff at large as it is reflected in my service user and colleague feedback, and therefore I hope I have left a legacy in African and Caribbean Mental Health Services to both the staff and patients.