Sustaining citizenship: people with dementia and the phenomenon of social death.

Social death is apparent when people are considered unworthy of social participation and deemed to be dead when they are alive. Some marginalized groups are more susceptible to this treatment than others, and one such group is people with dementia. Studies into discrimination towards older people are well documented and serve as a source of motivation of older people's social movements worldwide. Concurrently, theories of ageing and care have been forthcoming in a bid to improve the quality of responses to older people in times of need. Included in this theorizing has been the analysis of values and approaches that paid carers convey to citizens who require their help. In this article, the values and approaches of social workers and mental health nurses bring to people with dementia are considered within the context of social life and social death. It is based on a small study that undertook to critically examine how participation of people with dementia was facilitated. A thanatological lens was used to interpret inclusive and exclusive practices which potentially create opportunity for participation or reinforce the loss of citizenship for older people with dementia.

Culturally informed child psychiatric practice.

Child and adolescent psychiatrists are already serving an increasing population of culturally and ethnically diverse patients and families in their practices and in different agency settings. This article discusses adaptations to practice that enable child and adolescent psychiatrists to address the diverse clinical and cultural needs of this emerging population. Special attention is given to work in psychotherapy and in agency settings where diverse children and youth are found in large numbers.

Promoting the psychosocial health of the elderly- the role of social workers.

With the ageing of the global population, the wellbeing of older people in different parts of the world merits special attention. However, recent findings on certain aspects of the psychosocial health of the elderly are far from reassuring. The first problem is the inconsistency in psychosocial indicators, which give simultaneous high life satisfaction scores and high suicide rates. The second problem is the significant weakening of the social support network of the elderly. This article analyses the service and policy implications of these two problems. Suggestions are then made on the role of social workers in promoting the psychosocial health of the elderly at different levels of intervention, which include the individual level, the family and social network level, the community level and the international level.

[Ethical deliberation: from case study to responsible citizenship]. / La délibération éthique: de l'étude de cas à la citoyenneté responsable.

This article wants to be a contribution reflecting on the theme of applied ethics aiming at nourishing professional and interdisciplinary practices. The authors examine the process of ethical deliberation which has four major ends : the development of reflective and ethical competences of professionals, the elaboration by professionals, of an ethical reflective structure facilitating professional praxis, orientation and quick coordination of action ; implementation of a structure of collective deliberation useful in the orientation of difficult decisions and future actions. Finally, this process also has an objective of evaluation and appears relevant in the apprenticeship drawn from experiences of each participant.

Partnership in mental health and child welfare: social work responses to children living with parental mental illness.

Mental illness is an issue for a number of families reported to child protection agencies. Parents with mental health problems are more vulnerable, as are their children, to having parenting and child welfare concerns. A recent study undertaken in the Melbourne Children's Court (Victoria, Australia) found that the children of parents with mental health problems comprised just under thirty percent of all new child protection applications brought to the Court and referred to alternative dispute resolution, during the first half of 1998. This paper reports on the study findings, which are drawn from a descriptive survey of 228 Pre-Hearing Conferences. A data collection schedule was completed for each case, gathering information about the child welfare concerns, the parents' problems, including mental health problems, and the contribution by mental health professionals to resolving child welfare concerns. The study found that the lack of involvement by mental health social workers in the child protection system meant the Children's Court was given little appreciation of either a child's emotional or a parent's mental health functioning. The lack of effective cooperation between the adult mental health and child protection services also meant decisions made about these children were made without full information about the needs and the likely outcomes for these children and their parents. This lack of interagency cooperation between mental health social work and child welfare also emerged in the findings of the Icarus project, a cross-national project, led by Brunel University, in England. This project compared the views and responses of mental health and child welfare social workers to the dependent children of mentally ill parents, when there were child protection concerns. It is proposed that adult mental health social workers involve themselves in the assessment of, and interventions in, child welfare cases when appropriate, and share essential information about their adult, parent clients. Children at risk of abuse and neglect are the responsibility of all members of the community, and relevant professional groups must accept this responsibility.

Harm reduction: a social work practice model and social justice agenda.

Efforts in the United States to eradicate drug use through supply reduction (that is, the War on Drugs) have increasingly violated the principles of social justice and human rights, both locally and globally. This has created ethical conflicts for social workers in policy making, practice, and research. Harm reduction has been conceptualized as a peace movement and is aligned with the humanistic values around which social work is organized. The authors examine how social workers may reduce the ethical conflicts associated with efforts to address substance abuse by adopting a harm reduction approach to policy, practice, and research. They examine current drug policies, the consequences of the policies, and, in particular, how the policies affect social workers as practitioners, agents of social control, and guardians of social justice.

Social work practice in the donation of human tissue for transplantation: utilising social work values and competencies to achieve effective outcomes for transplant patients and donor families.

In Queensland, Australia, senior social workers have pioneered the coordination of tissue donation at coronial autopsies, seeking consent for the donation of heart valve, bone and eye tissue after sudden deaths which have been reported to the coroner. The urgent need for tissue for transplantation is balanced with the counselling, information and practical needs of potential donor families in their shock and grief. Social work assessment, advocacy, liaison, counselling, crisis intervention and particularly communication skills have been utilised, both as an integral component of obtaining informed consent and in working with families' experience of grief and loss in sudden, traumatic bereavement. This tissue donation program, over a period of eight years, has maximised the availability of tissue with its high donation rates, while upholding the rights and needs of potential donor families through provision of an effective social work service. The paper will reflect upon key social work knowledge and processes which have respected the subjective experience of client and worker while working within a medical model.

Translating psychosocial insight into ethical discussions supportive of families in end-of-life decision-making.

A large number of Americans would rather rely on family and friends more than their physicians about end-of-life care and decisions. Moving beyond traditional clinical ethics and its dyadic focus on the physician-patient relationship, this article presents an approach to ethical decision-making at the end of life that is more inclusive of the patient's family and has the potential to advance social work practice in end-of-life care. Initial attention is given to how psychosocial and bioethical perspectives and practices interact to shape understanding of moral issues in end-of-life decisions. Morally relevant principles are then adapted from contextual therapy as being useful for including more of a family focus and viewing ethical decision-making at the end of life as a family process. Specifically, focus is on exploring the ethical dynamics of family systems that impact the decision-making process and translating psychosocial insight into ethical discussions that are supportive of families. The case of a patient with sudden and unexpected brain death and without advance directives demonstrates one family's unresolved grief and illustrates how its members were helped to reason morally about end-of-life choices. Contributions of a social worker and bioethicist are illustrated.

Take some time to look inside their hearts: hospice social workers contemplate physician assisted suicide.

This article presents a subset of data from a larger study that explored the impact of the legal choice of physician assisted suicide (PAS) on hospice providers. Eight social workers shared their personal and professional voices about a very controversial and difficult issue. Oregon is the only place in the country where PAS is legal and these social workers practice in an environment where the choice of PAS has been an option for two years. Three overarching themes emerged from the data: (1) the dilemmas that arise from the hospice philosophy; (2) the conflicts that emerge between the choice of PAS and social works' cardinal values and practice principles; and (3) the struggles with personal values and PAS.