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  • in reply to: Growing up with Mental Illness in the Foster Care System #330

    1. What can Katie do within the next few months to assist Peter?

    Katie should take a number of approaches to assist Peter in the coming months. I think, foremost, she should talk with Peter about helping him find an apartment and, with his permission, attend his apartment showings with him. I think in doing so Katie could assist with Peters’ housing as a whole as he attempts to navigate the sparsely-available housing within his budget. Katie could also provide Peter a degree of advocacy as a clinician, potentially being able to provide support to Peter by discussing his need for affordable housing to landlords, explaining his situation, and, if needed, addressing some of the symptoms that he often presents with during apartment showings. Katie could also assist Peter in filling out housing paperwork and applications for additional funding, which would help address his difficulties concentrating when trying to fill out such forms.

    In the meantime, Katie could connect Peter with Phoenix youth shelter (which serves youth up to age 24) to see if they have any short-term or long-term beds available for Peter, so as to help with his housing situation in the interim.

    If Katie and Peter, together, were able to locate housing for Peter, Katie may also want to talk to Peter about some of the programs available through the SPCA that allow people to foster cats for short periods of time or to adopt older cats. Many of these programs offer ongoing support for foster/adoptive care providers, including free vet care if needed. As noted in the case, a cat has provided Peter with considerable support for his anxiety in the past; connecting him with a foster cat or an older animal with ongoing support from the SPCA or another organization would therefore benefit his symptoms and provide a client-centered intervention based on Peter’s self-identified needs.

    I also think that Katie could work with community mental health to put in a self-referral for Peter (again with his permission), so as to potentially connect him with a long-term clinician for support with his schizophrenia. Another service that Peter could also potentially benefit from is the Early Psychosis Program through the NSHA: given that his diagnosis of schizophrenia is recent, the team at Early Psychosis may be able to help him identify coping, self-care, and recovery-oriented strategies for the betterment of his mental health. They could also help address the ‘fog’ that he experiences, and strategies to help him deal with the voices that tell him to do things. Additionally, Katie could explain the role of the Mobile Crisis Team to Peter, and that he can call the service to connect with a clinician during times he has difficulty coping.

    Lastly, it might also be worth it for Katie to have a discussion with Peter to gain insight into his perspective on his relationship with Bailey, including if, and how, he feels that the relationship is affecting his situation. Katie would have to approach this conversation cautiously to ensure she did not impose any biases that she holds onto Peter and his relationship. However, I believe it is a conversation that is worth having to help understand Peter’s viewpoint and what he intends to do moving forward in the relationship given how it has impacted his housing situation.

    2. What are structural barriers that impact Peter?

    A number of structural barriers are impacting Peter. Foremost is the lack of affordable housing readily available for people with disabilities. Indeed, the fact that he has not been approved for housing based on his budget and his disability is indicative of a structural barrier regarding a lack of affordable and/or accessible housing in his area.

    A second structural barrier is the stigma associated with his mental illness. Such stigma may be impacting his ability to access housing, especially given that he often presents with psychosis-based symptoms during apartment viewings. Should the landlords that he interacts with hold biases and stereotypes concerning mental health, Peter would therefore be negatively impacted by such stigma.

    Another structural barrier is his rental history, which is impacting his capacity to seek out a new place to live. Especially given his history of damaging property, Peter is implicated in a low likelihood of approval from landlords.

    Assuming this interaction occurred in Nova Scotia, another structural barrier that may be interplaying within Peter’s situation is the lack of readily-available mental health services to help him with his schizophrenia. Long wait-times and a lack of clinicians for proactive support currently plague the province, leaving those experiencing mental illness without access to services for lengthy periods. Hence, this structural barrier may be perpetuating Peter’s situation insofar as leaving him without mental health support.

    3. What are alternative resources that may be helpful to Peter?

    I have noted a number of alternative resources that may be helpful to Peter in my answer to question one. In addition to these resources, Peter may also be able to access Out of the Cold emergency housing for a short-term bed to keep him off the street. Peter may also be able to connect with Metro Community Housing for additional housing resources and connections to government-based affordable housing. Laing House (a non-profit mental health agency serving youth age 16- 29) may also be able to provide Peter with ongoing support in which he could connect with peers and engage in client-centered activities based on his self-identified interests and needs.

    4. Is this more of an individual or systemic challenge (or neither)?

    I don’t believe that any challenge faced by a client is purely individual or systemic-based. In Peter’s case, I believe that there are certainly some individual factors impacting his situation—namely, his difficulty concentrating, his history, his relationship with Bailey, and his symptoms—but I also think that these factors make up only small percentage of the larger context of his situation. Additional factors that are undoubtedly interplaying to perpetuate Peter’s situation are the above-noted structural barriers that I have discussed. These factors, I believe, serve to interplay within his situation to render him without readily-available solutions to the issues that he is facing. They also serve to perpetuate and amplify some of his individual-based factors including his symptomology by leaving him with this overall lack of solutions and support. As a whole, then, I think Peter is caught in a cycle in which systemic forces of oppression and his individual factors are interplaying with one another to foster and perpetuate the situation that he is currently in, and that interventions are needed to address these forces in their entirety.

    5. Should Katie fill out Peter’s rental applications (as he struggles to fill them
    out correctly and apply by the deadlines)? If she does, should she mention Peter’s
    tenancy history?

    I believe that Katie should not take full ownership of filling out Peter’s rental applications, but rather that she should help him in completing the applications. I think that Katie could work with, and support, Peter in filling out the applications by filling out the forms together and helping him with his concentration. Doing so, I think, would be a much more client-centered intervention that would ensure Peter still has agency over the forms and his situation as a whole.

    Mentioning Peter’s tenancy history within his rental application is a much more difficult ethical question. I think, personally, she has an obligation to fill out the forms truthfully, without holding back information that is being requested. That said, I think I would personally leave out information not explicitly necessary to include within the application, and to only highlight aspects of Peter’s rental history that are required as part of these forms. Withholding such information, I think, could cause more issues for Peter in the future, and potentially implicate both him and myself in the law. I would therefore work to ensure that the information I include is truthful and acknowledges Peter’s history, but also that any unnecessary information or any information not explicitly requested is left out of the application.

    Jordan Z

    in reply to: Case of Non-Disclosure #328

    I found this case incredibly difficult to read and comprehend as a result of my own personal values, which I think largely align with Elizabeth’s. I personally place a high degree of value on client autonomy, especially around healthcare and end-of-life decisions. To me, the fact that the patient’s family withheld such crucial information as his diagnosis is very concerning, especially given that his disease is terminal and that he is in considerable pain. In these cases, I truly believe that a patient has a right to know their diagnostic information, regardless of what the family thinks is in that patient’s ‘best interest.’ However, the fact that the healthcare facility where the patient in question is receiving care accepts of the family’s decision to withhold his diagnosis is the most troubling aspect of this case to me, as this agency-level acceptance detracts from the value of client-centered care that I hold as being paramount. I therefore know that if I found myself in Elizabeth’s position that I would therefore face a considerable ethical dilemma, and one that I would have to act on in some capacity.

    Prior to deciding to take action within this case, however, I think I would first need to examine the entire context of the situation at hand and reexamine both my ethical stance and necessary actions from the information that I could gather. Information that might be missing that I think is important to the case as a whole includes the age of the patient (are they a child? If so, what age are they? Have they demonstrated competency over their care?), the cognitive capacity of the patient (for example, does the patient have dementia? Are they otherwise cognitively delayed? Most importantly-do they have the capacity to understand their health, the concept of death, etc.?) and/or any cultural values that are at play that may be influencing the family’s decision. I think, as a whole, it is crucial to consider the larger context of this case prior to acting on it, which is something I believe relates strongly to Mullaly’s (2010) discussion on situation-based ethics and the importance of making ‘ethical’ decisions that reflects a full understanding of the entire context of a situation. Indeed, even within the context of the CASW code of ethics it is important to consider the larger context of a situation in order to make truly informed ethical decisions that reflect an accordance with social work values, especially social justice, respect for personal autonomy, and respect for dignity and worth of all persons. If any of the aforementioned variables exist relative to the patient, I think a much larger discussion around the ethics of the situation and the harm being imposed on the patient would be necessary.

    Should no other potential variables exist within the case (as none currently do as the case is being described) after additional examination of the patient’s context, however, I believe I would take a number of actions in the case, as I perceive the choice of both the family and the agency to withhold information from the patient to be considerably unethical. For one, I would first talk to the patient’s family, so as to enhance my understanding of the reasons they are withholding the patient’s diagnosis. I think I would then talk to them about the importance of the patient’s right to be involved in their own healthcare and to be fully-informed of any decisions being made. I would also have lengthy discussions with the other members of my healthcare team regarding our roles as healthcare providers and our ethical responsibilities to act within the autonomy of our patients—especially, as noted, if none of the aforementioned factors (culture, cognition, age) are coming into play. Throughout these processes I would attempt to advocate for the patient who, at the end of the day, is the primary client in which I am serving as part of the healthcare team. If no solutions could be reached or justifying context presented at both the family and the healthcare team level, I would likely discuss the case with my supervisor (which would maintain the client’s confidentiality insofar as ensuring I only discuss the case with the persona that I am working under) to see if they could provide any insight into actions that could be done or the agency policies that are allowing for the non-disclosure of the patient’s diagnosis. In taking these actions, I would hope that a solution more in line with my values and the values of the social work profession as a whole could be achieved.

    That said, I also think that this situation brings attention to an additional, important role of the social work profession at the agency level—namely, creating institutional, policy-based changes to better reflect the interests, agency, autonomy, and dignity of the clients that we work with. As such, if I were the social worker in the case, I think an additional role that I would undertake is
    looking at the larger, institutionalized policies that are affecting the client in question, why those policies exist, and the extent to which room exists for changing those policies. I would then try to find allies within the agency that feel the same way that I do about the policy to try to advocate for changes to be made.

    Jordan Z


    Mullaly, B. (2010). Challenging oppression and confronting privilege 2nd ed. Chapter 9. Anti-oppressive practice at a structural level (pp.259-286). Don Mills, Ont: Oxford University Press.

    • This reply was modified 2 years, 5 months ago by Avatar B00678457.
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