Social workers know that there is nostandard response by clients for thediverse and complex challenges of lifeafter cancer. Since there is an obviouslyworse alternative to surviving cancer,the challenges facing a cancer survivor are often overlooked or minimized bysome. Prostate cancer is the mostcommonly diagnosed carcinomaamong men in the United States(American Cancer Society, 2006); andthe practice and research done by theauthors of this article suggest thatdifferent types of emotional, concrete,and informational support areindicated. In this article, we discusssocial support at the intersection ofnaturally developed helping networksand social work intervention.

Social workers may be able to besthelp clients with prostate cancer, aswell as other types of cancer, byhelping them identify and strengthentheir social support networks. Supporthas a salutary effect across the cancertrajectory, according to research byBloom (1996). The majority ofsurvivors do not face cancer alone(Hedestig, Sandman, & Widmark,2003). They are surrounded by socialworkers and other health careproviders, and often also have aconsiderable naturally developednetwork of support, including family

members, friends, and others (Ka‘opua,Gotay, Hannum, & Bunghanoy, 2005;Mitschke, 2006). Helping survivorstap into this potentially rich source ofsupport is an important part of thesocial worker’s role.

In assessing the social support networkof cancer survivors, social workersshould begin by examining with theclient the closest individuals and thosewho may have expressed concern orprovided assistance. For instance,naturally developed helping networksoften include spouses, adult children,family members, friends, and closeneighbors.

• Spouses - In our research on thecoping methods of prostate cancersurvivors, spouses played a criticalrole in the overall functioning of thefamily unit (Ka`opua et al., 2005;Mitschke, 2006). Survivors saidtheir spouses helped maintain dailyroutines, offering them normalcy in times of uncertainty (Mitschke,2006). Their spouses reportedhelping them access medical care by coordinating and providingtransportation to and fromappointments.

See Prostate Cancer, Page 3

750 First Street, NE • Suite 700 • Washington, D.C. 20002-4241202.408.8600 ext. 476 • www.socialworkers.org/sections

©2007 National Association of Social Workers. All Rights Reserved.

PROSTATE CANCER AND SOCIAL SUPPORT Diane B. Mitschke, PhD, MSW Lana Sue Ka`opua, PhD, ACSW, LSW

ISSUE ONE – 2007

IN THIS ISSUE

Prostate Cancer and Social Support ......................1

Letter from the Chair ................2

Anorexia Nervosa: A Case History’s Implications for Treatment ........................5

Prostate Cancer: A Practitioner’sPersonal Experience ..............8

NASW Government RelationsUpdate ..............................10

A Closer Look at Social Worker Safety ....................11

Publication of articles does notconstitute endorsement by NASWof the opinions expressed in thearticles. The views expressed arethose of the author(s).

Issue One – 2007 • Mental Health 2

Letter from the ChairWelcome to the latest edition of the SectionConnection.It has always been the intent of the Mental Health SpecialtyPractice Section Committee to provide our readers withprofessional articles that are informative and useful. We hope you find this issue to be consistent with ourintended objective.

The articles in this edition remind us that illnesses requiringmental and psychosocial intervention can apply to bothprofessional social workers and their clients. These articlesare written from individuals’ personal and professionalexperiences.

First, Diane Mitschke and Lana Sue Ka’Opua compareresearch and practice with prostate cancer survivorsundergoing psychosocial intervention. This issuedemonstrates that both personal and professionalexperiences provide social work practitioners with valuableinformation that can be utilized in developing treatmentstrategies for our clients. Then Lee Ann Ripstra, anundergraduate social work student, and I write about Lee Ann’s treatment journey after she was diagnosed with anorexia nervosa. These shared experiences are from a survivor and a professional. In the final article of this edition, we explore the personal and psychosocialintervention of Mark Smith, a professional social workerdiagnosed with prostate cancer.

I want to take this opportunity on behalf of the entireMental Health Specialty Practice Section Committee tothank our members and readers for their continuing interest and support of our newsletter. We try very hard to provide you with unique and interesting articles.

Enjoy.

Gwendolyn Scott, ACSW, LCSW

Mental HealthSectionConnection

A NEWSLETTER OF THE NASWSPECIALTY PRACTICE SECTIONS

SECTION COMMITTEEChair

Gwendolyn Strong Scott, ACSW, LCSW, BCDHouston, TX

David Laird, MSWWashington, DC

Nancy Rossi, LCSW, ACSWGales Ferry, CT

Irma Serrano, MSWSan Juan, PR

Ada Williams-Parr, ACSW, CISWMilwaukee, WI

NASW PresidentElvira Craig de Silva, DSW, ACSW

Executive DirectorElizabeth J. Clark, PhD, ACSW, MPH

NASW STAFFManager

Susan Rubin, MBA, MA

Senior Policy AssociateMelanie McCoy, MSW, LICSW

Senior Marketing AssociateYvette Mulkey

Administrative AssistantNonya Miller

3 Mental Health • Issue One – 2007

Prostate cancer is a disease typically diagnosedin older men, and the reliance on a longtimepartner as a source of love, support, andcompanionship is evident. Partners providestability and trusted advice that is oftenaccepted by survivors as an important part ofcoping. Mitschke (2006) found that partnershelped survivors maintain positive attitudes andencouraged them to reach out to others for help.

• Adult Children - While survivors rely onpartners most heavily for support, they alsoreported receiving extensive help from theiradult children in coping with the cancer(Mitschke, 2006). Adult children can providerespite for the caregiving partner and becomethe family spokesperson or liaison between thesurvivor, others in the support network, andhealth care professionals.

• Concerned Neighbors and Friends - Strongsocial support networks often include a cadreof concerned neighbors and friends whoprovide companionship, spiritual support, andoccasional assistance with transportation,meals, and errands (Mitschke, 2006). Intapping into the reservoir of naturallydeveloped helping networks, social workersmight assess if neighbors and friends arewilling to provide additional support to thesurvivor and family members.

Overcoming BarriersWhile the assessment of naturally developedclient support networks is important, prostatecancer survivors can sometimes present withresistance. It can be a challenge for socialworkers when the survivors are unwilling to develop a social support network orunaccustomed to relying on the assistance of other people. Research by Hedestig andcolleagues (2003) suggested that survivors will often try to protect their loved ones by notemotionally upsetting them with informationrelated to the cancer. In doing so, however,survivors may internalize much of the stressrelated to their illness and ultimately feel alone

in experiencing the burden of the disease. This self-imposed isolation, or protective buffering, can alsoinclude avoidance of discussion with significantothers about the cancer diagnosis or treatment.

Protective buffering is a common phenomenon,and social workers can play an important role in helping survivors and significant others toresist this tendency. This is easier said than donesince prostate cancer is associated with erectiledysfunction and urinary incontinence—conditionsthat are difficult to acknowledge and discuss.

Strategies to Enhance CommunicationWhen protective buffering is encountered, socialworkers should consider the individual needs ofeach client and ultimately respect the clients’ rightto self-determination (NASW, 1999). There arestrategies, however, to consider that might lendthemselves to assisting cancer survivors.

Survivor support groups are a promising meansfor addressing protective buffering. In ourpractice, survivors derive great value fromdiscussions with those whom they feel haveexperienced similar feelings. Throughparticipation in support groups, survivors oftendevelop a greater comfort in discussing sensitiveissues and may be encouraged to discuss themwith those in their natural networks. In addition,psychoeducational counseling provided by thesocial worker can emphasize the fact that mostprostate cancer survivors experience better healthoutcomes when they seek and attain supportfrom family and friends. Ptacek, Pierce, andPtacek (2002) found that men with familysupport tended to cope more effectively with thepsychosocial sequalae of the cancer diagnosis andultimately experienced higher levels of well-beingand marital satisfaction than those who did notseek support. Social workers might assistsurvivors in identifying their needs for supportand, as necessary, facilitate discussions betweensurvivors and significant others. Communicationtraining that specifically focuses on cancer-relatedissues may be helpful for individuals, couples,families, and survivor groups.

Prostate Cancer and Social Support

Issue One – 2007 • Mental Health 4

Support for partners and family members alsoneeds to be recognized. Mellon and Northouse(2001) found that families tend to view supportin terms of giving rather than receiving it—despite their own need for support. Other researchindicates that supportive interventions for spousesand others in natural networks are often neglectedby professional helpers (Isaksen, Thuen, &Hanestad, 2003; Ka`opua et al., 2005). This is acritical omission since support may be neededacross the cancer trajectory; ongoing assistanceaimed at preventing caregiver burnout is indicated.

Important Considerations• Assess protective buffering, which may hinder

functioning of support networks. • Promote communication and understanding

between survivors and those in their naturalsupport networks.

• Check in periodically with spouses, partners,and adult children. Their inclusion insupportive and psychoeducational counselingmay be helpful, if not necessary, to sustainnatural support networks across the cancertrajectory.

Helping survivors develop strong support systemsof family, friends, and others is an important partof the social worker’s role in working with cancersurvivors. Helping survivors identify and utilizethese networks can have long-lasting effects.

Diane B. Mitschke, PhD, MSW, is with the National Cancer Institute’sCancer Information Service Pacific and recently completed a doctoraldissertation on families coping with prostate cancer. She may becontacted at dmitschke@crch.hawaii.edu

Lana Sue Ka`opua, PhD, ACSW, LSW, is associate professor, School ofSocial Work and Cancer Research Center, University of Hawaii. She is a community-based researcher and committed to eliminating cancerdisparities of Native Hawaiians and other Pacific Islanders. She may be contacted at lskaopua@hawaii.edu

ReferencesAmerican Cancer Society (2006). Cancer facts and figures—2006.

New York: American Cancer Society.

Bloom, J. R. (1996). Social support of the cancer patient and the roleof the family. In L. Baider, C. L. Cooper, & A. K. De-Nour (Eds.),Cancer and the family. New York: John Wiley & Sons.

Hedestig, O., Sandman, P., & Widmark, A. (2003). Living withuntreated localized prostate cancer: A qualitative analysis ofpatient narratives. Cancer Nursing, 26(1), 55-60.

Isaksen, A. S., Thuen, F., & Hanestad, B. (2003). Patients with cancerand their close relatives: Experiences with treatment, care, andsupport. Cancer Nursing, 26(1), 68-74.

Ka‘opua, L. S. I., Gotay, C. C., Hannum, M., & Bunghanoy, G.(2005). Adaptation to long-term prostate cancer survival: Theperspective of elderly Asian/Pacific Islander wives. Health &Social Work, 30(2), 145-154.

Mellon, S., & Northouse, L. L. (2001). Family survivorship and qualityof life following a cancer diagnosis. Research in Nursing andHealth, 24(6), 446-459.

Mitschke, D. B. (2006). Families facing prostate cancer: Exploringcoping in cross cultural families. Unpublished doctoraldissertation, University of Hawaii, Manoa.

National Association of Social Workers. (1999). Code of ethics of the National Association of Social Workers. Washington, DC:NASW Press.

Ptacek, J. T., Pierce, G. R., & Ptacek, J. J. (2002). The social context of coping with prostate cancer. Journal of Psychosocial Oncology,20(1), 61-80.

THE CANCER SURVIVAL TOOLBOX®

The Cancer Survival Toolbox® is a free audio programdesigned to help cancer survivors and caregivers

develop practical skills to deal with thediagnosis, treatment and challenges ofcancer. The Toolbox is also available inSpanish and Chinese.

To get the Cancer Survival Toolbox®,visit www.HelpStartsHere.com

UNDERSTANDING CANCER: THE SOCIAL WORKER’S ROLE

Learn more about cancer and the care it involves by taking the NASW WebEd online course, UnderstandingCancer: The Social Worker’s Role. Earn free CEs and get basic knowledge of cancer, treatment, and outcomes.

To take the course visit www.NASWWebEd.org

5 Mental Health • Issue One – 2007

An increasing number of young Americanadolescent girls are resorting to starvingthemselves by restricting their food intake,depriving their bodies of essential nutrients, andcausing their heart beats to slow and menstrualperiods to stop (Urbszat, Herman, & Polivy,2002). Eating disorders are estimated to affect as many as 3 percent of young women in thecountry, according the 1999 report by the U.S.Surgeon General (Satcher, 1999). The specificeating disorder known as anorexia nervosacommonly associated self-starvation andemaciation is estimated to affect at least 1 percent of female adolescents (Urbszat et al.).

It is important that social work practitionersunderstand anorexia nervosa. The disorder hasone of the highest mortality rates of any mentalillness (Satcher, 1999), and without effectivetreatment has serious physiopsychologicalconsequences. While anorexia nervosa has beenpreviously associated primarily with young whitefemales, more recent research indicates that itaffects both genders and all cultures, and thedisorder is increasingly occurring in our society(Smolak & Streusel-Moore, 2001). Socialworkers should equip themselves with theknowledge and skills necessary to assist clientssuffering from this disorder.

The DisorderAnorexia nervosa, according to the Diagnosticand Statistical Manual of Mental Disorders (DSM IV) (American Psychiatric Association,1994), is a mental health disorder that ischaracterized by a refusal to maintain at least 85 percent of the normal height-to-weight bodysize; extreme fear of becoming fat; and distortedperception of body size and shape. Additionally,females are affected by loss of their menstrualcycles.

No generally recognized therapy for eatingdisorders exists, but there is evidence of some

promising interventions (Barlow & Durand,2005). Since eating disorders are often associatedwith low self-esteem and depression, some clientsmay benefit from treatment with antidepressantdrugs. Others find psychotherapy, includingfamily therapy, helpful. About half of the casesresolve themselves without relapses (Barlow &Durand).

The most successful treatment for anorexianervosa includes both individual and familytreatment (Logan, 2004). Other programs includemultifamily group treatment as well. Treatmentintervention initially seeks to stabilize thephysical symptoms. Once medically stable, the client can receive mental health treatment to resolve the underlying cause(s) of the disorder(Logan).

This article focuses on one of the author’sexperience as an undergraduate student inrecovery from anorexia nervosa. The informationprovided is gleaned primarily from the personalvantage point of her relationships, years of directobservations, and conversations with others withthe illness. This information is not a cookie-cuttertreatment plan or evidence-based strategy; it doesoffer a client’s personal insights into social workpractitioners working with clients diagnosed withanorexia nervosa.

The ClientLeeAnn Ripstra is a 26-year-old white femalestudent at the University of Houston-Downtownwho has been battling anorexia nervosa forapproximately eight years. Like many others witheating disorders, LeeAnn required professionalhelp of a licensed clinical social worker. She tookpart in an outpatient treatment program with amultidisciplinary approach. Individualpsychotherapy, nutrition counseling, and medical and psychiatric care—all provided bypractitioners specializing in eating disorders—hashelped LeeAnn maintain a healthy weight for the

ANOREXIA NERVOSA: A CASE HISTORY’S IMPLICATIONS FOR TREATMENTGwendolyn Strong Scott, ACSW, LCSW, BCD LeeAnn Ripstra

Issue One – 2007 • Mental Health 6

past five years and abstain from anorexicbehaviors for one year. Sharing her story withothers has proven to be an effective part of herrecovery plan. The following suggestions to socialworkers reflect her personal experiencerecovering from anorexia nervosa and herconversations with others with the illness:

• Don’t be discouraged—or fooled—by anargumentative client. The client may feeloverpowered by the eating disorder and may,in turn, have trouble asking for help when it is most wanted and needed.

• Recognize that an extremely agreeable clientneeds your help just as much as one who actsout. He or she may be directing anger andfrustration at himself or herself instead. It isimportant not to overlook the client’s innerturmoil.

• Don’t be discouraged by setbacks. Clientsoften will feel discouraged, and they need youto be positive in order to help them learn fromrelapses and find their voices again.

• Recognize common comorbidities of anorexianervosa, including depression, self-mutilation,and anxiety disorders, and address these intreatment.

• Steer conversation away from food and weightwhenever possible. This is crucial in order touncover and address underlying issues. Anincrease in food and weight talk indicatessomething is going on with your client thatneeds to be addressed. Remember, theseactions are often unconscious to the client, so do not blame them.

• Look beyond the anorexia nervosa to uncoverunderlying struggles and help clients expressthese in a productive way. Anorexic clients, forexample, often struggle silently with the notionthat they are losing control, but they havetrouble communicating this and other feelings.

• Recognize that the eating disorder may be aprimary symptom, but it is not the primaryproblem. Anorexic clients, who already feelunworthy of treatment, often fear that if theystop using anorexic behaviors they may lose

the help they are receiving. It is important tolet the client know that you realize they arenot “all better” just because their behaviorsdisappear. It is also crucial to communicatethis to the client’s outside network of friendsand family members.

• Understand that clients may need differenttypes of programs depending on theircircumstances. An intensive inpatient eatingdisorder program may be best for clients whowould benefit from treatment away from theirnormal environment or for clients who foundlittle success with long-term outpatienttreatment. An outpatient multidisciplinaryprogram might be helpful for a client whodoes not have the ability to pay for inpatientcare. Outpatient supportive therapy, combinedwith supportive assistance from familymembers seems to suggest there may be nodiscernable difference in recovery outcomes forinpatients and outpatients. Both inpatient andoutpatient programs are most helpful to clientsif they specialize in the treatment of eatingdisorders.

• Be aware that clients with anorexia are oftenintelligent and adept at rationalizing to defendtheir actions. Do not buy into theseexplanations. Eating disorders thrive on suchrationalizations, and the client needs you to bea force against them.

The idea that a young, seemingly-happy, teenagegirl would restrict her food intake, essentiallystarving her body of nutrients and causing herheart beat to slow, in order to appear thin doesn’tsound logical to most people. That is, however,what more and more young adolescents girls aredoing. According to Barlow and Durand (2005)young females are especially susceptible todeveloping anorexia nervosa during theadolescent years when their bodies are changingand the social pressures to be thin areoveremphasized. Consequently, social workersmust also be alert to the messages their clients are receiving and willing to disclose the miscuesyoung females are getting.

7 Mental Health • Issue One – 2007

This information is not intended to be a cookie-cutter treatment plan or strategy, but could be avaluable resource for social workers in developingeffective treatment and recovery plans withclients. Eating disorders are treatable, and clientsdo have the power within themselves to recover.Although the final decision to live a healthy life is up to the client, social workers can play animportant part in her or his road to recovery.

Gwendolyn S. Scott, ACSW, LCSW, BCD, is adjunct professor, SocialSciences Department, University of Houston-Downtown. She is aconsultant for Managed Care Companies for client EAP services. Ms.Scott can be reached at GWENSCOTTMSW@msn.com or scottg@uhd.edu

LeeAnn M. Ripstra is currently a senior at the University of Houston-Downtown. She is an active public speaker and is the public relationscoordinator for the Eating Disorders Association of Houston.

ReferencesAmerican Psychiatric Association. (1994). Diagnostic and

statistical manual of mental disorders (4th ed., text revision).Washington, DC: Author.

Barlow, D. H. & Durand, V. M. (2005). Abnormal Psychology: AnIntegrative Approach (4th ed.). New York: Thomson Brooks/Cole.

Logan, S. L. (2004). Eating disorders and other compulsive behaviors.In R.L. Edwards (Ed. In Chief) Encyclopedia of social work (19thed. Vol. 3, pp. 805—815). Washington, DC: NASW Press.

Satcher, D. (1999). Mental Health: A report of the Surgeon General.U.S. Department of Health and Human Services. RetrievedNovember 8, 2006, from www.surgeongeneral.gov

Smolak, L., & Streusel-Moore, R. H. (2001). Challenging the myth of the golden girl: Ethnicity and eating disorders. In R.H. Streigel-Moore & L. Smolak (Eds.), Eating disorders: Innovationdirections in research and practice. Washington, DC: APA.

Urbszat, D., Herman, C. P., & Polivy, J. (2002). Eat, drink, and bemerry, for tomorrow we diet: Effects of anticipated deprivation on food intake in restrained and unrestrained eaters. Journal of Abnormal Psychology, 111(2), 396-401.

RESOURCES

National Eating Disorders Associationhttp://www.nationaleatingdisorders.org

Academy for Eating Disordershttp://www.aedweb.org/

Anorexia Nervosa and Related Eating Disordershttp://www.anred.com/

Eating Disorders Coalition for Research, Policy, & Actionhttp://www.eatingdisorderscoalition.org/

National Women’s Health Information Centerhttp://www.4women.gov/

Issue One – 2007 • Mental Health 8

I am a licensed independent social worker, a 54-year-old male, and a prostate cancer survivor.The first two characteristics are ego syntonic, andthe last is ego dystonic.

I went for a routine prostate-specific antigen(PSA) test at age 48 at the request of a friend.What followed were seven months of medicaltreatment and, at age 49, a radial prostatectomy.A year before most men are tested for thiscondition, I had entered into a phase of life that included becoming a cancer survivor, havingsexuality greatly altered, and experiencing a greatdeal of pain and emotionality.

After having spent more than 15 years as amental health professional, I found myself livingin the aftermath of the most commonly diagnosed(American Cancer Society, 2006) form of cancerfor men, knowing many people in the mentalhealth field, and still not finding very manyresources on how to cope with the trauma I was experiencing.

I want to change that.

My writings emerge from my experiences and ideas as a mental health social worker. As you read, please remember that each manexperiencing prostate cancer is on a private andunique journey. For the emotional wellbeing of the prostate cancer patient, consider thefollowing areas related to the impact of thediagnosis and subsequent treatment, including:

• Decisions that need to be made regardingtreatment options.

• Secondary wounding that occurs during these times.

• Impact on the spouse, partners, and family.• Long-term effects of being a prostate cancer

survivor.

Impact of Diagnosis and SubsequentTreatment It is best to treat prostate cancer patients astrauma survivors. Although men deal withdiagnosis and treatment differently, the potentialfor trauma, “…an event or events that involvedactual or threatened death or serious injury, orthreat to the physical integrity of self or others”(DSM IV-TR, 2004) is always present.

The patient may be indecisive, tense, fearful,fretful, tearful, irritable, or angry. He also mayhave trouble concentrating, find it difficult to fall or remain asleep, become socially withdrawn,perseverate about issues, or experience othersymptoms of anxiety and depression.

Treatment options are increasing as researchunravels the mysteries of cancer. The number of options depends on the course and stage of the illness. I faced the options of not interveningand dying, a radial prostatectomy, radiation seedimplants, or radiation therapy. I felt frustratedthat if the onset of my prostate cancer had been a few years later, my treatment options mighthave been less intrusive.

Social workers can help clients at this stage oftreatment by:

• Enabling the patient to be assertive inobtaining information to make treatmentdecisions;

• Facilitating decision making so decisions are made based on objective criteria instead of emotions;

• Coordinating with physicians and othersproviding prostate cancer treatment to ensurethe emotional aspects are considered;

• Providing linkages to the spouse or partnerand other family members to facilitate supportand open communication, and to make suretheir mental health needs also are addressed;

PROSTATE CANCER: A PRACTITIONER’S PERSONAL EXPERIENCE Mark Smith, ACSW, LISW

9 Mental Health • Issue One – 2007

• Ensuring ongoing patient support is availablefor times of confusion and decision-makingmoments;

• Managing the patient’s secondary woundingexperiences, including things such as peoplecomparing prostate cancer to other cancers,jokes about sexual dysfunction, and negativedescriptors of men who have undergoneprostate cancer treatment; and

• Recognizing that support is needed throughthe phases of shock and disbelief, sorrow,anger, and fear.

Understanding Cancer SurvivorshipWhen treatment begins, there is potential forstrain on the psyche. There are no interventionsthat are fail-safe against sexual dysfunction andother side effects. Life during and after treatmentoften includes periodic re-examination andwaiting for results of tests to determine thepresence of cancer. This phase also brings with it some additional challenges, such as thefollowing ones noted.

Secondary Wounding In interactions with others, I was not preparedfor the jokes about sexual dysfunction and thestrategies available to counter them. For example,I listened to others unabashedly tell the latestViagra joke. The point of bringing up this issue is not to degrade others, but to illustrate thatsecondary wounding can be painful in manysurprising and unanticipated ways.

Every man is different in his regaining bodilyfunctions, gaining strength, and coping. Supportin these stages of recovery is very important.Sorting out the manageable and unmanageableconcerns with the prostate cancer survivor helps.

Long-term Coping Strategies Author Irving Yalom in 1931 suggested that all humans are trying to master four dilemmas:death, responsibility, isolation, and meaning(Winell, 1994). I explore these constructs withprostate cancer survivors. Therapy is directed

at sorting out distortions that might occur withthe meaning clients give to their experiences. I attempt to understand isolation issues imposedby self or others and clarify and resolve issuesthat relate to responsibility. For example, if I had eaten better, bicycled less, had differentgenes, etc., would I have gotten prostate cancer?

I assist prostate cancer survivors in self-evaluation. Does this affect a man’s view of hismortality? I often find one of these dilemmas ismore paramount for the person than othersaround him. Knowing that there is greatuneasiness about responsibility, for example, can help guide therapy.

A number of stress management techniques arehelpful during treatment. For example, the stressmanagement and relaxation techniques outlinedin The Relaxation and Stress ReductionWorkbook (Davis, Eshelman, & McKay, 1995),outlines a number of these methods, includingthought stopping, breathing exercises, andprogressive relaxation.

As a social work professional, I long have beenintrigued with the Jewish custom of payingattention to sadness before experiencing joy—the purpose of the breaking the wine gobletbeneath the groom’s heel before the weddingcelebration begins. I find that my clients and I benefit in developing rituals paying homage to sadness and then moving into joy.

Finally, I find long-term benefits to thedevelopment of a credo or statement of “I believe” to help synthesize the person’s feelings and actions. Credos consist of threestatements to which the person can answer “yes,” followed by a transition statement, andfinally the person examines strategies toimplement changes.

Prostate cancer took a toll on me by entering mybeing at a fairly young age. It is my hope thatsharing my personal experience and discussing

Issue One – 2007 • Mental Health 10

this serious illness will assist you in treating notonly men with prostate cancer but also otherclients living with serious illnesses.

Mark Smith, ACSW, LISW, is director of special projects at the SubstanceAbuse Treatment Unit of Central Iowa (SATUCI). He is a mental healthprofessional who is in his third term in the Iowa House ofRepresentatives and is the ranking member on the House HumanResources Committee. Mark is also a member of the NASW Board ofDirectors and a former member of the Specialty Practice Sections MentalHealth Committee.

ReferencesAmerican Cancer Society (2006). Cancer facts and figures—2006.

New York: American Cancer Society.

American Psychiatric Association. (2000). Diagnostic and statisticalmanual of mental disorders (4th ed., text revision). Washington, DC: Author.

Davis, M., Eshelman, E. R., & McKay, M. (1995). The relaxation and stress reduction workbook. Oakland, CA: New Harbinger Publishers.

Winell, M. (1994). Leaving the fold: A guide for formerfundamentalists and others leaving their religion. Oakland, CA:New Harbinger Publishers.

NASW GOVERNMENT RELATIONS UPDATE

The 109th Congress is coming to a close at theend of 2006. The National Association of SocialWorkers promoted a number of bills and workedto defeat others. Following is a quick recap of thestatus of bills of interest to social workers in the109th Congress.

Paul Wellstone Mental Health EquitableTreatment Act of 2005 H.R. 1402 would provide for equal coverage of mental health benefits with respect to healthinsurance coverage unless comparable limitationsare imposed on medical and surgical benefits.Currently there are 229 co-sponsors. The billsponsor is seeking to push this bill to a vote by filing a discharge petition. NASW supportsthis legislation for equal treatment of mentalhealth and physical health services.

Clinical Social Work Medicare Equity ActThis act would allow social workers to billMedicare for services that they cannot currentlybill for under Medicare Part B. This has been amajor priority for NASW over the past severalyears, and we will continue to push for this in the coming Congress.

Health Information TechnologyEfforts to establish a central database of health

care information did not include necessarysafeguards to protect the health care privacy ofconsumers. NASW worked with a coalition tostop passage of H.R. 4157.

Labor, Health and Human ServicesAppropriationsNASW pushed to increase funding for thePromoting Safe and Stable Families Programthrough the appropriations process. Theappropriations process provides funding fordiscretionary government programs such as some child welfare programs, the elementary and secondary school counseling program, and the social services block grant. To date, the Labor, Health, and Human Servicesappropriations bill has not passed the House or the Senate. All appropriations bills outside of defense and homeland security were delayedthrough a continuing resolution, which allowsprograms to be funded until November 17.

Tax CutsEfforts to permanently repeal the Federal EstateTax have been halted by advocacy organizationsthat see the repeal as a threat to funding of healthand human services programs. The Congressionalleadership may try to pass the Estate Tax repealduring the current lame duck session.

11 Mental Health • Issue One – 2007

The safety of social workers across the country is brought to the attention of the public when a social worker is killed in the line of duty. Thisis an issue of great importance to the NationalAssociation of Social Workers and its 56chapters. The October 18 murder of a childwelfare social work aide in Henderson, Kentucky,brings to light the diminishing resources of socialworkers and the increasing complexity of clientissues.

Social workers in all practice settings deal withthe threat of harm on a daily basis. Our jobs areoften with involuntary clients. As a result, ourinteractions may be fraught with tension, conflict,contention, and animosity that can escalate tophysical violence.

In certain professional social work settings, this likelihood of violence is acknowledged.Many child welfare agencies, hospitals, andmental health institutions are staffed withsecurity personnel. However, the work of socialworkers is not the sole province of agencies—or schools, as we well know. A critical amount of social work is in the field. Clearly, the risksescalate when there are home visits withcontentious clients. Police escorts are usuallyreserved for high conflict situations such as childremoval, but as was recently witnessed inKentucky, any situation, such as a routine home visit has the potential for escalation.

As a result, it is imperative that as HurricaneKatrina sent shock waves reverberating

throughout all social welfare agencies, schools,and hospitals in the nation that evacuation andsafety plans must also be put in place. It isimportant to urge schools to create safety plans to protect workers.

If your agency, school, or hospital does notalready have a safety plan in place, consideradvocating for the following ideas:

• Home visits conducted in teams;• Agency-supported self-defense training;• Risk assessments for violence: Currently,

we do risk of harm assessments for childrenand elderly adults but not social workers;

• Improved and more collaborative workingrelationships between local law enforcementand social welfare agencies; and

• Personal security items, such as pepper sprayor whistles, provided to social workers.

Utilizing violence as a means of handling conflicthas become common in recent decades. No sectorof America has escaped this dynamic. Violencewas once viewed as only occurring on the streetor in the home; It now has permeated theworkplace. As social workers practicing in aviolence-prone society, we must continue tostrongly advocate for improved safetyprecautions.

Yan Searcy, PhD, MSSW, is an associate professor in the Department ofSocial Work, Chicago State University. He is chair of the NASW SpecialtyPractice Sections’ Child Welfare Committee. He can be reached atysearcy@csu.edu

A CLOSER LOOK AT SOCIAL WORKER SAFETYYan Searcy, PhD, MSSW

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If you’ve changed your e-mail address lately, you may notbe getting the full benefits of your Specialty Practice Sectionmembership. Don’t miss out on SectionLink, eCONNECTION,or regular e-alerts. Update your information following thesesimple instructions to the right.

FAST BREAKING INFORMATION IS JUST A CLICK AWAY. DON’T MISS OUT.

1. Go to www.socialworkers.org/membercenter.2. Enter your NASW username and password.3. Go to “Modify/Change Your Profile.” 4. Click on “Your Personal Data,” then “edit.” 5. Update your information and then click “submit.”

Or call Customer Service at 800.742.4089

UPDATE YOUR E-MAIL ADDRESS.

Non Profit Org.U.S. Postage

PAIDWashington, DCPermit No. 8213

750 First Street, NE, Suite 700Washington, D.C. 20002-4241

COMING JANUARY 25, 2007

Depression

Enhance your understanding of how

talk therapy works for clients who are

depressed, why it can be the more effective

and first treatment choice for some clients,

and when it is most appropriate for clients.

www.socialworkers.org/sections202.408.8600 ext. 476

SPECIALTY PRACTICE SECTION TELECONFERENCES will be offered each year.For details on the teleconferences and to register, visit www.socialworkers.org/sections