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Macro Theories of Social Work and Mental Health

Holly Thompson

University of North Carolina at Pembroke-Department of Social Work

SWK 4450-800-S22

Dr. Jody Thomas

April 27, 2022

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Abstract

For many individuals who suffer from mental illness, it is crucial to recognize the importance of

their environment and the factors that contribute to their mental anguish. This includes the

systems that inhibit their problem or the people and environments that help resolve it. Macro

social work theories is paramount in establishing goals for change and finding solutions for ways

to diminish a social problem that negatively affects society on a personal and public level. The

systems theory and empowerment theory are both important aspects in the social work setting.

They provide the guidelines and structure needed to make positive changes in a person’s life

while also recognizing the individual’s strengths and weaknesses. In examining these two

theories, it is important to understand the emphasis each theory has on a macro level in the social

work setting particularly when dealing with oppressed and vulnerable populations.

Keywords: theory, environment, empowerment, systems, mental health, change

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Introduction

When navigating through obstacles of life, it is important to understand the internal and

external conflicts that contribute to one’s current dilemma. The importance of understanding

how, where and why things happen is critical in overcoming challenges that can cause a setback

or even help with forward progression. Macro social work theories are crucial elements in

understanding complex human and social environments that have a positive or negative impact

on one’s life. In examining the systems theory as well as the empowerment theory, it is

substantial to have a sense of control and purpose in deciding what is the best fit for one’s own

individual self while recognizing the factors that influence change. It is one’s strength and

determination that is paramount in the helping process and also being aware of how various

complex systems come together to create a whole.

Systems Theory

The systems theory is defined in social work practice as the environmental factors that

affect a client’s condition and the interrelated relationships between the individual, groups, and

communities in their social atmosphere (Kirst-Ashman & Hull, 2019). For a client to balance

their internal and external factors, one must recognize the groups for which they belong and

establish positive interactions among the systems in order to address change. This theory was

first introduced by German Ludwig von Bertalanffy who was later recognized as the father and

first founder of system approach. The systems theory is made up of a system, boundaries,

subsystem, homeostasis, role, relationship, and integration. It also includes pattern maintenance,

goal attainment, adaptation, group activities, interactions as well as sentiments and norms.
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The systems theory is various parts of smaller systems that come together to make the

overall complex system whole. It involves open and closed systems, equifinality, and context and

environment. For a social worker to use a holistic approach in understanding problems of clients,

they must first acknowledge the systems in the client’s life (external) and how they contribute to

their internal conflict. The external factors include economic status, friends and family, as well

as social settings and their home environment.

If an individual is dealing with mental health issues that include depression or anxiety, it

is possible if not for certain their external factors have contributed to their current mental

affliction. During the childhood and adolescent years, the development of social interaction, self-

control, as well as learning capabilities are vital at this stage of life and exposure to bullying or

other negative environments can lead to long-term mental health (Katrakazas, Grigoriadou, &

Koutsouris, 2020). Each individual situation is unique, and the analyzation and observation of

their systems must be addressed before goals and therapeutic treatment can be rendered. In

understanding and treating mental illness, it is important to study and research the systems for

which psychopathology comes from through explanation and prediction (Fried & Robinaugh,

2020).

Strengths and Limitations of Systems Theory

The systems theory is an important theory used in micro, mezzo, and macro levels of

social work. When one system comes together to work with other systems, there becomes a

solution to the problem. This means there is an interdependency amongst the systems through the

exchange of resources and through the exchange of energy as well. This strength of the systems

theory is a formidable opponent in solving problems and finding solutions to a client’s present

distress. While this theory emphasizes the importance of homeostasis and balancing of the
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systems, there is also limitations in stabilization of the system which inhibits the changing

environment. The systems theory is also lacking universality and practical applications is limited

to this theory due to no specific tools or techniques for administering (Santosh, 2021).

Empowerment Theory

Everyone has the right to have control over their lives and have access to resources that

help them live a sustainable life. Empowerment theory focuses on reducing powerlessness

among individuals who have low self-esteem and have a sense of worthlessness. Empowerment

is the process of giving control and power to a person or group by helping them become a

resilient, stronger, and determined individual to help change the negative aspects of their lives

into positive ones (Moran, Gibbs, & Mernin, 2017). When examining the empowerment theory,

it not only focuses on the client but their families’, groups’, and communities’ power which

interconnects the individual with their environment (Kirst-Ashman & Hull, 2019). The theory of

empowerment can also occur by empowering communities or groups to help members develop

skills and share in responsibilities that help in the decision-making process in order to progress

and better one’s community (Moran et al, 2017). This theory consists of empowerment, social

justice, consciousness raising, and mutual aid. It is also composed of power, socialization, and

group cohesion.

Having the support and resources needed to change oppressive situations into positive

ones that support cognitive, social, and behavioral development is dominant in enhancing one’s

well-being while also becoming more consciously aware of his/her abilities to strive for a better

life. In overcoming mental illness, it is crucial for the client to have control over their therapeutic

environment and be able to make decisions in deciding what is best fit for them. Self-
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determination and finding one’s strengths are substantial in overcoming mental health disparities

and learning to cope and treat the problem is an element of progress as well.

Strengths and Limitations of Empowerment Theory

The strengths of empowerment theory include coinciding with the person in environment

perspective which aligns with ethics and values in the social work setting. This allows the client

to engage with their environment and enhance the relationships that help the individual become a

better human being. It also can develop advocacy opportunities in social work that help address

and change the economic, social, and political inequalities that are experienced by oppressed and

vulnerable populations. Empowerment can also have limitations that include power imbalances

and individuals’ lack of understanding how to obtain goals and achieve them which will lead to

setbacks and challenges in the empowerment phase of the helping process.

Mental Health in Social Work

The field of mental health has become a vastly growing social problem over the last

several years, particularly in children and adolescents. Having control of the mind and

understanding the constraints that inhibit psychological development is all an integral part of

systems and empowerment theories. Not only is mental health an issue on a personal level but it

is also detrimental on a public health level as well. Advocating for funding and resources on a

macro level to combat this social problem is essential in the social work profession.

The connection of biological and psychological dimensions and how the two co-exist

with environmental factors is significant in how systems come together to create a whole

emergent relationship (Tramonti, Giorgi, & Fanali, 2019). In the social work setting, it is

important to understand the various systems and theories in order to help clients establish
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homeostasis within their systems or the groups which they belong. It is also paramount to help

clients understand and know their full potential and strengths so that they can move forward and

eliminate the mental challenges that impede their progression to live a happy, sustainable life.

Impact of Problem

Mental health is becoming an increasing popular occurrence among children and

adolescents. Over the last several years, there has been rise in mental illness that has led to an

increased dependence on drugs/alcohol and prescription misuse. These factors can also lead to

suicidal ideation as well. Most patients or clients dealing with suicidal ideation also had

thoughts of homicidal ideation which represents interpersonal conflict (Maniaci, Burton,

Lachner, Vadeboncoeur, Dawson, Roy, Dumitrascu, Lewis, & Rummans, 2019). Alkhouri

(2021) states: “In a recent survey conducted by the Centers for Disease Control and Prevention,

63% of 18–24-year-olds reported symptoms of anxiety or depression, with 25% reporting

increased substance use to deal with that stress and 25% saying they’d seriously considered

suicide” (p. 1).

Most of the population affected include racial/ethnic, gender, and sexual minorities who

are often struggling to fit into society. Minority adolescents who live in poverty do not seek care

for mental disorders due to lack of availability and cost (Alkhouri, 2021). These mental health

disparities can lead to problems such as inaccessible therapeutic options and lack of awareness

while also dealing with cultural stigma as well. Prejudice, discrimination and stereotypes

associated with mental illness can be seen as a deterrence in improving ones’ life who is

suffering from mental health disorders (Ran, Hall, Su, Prawira, Breth-Peterson, Li, & Zhang,

2021).
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There are numerous problems that impact adolescents and children who are dealing with

mental health issues. Some of these mental afflictions include anxiety, depression, bi-polar,

schizophrenia, substance/alcohol abuse, and eating disorders. The most common mental

disorders among children are ADHD and depression among adolescents (Centers for Disease

Control and Prevention, 2020). While these issues may affect an individual on a personal level,

they also impact society as well. The side effects that come with mental illness include isolation,

living in fear, emotional distress, and a disruption of a social life. It also leads to unemployment,

increased homelessness, and more dependence on government support.

Environmental factors that lead to mental illness include trauma, familial abuse, parents

who have a dependency on alcohol/drugs, and most importantly, poverty. Social determinants

such as where children live and learn, and their conditions of each environment can have a

negative impact on mental health (CDC, 2020). Socio-economic inequalities play a detrimental

role in mental illness among youth. Adolescents and children that are socioeconomically

challenged are twice as likely to develop mental issues compared to those who are from

financially secured environments (Reiss, 2013).

For children and adolescents who may be dealing with food insecurities and the worries

of where they may be sleeping at night, mental challenges may arise which will lead to cognitive,

social, and behavioral issues. Early childhood interventions on an individual level with children

is crucial to reduce mental problems (Reiss, 2013). When a child or adolescent is having

cognitive difficulties due to mental disorders, there can be developmental issues that affect their

psychosis state and lead to socio-emotional challenges and behavioral issues as well.
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Policy and Implication on Local, State and Federal Level

Local Level

With so many children and adolescents living in poverty in Robeson County, North

Carolina, many individuals from this population do not have the insurance needed to seek

therapeutic services. There is 1 in 13 children in Robeson County uninsured (NC Child, 2021).

This can be a devastating social determinant of health in terms of seeking treatment for mental

distress. This rural area does not have the resources needed to provide free coverage for children

and adolescents who are seeking mental health treatment. Most of the providers of mental health

and cognitive behavioral services require payment out of pocket or through some type of

insurance coverage. These factors will continue to transpire to challenges if changes in providing

healthcare do not occur.

While some may be covered through insurance providers, there still is a risk that the

mental health providers, such as psychiatrists, may not accept the insurance. Psychiatrists’

acceptance rates of various types of insurance such as Medicaid and Medicare were increasingly

lower than other providers which imposes a barrier for therapeutic services of mental health

treatment (Bishop, Press, Keyhani, & Pincus, 2014). This policy can be eliminated if everyone

had universal healthcare and more access to mental health services in poverty stricken rural areas

as well.

State Level

When addressing concerns of mental health on a state level, one particular policy stands,

out, the Baker Act. This policy which was established in Florida in 1971 allows individuals to be

hospitalized or evaluated against their own will for up to seventy-two hours if he/she appears to
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be a threat to themselves or others. This includes homicidal ideation, which is thinking or

planning to commit homicide (Maniaci et al, 2019). North Carolina has a similarly adopted

policy for involuntary commitments. Involuntary commitments can occur if a client or patient is

unable to think and act in which best suits their needs, then he/she can be committed without

agreement. The criteria for this in association with children and adolescents is that if a youth is

unable to have self-control and judgement due to mental anguish, he/she can be involuntarily

committed (North Carolina Department of Health and Human Services, 2020).

While this policy can have positive effects on an adolescent’s treatment, there can be

negative consequences to consider also. This can lead to familial problems among the home

environment and disdain and resentment towards mental health professionals. Another fact to

consider is trust issues for the client. Due to being involuntarily committed, the client may

discontinue future treatment services which will lead to ongoing mental illness in adulthood. It

also may lead to isolation and fear of society when they are discharged from the facility as well.

Another policy enacted under North Carolina laws regarding mental health is the

Psychiatric Advance Directives. This is a North Carolina General Statutes, Chapter 122C-71-79

which gives those suffering from mental disorders their preferences for treatment (NCDHHS,

2020). This allows the client to have a sense of empowerment and gives them the chance to be

part of the helping process. Boevink, Kroon, Delespaul, and Os (2017) states “At the individual

level, empowerment is about processes in which the person rediscovers his identity and self-

esteem and ‘takes his life in his own hands’” (p. 2).

In order to alleviate the rising number of adolescent mental health cases, schools

should focus on early intervention and treatment options in the school setting. This can include

contracting mental health providers to come into the school setting and offer free therapeutic
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treatment in an undisclosed location of the school. This will help those living in poverty and

unable to afford care. This policy can be funded through state funds for education and will help

lower the high number of statistics of those who abandon treatment due to inability to pay.

Federal Level

When an individual who suffers from mental illness commits a crime, he/she may be

incarcerated. While this setback may place a halt on their private mental treatment services, they

are entitled to receive treatment in prison. The Bureau of Prisons enacted a policy that provides

mental treatment for inmates through staff psychologists and psychiatrists. Due to the nature of

being incarcerated having placed a more stressful environment upon the mentally challenged

individual, he/she is able to receive counseling as well as education on suicide prevention. There

is three-fourths of juveniles incarcerated who are dealing with mental illness which leads to an

increased risk of suicidal thoughts and behavior (Nichols, Parker, & Kruse, 2020).

Not only does this policy impact inmates, but their families also along with staff receive

educational training to handle and understand inmates who are suffering from mental despair.

This helps to have a better understanding of an inmate’s current distress while also providing the

best treatment of services they need. The prison personnel are trained for crisis intervention and

how to assist in handling episodes of mental transgressions. They also are able to detect suicidal

inmates or those who may be attempting to harm themselves or others as well.

While this policy may have positive outcomes for inmates who suffer from mental

illness, it may also lead to negative consequences also. Often at times, treatment is not rendered,

and the system fails many, especially adolescents. In a study conducted, 59% of adolescents in

juvenile detention centers or prison do not receive the care and treatments needed to combat their
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mental health (Nichols et al, 2020). Individuals, particularly those of adolescent years, may be

incarcerated for minor offenses. There is an estimated 70% of adolescents incarcerated with

untreated mental disorders in juvenile facilities (Nichols et al, 2020). If someone is in prison due

to being caught with illegal substances, they should have been sent to rehabilitation facilities

rather than prison.

Decriminalization of some offenses such as these is important to helping individuals

move forward and live progressive lives. An eighteen-year-old suffering from a mental disorder

should not be incarcerated for a first-time drug offense. This can lead to more setbacks in their

treatment which will cause further affliction in their mental state of mind. Rehabilitation would

be a better solution and is paramount in overcoming their drug dependence and learning how to

cope with their mental illness. It is also a crucial aspect in their empowerment process which will

help them feel as sense of worthiness in the helping process as well.

Interventions

Systems Theory

For children and adolescents suffering from mental disorders, it is imperative to

implement intervention strategies that will help alleviate their current negative state of mind.

Systems theory interventions are used in therapy because behavior is influenced by

environmental factors that include family, community, and social and economic class. One of the

interventions effective among children and their families is play therapy. Bray (2018) states:

“Play therapy generally begins with a period of observation and assessment by the counselor,

followed by work to process and focus on challenges the practitioner has identified based on

cues the client exhibits during play” (p.8). This type of intervention is used in systems theory to
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help children overcome challenges that has contributed to their mental distress such as

depression, anxiety, sexual/physical abuse, death of a loved one, and other forms of trauma that

have impeded their cognitive function. Play therapy is a form of therapy used by observing

children while they play to recognize emotions or patterns of behavior that may lead to signs of

trauma or behavioral issues (Pietrangelo, 2019).

The goal of this intervention is to help children or early adolescents learn coping

strategies and ways to deal with their current mental incapacitated state. The therapist can

monitor their actions and gain an understanding of what might trigger their emotions or

behavioral changes. This type of intervention works because children grow and develop within

systems and subsystems. The benefits of play therapy include responsibility for

actions/behaviors, developing problem solving skills and self-respect, stronger family

relationships, and alleviating anxiety and depression (Pietrangelo, 2019).

The systems theory would be useful for this intervention in the case of a child who was

physically abused by a family member and is displaying signs of depression or episodes of rage.

This would lead the therapist to ask questions such as what factors led to this change? Are there

are financial constraints in the home that led to physical abuse or whether there is usage of

substance or alcohol. The psychological well-being is constructed from several variables that

include genetics, family relationships, psychological constraints and sociocultural derivatives

(Tramonti et al, 2019). The familial and social environment would be explored in order to

understand the client’s sudden change of behavior.

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Empowerment Theory

Empowerment interventions focus on the client’s awareness, strengths, developmental

skills, and self-image. Kirst-Ashman and Hall (2019) states, “Empowerment is the enhancing of

individuals’, groups’, families’, and communities’ power, ability, and control to determine their

own destinies (p.82). Interventions guided by empowerment to improve one’s health and well-

being enables individuals to have control and guide the changes of their lives (Zimmerman &

Eisman, 2017). Individual and organizational empowerment is important for change to occur on

a social, economic, and political level for individuals and society to enact social justice. An

intervention associated with empowerment is giving the client a range of options to choose from

in therapeutic sessions. For an adolescent dealing with a mental illness such as anxiety or

depression, he/she may be conflicted as to what type of treatment would be beneficial in

overcoming their mental distress. Providing them with information and resources and inclusion

in the decision-making process enables them to feel a sense of worth.

Social Privileges and Oppressions

Systems Theory

For individuals who live in affluent neighborhoods, they have access to services in their

communities that many oppressed and vulnerable populations are denied. Social privilege allows

members of these communities to have better opportunities and will continue to be the dominant

class in society. A community is a system that is bounded by subsystems that come together to

make a functioning whole (Kirst-Ashman & Hull, 2019). Someone living in a rural area plagued

by poverty often do not have basic necessities to survive. Human behavior is influenced by the

environment in which they live and if members of a community are denied access to services
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such as employment opportunities and community resources, these individuals may feel helpless

and be viewed as less than by society on a social, economic, and political level as well.

Empowerment Theory

In macro social work, it is important to allocate resources that keep members of a

community in a state of homeostasis in order to function and thrive. Empowerment theory helps

members of a community gain social, economic, and political power in order to improve their

lives (VCU, 2021). The use of consciousness raising helps members of oppressed communities

gain an awareness of their social environment and their individual self as well (Kirst-Ashman &

Hull, 2019). Social workers help members become more active in community participation by

giving them the power and skills to help petition for resources on a local, state, and federal level.

For communities in rural areas, this will help them prosper and live healthier lives. Someone

who lives in a community that does not have employment opportunities, access to community

resources such as hospitals and schools, their developmental skills will suffer, particularly

children and adolescents.

Conclusion

It is crucial to help those who are vulnerable and oppressed to learn how to empower

themselves in order to live a substantial life. Individuals and groups are bound together through

systems which include the familial, social, economic, and political structures of their lives. For

adolescents who are suffering from mental disorders, it is important to recognize the

environmental factors that impede their progressions in order to overcome their previous state of

distress. Empowerment gives individuals and groups the skills and information they need to gain
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control of their destiny while also giving them the power to change the negative attributes in

order to move forward successfully in life.

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References

Alkhouri, D. (2021, February 21). Pandemic’s mental health burden heaviest among young

adults. ABC News.

https://www.google.com/amp/s/abcnews.go.com/amp/Health/pandemics-mental-health-

burden-heaviest-young-adults/story%3fid=75811308

Bishop, T.F., Press, M.J., Keyhani, S., & Pincus, H. A. (2014). Acceptance of insurance by

psychiatrists and the implications for access to mental health. Journal of American

Medical Association, 71(2), p. 176-181. https://doi:10.1001/jamapsychiatry.2013.2862

Boevink, W., Kroon, H., Delespaul, P., Os. J. V. (2017). Empowerment according to persons

with severe mental illness: Development of the Netherlands empowerment list and its

psychometric properties. Open Journal of Psychiatry, 7, 18-30.

https://dx.doi.org/10.4236/ojpsych.2017.71002

Bray, B. (2018). The therapy behind therapy. Counseling Today.

https://ct.counseling.org/2018/08/the-therapy-behind-play-therapy/

CDC. (2020). Centers for disease control and prevention. https://www.cdc.gov

Fried, E.I. & Robinaugh, D.J. (2020). Systems all the way down: embracing complexity in

mental health research. BMC Med, 18(205). https://doi.org/10.1186/s12916-020-01668-w

Katrakazas. P., Grigoriadou, A., & Koutsouris, D. (2020). Applying a general systems theory

framework in mental health treatment pathways: the case of the Hellenic Center of

Mental Health and Research. International Journal of Mental Health Systems, 14(67).

https://doi:10.1186/s13033-020-00398-z
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References

Kirst-Ashman, K.K. & Hull, G. H. Jr. (2019). Human behavior in the macro social environment:

An empowerment approach to understanding communities, organizations and groups. (5th

ed.). Cengage Learning, Inc.

Moran, T. E., Gibbs, D. C., & Mernin, L. (2017). The empowerment model: turning barriers into

possibilities. Sagamore Publishing, 31(2).

https://js.sagamorepub.com/palaestra/article/view/8429

NC Child. (2021). The voice of North Carolina’s children. https://ncchild.org

NCDHHS. (2020). The North Carolina department of health and human services.

https://www.ncdhhs.gov/divisions/mental-health-developmental-disabilites-and-

substance-abuse/involuntary-commitments

Nichols, L., Parker, H., & Kruse, M. (2020). Nearly three-quarters of youth behind bars suffer

from mental health issues. Cronkite News.

https://cronkitenews.azpbs.org/2020/09/04/mental-health-kids-incarcerated/

Pietrangelo, A. (2019). How play therapy treats and benefits children and some adults.

Healthline. https://www.healthline.com/healthy/play-therapy

Ran, M., Hall, B.J., Su, T.T., Prawira, B., Breth-Peterson, M., Li, X., & Zang, T. (2021). Stigma

of mental illness and cultural factors in Pacific-Rim region: a systematic review. BMC

Psychiatry, 21(8). https://doi.org/10.1186/s12888-020-02991-5

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References

Reiss, F. (2013). Socioeconomic inequalities and mental health problems in children and

adolescents: a systematic review. Social Science and Medicine, 90(2), p.24-31.

https://doi.org/10.1016/j.socscimed.2013.04.026

Santosh, K. (2021). Systems theory management | systems theory approach | system theory:

definitions, contributions, and limitations. GyankoVander.Com.

https://www.gyankovander.com/2021/07/systems-theory-management-and-system-

theory-approach.html

Tramonti, F., Giorgi, F., & Fanali, A. (2019). General system theory as a framework for

biopsychosocial research and practice in mental health. Systems Research and Behavioral

Science, 36(3), p. 332-341. https://onlinelibrary.wiley.com/doi/abs/10.1002/sres.2593

Zimmerman, M.A. & Eisman, A.B. (2017). Empowering Interventions: Strategies for addressing

health inequities across levels of analysis. American Psychological Association, p.173-

191. https://doi.org/10.1037/14954-011