What is Medical Social Work?

Medical Social Work (MSW) is a sub-discipline of social work, also known as Hospital
Social Work and Healthcare Social Work. Medical social workers typically work in a
hospital, outpatient clinic, community health agency, skilled nursing facility, long-term care
facility or hospice. Social workers in this field have a graduate (post-graduate) degree or a
bachelor's degree with a graduate/post-graduate diploma in healthcare specialization and
work with patients and their families who face specific psycho-social barriers. Medical social
workers assess patients' and families' psycho-social functioning, environmental and support
needs and intervene. Interventions may include connecting patients and families to essential
resources and support in the community, providing psychotherapy, supportive counselling,
grief counselling, or helping patients expand and strengthen their network of social supports.
Medical social workers typically work on an interdisciplinary team with professionals of
other disciplines (such as medicine, nursing, physical, occupational, speech and recreational
therapy, etc.)
The prevalence of illness and premature death due to lack of awareness, access to good
medical care or failure to take advantages of care mental or psycho-social disorder have long
made medical care a topic of prime concern to the field of medical social work. We have
come to realize that success of medical care or treatment is based as much on the adequacy of
the delivery system as it is on the knowledge and skill of the medical personnel and social
worker. Medical care is an important field of practice for social workers who play significant
roles in facilitating the delivery in social services at the individual groups and community.

definition of Medical Social Work

Medical or Hospital Social Work is defined as "Social work practice in a responsible
relationship to medicine and public health within the structure of health care programs.
Initially, this field of social work practice was concerned almost exclusively with the social
needs of problems of ill persons under care in hospitals and civics.
Robert L. Barker defined Medical Social Work as “The social work practice that occurs in the
hospitals and other health care settings to good health, prevent illness, and aid physically ill
patients and their families to resolve the social and psychological problems related to illness.
He also stated that medical social work also sensitizes other health care providers about the
social-psychological aspect of illness (Barker, 1995)
The medical social worker seeks to remove those obstacles, either in the patient's
surroundings or in their mental attitude, that interfere with successful treatment, thus freeing
the patient to aid in his recovery as a whole person" - Ida Cannon, 1923
n her book Medical Social work, Miss E.M.R Clarkson defined Medical social work as a
specialized branch of social work practice in hospitals, clinics, community health centres, and
sometimes general practice. Its method consists of understanding the sick person as a human
being, temporarily or permanently incapacitated by illness, someone whose living habit may
be disrupted, who may be away from home for long periods on end, who may be unemployed
and consequently penniless, or who may react badly to illness or disfigurement, and working
with doctors, nurses and others in trying to help them (Clarkson,1974)
Development of Medical Social Work in UK, USA, India 

Historical Background of Hospital /Medical Social Work: Global Perspective

Nowadays, medical social work is considered a specialised branch of Social Work and an
integral part of the medical team. The present status of medical social work has not been
achieved overnight. It has taken a long period to reach its current level. During the nineteenth
century, significant scientific progress was made in medicine. The germ theory of disease and
the organic approach to the diagnosis and treatment of disease contributed in no small
measure to the beginning of a scientific ear in medicine. With the significant advance in the
development of a scientific body of knowledge and the discovery of several mechanical aids
for diagnosing and treating illness, specialisation and institutional medical care became
inevitable. 

n the early twentieth century, social work established itself as a vocation committed to major
social reform, social change, and poverty eradication. Over time, it shifted from religious and
charitable practice to a more systematic, professional one. Social service moved from a
privately funded volunteer activity to a publicly funded, paid occupation.

Britain and Ireland are the first nations that acknowledged the need for Medical Social
Workers to extend clinical care in administrative and support aspects. Medical social workers
in Britain and Ireland were previously known as Almoners or Hospital Almoners. They were
competent personnel of education and refinement who could consider and screen the position
and circumstances of patients. In Ireland, the origins of medical social workers go back to
Dr. Ella Webb, who, in 1918, established a dispensary for sick children in the Adelaide
Hospital in Dublin, and to Winifred Alcock, who trained as an Almoner and worked with Dr.
Webb in her dispensary.
In 1945, the Institute of Almoners in Britain was formed, which, in 1964, was renamed
the Institute of Medical Social Workers. The Institute was one of the founder organisations of
the British Association of Social Workers, formed in 1970. In Britain, medical social workers
were transferred from the National Health Service (NHS) into local authority Social Services
Departments in 1974 and generally became known as hospital social workers.

In the United States, Richard Clarke Cabot in Massachusetts General Hospital created the

position of Hospital Social Worker or Medical Social Worker in the early 1900s. This was
important from an epidemiological point of view, as it made it easier to control and prevent
outbreaks of syphilis and tuberculosis. The prestige of social work rose up in the USA with
war-related activities such as the Red Cross home services.

The earliest forms of social work activities were started in India. In ancient India, the nature
of social service was that of charity. Mutual help and reciprocal relationship were very high
in the community. People believed that "to serve man is to serve God" (Manav Seva
Madhava Seva). People were encouraged to practice the virtue of Dana. Dana was treated as
a way of purifying the soul of alms-givers, and it was a great relief to both the giver and the
receiver. The Rig Veda (Chapter 1 XIII, 2) encourages charity by saying, "May the one who
gives shine the most". Upanishad prescribed that every householder must practice charity.
Bhagavat Gita insisted that the privileged class has a moral duty to serve the poor. Christian
missionaries introduced modern social work in India at the beginning of the 19th century,
which was later strengthened by Rajaram Mohan Roy, Ishwar Chandra Vidyasagar, Sasipade
Banerjee Sayyid Ahmed Khan, Gopal Krishna Gokhale, Jyotirao Phule and Dhondo Keshav
Karve. In 1905 by the efforts of John Morely, provisions were made for special care for the
mentally ill through psychiatric social workers. The formal training in social work was started
in India in 1936 by Clifford Manshardt (Missionary) and J.M. Kumarappa (Academician) at
Dhorabji Tata School of Social Work (Now TISS) in Mumbai. The significant associations of
social work are NAPSWI (National Association of Professional Social Workers in India) and
ISPSW (Indian Society of Professional Social Work). India is a signatory to the Alma Ata
Declaration and has adopted WHO's principles. In 1945 Bhore Committee Report strongly
recommended the appointment of medical social workers in hospitals. The earliest records
show that the first medical social worker was appointed in 1946 in Bombay in JJ Hospital. In
the 20th century, the Government of India had legislated that every hospital should have a
medical social work department able to cater to various needs of the patients and later
extended this requirement of a trained social worker in psychology and related fields within
schools.
Hospital Social Work in the United Kingdom
In the beginning, hospital social workers were known as Almoners in Britain and Ireland. The
credit of introducing hospital social work in Ireland goes to Dr. Webb and Winifred Alcock.
Dr Ella Webb established a dispensary for sick children in the Adelaide Hospital in Dublin.
Winifred Alcock was trained as an Almoner and worked with Dr. Ella Webb in her
dispensary.
In 1885, the necessity of hospital social work practice was felt for the first time in England.
Then it was recognised that discharged patients of the mental hospital need aftercare in their
homes to escape recurrence of the illness. Physicians realised that recently released patients
are coming back to the hospital as they face problems in their living environment. It was felt
that these patients needed help to solve their socio-economic crisis that hindered the typical
recovery of their illness (Dastur, 1974; Ismail, 2005).

In Britain, professional hospital social work began its journey in 1945 by establishing the
Institute of Almoners. It was renamed the Institute of Medical Social Workers in 1964. The
Institute of Medical Social Workers played a vital role to form the British Association of
Social Workers in 1970 as of the founder organisations. In Britain, Medical Social Workers
were transferred from the National Health Services (NHS) into the local authority Social
Service Department in 1974. From then, they became known as Hospital Social Workers
Development of Hospital Social Work in the United States
In the United States, social work practice was based in the community till the early 1900s. In
the mid-1800s, social workers dealt with public health problems such as tuberculosis, infant
mortality, syphilis, polio and unmarried pregnancy through joint ventures with different
agencies (Nacman, 1977, Ross, 1995). Some women physicians, such as Elizabeth Blackwell
and Rebecca Cole, played an essential role in the development of social services. Elizabeth
Black Well formed a dispensary that developed into the New York Infirmary for women and
children. Rebecca Cole, an African American physician, became a sanitary visitor in 1866
(Ross, 1995). In 1893 Jane Addams established a medical dispensary at Hull-House
Settlement. But social workers were not permitted in hospitals before 1900 except in a few
isolated cases such an event took place City Hospital transformed into the hospital from
Almshouse in 1891. Fred Goldenbogen of the Cleaveland City Welfare Department was
assigned to set up records at City Hospital so that patients could be identified by name and
relatives could be notified in a can of death (Wagner, 1957, Ross 1995). In 1900, William
Kerry, director of the City Outdoor Relief Department, assisted the hospital in clearing wards
"clogged by chronic patients and by homeless civil war veterans," He also demonstrated the
value of social services in the hospital freeing beds(Ross,1995).
Medicine and social work joined lands in 1905 with the establishment of Medical Social
Work at the Massachusetts General Hospital in Boston under the enthusiastic, able
encouragement of Dr Richard Clarke Cabot. He and others recognised the need to understand
more about social factors related to illness and its treatment and utilise social and community
resources (Skidmore and Thakery, 1964). Almost at the same time, hospital social work was
introduced to three other hospitals; Bellevue Hospital in New York, John Hopkins Hospital in
Baltimore and Berkeley Infirmary in Boston (Friedlander, 1982; Ismail, 2005). 

In 1905, at the Massachusetts General Hospital, Miss Garnet Pelton and 13 volunteer
assistants were permitted to set up tables and chairs in a corridor known as "the corner
"(Canon, 1957, Ross, 1995). This hospital expanded its social services to include forty-five
social workers. The first organised department of Hospital training. She worked Dr. Cabot's
infirmary from 1906 and on inpatient wards beginning in 1919 (Canon, 1957; Ross 1995).
The American Association of Medical Social Workers (AAMSW) was established in 1918 to
support and strengthen the Embryonic Development of Hospital Social Work. This
association focused on developing a knowledge base, undertook a series of practice studies,
and set a standard for scholarship (Ross, 1995). 

In the mid-1920s, the American Hospital Association (AHA) produced the first formalised
articulation of Medical Social Work. By the time, the Social Work department was
established in 300 Hospitals. By 1930 the number of Hospital Social Service Department
increased up to 1000. By 1946 a total of 2095 Social Workers belonged to the American
Association of Medical Social Workers (AAMSW) (Skidmore and Thekary, 1964). 
The conception about the role of Medical Social workers, defined by Richard Cabot, was
expanded. Two additional roles were defined: (i) To serve as a liaison between physicians
and patients and between physician and community resources required for extra care and (ii)
To enlist cooperation with the medical treatment plant through patient's education (Caputi,
1978; Ross, 1995). 

Demand for Medical Social workers increased with the passage of the Federal Emergency
Relief Act of 1933, the Federal Security Act of 1935 and the establishment of the Federal
Crippled Children's Services, which included social work services (Nacman, 1977; Ross,
1995). 
In 1955, the American Association of Medical Social Work and other social work
organisations established the National Association of Social Workers (NASW). The Medical
Social Work section of NASW has remained active in the practice and education of Medical
Social Work. It has sponsored regional Institutes to raise the level of training in medical
settings (Skidmore and Thekary, 1964).

In 1961, the Joint Committee of the American Hospital Association and the National
Association of Social Workers formalised additional functions: assisting the health care team
in understanding the significance of social, economic, and emotional factors; helping the
patient and family to understand these factors to enable them to make constructive use of
medical care and promoting their well-being and morale, and assisting the hospital in giving
better patient care (advocacy) (AHA, 1961; Caputi, 1978). In the 1960s, theorists such as
Perlman, Parad, and Kaplan suggested that the individual with an illness could be understood
to be facing a series of adaptive tasks with a capacity for renewal, change, and growth
(Mailik, 1979). 
The role of social work in hospitals during the 1950s and early 1960s was expanded and
affirmed; consequently, there was a shortage of professionally trained practitioners (Heyman,
1962; NASW, 1959). The need for social work in hospitals was emphasised by chapter xviii
and xix of the Social Security Act. Based on the active health insurance for people over 65
years of age (Medicare); for medically indigent people younger than 21 years, permanently
and totally disabled and medically disadvantaged people between 21 and 60 years of age and
for the medically needy people older than 65 years ( Marcus, 1987; Nacman, 1977; Ross,
1995). In 1960 hospital social workers became involved in social action and emphasised
eliminating the external causes of psychological and social dysfunction (Lurie, 1984; Ross,
1995). The American Hospital Association (AHA) was renamed the Society of Social Work
Administrators in health care in 1993 (Ross, 1995).
Hospital Social Work in India
The introduction of Hospital Social Work in India was influenced by the work of lady
almoners of Britain and medical social workers in America. The physicians of India who
visited Britain and America for study got the opportunity to observe the activities of almoners
and medical social workers. After returning to India, some physicians were very interested in
starting similar activities in their hospitals or clinics. The opening of social and preventive
medicine departments in medical colleges, a psychiatric clinic in some of the general
hospitals and training programs in medical social work in some of the schools of social work
in Bombay and Delhi placed students for practical training in hospitals and clinics give
further impetus to the development of medical social work in India. The first medical social
worker in India was appointed in 1946 in the J. J. Hospital in Bombay. Gradually, the
medical social worker began to be established in other hospitals and clinics of India. At
present, medical social workers are working in almost all the States of India (Pathak, 1961). 
In short, hospital social work practice emerged in U. K and USA. Some significant steps can
be identified in the development of Hospital Social Work. The first step was recognition of
aftercare of patients of mental hospitals and appointment of visitors to avoid recurrence of ill
near. The second step of developing medical social work was the appointment of lady
almoners in English Hospitals. The step was the practice of visiting patients' homes by
visiting nurses. The fifth one was the training of medical students in social agencies. The
sixth step was establishing a medical social work department in Massachusetts Hospital in
Boston in 1905. The seventh step was the establishment of the American Association of
Medical Social Workers (AAMSW) in 1918. The last and most crucial step was the
establishment of the National Association of Social Workers (NASW) in 1955. Since its
inception, its medical social work unit has been working to date on the development of
Hospital Social Work globally.

Hospital Organization and Management

Board
All hospitals include some form of governing body responsible for making high-level
decisions about the organization. The board of directors is the highest in the hospital chain of
command and is made up of experts in their respective fields. Religiously affiliated hospitals
often include clergy on their boards of directors. Teaching hospitals often include university
faculty from the medical school with which they’re affiliated.

Executives
In the hospital leadership structure, executives are responsible for managing the organization,
making financial decisions, and overseeing business strategy. Medical and health services
managers may oversee entire practices or clinical areas. A hospital typically has a chief
financial officer who tends to the financial aspects of the business and a chief operating
officer or chief executive officer responsible for high-level business strategy and decision-
making.

Department Administrators
Department administrators report to the hospital executives and manage the day-to-day
operations of the hospital department structure. The chief of surgery, for example, is
responsible for overseeing daily activities within the surgical department as well as
performing surgery. A chief of surgery might engage in public relations activities, fundraising
and recruitment. Other segments within a hospital, such as transcription or switchboard
personnel, also have department administrators.

Patient Care Managers

Nurse managers and supervising physicians are both patient care managers. These individuals
manage small groups of professionals who provide direct patient care. They ensure that
orders are carried out, that hospital employees are fulfilling their duties appropriately, and
that employees are complying with legal requirements.

Service Providers
The vast majority of hospital workers are service providers: doctors, nurses, orderlies,
physical therapists, laundry workers, and the many other people required in order for a
hospital to function. They provide patient care, maintain records and ensure that the hospital
is able to deliver care to patients in an effective manner. Service providers have their own
hierarchical structure in healthcare. For example, doctors often give orders to nurses, who
might delegate to orderlies

Psychiatric Social Work,

Psychiatric Social Work a specialised branch of Social work, which concerns with theoretical
as well as clinical work and the knowledge of Psychiatry-which primarily deals with
problems of the mind and associated disorders. The essential purpose of Psychiatric Social
Work is to help the people with problems of the mind and/or with behavior problems or we
can say precisely the problems of mind and brain and their solutions.

It has grown as the result of the need felt and its realization for people with mental or
emotionally disturb could be helped more effectively by understanding their social and/or
environmental factors responsible for the problems of mind and brain in their management.
Professionally trained Psychiatric Social Worker is the qualified member of psychiatric team
treating comprehensively the patients with psychiatric disorders or behavioral problems.
These professionals utilize social work principle, techniques for the purpose of diagnosis,
patient care and treatment and finally plan the rehabilitation of the patients in the family and
in the community. Besides they also provide other services to mentally challenged people like
therapeutic treatment, social rehabilitation, crisis intervention or outreach services in the
community. A psychiatric Social Worker (PSW) works in close association with psychiatrist,
child guidance clinics, social services department as the team in the psychiatric hospital; and
they also extend their work in families and communities for mentally challenged people. The
role and responsibilities of the psychiatric social worker is fast increasing never before and he
is no longer confine to the hospital or psychiatric clinic, but they are accepting the new
challenges as the mental health hygienist in various public activities and helping the
preventive mental schemes of the government for the people.

Dieticiean

Mental health professional includes various professional includes all practitioner who offers
their services for improving an individual's mental health or to treat mental illness include
psychiatrists, Clinical/Psychiatric social workers, clinical psychologists, , psychiatric nurses,
mental health counsellors, professional counsellors, pharmacists, as well as many other
professionals like medical anthropologists. These professionals often treat comprehensively
the psychiatric illnesses, disorders, conditions and other issues, however, their scope of
practice varies cases to case.