This text is part of the special Social Work section
Administrative heaviness, bureaucratic absurdities, omerta… While the Ministry of Health and Social Services is preparing to become Santé Québec, those involved in social work in the public network are taking a very sad inventory of the situation. They denounce an inefficient hypercentralized and “medico-centric” system that harms their profession as much as the population.
After 35 years of career as a social worker, then manager and administrator in the south of Estrie, Martin Robert left the public network in 2017. He then felt that “the services offered by the network no longer corresponded to the needs of populations”.
A decision that occurred following major reforms (Couillard in 2003 and Barrette in 2015) which transformed the health and social services network into an increasingly rigid and centralized structure.
“When I arrived in the public network in 1984, my role was to help people who had social problems of all kinds in a given territory. And I was given the latitude to do it, he remembers. We have moved from a general social support system to a system that seeks to treat very specific problems as if they were pathologies. »
A “medico-centric” model
Although he no longer works in the public network, Mr. Robert is not the only one to denounce this approach to social work which seems modeled on medical care.
“As in the hospital, the system wants to get people back on their feet as quickly as possible by responding to a very specific need,” explains Maude Fréchette, social worker and union representative at the Alliance of Professional and Technical Personnel of health and social services (APTS).
Thus, users who use social services must be included in a “care trajectory” corresponding to a specific problem. Depending on this trajectory, they will be entitled to a predetermined number of meetings and limited services.
“But not all people come to see us for a specific ailment,” emphasizes M.me Frechette. Or in any case, this sore is linked to a bunch of problems that must also be addressed if we want to be able to really resolve the situation. »
Rather than helping people overcome the social difficulties they face, social workers today are increasingly focused on tasks related to the medical field.
“Social work is seen as an accessory to medicine,” laments Pierre-Paul Malenfant, social worker and president of the Order of Social Workers and Marriage and Family Therapists of Quebec. “For example, social workers have a specific mandate to free up beds in hospitals and it is not uncommon for budgets allocated to social services to ultimately be used in health. »
Conflict of ethics and omerta
Subject to quantified performance requirements and established programs, social workers are in permanent ethical conflict and are often forced to deviate from their code of ethics.
“We are constantly torn between what the system prescribes and what our profession requires. As a result, we are always at odds and this generates a lot of discomfort and anxiety. We end up being as distressed as our users because we are not adequately meeting their needs,” explains M.me Fréchette, who also mentions the time spent filling out paperwork for the slightest request for additional services.
In addition, the code of ethics requires social workers to defend the rights of users. But when it comes to denouncing situations that take place within the public network itself, it is silence that reigns, notes the union representative. Those who speak out face reprisals.
“We have put social workers in a straitjacket which reduces their professional autonomy and which deprives them of the possibility of denouncing unacceptable situations,” summarizes the president of the Order.
Make social work a priority
According to him, it is therefore urgent to put social work back at the heart of priorities, in particular by placing social work specialists in decision-making positions, by allocating blocked budgets to social services and by placing more trust in the professional expertise of workers. social.
An opinion shared by Mme Fréchette and Mr. Robert. Even if this is not the path that the government seems to be taking, the latter laments, since Bill 15, recently adopted under gag order, “completely erases social work from its name”: Santé Québec.
“Quebec has decided to put health and social services in the same ministry. It’s a model that worked in the 1980s and 1990s, but is it still viable? » finally asks Mr. Malenfant.
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