I. General Description Modern mental health services have, and continue to experience ongoing changes throughout the United States. Rapidly fading away are the days of long-term hospitalizations and institutional based systems of care (Breakey, 1996). As Dr. George Paulson, MD reports, “things are changing in America and the hospitals were not exempt from intense scrutiny by society at large” (Paulson, 2012). Depending on the region and availability of resources, mental health services are now intended to serve as a safety net not only for the individual, but for the community as a whole (Rosenberg & Rosenberg, 2006).
According to Catawba Valley Behavioral Healthcare Chief Clinical Officer Donald Mott, “Community mental health services are now currently meant to be available with the focus on easy access, low cost and resilient to sustain the ebbs and flows of the community” (Donald Mott, Personal Communication, November 5, 2012). According to Breakey, “Modern community mental health, success, measured by cost-effectiveness rather than by its faithfulness to any particular theoretical model, is achieved through interdisciplinary teamwork and the involvement of consumers” (Breakey, 1996).
II.Populations Served and Special Settings Modern community mental health services strive to provide services to populations in efficient yet cost-effective ways (Breakey, 1996). Helping services may be performed in a HSBE variety of manners, depending on the region and available resources. These may include: inpatient stabilization treatment, case management, housing placement, Assertive Community Treatment Teams, mobile emergency services, homeless prevention services, and Psychosocial Rehabilitation (Breakley, 1996).
Community mental health services may address target populations, whether they are the residents of specific geographic areas, or special populations such as the indigent population, HIV/AIDS victims, Severe and Persistent Mentally Ill (SPMI), or victims of various forms of trauma (Breakey, 1996). So who provides most of the country’s mental health services? According to government sources, 60% of mental health professionals are clinically trained social workers, compared to 10% of psychiatrists, 23% of psychologists and 5% of psychiatric nurses (Mental Health, 2012).
Modern mental health social workers treat and assess clients facing mental illness or struggling with substance abuse either within an inpatient crisis stabilization setting, outpatient clinic, or within the community. The social worker may conduct group therapy, individual therapy, crisis intervention, social rehabilitation, outreach and life skills lessons (Mental Health, 2012). When being discharged from inpatient facilities, mental health social workers must prepare their clients for a successful and easy return to the community (2012).
Beyond community mental health settings, social work behavioral healthcare is provided in a variety of settings, including: disaster relief programs, employee assistance programs, military and veteran services, private practice, hospitals and skilled nursing facilities, schools, and, rehabilitation programs (2012).
III. Special education and training requirements HSBE With an appropriate state-mandated license, mental health and substance abuse social workers receive the designation of licensed clinical social worker (Gibelman, 1995). A licensed clinical social worker who is a member of the National Association of Social Workers is legally bound to a detailed Code of Ethics (Code of Ethics, 2012).
Most states require 3,000 hours or 2 years of supervised work under a licensed clinician beyond the completion of Masters in Social Work to receive licensure and be able to practice (Gibelman, 1995). The LCSW licensure allows for reimbursement from a variety of payee sources including Medicaid, Medicare, and private insurance. An advanced position within mental health social work also requires a masters in social work (Mental Health, 2012).
This enables someone to continue to advance into supervisory and administrative positions. With experience and an advanced degree, licensed clinical social workers can move into the role of supervisor, assistant director, executive director or program manager (2012). Social workers continue to provide an array of varying mental health services. In employee assistance program a social worker may help employees with personal problems and workplace concerns (Mental Health 2012).
They also provide substance abuse treatment and help people experiencing depression, anxiety, or trauma (2012). Using individual, group or family counseling, clinical social workers are skillful in helping people to gain an understanding of their problems and in alleviating major stresses that impact daily life. (Gibelman, 1996). Whether it’s for a child, adolescent, adult, or geriatric individuals, clinical social workers can be counted on to provide a high level of mental health care (2012).
Deb Engelmann is a Licensed Clinical Social Worker who has been involved with inpatient, outpatient, and private practice since 1995. She was gracious enough to take a few HSBE moments out of her extensive caseload to provide her professional insight. Included are some of her impressions of modern mental health services during her time providing direct services.
1. What has been the most noticeable change you have seen in mental health treatment during your professional experience as a social worker? I have been in mental health since 1995. I have worked in inpatient and outpatient facilities. When I started in mental health there seem to be more resources for people who had low or no income such as housing and jobs but unemployment in this area (Catawba Valley Region) at that time was 1%. Also, people seemed to stay in the hospital a lot longer to heal further and to allow us to be able to get a better picture on how they were doing.
In the outpatient setting from 1999 – until present, I believe there have been many changes in payment reimbursement. Before, clients were able to be seen more frequently and again there seem to have more resources to aid in healing such as partial hospitalizations and group support. It also seems like now more people are in need of help and there are fewer resources (D. Engelmann, personal communication, November 2, 2012). 2. What are the differences you are aware of in the provision of mental health services in New York versus North Carolina?
I would say that by far the differences are cohesiveness and availability of resources. The system in New York was more centralized at that time and did not rely on Local Management Entities of various sizes to oversee services in an area. Resources were much more abundant during that time due to the governing HSBE control as well as the state of the economy (D. Engelmann, personal communication, November 2, 2012). 3. How do you feel a licensed clinical social worker stands out in direct mental health practice versus other professions? I believe that a LCSW stand out in direct mental health practice in many ways.
One way is that our training is helpful by providing access to the many different setting a LCSW can work in. Our studies cover abnormal mental health and can cover addiction, school, and social welfare. Another way is requiring group classes, learning how to organize, run and maintain a helping group for mental health is important. Also, I believe social work studies are specific enough to be able to know where a person can best fit. The last area that a LCSW can stand out is in the way it is recognized with insurance carriers, not all counseling degrees are able to bill the difference insurances.
Therefore, LCSW can reach more people (D. Engelmann, personal communication, November 2, 2012). 4. What is the favorite part of your professional experience? My favorite part of my professional experience is that I can help people. I can work with a person who is at a terrible place in their life and over time you see them get better. I have seen people’s lives change. To be a part of that is very special. It is amazing to me that something I can say or do can affect a person to where their life is changed for the better. I still love this profession after all these
HSBE years. I believe in it. (D. Engelmann, personal communication, November 2, 2012). V. Reason for Personal Interest My varied personal and professional life experiences have provided a template to continue crafting me into a diverse resource for others. I am learning and experiencing through my own personal and professional growth that you never know when one life experience may be reapplied in a different way. I am grateful today that I may apply some of the skills I have gained through the years to aid in improving the wellbeing of another human being.
I worked in the telecommunications field for several years. The technical troubleshooting, having to be very detail oriented and utilizing analytical problem-solving skills have been strengths when exploring creative avenues to help improve another’s quality of life. This experience has also been an asset in analytical data collection and outcomes interpretation. Part of this time of my life also included a large amount of customer service experience and provided me many opportunities to work individually with a wide variety of individuals and families to assist in determining the best solution for their individual needs in a sensitive and compassionate manner.
Furthermore, my bilingual skills in Spanish have enabled me to reach out even further within the community to provide support to those greatest in need. In my current role as peer support team leader, I have been conducting groups at local hospital psychiatric units concerning the recovery process to inspire and offer hope. I have learned and experienced the impact you can make and the engagement you can receive when you share relevant aspects of one’s story and let someone know that “I’ve been there too and it does get better as long as I do the work to take care of myself. ”
During these times at the various HSBE hospitals, I have been linking consumers to services locally and throughout the state as they prepare for the transition out of the hospital and into outpatient care. I also contact new consumers prior to their intake appointment in the mental health center to assure they are in a good place, provide coaching on being an active participant in their treatment and making sure they have the information they need prior to their initial appointment. This contact has made a difference in people’s outlook as well as motivation to make their appointment.
I have been directly involved assisting with the establishment and staffing of a drop-in center for consumers to use during challenging times or if they need additional support between appointments. People have also utilized the drop-in center when they need support accessing and linking to community resources or wish to educate themselves or their loved ones about their own symptoms and diagnosis. I also have an active caseload and work with people individually for additional support between their clinical appointments or assist them in linking them to additional resources.
Some of these connections have included access to job skills training, community educational opportunities, referrals to vocational rehabilitation, food and utility assistance, low cost medical care, area recovery groups, affordable housing opportunities and assistance with filing and completion of disability paperwork. The availability of drop-in center and working certified peer support specialists makes this daunting and confusing process easier for many desperately in need.
I have been very grateful of my role in peer support and taking this first step in my mental health career. This position has given me the opportunity to be a supporter that offers dignity and respect and providing hope that one’s quality of life truly can get better. My own personal recovery has blessed me with the opportunity to provide an empathic and understanding ear to those in need. I have been actively working on turning negative attitudes, experiences, and HSBE consequences into an avenue for personal and professional growth.
These types of interactions have been invaluable in my own life experience as making progress and supporting others has aided me in my own life journey. I am unexpectedly and continually utilizing my positive and challenging life experiences to truly make an impact. This is why I have become dedicated to continuing my educational and career paths in the mental health specialization of social work. References (2012). In Code of ethics. Retrieved November 5, 2012, from http://www. socialworkers. org/pubs/code/default. asp (2012). In Mental health. Retrieved November 5, 2012, from http://www. socialworkers.
org/pressroom/features/issue/mental. asp Breakey, W. R. (Ed. ). (1996). Integrated mental health services: modern community psychiatry (pp. 3-10). New York, NY: Oxford University Press. Gibelman, M. (1995). What social workers do (4th ed. ). Washington, DC: NASW Press. Paulson, G. W. (2012). Closing the asylums: causes and consequences of the deinstitutionalization movement (pp. 121-139). Jefferson, NC: McFarland and Company. Rosenberg, J. , & Rosenberg, S. (2006). Community mental health challenges in the 21st century (pp. 3-181). New York, NY: Routledge Taylor & Francis Group.