Mental Health Social Work
Explore the field of mental health social work
The tragedy of mental illness is its perceived lack of a cure. Schizophrenia, bipolar mood shifts (see Bipolar Disorder), erratic behaviors, panic disorders (see Panic Disorder), depression (see Depression) – the diagnosis of mental illness seems dire and traps people into believing recovery is hopeless.
However, statistics show that's not the case. More than 44 million or nearly 23% of U.S. citizens have a diagnosable mental health occurrence during a given year, according to the U.S. Surgeon General. And of that 23%, only about 3% have severe and persistent mental illness for whom treatment will not result in a return to near normalcy.
Mental health care, as a result, has become one of the fastest growing sectors of the medical industry, requiring many more health care providers to treat patients and facilitate their adaptation to the many challenges in their lives. Among the most important providers are mental health social workers who specialize in solving the particular problems patients encounter, such as transportation to therapy, medication, general vocational counseling, and finding appropriate living arrangements for their clients.
What is mental health social work
The brain, the mind and mental illness
Conversations about the relationship between the brain and the mind reach back to Hippocrates, the “Father of Medicine.” About 450 B.C., Hippocrates hypothesized that the mind and the brain were one. Subsequent philosophers and scientists had differing opinions. Some thought the mind was located elsewhere in the body, such as the heart, or that it was part of the soul, while others felt the brain wasn't adequate in describing the full scope of the mind.
Read more about the connection between the brain, the mind and mental illness...
Mental health social work is much more than just treating individuals suffering with mental illnesses or substance abuse problems. It is a system where patients find the support they need to help them interact with their surroundings in new ways. Mental health social workers have special training that enables them to understand what patients are thinking and feeling, enabling them to respond in a manner that helps their patients find relief from fear and resistance.
These social workers are typically part of multidisciplinary mental health teams working in hospitals, local government agencies, and community health centers. Each team includes psychiatrists or clinical psychologists who provide diagnoses and different kinds of individual or group therapies; specialists who might provide help with issues such as speech therapy; counselors who might provide crisis intervention; and mental health social workers who work with patient outreach, social rehabilitation, and patient monitoring.
Mental health social worker tasks
Mental health social workers have many important tasks:
- Help the team develop patients' treatment plans, locate pivotal resources, and solve logistical issues, such as how to get a patient to therapy.
- Maintain good communications with patients and their families in order to collect pertinent health information so they can accurately assess patients' progress. Ongoing monitoring of patients' health enables the team to correct or update treatment plans.
- Gain patients' trust in order to influence patients' decisions. For example, if the treatment plan includes an important medication that the patient seems unable to consistently take as prescribed, the mental health social worker might counsel the patient in an appropriate manner. The patient might be in denial about his need for the medication, or he might periodically deny he has a mental illness at all.
- Helping patients function as normally as possible. Mental health social workers have to ensure that clients' needs are being met and that they are given every advantage to function at their highest level. To do this, they get to know their patients, listening to their perspectives, observing their interactions, and acting as the eyes and ears of patients' health care teams.
- Act as clients' advocates and plan administrators. Mental health social workers monitor resources, help patients with applications for benefits as well as other necessary legal papers. As they counsel and provide emotional support, mental health social workers are often best at understanding and providing for their clients' needs.
- Meet with community agencies and contribute to the development of new programs designed to meet specific needs, such as those for addiction disorder, bipolar disorder (see Bipolar Disorder), or schizophrenia. Joint endeavors between social workers and community health networks extend treatment options for more patients – especially in less populated areas - and typically result in better outcomes because of the added services.
Recovery programs
The U.S. Department of Health and Human Services defines recovery as an “individual’s journey of healing and transformation to live a meaningful life in a community of his or her choice while striving to achieve maximum human potential.” Yet, people who suffer from mental illness often feel that those around them stigmatize them- even though recovery from a mental illness is possible.
Several different recovery models have been developed over the last 30 years, variations of which have been applied in the U.S. and throughout Western Europe. A familiar recovery model is the 12-step program, but there are many others that are administered by patients' mental health teams, and monitored by social workers.
The best known 12-step program is the Alcoholics Anonymous program that has been adapted to help people with addictions to a variety of substances such as cocaine or methamphetamines, as well as behaviors such as gambling. As a part of recognizing one's illness, these programs typically embrace an aspect of surrender to a higher power in finding peace and reducing anxieties.
Other 12-step programs, such as Recovery International, address issues of personal willpower and constructive perspectives on life. As different as these two approaches seem, they often combine to produce a greater effect – acknowledging the problem, realizing one's failures at dealing with the problem, relying on divine help, nurturing greater will power, and feeling more empowerment with each successful day.
Recovery approaches typically reflect the perspectives of survivors. They promote the strength and empowerment that support the potential of individuals to take control of their own lives. This differs from a clinical perspective that is based on the improvement of symptoms.
Recovery programs base their convictions on the belief that patients should not be isolated, but as engaged as possible in appropriate social interactions. And more importantly, patients, to the extent possible, should take control of and be responsible for their own health decisions.
Fundamentals of Recovery
The concept of recovery requires that mental health social workers nurture patients. To this end, the following elements have been determined to be important to a patient’s improvement and recovery:
Hope. Hope is essential to everyone's well-being, but for patients, it is the fragile foundation on their journeys to recovery. It involves trusting one's caregivers, and often depends on social workers' abilities to sustain their patients in times of setbacks.
Security. Security is also essential to growth. Patients must feel that they are safe, with adequate housing, food, and reliable social interactions. Because all patients’ needs are different, mental health social workers must carefully consider their placements in transitional facilities.
Self. The sense of self is important to a patient's growing confidence. Their social involvement needs to be monitored and possibly limited to avoid overwhelming situations. Developing a stronger sense of self often depends on the quality of social interaction, requiring vigilance on the part of the social worker to make sure the patient is progressing well.
Relationships. Relationships that provide reliable support for patients are an indispensable part of recovery. Family and friends are the foundation for a patient's expanding social skills, and often need coaching by a mental health social worker in order to provide the growth in self-confidence the patient needs.
Empowerment. Relationships and growing social skills lead patients to a greater sense of empowerment. Regaining their self-assurance through positive social inclusion helps patients feel more in control of their lives, leading to increasing involvement in their own recovery, and self-assured interactions with their social workers.
Coping mechanisms. The ability to analyze different situations and determine a coping strategy is a significant step toward self-determination. Controlling one's responses and behaviors is substantial, but being able to cope with emotional challenges in an appropriate way is a real sign of recovery.
Meaning. Finding meaning in life often depends on finding a purpose. This could mean integrating back into the workforce and finding comfort in a daily routine. Or it could mean finding a philosophical or spiritual path that sustains patients as they move back into their lives. In either case, patients respond to the stability each effort provides.
The mental health social worker's role in these recovery models is essential, and new therapeutic ideas often begin with a social worker's observations. A patient might show an interest in art and an art therapist might be added to the therapeutic team. Or a somatic dance therapist might be able to help an anxious patient release tension. In this respect, mental health social workers depend on their patient relationships to anticipate the next best way to help their patients along the road to recovery.
Additionally, recovery is not a linear or incremental process, and ultimately is the judgment of medical authorities. For this reason, the resources mental health social workers bring to an individual's recovery plan are essential for tracking patients' progress.
Mental health social work provides the structure that supports patients' journeys to recovery. It is a delicate process, requiring compassion, an understanding of mental health science, an acute sensitivity to patients' needs and progress, and strong management skills.
Panic Disorder
The plane had experienced too many delays. First there was the fuel leak. Passengers were already in their seats when the crew ordered the plane evacuated. People panicked, some men climbed over seats and pushed others out of the way. After they re-boarded, there was a hydraulic leak – and more time spent sitting in a hot plane at the gate with the plane door closed.
The passenger sat waiting in her seat. Suddenly she felt hot. She began to sweat. Her heart was pounding in her chest. She felt like she couldn't breathe. She felt light headed, then nauseous. The child in the seat next to her kept bumping into her. The walls were closing in. Finally, she unlatched her seat belt, walked to the front of the plane and, as she began to cry, told the hostess she needed to de-plane.
A panic attack is an anxiety disorder (see Panic Disorder) that can strike without warning. It is a condition that is often chronic and recurring. People who suffer from these attacks report periods of uncontrollable and intense fear. They are also typically prone to depression and bouts of agoraphobia (see Agoraphobia), a condition that causes them to be unable to leave their homes because of their fear of public places. (for more info, see What is Anxiety?)
People who suffer from panic and other anxiety disorders are severely debilitated. Until recently, it was unclear if their condition was a mental illness or if it was only a physiological disorder. It turns out it is both.
Panic starts with brain anomalies
Although the subject of ongoing research, early investigation indicates that panic disorder is the result of an abnormality involving a neurotransmitter called serotonin. It appears that a lack of serotonin affects the neurocircuitry of panic. Brain scans done at the National Institutes of Mental Health revealed that the brains of people who have panic disorder have over one-third fewer serotonin receptors in brain structures saddling the center of the brain. (see Brain Structure).
As a neurotransmitter, serotonin is one of the chemical messengers the brain uses to initiate certain activities throughout the body. One part of a neuron or brain cell releases a neurotransmitter, and specialized receptors in another neuron receive it. Serotonin is a well-known neurotransmitter that is associated with feeling happy and well adjusted.
But fewer neuronal receptors means that not enough of the neurotransmitter becomes activated, and researchers speculate that the lower number inhibits the amount of serotonin needed to resolve panic in a patient.
Because panic disorder and depression are often observed in families, and the number of serotonin receptors is thought to be genetically controlled, scientists believe that genetics contribute significantly to the disorder. Scientific evidence suggests that specific gene sequences actually code for fewer receptors. This means that the genetic material of some families triggers an inadequate number of serotonin receptors, exposing family members to the possibility of developing anxiety.
Fight or flight
The intense anxiety of panic disorder also causes an involuntary shift in brain activity from the frontal lobe to the mid-brain that is the center of the “fight or flight” mechanism. The Lundbeck Institute, a forum for professional interaction in neurology and psychology, lists symptoms for panic disorder as:
- shortness of breath or choking
- dizziness, unsteady feelings, or faintness
- palpitations or accelerated heart rate
- trembling or shaking
- excessive perspiration
- nausea or abdominal distress
- numbness or tingling sensations
- flushes or chills
- chest pain (angina)
- depersonalization and derealization
- fear of going crazy or doing something uncontrolled
- fear of heart attack or dying
Treatment
Repeated intense fear has potentially severe side effects on the body, so resolution of the serotonin levels is important not only for mental health, but also for the long-term health of the body. Fortunately, there are medications available that, over time, start to resolve the issues.
Treatment by a psychiatrist is paramount because as many as 70% of patients typically have other psychological conditions that also need to be addressed. It's generally advised that a full psychological assessment be part of the diagnostic process.
Current thinking among many neuroscientists is that many mental illnesses are the result of physiological or biochemical abnormalities in the brain. Researchers studying panic disorder are, once again, adding evidence to that hypothesis.