Every day, the stigma that shrouds the topic of mental illness fades a little more. We still have a lot more to talk about, but the very presence of an ongoing conversation at all is a mark of steady progress. The National Alliance on Mental Illness reports that one in five adults and one in six children in the U.S. experience mental illness each year.

Even though the world is catching up, it will take much more effort on the part of psychiatric social workers and other professionals to close the “mental health gap.” This term refers to the millions of patients who fail to receive treatment, or whose treatment is delayed. Right now, the average gap between mental disorder symptom onset and treatment (also courtesy of NAMI) is eleven years. It is the psychiatric social workers mission to decrease discrepancies such as these in patients across the mental health spectrum.

A Brief Overview of the Field

Given their education and training background, psychiatric social workers focus on more than direct therapy. While master’s-level social workers can provide therapy and counseling services to help the client work through their mental illness, the sociological perspective calls for a slightly broader approach.

Psychiatric social work entails counseling, re-integration training, financial resource accommodation, healthcare service accommodation, housing services and more. Further details on each of these roles will be provided below. The point is to not only address the mental health problem directly, but to facilitate the client’s healthy function in society. Since mental illness can significantly affect work status, relationships, learning ability, conflict resolution skills, physical well-being and more, this requires a thorough, yet comprehensive approach.

Depending on level of education and experience, psychiatric social workers may provide therapy and counseling services on a one-on-one basis, or they may have a supervisory role within an organization or department. One day, a social worker may be assisting a client in gathering legal documents for a hearing, and the next, they may be coordinating a group psychotherapy session. Since no two clients are the same, no two approaches will be the same.

Who Psychiatric Social Workers Serve

It would be reductive to lump everyone into the “mental illness” category, because different psychiatric conditions can require drastically different social work approaches. Below are listed some of the most common mental health disorders that psychiatric social workers encounter on a regular basis.

Anxiety – Often attributed to the increased demands of a post-industrial society, the staggering prevalence of anxiety disorders (19+ million adults in the U.S.) hints at systemic causes. These disorders can cause clients to develop aversions to important social environments, like work or school.

Depression – Most are aware of the strong correlation between depression and suicide, but depression is linked to serious health conditions as well. People suffering from depression are much more likely to develop heart problems and hormone disorders than those without the mental illness. Psychiatric social workers must be holistic in their assessments to catch these issues.

ADHD – Still affected by controversy, ADHD often goes misdiagnosed, and some parents object to medication. Still, more than six percent of children in the U.S. are being medicated for ADHD. Especially when untreated, ADHD symptoms can significantly affect educational outcomes.

Bipolar disorder – Characterized by manic “highs” and depressed “lows,” bipolar disorder affects everyone differently. Even if a client is on mood stabilizers, they may still display bipolar behavior. Psychiatric social workers help bipolar patients to identify when they’re having an episode, develop an action plan and prevent self-harm or other adverse events that may result.

Substance abuse – Often viewed as just a symptom of one or more of the above disorders, substance abuse is a mental health disorder in its own right. It has measurable effects on the brain, some of which manifest over long periods of time. Addiction counseling is often the first step to addressing an untreated mental health disorder.

What Psychiatric Social Workers Do and Where They Do It

As mentioned, psychiatric social workers seek to alleviate the strain that mental illness exerts on important social institutions, such as workplace or school behavior, physical health, relationships and so on. Since mental illness is often fluid, difficult to identify and unique to each person, the first step is absolutely critical: assessment.

An effective psychosocial assessment  requires social workers to consider a range of factors that comprise a patient’s psychological state. The purpose of these assessments is to clearly delineate the patient’s deficits, while adding context to the case with their relevant history. This allows for a much more targeted approach to care. Assessments may include points like:

  • Behavioral history
  • Physical examination
  • History of mental health treatments and diagnoses
  • Current living situation and support structure
  • Neurodevelopmental status
  • Current medications and treatments

As always, assessment data can vary based on a particular case, but the above points capture the basic gist.

The natural jumping off point from the assessment is the plan of care, also referred to as case management. This can vary greatly based on the environment, which will be described shortly. In this step, the psychiatric social worker collaborates with any other professionals in the client’s team to apply interventions, monitor progress, communicate progress to family, recommend resources and coordinate discharge when appropriate.

Psychiatric social workers can work for inpatient facilities, government programs, crisis response units, standalone outpatient facilities and group therapy environments. Each environment brings with it a unique set of demands as it concerns communicating with professionals in related disciplines – as with doctors and nurses in a hospital – and structuring interventions to make the most impact before and after discharge. Regardless of the specific environment, psychiatric social workers will be faced with ethical dilemmas and other challenges on an almost daily basis.

What makes psychiatric social work challenging? The obvious issues, like seeing clients in restraints and/or heavy sedation, being verbally or physically attacked by someone having an episode and so on are common enough, but there are also more insidious problems working below the surface. It’s very difficult to objectively measure the effects of mental illness, and when a client’s state changes, it’s often equally invisible. Assessment is described by this piece and most others as a definitive step early on in the client-social worker relationship, but the truth with psychiatric social work is that assessment is an ongoing process.

Tim Kalantjankos

B.S. Sociology| University of Nebraska at Omaha

A.S Physical Therapy | Clarkson College

September 2019

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