This mental health worker, with more than 23 years of experience, has worked in a number of mental health roles. Her jobs have ranged from maintenance for chronically ill adults, to a role in early intervention with the Head Start program. Here, she tells her story in her own words:
I decided to major in Psychology for two reasons: it didn’t require math, and I was the one who everyone came to with their problems. I chose Western Michigan University, not because of the psychology department but at the time their football team was better than most in the state.
After a semester in the psychology department rat lab, I was able to gain real life experience through the practicum courses offered. My practicum assignments were at a day care center with kids, and at a day treatment program for developmentally disabled adults. Neither of these encompassed what I thought I would do with my degree, but I did get some useful experience in these settings.
Out in the Real World
It was my first out-of-college job when I began to see more of a purpose for the degree in psychology. I took a low paying job ($8.00 per hour) as a day treatment worker in an adult day program for chronically mentally ill adults. My main function was to prepare group activities and facilitate socialization and community integration opportunities.
This job was a good entry-level position. The work wasn’t demanding; it was a good way to get acclimated to the field. Being fresh out of college and eager to take on anything, I got caught up in the notion of being able to cure all of the clients. I was determined I could make the nonverbal speak and the depressed smile. It was a humbling experience to discover how unsuccessful I was in curing these chronically ill patients.
To me, the hardest part of the day treatment work wasn’t necessarily what I did, but what I began to feel. As I learned the stories behind the clients, I found that it was at my age when many of the clients began to experience their mental illness. I began to internalize this and recognize how I could be just one step away from a life of delusions and manic episodes. My abnormal psychology class in college provided insight into these disorders, but textbook illustrations cannot compare to real life. I eventually found myself in my boss’ office seeking answers to my questions and validation of my judgment.
A Step up the Ladder
After a year in the day treatment program, I transferred to the front office with a $2.00 raise and the title of case manager. My new job duties were to monitor clients’ mental health status. Of the 75 clients on my caseload, I was responsible to maintain monthly contact either face to face or by telephone depending on the severity of their illness. For instance, someone who saw the psychiatrist periodically for medication maintenance would require a phone call. Those with multiple hospitalizations and history of treatment noncompliance were to be seen either in the office or at a home visit.
A Memorable Experience
Marcus was my first face to face contact as a case manager. He came to the office for his appointment with the psychiatrist and was eager to meet me. He came in, sat down and asked if I had read his chart; it was my first week and I hadn’t gotten to the charts yet. Marcus leaned forward in his chair and said, “I’m here because I killed a man.” It was all I could do not to gasp, scream or run. I tried my best to react appropriately but I am sure my facial expression gave me away.
Marcus proceeded to tell me the whole murder story. As soon as he left I got his chart and read it all the way through. He was found, Not Guilty by Reason of Insanity (NGRI) for the murder. Marcus would always be branded with an NGRI status. I had to maintain close monitoring with him.
Even though that first interaction is among my most memorable, I learned an important lesson from Marcus’ story. I was advised to only visit him at his workplace or see him in the office. But he would often challenge me and ask me to come to his apartment for the visits. It was important for me to set firm limits to ensure my safety. Working in the mental health field, it is crucial to maintain boundaries and keep personal information from clients.
A New Job at the Psychiatric Hospital
After three years in case management, my next job was as a Mental Health Worker in a psychiatric hospital. Working on an inpatient psychiatric unit is a guaranteed way to get a true depiction of the mental health field. The experience I brought to this job was helpful, although working with mentally stable clients pales in comparison to those in crisis needing immediate intervention.
The mental health workers basically did everything the charge nurse requested or didn’t want to do. One of the main things was to check patients in, remove all sharps (anything a patient could use to harm himself) do vital signs, explain the rules and expectations of the floor and develop the treatment plan.
The patients who were considered a danger to themselves would be put on suicide watch. There were two stages of suicide watch, the 24-hour one-on-one and the 15 minute increment checks. I was always nervous when there was a one-on-one suicide watch; it was necessary to be within sight and sound of the patient at all times. Even the door to the bathroom had to be cracked open.
It was also the mental health workers’ role to accompany a patient to the emergency room if anything medical came up. I did not like going to the hospital with patients. For me, going to the doctor is personal; I was always uncomfortable being there while the patient was being examined and tested.
Mounds of Paperwork
A big part of the mental health world is documentation. In the psychiatric hospital documentation was required on each patient every shift. Every staff member was assigned a group of patients to monitor and report on. It wasn’t uncommon for the psychiatrist to dispute the unit staff’s reports of progress. The documentation had to prove to the insurance company that the patient needed to be hospitalized. I always thought it was a shame that a person’s illness is based on money; the amount the insurance pays and the amount the doctor makes. I had a hard time with these issues.
On the rare occasions when a patient became aggressive, the staff would have no option but to engage in a non-violent physical intervention to restrain and maintain the safety of the patient and those around him. These situations required all staff assistance and the leader, usually the head nurse, dictated each person’s role. The worst physical restraint I ever participated in was on the adolescent unit.
Two teenage girls had held themselves up in the day room, breaking things and verbally threatening the staff. The charge nurse decided it was time to take control and directed us to go in without a plan to show them who was in charge. Without an offensive plan, the whole situation turned into a full blown defensive attack. Once the doors were opened, the girls went after all of us. It was nothing but an all out battle until we were able to get them down. When it was all over, we took inventory of the injuries; two of us were bitten, someone had broken ribs and many of us had scratches and bruises. During the debriefing, it was determined that this was a good example of what not to do during a physical intervention. I lost a lot of respect for the charge nurse that day.
Despite the challenges of working on a psychiatric unit, I did learn a lot of valuable skills. It definitely was not my favorite place to work. I can be flexible in my job, but I am not very good at going from calm to chaos in a split second. It was difficult to get time off, especially on weekends. Everyone was required to work every other weekend as well as holidays. The only way time off was allowed is if a replacement was found to switch shifts.
On the positive side, there were frequent overtime opportunities; the downfall was being assigned to mandatory overtime when a replacement could not be found. No one could leave for the day until the next shift had enough staff. There were three shifts: 7:00 am to 3:30 pm, 3:00 pm to 11:30 pm and 11:00 pm to 7:30 am. The first 30 minutes of the shift was the report on all of the patients on the floor. I worked the days but I also did my share of overtime on the other shifts.
After three and a half years of unlocking every door I entered, I left the hospital for a Monday through Friday job. I took a social work position at a sheltered workshop for chronic mentally ill adults. Each client lived in a group home and was assigned to a community case manager. My role was to tend to the clients’ activities and well being while at the workshop. If issues came up with any of the clients, I was to contact the case manager or the group home staff who handled it. This was a big change from the ongoing crisis at the hospital.
The clients’ job at the workshop included sorting, packing or assembling products. I was responsible for supervising the work activity and overseeing the daily living skills groups the clients were required to attend. I also took on additional tasks within the workshop such as conducting time studies, coordinating projects with customers and tracking the clients’ production. I had to keep progress notes on each client but I never felt overwhelmed by the paperwork.
I enjoyed my work and the clients at the sheltered workshop. I had more flexibility in this job compared to the hospital. I had a good relationship with my supervisor who entrusted me to make decisions and organize the daily operations.
Vacation and sick time was accrued and stored to be used whenever I needed it and the pay was about $32,000 a year. The agency had a four day work week which I took full advantage of.
I remained at the workshop for almost four years, through my wedding and the birth of both of my kids. I would have stayed longer had the commute not been so far. I pursued a position with Head Start because I had to do what was best for my family. This new job started at a lower rate of pay but had increment and cost of living raises to move me beyond my previous rate; plus I would be closer to home.
Giving Others a Head Start
I was hired at Head Start as a Family Services Coordinator; that was short-lived when my mental health background was uncovered and the need for a Mental Health Coordinator was needed. It was up to me to define the role and scope of the position since no one had worked in this capacity before. The biggest hurdle was my lack of knowledge in early childhood education. I had the mental health piece down so adding the early childhood element gave me new experience.
It didn’t take long to get a handle on the early childhood practices. In my role, I conducted classroom observations tracking the positive interactions between the staff and children. I worked with the teachers to ensure their classrooms promoted a sense of belonging, trust and well-being. In addition, I held training seminars for teachers on building social/emotional competency skills. It was in this position where I found the opportunity to make a difference in people’s lives. I was able to meet with parents and hopefully influence them to be more responsive, respectful and involved with their children. I liked being on this side of the continuum; basically the opposite of my earlier work experience.
I still work with the Head Start program. Of the 14 years I have been here, I spent ten in the dual role of Mental Health and Disabilities Coordinator. In my role today as just the Disabilities Coordinator, I continue to enjoy working with children, parents, teachers and special education staff. I am also considered middle management where I have the chance to develop program systems and have a say into program practices and operations.
I often think that working in Head Start was my calling. Watching children in their prime developmental years grow into independent thinkers, show empathy, and interact with one another is beyond rewarding. I often wonder about Marcus, would he have chosen another route had he been raised to appropriately express his feelings, show empathy towards others or have effective problem solving skills?
Pay and Benefits
The Head Start I work with happens to be organized within the county government. I am considered a county employee working for a federally funded program. I make $24.30 per hour and receive good employee benefits including retirement. I earn five weeks of vacation a year and my sick time accrues. Time off requires approval which is granted without a problem. I tend to spread out my vacation days during the year, but I always take two weeks off at Christmas. The biggest issue with taking time off is returning to a pile of work that no one does when I’m not there. I feel a sense of security in my position however, being government funded, nothing is guaranteed. At this point, unless big changes affect the design of the grant structure, I hope to retire at age 50.
The human services field is not known to be lucrative; it is hard to look at a pay check knowing your output is a lot more than the intake. This is the reality of the line of work. Working in the mental health field is more about the intrinsic reward of helping others.
Looking to the Future
Overall, I have 23 years of professional work experience. When I started that first job in the day treatment program I wasn’t sure of where the field would take me. As I reflect on these experiences it is nice to have gone the full circle from maintenance to prevention. I am not sure if many people get this type of opportunity in their careers. What I do know is when I grow up I want to be a full-time writer.