An Insider's Perspective: The Great and Not So Great Things About Community Mental Health

As I'm nearing the close of fall quarter in the second year of UCLA's MSW program, I wanted to take some time to reflect upon my experience interning as a Child and Family Therapist for a Community Mental Health (CMH) Center in Inglewood, CA.

From the moment I started seeing clients, my internship experience accelerated from 0 to 60 faster than I can say "self-care." Between learning agency norms, to deciphering Evidence-Based Practice (EBP) acronyms, to absorbing how to document clinical sessions (writing progress notes), to staying present in 8 hour trainings, I feel as though I'm in a constant state of playing catch-up. Someone important to me recently made an analogy that, in several ways, captures how I feel on a day-to-day basis at my internship. In describing his own experience at a new and very demanding job, he said that, "It often feels like I"m drinking from a fire hose." I too, feel as though information is gushing my way at a tremendous speed. Part of me questions how viable it is for an intern, who only works 20 hours a week, is supposed to absorb all the non-clinical information, all while trying to deliver mental health therapy sessions to a caseload of 7-10 clients?

Despite feeling behind most days, working in a CMH setting is tremendously fulfilling and has validated my decision to transition from the corporate sector to the humanity sector. On the not so great days, I always remember what a privilege it is to provide services to struggling individuals. And while the business of relationships is exhausting, it certainly is worthwhile.

Because I am a big fan of lists, below is a brief list of the great, and not so great things about interning in CMH.

Not So Great:

1. The ungodly amount of paperwork
2. Frequent client cancellations
3. Shortage/lack of resources (includes offices to conduct therapy sessions, office supplies, broken bathrooms, etc.)
4. Being at the mercy of the Department of Mental Health
5. Shortage of trained translation staff

So Great:

1. Clinically fascinating cases
2. Tremendous support from other agency employees (psychiatrists, nurses, other therapists, interns, directors, coordinators, administrative staff, etc.)
3. Client diversity (culture, religion, diagnosis, family dynamics, immigration status, etc.)
4. Number of hours of supervision (5 hours/week or 25% of my time is spent in supervision!)
5. Ongoing learning opportunities (primarily through continuing education seminars and group supervision)

Cultivating my Passion to Work with an Eating Disordered Population

While I have not mentioned eating disorders as a topic of discussion on this blog before, I'm incredibly interested in working with individuals who suffer from anorexia, bulimia, in addition to other eating disorders not formally recognized by the DSM-IV, such as binge-eating disorder.

It is extremely common for mental health professionals to work in this field because they are either recovering from a disorder, or they know someone close to them who has. In fact, several eating disorder agencies, such as Monte Nido, would rather hire therapists that are in the midst of their own recovery, primarily because many experts believe "it takes one to know one."

For me, my desire to work with this population is not because of a firsthand experience with the disease, but rather, an intellectual curiosity fueled by a strong desire to help individuals discover a healing relationship with food. So many women (and fewer men) are dangerously close to developing an eating disorder, and I am passionate about wanting to help individuals formulate a nurturing relationship with what they eat.

While this may or may not have increased my desire to work with an eating disordered population, my mentality about food in addition to my food shopping habits have changed dramatically over the passed few years. For example, I now purchase organic food at my local Trader Joe's whenever possible, I buy local produce at the Brentwood Farmer's Market (somewhat of a ritual every other Sunday), and I stay up-to-date on food issues by reading Marion Nestle and Darya Pino. I believe that the act of eating should be a wholly enjoyable experience, and to some extent, a sacred one.

Because my desire to work with an eating disordered population is so strong, I found a local eating disorder agency in Santa Monica to intern with. While I was only able to shadow the therapists at the agency for a few days in July, the experience significantly reinforced my desire to work with this population. While I'm not quite sure if I'll be able to maintain both this internship, in addition to my internship at Didi Hirsch, I figure I owe it to myself to at least try.

My advice to my readers is that if there is a population with which you absolutely want to work with, and your school or program does not give you the opportunity to do so, find a way to do it on your own.

Photo Credit: National Institute of Health

UCLA MSW Field Internship: Exposure to the Other Four Senses

Trying to describe my internship at an inpatient psychiatric unit, feels like trying to explain stage-fright to someone who has never been on a stage... or better yet, someone who doesn't even know what a stage is.

I have interned only two days at UCLA Harbor Hospital, and I can already tell I have my work cut out for me. The psych ward is staffed with two doctors, four residents, three to six nurses (depending on the shift), and two to three clinical social workers. The ward has 24 beds (12 of which are currently in use), a nursing station, two seclusion rooms, a cafeteria, and a place for patients to lounge. The office I share with my supervisor is tucked behind a hallway on the floor of the ward. The office door is always bolted, and the office comes equipped with a panic button (something I hope I never have to use). 

The image I just described might sound familiar. Nearly all of us have some notion of what a psych ward looks like, probably due to Hollywood's portrayal of them in the classic film, One Flew Over the Cuckoo's Nest, or more recent films, Girl, Interrupted and Gothika. I have to say that Hollywood does a pretty good job of depicting what a typical psych ward looks like: a white, sterile environment, with patients wandering the halls in hospital gowns.

While these films accurately depict the scenes of a typical psych ward, they only offer a loose sense of what it is really like to be present and interacting with patients in the unit. To give a more compelling idea of this reality, I'd like to push beyond the sense of sight by detailing how my other four senses (hearing, smell, touch, and taste) are actively engaged in the psych ward.

Hearing: The most shocking part of working in the psych ward are the sounds I hear: patients screaming, singing, shouting, rambling, crying, mumbling, etc. I was quick to learn about Code Green (combative person/elopement risk/person with internal disaster), when an unruly patient burst into rounds and had to be restrained by security and the nursing staff. Later that day, I encountered one patient who, according to the nursing staff, had been belting out lyrics for six hours straight, and had to be moved into seclusion so she wouldn't disturb other patients. Lack of sound is surprisingly shocking as well. In contrast to the patient who was singing, I met another individual who has not uttered a single word for over a year.

Smell: Being a state hospital, UCLA Harbor receives its fair share of homeless individuals. Regardless of whether the patient is homeless or not, patients are encouraged to shower everyday. However, no one is forcing them to do so. As you could imagine, it's not the most pleasant to conduct a psychiatric intake interview when someone hasn't showered for multiple days or weeks. On the bright side, all hygiene is documented in a patient's chart, so at least I know whether or not they have showered prior to when I interact with them.

Touch: Physical interaction with patients is limited, nonetheless, it happens. A patient, for instance, reached out to shake both of my hands, and held them for what felt like an eternity. His hands were shockingly cold, dry and frail. Moments later, he volitionally fell on the floor. When I grabbed his arm to help him up, I was shocked by how light his body was.

Taste: I'm not sure if it's the hand sanitizer stations, the lingering smell of rubbing alcohol, or the combination of both, but I seem to barely have active taste buds by the time lunch rolls around.

I can say, with confidence, that I have never had such eye-opening experiences in such a short amount of time. Who knows what the next 8 months will bring, but I certainly welcome the challenges that will no doubt come my way.

Photo Credit: loojie