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)

Purposeful Action

Tomorrow I begin my field placement at the UCLA Harbor Hospital in the inpatient psychiatric unit. Like many of my classmates, I have no formal experience working in the setting (hospital) or with the population (acute mentally ill) I am assigned to. I am anxious to see how the details of my internship unfold, but I feel much more acclimated to the field component of the program, now having gone through field orientation in the last week.

UCLA faculty and staff gave us a ton of information, dates, assignments, and materials to process. I did, however, feel the advice given to me by my field liaison stood out amongst the administrative details. As new social work interns, she said the most important thing we could start doing is acting and making decisions with purpose, instead of just reacting; something she referred to as "purposeful action."

I was immediately reminded of Ericcson's theory of "deliberate practice" since his framework suggests that acquiring a skill or gaining expertise is much more about how hard you work, rather than the innate talent you posses.  Both Ericcson's theory and my field liaison's advice focus on the importance of intentional action, rather than knee jerk action.

While I know I am far from becoming an expert in the social work field, it helps to keep Ericcson's framework of "deliberate practice," or my field liaison's explanation of "purposeful action" in mind. The following are just a few ways I hope to carry out deliberate or purposeful action, while pursuing an internship in the field of social work: 

1. Follow the client at every level. This means I need to engage and listen to clients while keeping unique cultural, physical, or emotional circumstances top of mind.

2. Engage with others as much as possible. Even though I might be in a micro social work setting, it is my responsibility to seek out macro ways to be involved (policy initiatives, community outreach or education, inter/multidisciplinary team meetings, etc.).

3. Never make assumptions. I cannot assume all clients are comfortable with cultural norms (i.e. a handshake or other greeting).

4. The potential to learn comes from not-so-obvious places. Clients are just as much teachers as supervisors or faculty are.

5. Form relationships with everyone. A security guard, administrative assistant, or someone from the cleaning crew might help me in a sticky situation.

6. Mentally and physically prepare to work in any setting or context. This will allow me to do great work, be safe, and get to know my new work environment.

Photo Credit: Martin the Hat