7.4 Current Practices and Settings
This next section describes some of the common practices and settings focused on mental health services. The human services professional is likely to encounter people struggling with mental health disorders in almost any setting in which they work.
You are likely to encounter clients with mental disorders in almost any setting or job. Depressive and anxiety disorders are especially prevalent throughout the population. Any setting that addresses unmet needs such as homelessness, food insecurity, loss and grief, or abuse will include clients that may come to the service with one need identified but may also have treated or untreated mental disorders.
Inpatient and Outpatient Settings
Clients are served in inpatient or outpatient settings based on which environment is the least restrictive for meeting their mental health needs. The overwhelming majority of people experiencing the symptoms of mental health disorders do not need to be hospitalized; however, mental health crises can cause someone to be an immediate danger to themselves or other people, requiring hospitalization or residential treatment.
There are two medical practice settings where you as a human services professional are likely to encounter people with mental disorders: inpatient (hospitals, both medical and psychiatric) and outpatient (substance abuse centers, mental health clinics, counseling centers). Though there are some similarities in goals and strategies, the differences between these two settings are certainly worth noting.
Inpatient services in these settings are provided by social workers, counselors, and other professionals who work with individuals or groups to provide treatment in a variety of forms. The inpatient worker also works with the client’s friends, family, and employers to help the person return to their outside life. The human services professional may advocate and work with other agencies to provide assistance or resources for individuals under their care.
When a patient is ready to leave a psychiatric facility or hospital, the practitioner may connect them to an outpatient clinic. In these settings, outpatient workers assist the individuals or groups in maintaining healthy functioning in their environment through therapy or clinical activities. The social worker or counselor in this setting will conduct therapy or planning sessions, contact outside agencies, and advocate for their client’s best interests.
Employee Assistance Programs (EAPs)
Many employers have come to recognize that it is to their advantage to handle mental health much like they address physical health, and that giving employees access to mental health treatment and resources not only is the right thing to do, but actually makes for good business. Mental health concerns can be a drain on employee productivity and cause increased absences from work. To prevent these workplace losses, more employers have instituted employee assistance programs (EAPs) to link workers with services that can assist them.
EAPs are free for employees to access (or part of an employee benefit package), and there is an understanding that what’s shared with the EAP is kept confidential from one’s employer as they are not employers or the companies that pay for this benefit. Naturally, if an employee had concerns that their personal struggles would be shared with a supervisor, the individual would be quite unlikely to access EAP services. In some cases, EAPs provide counseling directly, while in others they refer employees to specific agencies and may cover the cost of a predetermined number of sessions.
EAPs are now required benefits for employees in any federal government workplace (U.S. Office of Personnel Management, n.d.), as well as many state and municipal offices. Among the most common issues addressed by EAPs are:
- Mental health concerns (short term)
- Substance abuse/dependence
- Family relationship problems (short term)
- Job stress
- Financial concerns, wills and contract questions
Apart from these services, EAPs working with particular employers may also offer services for aging issues and elder care, debt and financial assistance, legal advice, nutritional counseling, smoking cessation, childcare, and much more (Employee Assistance Group, 2015).
The Multidisciplinary Provider Health Team
You may be surprised to learn that clinical social workers are the number one provider of mental health services in the United States. Clients seeking assistance with mental disorders have a 60–70 percent chance of seeing a licensed clinical social worker (Masiriri, 2008; NASW, n.d.). However, clinical social workers are often just one part of a multidisciplinary team working together for the coordination of the client’s care. In certain settings—like psychiatric hospitals, residential treatment centers, and outpatient mental health clinics—these teams provide a convenient way for clients to get their needed services in one place, with a group of professionals who are all on the same page.
Some of the people with whom you may work on a multidisciplinary team include:
- Psychiatrist: A psychiatrist is a medical doctor with a specialty in mental health. Psychiatrists can assess and diagnose clients as well as prescribe them psychotropic medication, and assess any medical conditions that may be contributing to the issue.
- Psychologist: Clinical psychologists may conduct therapy, psychological testing, and/or assess and diagnose clients. They generally have doctorate degrees in their field but cannot prescribe medication.
- Counselor: A counselor typically has a master’s degree in counseling or a closely related field and may have a credential like LCPC (licensed clinical professional counselor), LMHC (licensed mental health counselor), or LPC (licensed professional counselor). Counselors may engage in assessment, diagnosis, and provision of therapy services.
- Marriage and family therapist: This specialized area of counseling and therapy involves the professional being trained in family and relationship dynamics and helping people to resolve emotional and behavioral concerns impacting those relationships.
- Art or music therapist: More and more treatment facilities are employing specialized therapists who can assist in the healing process through the use of art, music, dance, and other means of creative expression and relaxation. These individuals often have master’s degrees in their area of specialty and are sometimes called expressive therapists (Neukrug, 2014).
- Psychiatric nurse: These professionals have a nursing degree and license, and typically additional schooling to a master’s or doctorate level. Those without an advanced degree can still perform basic tasks like nursing diagnosis and care (Neukrug, 2014). Psychiatric nurses can perform much as counselors, therapists, or clinical social workers do, but they also have additional specific training in the medical field. If they are also licensed nurse practitioners or advanced practice registered nurses (APRNs), they can prescribe medication as well (American Psychiatric Nurses Association, n.d.; American Association of Nurse Practitioners, n.d.; Neukrug, 2014).
- Play therapist: A specialized method for working with younger children, play therapy is a process that helps children to communicate and open up with a therapist about things they might otherwise struggle to put into words.
Some multidisciplinary teams are part of formal treatment models like assertive community treatment (ACT). As visualized in Figure 7.4, ACT serves people with the highest service needs through intensive daily coordination about each client from providers across each discipline.
Licenses and Attributions
“Inpatient and Outpatient Settings” adapted from “Mental Health and Substance Use: Practice Settings” by Keith Bogucki and Department of Social Work, Introduction to Social Work at Ferris State University is licensed under CC BY 4.0. Adaptations: lightly edited. Revised by Martha Ochoa-Leyva.
Figure 7.4. “PACT-diagram” by Kind County is in the public domain.
a professional field focused on helping people solve their problems.
an academic rank conferred by a college or university after completion of a specific course of study.
a certification conferred by the government or an educational institution that is required for certain occupations.