Author: Monica Rowden
Clients managing mental health concerns present some specific challenges that are important to understand in order to succeed in supporting them. Close to 40% of people with depression do not seek treatment, making it extremely important to recognize symptoms and how they manifest in daily life. Thus, it is essential for case managers to have a working knowledge of how mental health symptoms present and the resources available to address them.
When collaborating with clients experiencing mental health challenges, it is important to view them through the framework of cultural humility. This allows the case manager to approach them as a whole person while recognizing the impact of structural stressors via racism, sexism, and homophobia, to name a few.
Some examples of how structural issues can impact clients include access to services, difficulty with following through on tasks, and behavioral challenges stemming from trauma. One commonly seen behavior related to many different mental health diagnoses is avoidance. This can look like not following through on tasks, missing important appointments, or losing documents. When we can connect these behaviors to mental health symptoms or neurodiversity, we can better support our clients’ successes by developing interventions that foster effective behavioral adaptation.
Empathy
Understanding our clients through a lens of cultural humility allows the case manager to focus on supporting behavior change and creates space for increased empathy. Empathy is another essential tool for the case manager to effectively engage the client and overcome stigma. Using empathy to strengthen the case manager/client relationship often leads to better health outcomes. Through open-ended questions, reflective statements, and genuine curiosity for our clients, we can foster strong connections that create trust.
Shared Decision Making
As our systems of care have grown to recognize the prevalence of mental health conditions in the community, evidence-based practices have emerged to provide a framework for how to work with this population. One such practice is shared decision making. This calls for service providers to work in conjunction with clients to understand their goals and work together to meet those goals. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), this process includes actively engaging the client, assessing their values and preferences, supporting them in identifying and comparing treatment options, reaching a decision together, and finally evaluating this decision. Through this process, case workers can effectively promote autonomy in clients managing mental health issues.
Case Management
Case managers play a unique role in serving as a coordinator between multiple providers and the client. They can assist patients in normalizing the impact of symptoms on daily functioning while advocating with other providers to ensure they get the care they need.
One useful framework is acknowledging that behavior is a form of communication. This allows space for the case manager to step back and consider the larger picture of what is impacting the client, to help understand their actions in a compassionate way. Similarly, that step back gives the case manager an opportunity to figure out what resources are needed to support the client’s needs. Given the limited resources available to our clients, this essential role of case manager as the link between client and treatment is of great value.
Stigma/Stereotyping
One way that stigma significantly impacts the treatment of clients experiencing mental health symptoms is the stereotype of these clients being aggressive or violent. The reality is that individuals with mental health concerns are much more likely to be victims of violence than perpetrators.
Clients with mental health concerns can have difficulty managing their emotional reactions and impulse control, which can lead to them feeling upset somewhat easily. It is essential that case managers are provided with an empathetic framework for the experiences that may be contributing to a client’s expressions of frustration, and the skills necessary to help de-escalate the client in the moment. Equally important is the need for case managers to be supported by their agencies with clear protocols of what to do when these situations arise. Considerations regarding mandated reporting can come into play, especially if the client is expressing suicidal or homicidal ideation. Through individual and group supervision, case managers can develop the skills and confidence necessary to support clients who are struggling with mental health concerns.
Trauma Informed Care
Another important aspect of supporting clients dealing with mental health concerns is integrating trauma-informed care (TIC) into both clinical practices and institutional practice. Trauma-informed care acknowledges the impact of trauma on the lives of individuals and moves towards understanding the story behind the behavior they exhibit. TIC not only creates space for the health and well-being of the client, but also acknowledges the importance of supporting the health and well-being of case managers. A robust TIC intervention includes the following:
- Ensuring the physical and psychological safety of clients and staff
- Transparency in decision making
- Ensuring there is peer support
- Effort to reduce power differentials between clients and staff
- Empowerment to ensure all voices are heard and maintaining a focus on cultural humility
There are a variety of tools and strategies case managers can employ when working with clients who have mental health concerns. Using empathy, recognizing the impact of stigma, practicing trauma-informed care, and focusing on behaviors are some of the tools that lead to impactful relationships and ultimately access to care.
Examples/practical applications
- Meet the patient where they are at. They may or may not be ready to directly address their mental health needs. Understanding what their priorities are, building that strong relationship, and consistently supporting them opens the door to getting them connected to care when the time is right.
- Address institutional and internalized stigma with the client.
- Recognize the impact of mental health symptoms on behaviors.
- Understand behaviors as a form of communication.
- Implement trauma-informed systems to support clients and staff.
- Use open-ended questions and reflections to elicit from clients their priorities and values.
Important links/resources
References:
- 6 Tips for Working with Patients with Psychiatric Disorders | Incredible Health
- What is Trauma-Informed Care? – Trauma-Informed Care Implementation Resource Center (chcs.org)
- COMPREHENSIVE CASE MANAGEMENT FOR SUBSTANCE USE DISORDER TREATMENT (samhsa.gov)
- The Role of Empathy in Health and Social Care Professionals – PMC (nih.gov)
Author
Monica Rowden (she/her) is an anti-racist, bilingual, and gender-affirming licensed clinical social worker and calls Oakland home with immense pride. She has worked in the field for 20 years, focusing on the intersectionality between mental health, substance use, housing, HIV, and harm reduction. She is passionate about serving the members of her community through direct service and advocacy.