Mental Health: More Than A Diagnosis

Mental Health: More Than A Diagnosis

The Heart of Mental Health

Each month, a different area or role of social work is highlighted here at real life social worker! This month’s insight comes from a dear friend sister who also happens to work in mental health. However, her work within mental health is incredibly different than mine (check it out here). What will you learn from Ellen? A lot. But, perhaps most importantly, that a person is more than his or her diagnosis.

Prepare yourself for this post.

Ellen is fully of wonderful insight. She challenges the status quo. And she has a huge heart for every human (and animal) she comes across.

Read this post and you’ll find that part of you has changed for the better. I guarantee it.

Ellen: An Introduction

“When Adrian asked me to “guest” blog about being a social worker, I found it incredibly difficult to talk about one experience or job.

Truly, I believe, the best social work practice begins when we integrate lessons learned and skills developed from different segments and apply & adapt them to the varied clients we serve. But perhaps equally important is giving dignity of memory to the people we’ve been with as we begin new journeys with fresh faces. I like to think part of my role sometimes is as a story keeper. In each chapter I collect people’s stories, their struggles and triumphs, and I love that in knowing what I’ve learned from them, I can go more confidently into the next chapter, loving and partnering with the next person better than the last.

Social workers believe in a great exchange, because we are not only giving, we are taking and trading. I would argue even that there isn’t a lot we give but what we receive that pushes our clients towards change. In being heard, clients know they matter and that they have power, and that yes, they can change. There is something powerful in what we are given, I would argue these stories are holy, and to not let them influence your work is not only stupid, but disrespectful to those who entrusted them to you.

I don’t really have the time to talk about my undergraduate experiences I dipped my toes in- such as observing a sex offender counseling group, facilitating a stress management group for college students, interning at an after school program in Harrisburg, or doing case management and counseling at a child development center in Uganda.

But I don’t want to downplay these experiences, because those experiences made me who I am today. I could do a whole blog post on each. So I name them above because each has held significance for how I interact with people, be it through developing practical skills like learning how to incorporate CBT, or reframing interactions through learning the importance of cultural humility and how I can display that. And one of them gave me a beautiful friendship and colleague-ship with Adrian; shout out to USP (Uganda Studies Program).

But for the purposes of this blog, I’ll focus on my latest social work focus, post-undergrad.”

What is it?

Behavioral Health Social Work, Psych Social Work, Residential Treatment Centers/                       Facilities (RTCs)

What is the purpose of those agencies?

“Provides comprehensive residential treatment for children, ages 5-14, whose behavioral and emotional needs have not responded to community based interventions and services” (Catholic Charities- St. Vincent’s Villa RTC)

            “Provides crisis stabilization, for children and adolescents ages 3 and older, that includes a 6-7 day stay during which time a patient receives an individualized treatment plan, that may include individual, group, and family therapy as well as medication management” (Brook Lane Health Services)

Describe The Roles You’ve Taken On.

This focus, has been primarily on social work interacting with mental and behavioral health, particularly that of children and adolescents. My first job out of college was working at an Inpatient Psychiatric Hospital, Brook Lane, primarily on the children, tween and adolescent units, as a Mental Health Associate. I guess you could say I was thrown into this area of social work (although I wasn’t in a social worker role per se), as this certainly wasn’t what I was expecting to get into.

I’m incredibly thankful for that gap year, and I learned so much about myself and my love for this client base while working at Brook Lane. I wrestled with a lot of my own inner doubts and demons, and learned what self care really is for me. Plot twist, it isn’t always bubble baths or warm fuzzy “activities” on Pinterest.

Sometimes, its allowing yourself to ugly cry the whole way home at 1 am in the morning after making yet another CPS call after your shift ended, and other times it’s saying “no” to an extra shift even if you’d love to give a co-worker a break.

It was hard…so hard…but I loved it. I fell in love with the kids, and crisis intervention, and the need for mental health interventions. I learned a lot from people who had worked there for years and I am still deeply appreciative of the coworkers I got to learn from; who are the brave and caring souls that are committed to seeing people as people first, before their diagnosis. I also learned how incredibly broken our mental health care system is and what systemic changes still need to be made.

There’s a lot more to say there but I’ll leave it for now.

That said, I knew I needed my MSW, so off to graduate school I went. The (almost) last year of my life, September 2017-April 2018, has been spent working in Maryland’s one remaining residential treatment facility for children under 14 years old. Specifically, I completed my internship working on their 10-14 year old girls unit- Ambrose- the unit with the most “aggressiveness” so they say.

Imagine your overtly dramatic and sassy middle school girls and turn up the volume ten fold. Add some behavior and mental health diagnoses. Sprinkle foster care failed placements and abandonment issues into the mix. Oh, and hormones! And put 13 of these beloved young ladies into one somewhat cramped space (did I mention systemic issues?…ahem!) If you imagined chaos, you’ve got it about right (although there was a lot of wonderfulness in that beautiful chaos). A few months out, and I miss these girls dearly. They were so much fun, so smart, quirky, beautiful, thoughtful and energetic. I even miss the middle school relationship drama. I know, I know, you’re probably shaking your head at me. But the passion of middle school girls is hard to find elsewhere!

Yes, again, it was a challenging placement, because interacting with hard to treat diagnosis’s such as ODD, ADHD and others is difficult at times. Doing therapy with families who face incredibly difficult barriers and advocating for children to stay in schools that want to kick them out…hard. But so so so worth it. These kids are still kids, and enjoy Monopoly and basketball just as the next kid. They can experience joy as much as anger.

They still want love, stability and acceptance, even if they ask for it in an unusual way.

What are some typical challenges?

Typical challenges?

I think when I consider what is “typical” I’m frustrated by this word.

“Typical” changes and yet stays the same for each of my kids. At the base level, it’s meeting needs, and rights (and when we can, wants/desires!). For a lot of my clients, that means a lot of different things.

When I worked at Brook Lane, sometimes that meant like taking 20-30 minutes convincing a 6 year old she can use the restroom and that I would stand outside and guard the door the entire time. A bathroom was where she was sexually assaulted, but not ‘that’ bathroom and I would keep her safe this time so she could pee. Other times it meant sitting with an adolescent girl for an hour, helping her work through a panic attack, and then helping her cope with life in a way that didn’t lead to self harm.

At St. Vincent’s sometimes these challenges were as simple as going over with one of my girls how to manage anger differently so she wouldn’t fight another child in school and get suspended (again). Or calling that same school, and asking what more support we could give her, and ask for one more chance. Other times, it was preparing a child who has been in residential placement over a year to what life will be like in yet another foster care placement, and processing what not going home with mom means to her. Processing this through use of art, Google Maps, and conversation (yes, I’ve used Google maps in therapy!). And then looking at what her goals are moving forward, not just so she doesn’t get into a treatment facility again, but so she can become a chef and graduate middle school.

Challenges are never having enough staff to give children the attention they need, and deserve.

Challenges are interacting with families who care for their children but not in the way that is expected or needed, or with obstacles of poverty and their own struggles of mental illness or drug abuse.

Challenges are that somehow there’s enough support if you’re suicidal or behaviorally acting up, hospitalization and residential placement, but never enough in the community for a family that is struggling so we don’t get to this place/point of intervention.

Challenges are racism and poverty and all the barriers that we in our comfort can ignore, but we should not ignore because it affects those we have contact with.

The challenges are endless and seem insurmountable at times, but as long as there are people who care and value all lives, I hold unto a flame of hope that will not be extinguished.

What do “small victories” look like?

Small victories? Why do we always ask for those?

It’s like big victories are never occurring… and what even is “small”?

Every victory in my book is SUCH a big deal. *let me pause time as I explain all the victories for the next ten years* I think as social workers we need to stop looking for small victories, and see them as they are; victories!

I could rant more, but in my exuberance I’ll explain a few of my victories! I’ll try to keep it short.

A victory is someone finally learning to trust and confide again!

A victory is my middle school girl being able to name her emotions, and what contributed to her feelings in that moment. And working towards what she’s going to do about them!

A victory is having an IEP that meets a child’s needs! A victory is having a parent interact with their child in the way the child needs them to!

A victory is the 27 letters written by one girl over a month long hospitalization all starting with “Dear Ms. Ellen” and documenting what she is thinking and feeling, and by the end of her hospitalization her admitting she’s stopped self-harming for x number of days and how exciting is that?!

A victory is de-stigmatizing mental illness and getting a child’s parents to learn about anxiety and depression!

A victory is an adolescent recognizing the abusive relationship she/he is in!

A victory is a successful CPS call that leads to the removal of an adult sexual predator from the home!

A victory is making it through a really long or hard day!

A victory is a child improving in any capacity!

A victory is saying its okay to not be okay, and lets do something about it!

A victory is looking past the “even ifs” behind all these statements, looking beyond what still needs to be done or the possibility that the victory reverses or that a client might take two steps back.

I am convinced we need to savor and celebrate these victories. Simplified, perhaps? Important, yes.

What is one of the biggest lessons you’ve learned in this area?

I’ve learned a lot, suffice to say.

Ask

I’ve learned sometimes all you have to do is ask. One of my fondest memories was working with an adolescent girl who consistently self harmed while staying at Brook Lane, up until the day she left. A girl who was powerful in her own right and grasping to anything to help her navigate her world. I’ll never forget early in her hospitalization I was sitting alone with her, and I was frustrated because I didn’t know how to help her. So I simply asked, “What would it take for you to tell me your story?” Her reply shattered my world… “Ms. Ellen, all you have to do is ask, and no one has asked before”. So I asked. I spent the next hour listening. And thanking her for trusting me. It was in that moment, that space, I truly understood what it means to be present with another person. That I couldn’t help her. At least, not in the way I defined help.

The days following that we figured out how to help her cope with her intense urges to self-harm. Sometimes that meant going onto the playground and getting fresh air and staring at the stars. Sometimes that meant me holding her hands while she was shaking, suffering a flashback and wanting nothing more to scratch herself. Sometimes that meant I wasn’t there or I was, and she still managed to self harm. It meant accepting her then more than any other time. That I wasn’t ashamed of her or disappointed in her, but that I knew she deserved better for herself.

It meant uttering the three phrases to her daily for the month leading up to her leaving; you are beautiful, you are deserving of love and are loved, you will love others again. I don’t have all the answers, but I now know why the therapeutic relationship is so important, there is something to be said about being with your clients. Being authentic. Allowing vulnerability. Sometimes you have to let the client take the lead. I can read about motivational interviewing and CBT forever and I can structure things perfectly, but I have to also let go and learn through that way too.

Unconventional Isn’t Always Bad

Another vivid moment I hold is one of my middle school aged girls talking about her impending discharge. She wanted to show me her new foster home on Google Maps. I was hesitant as I’d made the mistake of letting a client use my computer in therapy before and had to backpedal because of it. But I was curious, and that overruled. I’m so glad curiosity won out. She was able to show me her new house, and process her feelings through showing it to me. Then she kept going! She literally shared a patient history though Google Maps. She showed me the home she grew up in, her foster homes, and places of importance, processing her past and what she missed as she pulled them up on the screen. Let your clients lead sometimes.

Control is incredibly powerful to be given. Somehow we trick ourselves into this high and mighty hierarchal role I don’t believe we were ever supposed to hold. Not to say we don’t have insight or authority but only to say we hold ourselves back in being “the expert” in everything.

Be humbled often, I know I am. I’ve learned I’m more argumentative and sassy that I originally thought. Perhaps that means I care, and perhaps that makes me more of an advocate. I’m still figuring all that out. All I know is I’m invested, and to be anything less is to be of great disservice to those we partner with.

That’s not to say I can’t have crappy days, but to say, kids pick up on inauthenticity, on being with them being “a job” or them being a “project” needing of fixing. One of our core values is relationships, and I think we should all be learning how to live that out with our clients. I’ve learned I’ve a lot left to learn.

This summer marks my last class and then I’ll have my MSW. Perfecting therapeutic techniques takes years, and even then they won’t be perfect.

What I’ve Learned:

I’ve learned I have privilege, and how to use it in a way that honors those that deserve it. I’ve learned mental health care and interventions are always changing, as are the policies that have large reaching effects.

I’ve learned to not take myself so seriously.

I’ve learned what it means to interact with a child, and how entering a child’s world is unique and a privilege.

I’ve learned pain is a hard place to be. And holy ground to walk on if your clients are ready for you to enter into their pain…and clients don’t have to “let you in” for good work to be done.

I’ve learned that I have a lot of interests and areas of social work I value and that’s okay.

I’ve learned sorrow and joy and what they look like to me and to different people.

I’ve learned community in different places with different people.

I’ve learned to not assume. I’ve learned I don’t hold all the answers or solutions or advice.

I’ve learned to do things differently if they’re not working.

I’ve learned people are constantly and consistently amazing.

What does a typical day look like?

You got me again with the “typical”.

I will say that “typical” sometimes involves treatment team meetings, IEP meetings, writing notes and documenting most everything.

I will also say sometimes it involves productive and what is deemed “unproductive” individual therapy sessions (although I would argue resistance to treatment is hardly unproductive), facilitating group therapy, daily living needs being met, family therapy sessions, prepping for all the previously named activities and facilitating varying crisis intervention models for my kids.

Typical sometimes being cursed out thoroughly and degradingly, or having a child cry about how they were bullied in school or abused in their past, or stare blankly at you, or high five you because they brought up a school grade.

Typical is about making sure medication is taken and homework is completed. And always advocating for deodorant. It’s a day of being caring and stern, sassy and sentimental, but most importantly, being real and being with.

And failing at all of the above, and growing and doing better at all of the above. Finding grace in all of this.

What else would you like the general public to know or understand about this area of social work? Why?

I would love, just for a moment, for the general public to see the children and adolescents I work with as more than their diagnosis, behavior or what they verbally say or do.

I would like the public to see them as brave. As resilient. As smart. As beautiful. As good. As worthy of love and admiration. To not be overly pitied but definitely respected.

To see things less black and white and more in shades of grey.

Its incredibly easy for the public to write a lot of kids I work with as “bad kids” or “troubled” or “crazy”. And I hate that. They are children or adolescents in a lot of ways that have faced insurmountable odds, who have endured more than an “ideal” childhood we hope every kid gets, and who are still trying to beat the odds stacks against them. Or even the ones that have had a decent childhood…the brain chemical imbalance is just as worthy of treatment as a broken leg.

For this, they deserve respect, not pity or rolled eyes or anger for the little mishaps. They deserve encouragement. They deserve community, not empty promises or “it”ll get better”. They deserve the possibility to be awesome and do awesome things, to have an avenue for that.

They deserve to be accepted and challenged and cherished.