Mental Health and Counseling

Normalcy and Labeling

  • We tend to pathologize deviations from what we consider normal without examining our definition of normal. This can lead to labeling people who deviate from this concept.

  • Labels can be damaging, especially to children, as they can follow them throughout their lives.

Factors Affecting Mental Health

  • Emotional dysregulation can be caused by various factors.

  • Impact of traumatic events like intimate partner violence and child abuse on individuals, families, and communities.

Views on Mental Health

  • Medical view: Labels mental health issues as medical problems.

  • Lack of parity: Mental health problems are often not given the same importance as physical problems.

  • Need for balance: Physical and mental health need to be balanced for complete healing.

Research and Vulnerability

  • Increased neural biology research since 2020 supports the link between physical and mental health.

  • Physical illness can make individuals more vulnerable to mental health problems, and vice versa.

Homelessness and Mental Health

  • Not every homeless person is mentally ill or abuses substances.

  • Homelessness can make individuals more vulnerable to substance use and mental health issues.

  • Between one to three million homeless people have mental health problems.

  • Causation: Deinstitutionalization, overwhelmed communities, cutbacks on social services and urban renewal projects impact homeless individuals with mental health problems.

Deinstitutionalization

  • Historically, individuals with chronic mental illnesses were housed in large state-run mental health institutions (sanitariums, asylums).

  • States closed these institutions due to financial constraints, leading to the return of chronically mentally ill individuals to under-resourced communities.

Civil Rights and Mental Health

  • State laws permit involuntary commitment to mental health hospitals.

  • Individuals can be hospitalized without consent if they commit an illegal act or pose a threat to themselves or others.

  • The balance between personal liberty and community safety is a key consideration.

  • Not every mentally ill person is violent, and not every violent person is mentally ill.

  • Historical context: In the past, limited understanding of mental health treatment led to widespread institutionalization.

  • Today, deinstitutionalization has occurred because of lack of capacity and recognition that institutionalization alone was not effective.

The Impact of Homelessness on Mental Health

  • Homelessness creates chronic survival stress, which can lead to mental health problems.

  • Survival stress experienced 24/7 can drastically affect a person's mental health.

Medication and Mental Health Treatment

  • There is ongoing debate about the effectiveness and appropriateness of mental health medication.

  • Medication needs to be coupled with counseling.

  • Concerns about over-diagnosis and the influence of drug companies.

  • Medication should generally not be a long-term solution without a balancing approach.

  • Side effects often lead people to stop taking medication.

Service Delivery and Client Experiences

  • Many people who need help may not seek it or may find it difficult to access.

  • It's important to work to help individuals, even if they are not actively seeking it.

  • Most people know when they want change, but may not know how to achieve it.

  • Often, showing up is the first step, and social workers need to help with the rest.

Problem-Solving Approach

  • Break down complex issues into smaller parts.

  • Focus on fixing one part and then assess the impact on the rest.

  • This approach is valid, but depends on the person and what they are ready to deal with.

Client-Centered Approach

  • Address the issue that the person wants to work on, even if there are other pressing issues.

  • Don't assume things based on gathered information; allow the person to lead.

  • Adapt your approach based on what the person is ready to deal with.

  • Build trust and rapport by going with them where they are at.

  • Client-centered counseling/person-centered therapy starts with the person's perspective.

Building Rapport and Trust

  • Essential for social workers to build rapport with clients.

  • Assess people relatively quickly depending on the type of work.

  • Counseling is a key skill in social work.

Social Work Training and Licensing

  • Bachelor's and master's degrees in social work are available.

  • Master's level social workers can become Licensed Master Social Workers (LMSW) or Licensed Clinical Social Workers (LCSW).

  • To provide mental health care independently, a master's degree is required.

Phases of Counseling

  • Building a relationship with people

  • Exploring the problems in depth

  • Exploring alternative solutions based on the person's experience, values, and norms

Establishing Safety and Open Communication

  • Communicate openness to help and expertise.

  • Be calm, nonjudgmental, and non-moralistic.

  • View clients as equals.

  • Share vocabulary and use language appropriate for the person.

  • Maintain confidentiality and avoid conflicts of interest.

Ethical Considerations

  • Avoid relationships with clients.

  • Be in control of the therapeutic relationship.

  • Refer clients to someone else when you don't feel competent to handle their problems, or if there is an ethical issue.

  • Counseling and therapy are vulnerable places; counselors must be impartial.

  • Don't give advice; model self-regulation.

Key Skills: Listening and Empathy

  • Listen and empathize without expressing your own emotions during sessions.

  • Be a constant, stable point for the person.

Example: Providing Support in Crisis

  • A social worker must remain composed when supporting someone in crisis.

  • Provide a steady presence and support.

Open Communication

  • Offer people space, presence and time to absorb the tragic incidents that have occurred within their lives.

The Importance of Calmness

  • Being calm is essential for social workers.

  • Calmness enables counseling and assessment.

  • Practice self-care rituals to create balance.

Assessing the Situation

  • Assess clients' nonverbal cues, appearance, and emotional state to understand their mindset.

Maintaining Perspective

  • Recognize that the crisis is for the person, not for you.

  • Lean on your skills and approach the situation in a particular way.

Responding to Emotional Distress

  • Use open-ended questions, actively listen, and respond to what the person says.

  • Acknowledge and validate the person's feelings.

Documentation

  • Document the encounter in generalized terms, focusing on the support provided and recommendations made.

Addressing Suicidal Ideation

  • Ask direct questions to assess the level of risk.

  • Provide resources and crisis lines.

  • Contact emergency services if the person expresses immediate intent to harm themselves.

  • Due diligence helps you to do your best for the distressed individual.

Focusing on Resources

  • Identify and utilize the person's existing resources and strengths.

Self-Determination

  • Clients have the right to make their own decisions, even if they are not in their best interest.

  • The role of the social worker is to provide information and support, not to make decisions for the person.

  • Helping is about supporting self-determination; saving is about taking over.

Counseling vs. Psychotherapy

  • Counseling:

    • Focuses on specific problems and life adjustments.

    • Short term.

    • Educational modality.

    • Problem-solving (dealing with the present).

  • Psychotherapy:

    • Focuses on restructuring the personality.

    • Long term.

    • Emotional restorative modality (cognitive behavior therapy, didactic therapy, trauma interventions).

    • Examines personality development (psychodynamic model).

Scope of Practice

  • LMSWs cannot diagnose; LCSWs can diagnose but cannot prescribe medication.

  • Refer clients with complex issues, such as complex PTSD, to specialized therapists.

  • Psychoeducation important within short-term counselling interventions.