Psychiatric-Mental Health Case Manager – A Day in the Life

For people who have fallen through the cracks, psychiatric and mental health case managers are human safety nets. Often working with large but overlooked segments of the population, psychiatric and mental health case managers make it their mission to connect clients to resources that can improve their quality of life.

While society is set up to serve people of the status quo, it unintentionally punishes individuals suffering from psychiatric issues and poor mental health. And according to the National Alliance on Mental Illness (NAMI), that’s a lot of people. Approximately 45 million Americans experience mental illness in a single year and almost 10 million experience it severely enough to interfere or limit at least one significant life activity. Over 20 percent of teenagers experience a severe mental health event, the same rate at which state prisoners are likely to have a mental health condition. Psychiatric-mental health case managers exist to catch and assist these most vulnerable and afflicted sets of the population.

The circumstances surrounding mental health issues are often intersectional, requiring a holistic understanding of a client’s finances, culture, housing, language, and history of physical illness. It’s up to psychiatric and mental health case managers to assess their clients thoroughly and compassionately and use the results of those assessments to connect clients to resources within their community that can help. This requires phone calls, it requires pounding the pavement, and in many cases, it requires holding a client’s hand through the process.

It’s a rigorously demanding job that can tax one’s heart and soul. Still, the outcomes can also be life-changing: getting a homeless person into housing, finding an addiction support group, or placing a person with schizophrenia into a compassionate cycle of treatment.

Psychiatric and mental health case managers can be employed in various settings: mental health clinics, home care facilities, hospitals, substance abuse treatment facilities, and detention centers. While they will spend some time in an office, which is their hub of operations, in practice, psychiatric and mental health case managers move around a lot, and often go where their clients do.

Sometimes their work can function as a mix of a taxi driver, advocate, psychiatrist, babysitter, teacher, and sibling. Between outreach, home visits, doctor’s appointments, follow-up assessments, and interagency collaborations, a case manager’s work environment can stretch across the entire community in which they serve.

Case management is undoubtedly a team effort. Within their facility, psychiatric and mental health case managers collaborate with their colleagues on specific aspects of a client’s case, covering each other’s blind spots and assigning clients to the people with whom they’re the best fit.

Outside the facility, case managers need to have strong connections to a multitude of community resources. Building relationships with doctors, nursing home administrators, housing shelters, other treatment facilities, and the local police is crucial.

No day is typical for someone working in psychiatric and mental health case management. A case manager may work with a specific subset of the population (e.g., teens, geriatrics, those addicted to substances), and within subsets, each client is different. But even in a role that sees an ever-rotating mix of individual clients with individual needs, some general tasks repeat themselves. And while the individual client will differ, there is a standardized pipeline of care that many psychiatric and mental health case managers will follow.

In an initial assessment, the case manager will conduct a client-focused, all-point assessment that considers factors contributing to a client’s condition. This often includes a client’s financial status, housing situation, language competency, cultural factors, substance abuse and dependency issues, and other health conditions. Especially in psychiatric mental health case management, many of these factors contribute to a client’s condition and act as barriers to care.

Proper documentation of these and other assessments (and adherence to HIPAA privacy standards) is critical, especially as the client is connected to additional resources and mental health professionals in the future.

Following an initial assessment, the case manager employs a strengths-based approach to developing a course of action for their client. This considers the client’s strengths and seeks to resolve problems by nurturing the positive aspects of a client’s life. This can also include identifying positive interpersonal relationships, outlining realistic and achievable goals, and charting out a path forward for the client, complete with reasonable and actionable steps.

Following thorough assessments, psychiatric and mental health case managers can begin connecting their clients to resources within the community. This could mean driving a client to the grocery store and helping them shop, or giving them the phone number and address of a food pantry, or accompanying them to a doctor’s appointment and everything in between.
Taking a holistic approach, they provide links to medical, educational, vocational, and social resources within the community. Connecting clients to resources is a critical step for case managers. Over time, it can empower the client towards a greater level of self-sufficiency or, at the very least, distribute the labor across agencies designed to assist with specific needs.

Through a client’s journey, psychiatric and mental health case managers conduct follow-up assessments and make progress notes on whether there have been measurable outcomes. Each follow-up assessment is tailored to the specific client it’s focused on. Still, progress metrics can include a higher level of functionality, fewer instances of hospitalization, less dependency on community programs, and increased quality of life.

In the early stages of a client’s journey, more follow-up care is generally required, and a case manager may need to be more available to respond to a client’s needs. But, if successful, the level of involvement gradually can taper down as new habits take hold and outside resources become further integrated into a client’s life.

The final step in the care pipeline is selecting an appropriate time of discharge for the client. As with every other step in the process, the criteria for release depend on a client and their goals. It could be when the client has been successfully handed off to a treatment facility or when the client has found employment. However, it’s unlikely that a client will need no further assistance, and it’s up to the case manager to ensure that lifelines are in place for the client even after discharge.

Case managers typically need at least a bachelor’s degree, but many employers increasingly request a master’s degree, preferably in an area such as social work or psychology. This is especially true in psychiatric and mental health case management, where the factors underlying a client’s condition are often myriad and individualized.

Psychiatric and mental health case managers need to take a holistic approach that considers all the social determinants of a client’s health and the numerous community and health resources that can be integrated into their care. Furthermore, most states require psychiatric and mental health case managers to be licensed, usually as a certified mental health professional (CMHP), and requirements for this will vary from state to state.

In addition to a robust understanding of psychology and mental health, psychiatric and mental health case managers also need to be well connected to a local community’s resources. Collaboration between organizations and community members is necessary, as a team-based approach is often integral in sustaining a client’s overall recovery. Case managers also need a steadfast dedication to the ethics and standards of the profession and a commitment to continuing education to stay abreast of the evolving best practices of psychiatric and mental health case management.

Perhaps the least teachable skill for psychiatric and mental health case managers is their most critical character trait: compassion. In many cases, clients are not going to reach recovery but are simply in need of a higher level of functionality, and this can put enormous strain on a case manager over time.

Often working with heavy caseloads that include unstable clients who believe they are beyond hope, it’s up to psychiatric and mental health case managers to hold on to their sense of positivity and instill that belief in the clients they serve as well. Balancing this attribute with a set of healthy professional boundaries is crucial for nurturing a client’s sense of self-sufficiency and retaining the case worker’s ability to remain continually compassionate and hopeful.

Psychiatric and mental health case managers almost always need to be licensed by the state they choose to practice, and licensure regulations will vary from state to state. But those who wish to go further can attain board certification as a case manager, and an increasing number of employers require this additional step. The Commission for Case Manager Certification (CCMC) is the first and largest organization to offer such a credential: the Certified Case Manager (CCM) designation.

To apply for the CCM exam, applicants must first fulfill eligibility requirements in two categories: licensure/education and employment experience. For the licensure/education requirement, applicants must have either a license that allows them to conduct assessments independently or a fully accredited graduate or baccalaureate degree that includes supervised field experience in case management.

For the employment experience requirement, applications must have had, in the last five years, either one year of full-time case management experience in which they were supervised by a CCM or two years of full-time case management experience (without the requirement of CCM supervision), or one year of full-time case management experience in which the applicant was responsible for supervising others.

Those holding the CCM credential must recertify every five years. At the time of renewal, credential holders need to provide proof of completing 80 units of continuing education or retake the CCM exam.

Careers in psychiatric-mental health case management are in demand to meet growing mental healthcare needs in the United States. The US Bureau of Labor Statistics (BLS) doesn’t keep specific statistics for psychiatric-mental health case managers. Still, it does predict that substance abuse, behavioral disorder, and mental health counselor careers will grow 25 percent between 2019 and 2029 (BLS 2020). This is much faster than the national average for all occupations (4 percent) and estimates that 79,000 new positions will be created in the same decade, earning a median annual wage of $48,720 (BLS 2020).

Salaries depend on several factors, including education, certification, and location of employment. Here are the salary percentiles for mental health and substance abuse social workers, a similar occupation (BLS May 2020):

• 10th percentile: $30,770
• 25th percentile: $37,220
• 50th percentile (median): $48,720
• 75th percentile: $65,210
• 90th percentile: $87,420

By comparison, PayScale.com, a self-reported aggregator of salaries, shows the average base salary for mental health case managers is $39,112, not including bonuses (PayScale May 2021). This is based on the 904 individuals reporting, a sample size that is significantly lower than the 319,400 currently employed substance abuse, behavioral disorder, and mental health counselors (BLS May 2020).

Payscale lists salary percentiles based on years of experience:

• Entry-level (less than one year): $31,400
• Early career (1-4 years): $33,380
• Mid-career (5-9 years): $35,080
• Late career (10-19 years): $36,080
• Experienced (20 or more years): $41,460

The BLS provides granular salary data at the state level. Here are the five top-paying states for mental health and substance abuse social workers, a similar profession to psychiatric-mental health case managers (BLS May 2020):

• New Jersey: $901,070 average annual salary
• District of Columbia: $73,490
• California: $73,150
• Connecticut: $66,500
• Rhode Island: $65,430

Cost of living is an essential factor to consider when comparing salaries offered for different jobs. The Missouri Economic Research and Information Center (MERIC) provides a cost of living index that illustrates how much it costs to live in a particular area of the United States. By illustration, the five states listed above are also in MERIC’s list of top 10 most expensive states. This is calculated by factoring in the cost of groceries, housing, utilities, transportation, health, and other metrics from state-level data.