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

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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: in a single year, approximately 43 million Americans experience mental illness and almost 10 million experience it severely enough to interfere or limit at least one major 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.

Often the circumstances surrounding mental health issues are 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 not only assess their clients in a thorough and compassionate manner but also 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 all the way through the process.

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

Work Environment

Psychiatric and mental health case managers can be employed in a variety of 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.

Clinical Team

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

Typical Daily Responsibilities

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 do 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.

Initial Assessment

In an initial assessment, the case manager will conduct a client-focused, all points assessment that takes into consideration 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 (as well as adherence to HIPAA privacy standards) is critical, especially as the client is connected to other resources and mental health professionals in the future.

Strengths-Based Evaluation

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

Resource Integration

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, and 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.

Follow-Up Care

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, but progress metrics can include a higher level of functionality, fewer instances of hospitalization, less dependency on community programs, and an 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.

Discharge

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 discharge will depend entirely 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.

Required Skills & Knowledge

Case managers typically need at least a bachelor’s degree, but many employers are increasingly requesting 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, as well as the numerous community and health resources that can be integrated in 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 members of the community 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, as well as a commitment to continuing education in order 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 also 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 not only hold on to their own sense of positivity but also to instill that belief in the clients they serve as well. Balancing this attribute with a set of healthy professional boundaries is crucial both for nurturing a client’s sense of self-sufficiency and for retaining the case worker’s ability to remain continually compassionate and hopeful.

Certification for Psychiatric-Mental Health Case Managers

Psychiatric and mental health case managers almost always need to be licensed by the state in which they choose to practice, and conditions and regulations surrounding licensure 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 are requiring 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.

In order to apply to take 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.

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