In the wide spectrum of mental health, there are those who are capable enough to live independently but need a little help along the way. Such is the work of a mental health case manager we spoke with who helps individuals with certain needs go about their daily lives.
Photo by Photographee.eu (Shutterstock).
He works with a wide range of people, but they’re all individuals who need some monitoring and help with simple tasks like grocery shopping, maintaining their proper medication, and going to doctor appointments.
Tell us a little about your current work and how long you’ve been at it.
I work for a mental health agency in Washington state as a case manager for an Intensive Out-Patient (IOP). We work with mentally ill people who are more symptomatic than average. Picture someone roughly between “scary screaming homeless guy” and “your eccentric uncle who thinks he was abducted by aliens” and you’ve got a good idea of the type of population we serve. That sounds like a big range because it is; some days I get yelled at by clients and other days everyone is super cool and chill.
My job in a nutshell: I help my clients to meet their basic needs. I’m a combination taxi driver, professional grocery shopper, and tag-along to doctors appointments.
What drove you to choose your career path?
I had a lot of friends in high school that had various mental illnesses, mostly depression, anxiety, and some self-harm (most people probably knew someone in high school who had some of these issues, I imagine). I really wanted to help these people so I decided to learn about psychology. My first psych course was super interesting so I studied it in college as well. Figured I could make a small difference in the world and get paid for it too.
How did you go about getting your job? What kind of education and experience did you need?
To become a case manager you realistically need a liberal arts BA or BS (majors in psychology, sociology, and anthropology are popular as is social work) and at least a year of experience being something similar. Technically you only need to be a “Agency Affiliated Counselor” (see next question) but the more education you have the higher rate you can bill for (and the more money you can make for your agency).
After college I worked direct-care with severely autistic men and eventually worked my up to being a manager of a few assisted living facilities. I didn’t much enjoy that field so I started to look for a job in the mental health field (which requires experience to begin with) and managed to get an interview with my current employer. I used my years of experience working with severely autistic men and managing staff to sub for experience in case management.
Did you need any licenses or certifications?
You need to be an Agency Affiliated Counselor in Washington state, which is actually pretty easy to get. You need four hours of HIV/AIDS education and you have to sign a form saying you are not a horrible person (not an arsonist, thief, etc). One would also need to have the agency that one works for approve said application. So, typically, you get a job at an agency and then you have 30 days to apply for a credential.
What kinds of things do you do beyond what most people see? What do you actually spend the majority of your time doing?
I spend the majority of my time driving around, taking clients to doctors appointments and going shopping and doing general errands that my clients would have a hard time doing on their own. I do an average of 56 kilometres of day of city driving, about two hours a day give or take (not including commuting to and from work).
Behind the scenes, so to speak, I spend quite a lot of time on the phone and doing paperwork. All client interactions have to be documented so that they can be billed for. The money is what keeps the agency afloat; without the paperwork then the agency as a whole goes bankrupt and can’t help anyone anymore.
What misconceptions do people often have about your job?
That it’s really really hard and it drives us (the case manager’s) insane. That’s true after a fact — the job is stressful. But it’s not that hard really. You just have to have a lot of patience to deal with people who’s issues are getting in the way of living their life. From someone yelling at you about the government (above and beyond what your eccentric uncle may rave about at Thanksgiving) to speaking with someone who takes 15 minutes to fully form a thought. Patience, patience, patience.
What are your average work hours?
I work a little over 40 hours a week on average. The agency I work for is pretty good about watching out for its employees so they don’t get burned out. Like I mentioned before, you need a lot of patience to do this job. But if you work for more then 40 hours a week and don’t take vacations then the stress WILL start to get to you and you may find yourself on the other side of the case manager relationship before too long.
What personal tips and shortcuts have made your job easier?
I use the crap out of technology. Smartphone to check my email while I wait in a doctors lobby with a client, documents to track my time and my mileage, and digital remainders (phone again) to make sure I don’t forget the million things I have to remember every day. Anything that makes my job more efficient I am game for.
A tip for aspiring case managers: never take anything personally, ever. Clients may yell at you and call you terrible names (or even try to assault you) when they are quite sick (often when they have stopped taking meds for whatever reason). You can’t take it personally. Most of them are yelling at their symptoms, not you. It’s because they are in mental pain, which stings just as much as actual pain (or more so). Just try to imagine having a decent conversation while you are suffering a migraine, except the migraine is emotional. It’s bad news, and you cant take what clients do personally.
What do you do differently from your coworkers or peers in the same profession? What do they do instead?
I don’t do that much differently then my coworkers because our clients tend to thrive on consistency. At my agency we work as a team so we all have to be on the same page when it comes to client interactions. If I do anything differently then my coworkers it’s the tips and shortcuts I listed in the last question.
One thing that does come to mind that makes me different is my physique. Most of my coworkers are rather petite woman; this field is dominated by women in general (I would say 75% of people in this field are female). I am a very large man which I suppose would set me out from the crowd. It also lands the more sexually aggressive clients on my caseload because they typically have little desire to sexually assault a person of my size and/or gender. I’ve been told it’s quite beneficial to have a man on team for this reason. My gender also works against me sometimes as some clients feel intimidated by my size or feel like I don’t seem “warm” or “loving” enough. Some clients also have a history or abuse from men and subsequent PTSD; it’s rare but I there are some clients I can’t really work with because they experience extreme anxiety or paranoia when any man is around them for more then a few minutes at a time.
What’s the worst part of the job and how do you deal with it? I’m sure it takes an emotional toll when a client is struggling.
Doubt. Doubt is the worst part of the job in my opinion. A heavy example: when a client dies due to exposure (it happens to homeless people more often then most realise) it can really get to you. You start thinking “What could I have done differently? Is it my fault this person is dead?” That’s hard to deal with sometimes, the raw nature of it. Thankfully clients die pretty rarely. When they do I remind myself that, at the end of the day, sometimes the best I can do is present clients with better options and try to encourage them to change their lives. I can drive them to the doctor but I can’t make them get in the car.
It’s tough when a client is struggling, especially when their struggle seems self-inflicted. Substance abuse is a common co-occurring issue with clients, for example. Another tough scenario is a the med-compliance spiral. A client starts to feel paranoid about their medications and decides to stop taking them. This makes their symptoms worse and they start to spiral out of control. Hopefully they come back into compliance or, alternatively, voluntarily land themselves in the hospital before they do something illegal and/or dangerous.
Finally, like any job, the bureaucracy involved can be a hassle. The paperwork I mention above can take a very long time and is very tedious but ultimately necessary.
What’s the most enjoyable part of the job?
Success. Those little victories are the best part. When a client decides, all on their own (with your help of course), to start saving money to buy a new guitar by quitting methamphetamine. Or when you finally find the right med combo that helps a client maintain control of their senses so they start looking for a job. Or the bittersweet feeling you get when you are finally able to beat the system and get someone dangerous detained. That’s a tough scenario all around, when you know a client is headed for disaster and the only thing that you can safely do is try to get the police involved before someone really gets hurt.
As an aside, it’s very difficult to get someone involuntarily committed (detained) now-a-days. It used to be you could get someone detained if they started to, for example, scream and threaten to kill people (with an actual weapon or otherwise). Makes sense right? Someone not in their right mind and presenting a danger to themselves or others should be somewhere safe until they get a chance to calm down, sober up, and/or get on the right medications. Now a client needs to be covered in their own faeces, running around in traffic, and screaming and threatening to kill people (with a weapon in hand already) in order for them to even be evaluated for detention. This is because psychiatric boarding was recently determined to be “unlawful” in Washington State and no funding was made available for any alternatives. Google it, call your legislature.
Occasionally we get to do fun stuff with clients too, like take them as a group to a park or something. That’s always enjoyable too.
What kind of money can one expect to make at your job? Or, what’s an average starting salary?
One can expect to start at about $US14 an hour and work your way up from there, getting about a $US0.75 raise each year or so until you cap out at around $US26 an hour. I’ve been at this for a while so I make somewhere in the middle of that.
How do you “move up” in your field?
Typically you have to get a Master’s degree to be eligible to move up directly in mental health. Technically all Bachelor’s level case managers work under the supervision of one or more mental health professionals (MHP). The process of becoming an MHP is similar to becoming an Agency Affiliated Counselor except that you need a Master’s degree or your agency needs to fill out some paperwork to make you a special exemption for you. These exemptions occur extremely rarely; typically they happen because the MHP in charge suddenly was fired/quit and the agency needs someone to step up immediately.
What do people under/over value about what you do?
As I mentioned before, most people don’t understand the amount of work that goes on “behind the scenes,” so to speak. For example, getting a client into a nursing facility can be pretty rough going sometimes. From the outside that process can seem like this:
- Declare client needs to be in a nursing home.
- Time passes.
- Client gets admitted to a nursing home.
Sometimes people don’t realise that Step 2 actually involves a lot of work; phone calls, endless doctors visits, and giving a client a lot of extra help to make sure they don’t die while they are waiting for the right level of service to materialise.
On the flip-side I get a lot of people who over-value the level of patience it takes to do this job. For me it’s not hard to be patient with people with mental illness; I realise the limitations that their symptoms impose and adjust accordingly. It doesn’t hurt that I get paid to be patient too.
What advice would you give to those aspiring to join your profession?
Read this entire interview and ask yourself: could I do this job? Seriously, that’s the advice I would give. Also, practice good self-care. This kind of job can take a lot out of you emotionally. It’s important to take time for yourself (get a hobby!) and to leave your work at work. Everything will get done, in time. I could work 16 hours a day, seven days a week and still not get everything done. It’s important to know how to prioritise.
Knowledge is power — in this field it literally is. Know your clients; know which client can go shopping on their own if you have to drop everything in an emergency, know what their baseline behaviour is so you can tell the difference between a client’s illness taking a downturn and said client just having a bad day. Know your teammates; know their schedules so you can lean on them when you have to and so they can lean on you, know their skill-sets so you can trade clients if one just isn’t working out for you. Finally, know your agency. Follow the rules and use common sense. If you have any doubt as what to do in a situation then kick it up to a supervisor. Call your boss and get their take on the situation, talk it out and find the best solution for everyone.
This interview has been edited for clarity.
Career Spotlight is an interview series on Lifehacker that focuses on regular people and the jobs you might not hear much about — from doctors to plumbers to aerospace engineers and everything in between.
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