Mental Health Care For All

I started my MSW program at the University of Chicago in the fall of 2009. Social work was a second career goal for me. The Bush Era “No Child Left Behind” policy soured me on becoming a teacher, but I thought I’d be a professor. Well, that never happened. In grad school, I quickly learned that the field of social work had become a legion of underpaid therapists and psychologists. Before grad school, I was under the impression that social workers worked with communities to resolve or amend social problems, much like the work my grandmother Lula Jean Patton did before her untimely passing. 

The mature adult female therapist listens compassionately to the unrecognizable female client share her problems.

My grandmother unofficially drew me to the field of social work, but I wasn’t prepared to learn we’d been reduced to an entire field of discount therapists. I felt my two-plus years at the Crown School of Social Service were just a two-year case study on poor black and brown people on the South and Westside of Chicago. 

Mental health policymakers, counselors, educators, and social workers have made their careers analyzing and diagnosing the problems in poor urban and rural communities. Many in my field have made a name for themselves by designing, implementing, and lobbying the local, state, and federal governments and business communities to develop means-tested ways to alleviate poverty and address the mental health crisis plaguing society. Like what we see in the poor and working-class Southside Chicago neighborhoods like where I grew up as a foster child and teenager. 

It’s a serious problem in how mental health is addressed in my profession and by mental health specialists in general. I always wanted to empower people and give the clients I worked with the self-determination to resolve their own problems. But I always knew it was the elephant in the room.

Like everything else, mental health in the United States is considered to be placed on the individual. Rather it’s a homeless man with bipolar sleeping under a viaduct, a child with ADHD constantly acting out in class, or a former soldier afraid to sleep at night due to repeated night terrors. Mental health specialists consider these instances simple individual cases to be resolved with individualized treatment. I wish it were that simple. 

Mental health professionals often ignore the external factors that drive many mental health problems. These systematic problems help foster terrible mental health outcomes for countless individuals in the country’s most resource-starved communities. We treat mental health issues for people in these communities only in a collective manner by asking if a family member suffers from a history of mental illness. But all in all, their problems are theirs alone, and counseling will help. We need a far more holistic approach. I’m saddened that social workers who understand the complex interaction and connections between the individual and the larger society fail to bring this into the mental health profession. 

This could be social work’s greatest contribution to mental health in the United States and far beyond our borders. It’s time we start acknowledging the social, economic, and cultural factors that influence mental health in our society—a case in point is a disease like Schizophrenia. In the United States, individuals with the condition hear voices that are often violent and self-harming. In many African nations and in India, individuals with similar conditions hear voices, but their voices are more playful and spiritual. They hear the voices of their ancestors or mischievous spirits. 

This is just one example of how culture and society influence an individual’s mental health. We also need to look at an individual’s faith-based and emotional factors. Those with specific religious backgrounds may be more comfortable speaking with a counselor or psychologist who shares their spiritual knowledge. Mental health professionals should also look to alternative therapies too. A plethora of research outlines the benefits of being in nature and its impact on one’s well-being. This option might not be realistic for those who lack transportation or access to green spaces. 

It should be up to the social workers to influence our nonsocial work peers in the policy and mental health space to find ways the break down these barriers that prevent access to green spaces, perhaps as undocumented families aren’t comfortable visiting a state park when park rangers and ICE agents wear similar looking uniforms. But we could encourage community gardens, building public parks, and playgrounds for kids. Even a tree planting program in an urban area could help to boost the mental health of people in low-income communities.

Successful therapy. Young female client having consultation with psychologist, grateful for professional help at clinic. Happy black lady speaking with her psychotherapist, solving emotional problem

Since we are speaking about barriers when it comes to resources. Some people can’t afford mental health services, or their families can’t either. It bewilders me that it isn’t a critical mass of social workers who advocate for universal healthcare. This would reduce cost and give access to those who think therapy is just for the well-off people. Schools in black and brown low-income communities have more police officers than social workers, psychologists, and school nurses. Mental health breaks and outbursts in poor neighborhoods are treated as law enforcement issues versus requiring a trained mental health professional to de-escalate the situation and treat the individual. 

Poverty alleviation programs that are not means-tested can be a great boom to those facing financial barriers and economic hardship, fueling countless individuals’ bouts of depression and anxiety. Especially low-income and working-class communities. Things like raising the federal minimum wage, making the PRO Act, and the right for workers to unionize the law of the land. All Americans have a four-day work week and six weeks of paid vacation. Paid maternity leave, plus my other recommended suggestions, will do wonders for all Americans and their peace of mind.  

Insuring rural communities access to hospitals and mental health clinics would greatly help those seeking care. Internet access and improving our wifi infrastructure would permit rural communities where patients could have telehealth mental health services from a smartphone or laptop computer. 

Finally, about the mental health workers themselves. I’ve worked with military veterans who speak about their mental health care providers in hospitals and clinics not having the same experiences and cultural backgrounds. They find it hard to relate to someone from a more privileged or just plain different background than them. This isn’t always the case. But schools and universities should look to recruit people from culturally diverse communities. That includes recruiting those from the LGBTQ community and religious minorities too. 

Cost hinders people from pursuing higher education. That means fewer people from diverse backgrounds entering the mental health fields. Canceling student loan debt and making public colleges and universities free for all will break down barriers for people in marginalized communities. 

There is always the burnout factor for those who work in the mental health profession. Higher pay, greater paid vacation time, and sabbaticals could also address the burnout problem in the field. And mental health professionals need to vent and let off steam too. Someone must talk to those who help the most vulnerable in society. Therapy for the therapist would benefit those who serve their communities and their clients. You can’t help anyone without first helping yourself.

The point of this post is not to denigrate those in the mental health services. But to help us think outside the box. We can no longer ignore societal factors’ impact on mental health outcomes. It’s time we go beyond traditional mental health. 


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