10 Tips on surviving community mental health clinic work
Working at a community mental health clinic (CMHC) can be incredibly challenging, yet meaningful work, that will transform a novice clinician into a more confident, knowledgeable, seasoned mental health professional. Often at a CMHC you will see an array of clients with different religious, cultural and professional backgrounds with a wide variety of different mental health concerns. Often, there is little to no choice in which clients end up on your caseload, forcing the therapist to learn many new modalities to treat specific conditions. Often, there is little formal training on how to deal with specific disorders and conditions. On top of the immense personal learning a clinician must do while treating client’s mental health concerns, there is an equal learning curve on how to complete necessary paperwork in a timely fashion and adjust to the demands of fee for service work.
Below are a few tips to help survive working in a CMHC:
1-Learn exactly what is expected of you.
CMHC often expect you to do a treatment plan update every 3 months, on top of screens and any additional notes. Session notes are often asked to be completed within the week. Ask your supervisor for the rules in writing or a employee manual about the paperwork expectations and compensation.
2- Bundle your notes by creating several different templates for common notes
In an effort to save time, create a standardized note for all sessions. It may look like different depending on your personal style and how much you are expected to document in your notes.
“Client presented as ___________ evident by affect, mood, self report, etc. Client reported ____________. Main themes discussed included; time management frustrations/impact of childhood on current functioning/ vocational stress/ difficulties in relationships/low self esteem/substance abuse/ etc. This therapist used ______ (CBT/DBT/ACT) interventions such as__________ (mindfulness/grounding/distress tolerance) to address any _______ depressive/anxious sx”
Each of my notes follows this structure, allowing the clinician to fill in the necessary information as needed.
Another example is for missed or canceled sessions.
“Client contacted this therapist to report that they would be unable to make their session due to _______________”
Whatever notes you find yourself writing each week, create a simple template to copy and paste into their files.
3-Schedule specific time to do Treatment Plan Reviews
Many supervisors suggest you complete the clients treatment plan with them in the room. While I agree this is best practice, it is not always possible due to the strict deadlines for treatment plans. Schedule a specific time, earlier in the week and day to figuring out which TP need to be updated and signed by the client during the week.
4-Keep high protein snacks in your desk drawer.
Often, I would need to schedule clients back to back in order to make a decent living. I would expect to eat a full meal when someone canceled on me, which was inevitable working in a CMHC. However, there would always be a few days where everyone would show or a crisis or expected session didn’t allow for a proper meal. Keeping high protein or high energy snacks in your desk can be a lifesaver when you only have 10 minutes between session.
5-Put in more work when you begin the job.
Create an excel sheet of all of your clients, their numbers, case numbers types of insurance, last date of Treatment Plan and other mandated paperwork. Most treatment plans are expected to be updated every 3 months. Create a shortcut in excel to depict when they next treatment plan is due.
6-Learn your clinic’s termination policy and enforce it as strongly as possible.
Many clinics allow therapists to close cases after 2-3 missed, scheduled visits. Many clinics ask that you sent a letter to the client’s home with a final appointment stating their case will be closed, should they not attend this appointment. Create a standardized letter with this information to make it easier to send out. Create the form with blank spaces so you do not have to edit a word document with each note. The note should provide 3 alternate resources for them to obtain services, should they not wish to return to your care.
7- Use sensitivity in your note taking.
Your notes may be subpoenaed at any time. Write with intention. Refrain from adding personal opinions about the clients. Only report what the clients reports and not your interpretation of it. Keep a separate notebook for any analysis, personal interpretation and feelings of the client. The client also has the right to access their records at any time so be careful to use language that is neutral and not offensive.
8- Learn exactly how you’re allowed to bill
Some CMHC allow you to bill for a crisis call, depending on length of call and insurance policy. Make sure to use the correct codes when writing session notes. For example, family sessions often pay a higher rate and require a 60 minute session while individual sessions might be 30 or 45 minutes.
9- Get to know your coworkers
Your coworkers can be an excellent resource to learning the ins and outs of CMHC work and how to best cope with some of the difficulties you may experience. Coworkers are one of the best ways to obtain help within the system you work. The emotional support and social connections you make will benefit your ability to handle the difficult cases. Having coworkers to discuss cases, new modalities, new treatment methods, books and articles to read and have informal supervision is truly valuable and makes working in a CMHC much more rich.
10- Show compassion to yourself
Working in a CMHC is difficult. You are mostly working with people who are experiencing poverty, have severe mental illness and few resources to manage their symptoms. Frequently in my early years working in CMHC, I was given cases that were far more complex/advanced than my my knowledge base, which forced me to study treatment options on my personal time. Learning how to treat Borderline Personality Disorder meant ordering a DBT book and beginning to learn the basics myself, unsupported. There is only so much one person can learn and understand in the mental health field. It is impossible to be an expert on each disorder and be able to create it skillfully. The expectations placed on CMHC workers are often unrealistic and at times, dangerous. Find compassion for yourself that you are learning and will inevitably make mistakes. Learn from those mistakes. Admit your mistakes to your clients and help them understand that you, as well, are only human.