When Clients Lose Services Peers and Social Workers May View It Differently

People recovering from serious mental illness can become peer specialists and work in mental health clinics. After they have had only rudimentary training peer specialists can be very effective, as has been proven by research. Peers work with clients on specific problems. Social workers monitor up to a hundred people while trying to help them with their problems.  Social workers have extensive training but with such high caseloads, approaching 100 people or more, they typically spend a lot of time on the people who are in crisis. Keeping people out of crisis is very important. Helping people move into recovery and become more independent is also very important, and peer counselors may be in a better position to do so.

If the roles that peers and social workers play may be somewhat different, the views of peers and social workers are similar. That being said, there may be differences in how these two types of clinic workers see things.

 I have had the opportunity to read the electronic notes that social workers write and also talk to those same clients.

We all want to allow our clients to identify his or her own problems and choose solutions. In fact, most people will  identify problems and discover solutions on their own, even if they don’t have someone to help them. But if people don’t, in fact, need someone to help them resolve their problems, they may not need a mental health clinic. People who go to mental health clinics might be characterized as people who thinking on their own often don’t figure out solutions. So if people with serious mental illness need help, what kind of help do they need?

Their are many possible examples of the different kind of help which peers and social workers might offer. To take one example, peers and social workers might have different approaches to the problem of a client losing eligibility for services. Clients lose eligibility for a variety of reasons, some bureucratic, some seemingly random and some because the client doesn’t have enough problems to warrant government funded treatment. Regarding this last issue, people often start out on state aid and then if they are turned down for federal aid, they then lose the state aid as a result of not being found “disabled” by the Social Security Administration. That may not be a finding that a person does not have a serious mental illness. Maybe they will be able to find and keep work and survive. Others who lose services lose access to medication and spiral into worse and worse shape until they hopefully seek help again, obtain it and move onto a path of recovery.

When services are terminated, people may lose monthly checks, medical  and prescription med coverage and housing. They may end up on the street.  Since the client can’t come to the clinic, a social worker might feel no need to address the clients life or issues after they become an non-client.  Why should a social worker address future problems a “non-client” might face? Social workers are paid to help clients not people who are not clients.

Agencies rarely have any policy about such termination situations beyond a xeroxed handout listing shelters, feeds and free medical clinics.

On the other hand, a peer specialist might be more likely to view the termination of services as something which should be the focus of much more attention. A social worker may reason that terminated clients will either find a job or deteriorate to the point they become eligible for services again. But a peer specialist might think that helping people plan how they might survive on the street or even with a job but without medication is something worth spending energy planning. Some clients will find jobs, not be able to access medications and while they are working still live in shelters–essentially on the street.   And there are, in fact, “services” for people who don’t have services–the shelters, feeds and free clinics on those xerox handouts–but  a person can also obtain medications from charity programs at pharmaceutical companies.

How often are clients terminated by clinics told about charity medication programs which the manufaturers have? At most it might be mentioned in passing.  The client probably won’t be provided detailed information or training in how to do it. After all, a person with this problem is not a “client” but a “former client. And social workers may not see it as their role to help people with issues which are not part of the encapsulated world of their clinics. They help people who have benefits. Those people without services, out their on the streets, whoever they are, whether they are former clients or not, might be seen as somebody elses problem.

Peer counselors may appreciate the fact that they are prohibited from any contact with those former clients–under a variety of rationales. But peer counselors may be willing and able to help the client plan for being a nonclient in a meaningful and effective way. Of course social workers could do so too.

If you work at a clinic, you should raise the issue of what the termination and exit policy is. At the very least, people should be handed (and mailed) those xerox sheets of shelters, feeds and free clinics–along with information about how to access free meds. Or if they are working, some meds might be within their means to purchase.

But more than this is really called for, including a policy about the topic being addressed in whatever time is left for a client at a clinic. Or clinics can make the time and provide a planning session for clients even after they have lost their coverage.  Your clinic may say that it can’t let staff see clients once their coverage has ended because this raises an “issue of liability”. This explanation is in fact absolutely, completely and unequivocally untrue, at least in any meaningful and realistic sense. In fact, it would be astonishing and a serious issue if a clinic did not have insurance coverage for dealing with clients who don’t have Medicaid coverage, because treatment is inevitably provided to such clients due to computer and other errors.  

Clinics can and should help their “former” clients with at least one last session  to address exit and termination plans. Maybe that last session will be the most real and effective discussion the social worker and the client ever have.


About mentalrecovery

I work in a large mental health clinic and am active in NAMI
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