Alison H. Climo, MSW, Ph.D., is a community engagement specialist in aging at the UNC Chapel Hill School of Social Work Center for Aging & Adult Research and Educational Services (Cares) Program
According to the 2023 State of Mental Health in America survey, one in five adults (21%) are experiencing at least one mental illness, and a little over half of them (55%) have not received any treatment. As an APS worker, it is very likely you will encounter individuals who are experiencing mental illness, whether they are diagnosed (and/or receiving treatment) or not.
Let’s first distinguish between mental health and mental illness. Mental health includes emotional, psychological, and social well-being. It is part of the larger umbrella of behavioral health, which includes both mental health and physical behaviors that contribute to a person’s overall health and well-being. An example of a physical behavior would be avoiding or moderating one’s use of substances such as alcohol.
Mental illnesses are conditions that affect a person’s mental health. They are generally characterized by changes in thinking, feeling, mood, or behavior, and they can cause distress and impair one’s functioning. Of course, the experience of mental illness can be highly subjective and informed by social, cultural, and historical contexts, norms, and expectations.
It’s important to note that poor mental health doesn’t automatically translate to mental illness. A person living with mental illness can experience excellent or poor mental health. Conversely, a person could experience poor mental health without having a mental illness. Furthermore, due to certain stigmas, seeking and/or receiving mental health care can sometimes be seen as a sign of dysfunction, but in reality, it is a sign of health and strength. While there is no cure for mental illness, there are effective treatments, and people with a mental disorder can recover and live long and healthy lives.
Behavioral health professionals have a resource created by the American Psychiatric Association (APA) called the Diagnostic and Statistical Manual of Mental Disorders (DSM). It is considered the authoritative guide to the diagnosis of mental disorders and is used by health care professionals in the United States and much of the world. The DSM contains descriptions of symptoms and other criteria for diagnosing mental disorders. It does not, however, address causation. There are 19 disorders listed in the current edition of the DSM (Edition 5 Text Revision).
The DSM does not prescribe treatments for mental health diagnoses. It is a diagnostic tool that clinicians use, as well as a means of communicating about client cases between professionals. Receiving a diagnosis from a qualified professional is necessary for insurance to cover and reimburse treatment, and is typically necessary to enroll in specific treatment settings.
Access to mental health treatment varies greatly from state to state, community to community. Some variable factors include access to insurance, quality and cost of insurance, access to providers, and availability of providers with specialized training. While options will vary, it is important to understand the mental health system that exists where you live. Mental health services in general include the following:
Regardless of setting, treatment for mental disorders often includes psychotherapy, also known as talk therapy, which explores thoughts, feelings, and behaviors, and seeks to improve an individual’s well-being. Medications can also be used to treat the symptoms of mental disorders. Medications are often used in combination with psychotherapy and are offered in both inpatient and outpatient mental health settings.
While mental health treatment has come a long way in recent years, there are still problems and barriers associated with treatment. Good treatment can be expensive, stigma can be severe, and the settings in which treatment takes place can cause added stress for some individuals. Depending on culture, language, and even the nature of their diagnosis, individuals may experience efforts to help them as insensitive, invasive, and even traumatizing.
To avoid stigmatizing the people we work with, we must work hard to provide truly person-centered care. Around the turn of the 21st century, a new model of care began to emerge. Person-centered practice was codified in the 2010 Affordable Care Act, marking a shift from seeing people as patients who must comply with doctor’s orders to seeing them as consumers of mental health services. Although there is no single definition for person-centered practice, one way to describe it is to summarize its core principles, which include the following:
It is also important to remember that health and illness are perceived differently across cultures. Much of the mainstream approach to mental health, mental illness, and treatment are rooted in Western culture and Western understandings of the human condition.
Cultural differences affect how people view health and illness, how they approach seeking treatment, how they experience the therapeutic relationship, their coping strategies, and their experiences of racism and discrimination. This has important implications for practice.
A person-centered practice approach would suggest tapping into cultural resources to better understand what people from a particular culture want and value. For example, this might include involving traditional healing practices and systems in the provision of mental health services.
The term “cultural competence” is loosely defined as the ability to engage knowledgeably with people across cultures. However, this term suggests that there is some finite set of knowledge a person could attain about a group of people or a culture. This can lead to stereotyping and bias, and it implies there is an endpoint at which a person has become fully culturally competent.
Alternatively, the term cultural humility was coined by Tervalon and Murray-Garcia (1998) to describe “a lifelong process of self-reflection and self-critique whereby the individual not only learns about another’s culture, but starts with an examination of their own beliefs and cultural identities.”
Cultural humility is person-centered in that the client describes their experience, goals, and values, informed by their culture, and the social worker is the learner.
With cultural humility, partnerships between service providers and individuals are empowering and more equitable, providing integrated and holistic approaches toward mental health treatment.
Finally, the concept of recovery for people with mental health problems is not clear cut. Rather, the “recovery model” of mental illness emphasizes building resilience and supporting those in emotional distress instead of just treating or managing symptoms.
The recovery model is often referred to as a process or guiding principle and provides a holistic view that focuses on the person with mental illness, not just their symptoms. This model asserts that recovery is possible and that it’s more of a journey than a destination. Like life, it can have many ups and downs.
Each of us is on our own journey, in which our emotional, psychological, and social well-being determine our thinking, feeling, mood, behavior, and functioning. By having a solid grasp of the mental health system, honed skills in person-centered practice, and a strong commitment to cultural humility, you establish a firm foundation for effective practice in adult protective services.
Mental Health 101
Related APS TARC webinars:
Last Modified: 11/30/2023