Assisting Individuals with a diagnosis of Mental Illness

As a social worker, you often work with vulnerable and struggling clients. One such group, you may work with are individuals diagnosed with a mental illness. Mental Illness does not discriminate. Any population you work with, will likely have some people living their life with mental illness. Sometimes because of media portrayals and other misconceptions, working with people diagnosed with mental illness can be scary or daunting.

There are many types of mental illness. The DSM-V (where the criteria for different mental health diagnoses is listed) has about 991 pages.

Below are some basic definitions of common diagnosis you might come across.

One definition of Mental Illness I like is from the Mayo Clinic

Mental illness refers to a wide range of mental health conditions —disorders that affect your mood, thinking and behavior. Examples of mental illness include depression, anxiety disorders, schizophrenia, eating disorders and addictive behaviors. Many people have mental health concerns from time to time.

(www.mayoclinic.org/diseases-conditions/mental…/definition/con-20033813)

I like this definition because it normalizes mental health issues. Mental health conditions run on a continuum. Just like people, mental illness is complicated and some people struggle with more difficult issues than others.

Specific Diagnosis Definitions (Also using the definitions from the Mayo Clinic.)

Major depressive disorder — prolonged and persistent periods of extreme sadness

Bipolar disorder —also called manic depression or bipolar affective disorder, depression that includes alternating times of extreme sadness (depression) and extreme happiness (mania) (//www.mayoclinic.org/diseases-conditions/mood-disorders/basics/definition/con-20035907)
Generalized Anxiety Disorder – excessive, ongoing anxiety and worry that interfere with day-to-day activities may be a sign of generalized anxiety disorder. (//www.mayoclinic.org/diseases-conditions/generalized-anxiety-disorder/basics/definition/con-20024562)

“Schizophrenia is a severe brain disorder in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and extremely disordered thinking and behavior. Contrary to popular belief, schizophrenia isn’t a split personality or multiple personality. The word “schizophrenia” does mean “split mind,” but it refers to a disruption of the usual balance of emotions and thinking. (//www.mayoclinic.org/diseases-conditions/schizophrenia/basics/definition/con-20021077)

Those are just some of the diagnoses you may come across in your work. Let me share some tips for a social worker to remember when working with this population.

Remember that the individual is not their mental illness. They are a person with a diagnosis of a mental illness. Instead of saying “Schizophrenic” say, “my client who is diagnosed with Schizophrenia.” For example, if you worked with someone who had cancer you wouldn’t say, “my client, Cancer missed his appointment.” You understand that cancer may take up a lot of the client’s time and thoughts but that they are so much more than their cancer. It is the same with mental illness. It is only a piece of a whole person.
Ask yourself if you would say the same thing about someone with a physical health problem. If the words you use would sound ridiculous if said pertaining to a physical illness – you likely shouldn’t be saying it in relation to mental health. I can’t imagine you would tell someone to “just get over” a broken leg and it is no more appropriate to tell that to someone with Depression.
Listen without judgment and don’t argue. If someone has hallucinations or delusions – don’t argue. Arguing will not change the other person’s mind and could build a wall between you. If a client tells you that the TV is sending them messages you can certainly assess if the messages are harmful and assess where the client is in relation to their baseline, but you will get nowhere if you spend your time trying to convince the client that they are wrong.
Remember that Severe Mental Illness does not equal stupid. This is one of my biggest pet peeves. In my work, I collaborate with other professionals, most are excellent. My experience has been that some professionals tend to talk down and condescend when assisting someone with mental illness. Don’t assume someone with a severe mental illness has cognitive problems. They aren’t the same thing. Mental Health has to do with emotions and the way the brain interprets events. It does not equal the intelligence level of a person.
Build a relationship similar to how you would with any client. Don’t start every interaction with “are you taking your medications.” I need to lose weight, but I would not want to work with someone who started every conversation with ‘”did you stick with your nutritional plan?” Listen, interact and encourage as you would anyone.
Believe in the possibilities of your client’s life. People with mental illness run the gambit from homeless to professional executive to artist and I have worked with all ends of the spectrum. Don’t assume that your client will live a life a despair. Someone with mental illness can feel joy, love, and be as successful as anyone.
Someone with mental illness can have a bad day or be angry or impulsive and it may have nothing to do with their illness. Each of us has days we struggle more than others. Sometimes I got angry at work or overtired or sad. This isn’t a sign that everything is falling apart. Get to know your client’s baseline and understand they may have bad days that are just bad days and not indicative of a decline of their symptoms. You can work with your clients to recognize which symptoms mean they are getting worse – such as voices getting more insistent or staying in bed all day- and not assume every bad day is a sign of decompensation.
Keep learning and educating yourself on mental illness and advocate for your client’s right of self-determination.

Working with individuals who struggle with a diagnosis of mental can be rewarding. You can learn a lot from your clients while assisting them to live the best life they can. As a social worker, you can be another person fighting against the stigma of mental illness.