I read two things in my local newspaper recently that struck me forcibly.  One was that my state has the dubious distinction of being 50th out of 50 in the number of psychiatric beds it has available.  The other was that social work was the most poorly paid out of any of the majors one could choose.

It made me sad.  Sad for all of the mentally ill people I see wandering the streets.  Sad for the families who have fewer and fewer community resources to help with their troubled siblings and children.  And very sad for the young, idealistic people who acquire massive college debt and then feed themselves into the maws of social services and community mental health, only to find that they will be paying off that debt until they retire. 

The institutions they work for can be very dark places.  Many community mental health centers do the best they can, but with such heavy case loads (anywhere between 50-170 cases per clinician or case manager) it is difficult to feel that one makes a difference.  The work is exhausting and most frequently cannot be done in a 40 hour week.

The second point, that of a dearth of psychiatric beds, says several things.  One is that insurance companies  frequently exclude mental health issues from  coverage, and so families cannot afford to pay for decent mental health care: hence no beds. Stigma about mental illness still prevails, despite increasing scientific evidence that mental illness is as biologically based and "real" as physical illness.  And those abusively  underpaid social workers and therapists will be the ones managing very ill  cases outpatient, because there is nowhere for the patients to go.

At every level of the mental health system, acuity of illness is rising.  That is because we are trying to care for people who should properly be accomodated  at the next level:  some outpatients should properly be cared for in day treatment; some day treatment people need residential care; and some people in residential really need to be hospitalized. 

The bad news doesn't end there.  Pay tends to flatten out as one works in community settings: that is, a social worker with 20 years of experience will not get paid all that much more than one with ten.

 Assuredly, money is not the only reward of working with the disenfranchised and dispossessed.  There is a sense of altruism, of making a difference.  The social services and community mental health system rely on this to keep themselves going.  They bring in newly graduated human services people, work them hard, and show little compassion for the impact on them  of the waves of poverty, cruelty, waste, and grief that is the fate of most mentally ill people in our country.    The lack of appreciation  the system displays for its workers is a commonplace.   When one is trying to support a family on the wages and consideration  that this system provides, altruism can seem like very thin gruel.