American practice patterns

American mental health social workers are more likely to follow closely a specific theoretical approach when they work as counsellors only. In this role they are likely to follow either a behaviourist or a psychodynamic-humanistic (Rogerian) approach.

Presently, many work within the private not-for-profit and for-profit sector, predominantly as care managers and counsellors/psychotherapists, rather than in the public sector. The move to private practice occurred during the 1970s and 1980s. It was seen as desirable for the purpose of professional autonomy and to enable the worker to be engaged in counselling and family therapy, at a time when less and less counselling was on offer within the public sector.

It is perhaps easier to follow a specific conceptual approach within private practice, which is largely freed from the obligations of welfare bureaucracies. However, working for a private corporation is likely to introduce its own limitations, such as a time limit on the number of therapeutic contacts, assessment, hospital admission, and lack of eligibility for those people who are uninsured. In addition, working mainly at this end of the mental health system implies not working with the millions who are not insured, who are more likely to be poor and deprived, and therefore placed within the group to which social work is committed to work with first and foremost.

Mental health social work, especially with adults, is a major growth area in terms of employment opportunities.

As care managers social workers are responsible for the assessment, planning, and implementation of a package of care. Thus they have the key position of discharging people from mental health facilities as well as placing them in residential and day facilities. Within American social work care management in mental health there are strands described as 'clinical care management' which is akin to the psychodynamic approach, (3,9) and the application of the strengths approach within care management.(33)

Social workers can be licensed to compulsorily admit people to psychiatric units, including those who work in individual private practice. Although the examination for licensing is demanding, psychologists, nurses, and psychiatrists—as well as social workers—can become authorized to carry out the process of compulsory admission (which in the United States is termed 'civil commitment').(40)

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