“Thank God for trump”: Staying unbiased in social work

I was speaking with a client the other night and was struck by her rigid view of the world. Her boyfriend’s friends are” evil,” she’s being “attacked” by her family members.

I like to use humor, and I nearly said this: “In all my years I’ve never heard of anyone who’s actually evil – with the possible exception of Donald Trump.”

Trump was on my mind because he’d just won the Indiana primary. As much as I’d like to sit back and eat popcorn while watching the Republican Party explode, I find it so disturbing that so many Americans could be won over by hate.

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The implications of Donald’s success paint a darker picture of humanity than my clinical experiences, which generally leave room for human strength and resilience. Trump is different. The fact that vast numbers of Americans would be attracted to somebody who basically embodies the fantasy of grotesque wealth no matter the human cost – I find that chilling. To me, Trump is saying “I hate all these people, but if you support me you’ll be rich like I am”; and it’s hard to see Americans buy that pitch.

Here’s why I’m glad I didn’t make a comment about Trump with the woman. During our conversation she kept bemoaning the world’s problems. Then she said, “Thank God for Trump. At least something’s right.”

I didn’t laugh in her face. Maybe that would have been justified during a normal encounter. But this is social work.

I encouraged her to volunteer with the Trump campaign.

Let’s face it, social workers tend to be liberal – myself included. Liberalism is about helping people while conservatism is about people helping themselves, so it’s hard to understand how a conservative could be a social worker (I’d love to talk to one! Please get in touch.) We need to be really careful around our political biases. Because I came damn close to ending my conversation with this woman in need before it even started.

Why social work isn’t changing – and why that’s hurting consumers

I vividly remember my social work field placement at a residential drug treatment program. The one licensed social worker on staff was so burnt out she’d taken to listening to Leonard Cohen’s “Hallelujah” with her office door closed. With no meaningful guidance I was in a constant state of panic.

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Not music therapy

The staff psychiatrist, meanwhile, would jet in like a rock star. He always seemed happy and people lined up to see him.

It was a vivid demonstration of a real problem: as social workers we fail to advocate for ourselves, and in the end this hurts our clients.

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My wallet's never looked like this

Society wants us to work – and work cheap

The baby boom is aging, the healthcare system is changing, and demand for social workers is only going to grow. Demand for most kinds of social workers (mental health, substance abuse and healthcare social workers) is expected to explode by 19% between 2014-2016, far outpacing the average for all industries (around 6%) and exceeding the growth rate for psychiatrists (15%).

Despite this boom in demand, social workers’ salaries are not keeping up. According to surveys from Payscale.com, the average social worker increases their earnings by only 37.5% over a 20-year career, going from $40,000-$55,000. In contrast, a psychologist will increase their earnings by 50% ($60,000-$90,000 per year) and a psychiatrist will increase their earnings by 24%-but that’s from an already high starting salary of $174,000 per year, capping out at $216,000.

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Salary of social workers, psychologists and psychiatrists after 20+ years in field

For some in society – nonprofits and government agencies – this has obvious short-term benefits. Bossman loves cheap labor. (Indeed, it’s probably worth noting that social work is more populated by women and minorities than psychiatry and psychology – I’d suspect that’s one reason for the lower pay). Whatever the cause of the salary gap, it has serious long-term consequences – and not just for social workers.

The sick reality is that interns and beginning social workers are charged with the most vulnerable, high-need people. Survive in the field for 20 years and you can get rich helping millionaires with public speaking anxiety.

The cost of low pay

Most social workers don’t last for 20 years in the field, according to Salary.com’s survey, a fact that isn’t true of psychiatrists and psychologists.

This high burnout rate might create opportunities for beginning social workers, but is that really such a good thing? Not for clients.

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I’m thinking of the jobs and field placements I’ve had so far. I’ve been an intern with zero experience with responsibility for the emotional wellbeing of recovering drug addicts with extensive trauma histories. My first job out of grad school was as a preventive worker with families involved with Child Protective Services – an incredibly demanding job that involved trauma-informed therapy, legal advocacy and intense casework. These are jobs that should have been performed by somebody with years of experience.

I don’t buy the argument that beginning social workers make up for their lack of experience with enthusiasm – how many domestic violence survivors have been forced to pin their hopes on somebody who was working with a client for the first time? Would you want to be in that position? If it was your mother would you want her to see an intern or someone with 10 years’ experience?

The sick reality is that interns and beginning social workers are charged with the most vulnerable, high-need people. Survive in the field for 20 years and you can get rich helping millionaires with public speaking anxiety.

By the way, if you’re thinking psychiatrists and psychologists deserve higher pay because they have expertise your thinking is part of the problem – they have expertise in their fields, but do they know how to advocate for somebody in court? Or get someone into a domestic violence shelter?

Moving forward

It’s a truism – but also true – that in order to care for our clients we must also practice self-care.

As social workers many of us seem willing to sacrifice everything we have, including our financial security, for the greater good. But in the end this is catastrophic, not only for social workers but for the people we serve.

If we advocate for ourselves – by demanding raises and salaries that reflect our good work – the result will be satisfied, dedicated social workers who remain in the field longer during these times when we’re needed more than ever.

Stand up for yourself! And let me know in the comments what you think the best way to do this is. Should social workers unionize? Do we need a culture shift?

The Weed Truck, Part II

This is the second installment in a multi-part story I’m writing for Child Abuse Awareness Month. Everything happened as described. Names have been changed. Nobody’s innocent.

Click here to read The Weed Truck, Part I

Panic comes flooding up my throat. It tasted like stomach acid.

“Chris Chris Chris Chris Chris,” I say.

Chris, my supervisor, strolls over. A bit older than me at 32 and fashionably dressed, he tries to keep his people calm and productive. He’s white, like I am.

“What’s the deal?” he says laconically.

I show him the note: “New CPS case re: Ms Tambora. Charges prostitution / drug use.”

“That’s not good,” he says. “Is it true?”

“It’s bullshit,” I say.

“Who’s the worker?”

I log into the computerized system that logs families’ Child Protective Services involvement – a catalogue of failure and suspicion. I navigate to Ms. Tambora’s new case.

“Patricia Black,” I say.

“I don’t know her,” Chris says.

The panic in my throat has receded somewhat, met in my throat by a generalized sadness, a despair mixed with acceptance that this is my life.

“Guess you’re about to,” I say.

* * * * * * * * *

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I take three deep breaths before dialing the phone.
The deep breaths never work.

Ring. Ring. “What.”

“Um hello, Ms. Black. This is [—] with [—]. I’m Ms. Tambora’s preventive worker.”

I don’t know why I’m so nervous. The panic is back.

“Oh yes, the prostitute.”

“Well, about that. She’s actually a very good mother. I don’t think – -”

“Do you need something?”

“I thought it would help if I joined you when you make a home visit to the family.”

“Fine. 3 o’ clock today.”

“Great. I’ll let Ms. Tambora know to expect us.”

“Please don’t. I like to catch families when they don’t expect me. I don’t want her having time to hide anything.”

“Fine.”

“3 o’clock. I’ll be wearing black.”

“Really?”

“Really what?”

“Nothing. See you at 3.”

I hang up the phone. The panic is gone again. This time it’s anger that’s pushing it down. A righteous, durable anger.

My next call is to Ms. Tambora.

* * * * * * * * *

I show up 30 minutes early to prepare Ms. Tambora, but when I knock on the door Ms. Black is already there. “Bitch,” I think. She’s standing above Ms. Tambora, who’s sitting at her kitchen table. A framed picture of her daughter is on a curio shelf behind her; as always, she’s clutching her daughter on her lap.

Ms. Black is younger than I expected – about my age, late twenties – white and, as she said, dressed entirely in black. I wonder if she was aware of the symbolism when she got dressed this morning – a woman in black, here to take your children.

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I try to remember the last time I thought of Child Protective Services as people who help.

Ms. Black doesn’t acknowledge me. She’s giving Ms. Tambora a release form. Like me, Child Protective Services workers need written permission from a caregiver before talking to a child’s provider. A strange facade of respect, I think – how odd what we choose to care about.

“Sign this so I can talk to Helena’s doctor,” she says.

“Ms. Tambora, is the doctor’s name filled in?” I ask.

She hesitates, looking at Ms. Black, then at me. “No.”

“Then signing that form would let her talk to anybody.”

Ms. Black bends down and scribbles on the form. “I was going to fill in the doctor’s name later, but whatever makes you happy,” she says.

Ms. Tambora signs the form.

* * * * * * * * *

Ms. Black is finally getting ready to leave.

“Can you tell me anything else about this family?” she says.

“Just that they seem to me like a great family. I’ve never seen a sign of drug use, prostitution or anything else.”

“Will Helena’s doctor tell me anything is wrong?”

“I haven’t spoken with her doctor yet.”

Ms. Black wags her finger. “It’s your job to communicate with the child’s providers, Mr. [—]. When Child Protective Services contracts a family out to your agency that’s one of our expectations.”

“Right, sorry. I’ve left the doctor messages.”

“Very well. The next step for Ms. Tambora will be to take a drug test. I’ll arrange that. See that she takes it.”

“She’ll take it.”

“Very well. Good bye.”

She says good bye to me, of course – not to Ms. Tambora. Then she leaves.

Ms. Tambora is still clutching Helena, tighter than ever. She looks terrified.

“I can’t take the drug test,” she whispers, even though we’re alone.

“Why not?”

“I’ve been going to the weed truck.”

To be continued

The secret history of mandated treatment

Mandated treatment is about society’s needs, not the mentally ills’.

On the evening of January 3, 1999 Kendra Webdale stepped onto the platform of the uptown R train at the West 23rd St station in Manhattan. She was 32, blonde and had a reputation for being kind to a fault, so it must have been typical for her to exchange words with the man beside her.

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Kendra Webdale

Then the man pushed her in front of an oncoming train, decapitating Webdale.

The man, Andrew Goldstein, had a history of hospitalizations for schizophrenia. When asked why he killed Webdale he later said he “just had the urge to push her.”

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Andrew Goldstein

In response to what he did that evening state lawmakers would pass Kendra’s Law, far-reaching legislation that lets judges mandate mental health treatment. But like any ambitious mental health program Kendra’s Law says as much about society’s fears as it does the needs of the mentally ill.

To understand what mandated treatment is really about, we need to understand those fears.

Kendra’s Law is a marketing tool designed to assure affluent white people that the problem of dangerous, crazed loners is under control.

Kendra’s Law is sweeping. It lets judges require people to submit to mandated treatment for up to a year at a time if they’re judged not to be safe without supervision and establishes teams of workers to provide services and monitor compliance. Though often justified with the rhetoric of public safety, a person doesn’t need to have a history of violence to be mandated under the law.

The law was used more than 8,700 times by mid-2007, with more then 5,600 of those people seeing their mandated services extended. Most people affected by the law (70%) are in New York City; many upstate counties don’t use the law at all.

That’s the law. Understanding the law’s purpose requires knowing a bit about New York – and Kendra Webdale herself.

Webdale was in many ways the prototypical New Yorker. An aspiring screenwriter from Fredonia, NY, she was drawn to the city by its parks and museums.

She wasn’t the first person to die on the subway tracks. Subway crime was down in 1999, but according to the New York Post, “even in safe times, a common fear haunt[ed] riders standing on a crowded platform. It’s of being shoved in front of a speeding train by a crazed attacker.” People remembered Renee Katz, who lost a hand in a similar attack, and several other people not named in the article (a 63-year-old grandmother, a Staten Island chemist, a 20-year-old mother described as having “cheap costume jewelry”).

Why did Webdale’s death merit a response from then-mayor Rudy Giuliani and eventually lead to a landmark state law while these other victims have been forgotten?

The numbers tell the story – a story of race, money and politics.

In the 1970s New York City was in trouble. Plagued by crime and a bad economy, white people and families fled in record numbers, to the point where whites were nearly a minority group. In the 1980s the population started to rebound, but the increase was driven by immigrants, who made up for a continuing exodus of white people. Crime was still rampant, and
the city’s image was reflected in the unstable loner Travis Bickle, Robert Dinero’s character in Taxi Driver. It wasn’t until the 1990s, the decade that Webdale moved to New York, that the city’s population really began to take off, growing by nearly 1%. By now the bleak image painted by Taxi Driver was being supplanted by Seinfeld and Friends – images of a kinder, more liveable city.

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I love New York!

However, crime still scared both current and potential New Yorkers. And even then a quarter of the city lived in poverty, up from previous years.

When a white woman who moved to the city in pursuit of her dreams was murdered by an unstable New Yorker, then, it must have been the worst publicity imaginable for city leaders.

They sprang into action.

After Webdale’s death Elliot Spitzer, then state attorney general and a city native, proposed legislation requiring mandated treatment, and the New York Times editorialized that such a law would be good for both people with mental illness and the city as a whole. Powerful New York State Assembly Speaker Sheldon Silver, who represented a Manhattan district, introduced the bill that would become known as Kendra’s Law. Silver was clear that “the specific incident that inspired ‘Kendra’s Law’ accurately depicts this as a public safety issue” while noting that his bill would also benefit those with mental illness.

Kendra’s Law passed. But like other public safety initiatives it wasn’t applied evenly.

In 2005 New York Lawyers for the Public Interest condemned Kendra’s Law, stating that only 15% of people mandated to treatment under its provisions had a history of violence. NYLPI accused those implementing the law of bias – citing figures from the New York State government, they said black people were nearly five times more likely than whites to be subjected to Kendra’s Law orders (others would say this is because black people are less likely to receive appropriate treatment). They also noted a regional bias, stating New York City accounted for 76% of orders despite having only 42% of the state’s population – exactly what one would expect if the law was created to make the city seem safer.

The marketing seems to have worked. By 2007 the number of people moving to New York City from other parts of the country surpassed the number leaving, a “new pattern,” and immigrants from within the United States went from representing half of the inflow at the turn of the millenium to two-thirds by 2011. Incomes rose too, with the median household income going from $31,591 in 1990 to $54,310 in 2014 when adjusted for inflation.

New York City became wealthier, whiter and more appealing to people from other states after Kendra’s Law passed. The law wasn’t solely responsible, of course, but it was one of the policies that made the New York success story possible.

What does this all mean? Many conclusions can be drawn. Here’s mine: Kendra’s Law is a marketing tool designed to assure affluent white people – inside and outside of the city – that the problem of dangerous, crazed loners is under control. When a mentally ill man murdered an attractive white woman from the suburbs city leaders feared Taxi Driver New York was killing Friends New York. They sprang into action, successfully lobbying for a law that’s used almost exclusively against poor black city residents.

None of this is to deny that Kendra’s Law has been effective. Studies by Duke University and the New York State Office of Mental Health have found the law reduces hospitalizations as well as suicide attempts, homelessness and other problems associated with untreated mental illness. Supporters of the law say it’s helping people who are mandated to services and saving the city money by reducing the need for inpatient care.

Mandated treatment is clearly a complicated issue that defies easy answers. But when we debate its wisdom we should consider all of its pros and cons, including some that are often overlooked by its supporters.

For example, any discussion of Kendra’s Law should consider:

The increased burden on mental health clinics that are required to treat mandated clients;

The impact of stringent rules clinics impose to manage mandated clients, such as policies to drop clients if they miss appointments;

The waiting lists clinics create to accommodate increases in demand;

The potential clients who give up on counseling because they’ve been placed on waiting lists;

The stress experienced by therapists and social workers who must work with mandated clients;

The impact this stress has on their work;

The good things providers could be doing with voluntary clients but aren’t because they’re working with mandated clients instead;

The things that could be done with money currently spent on mandated clients;

The pain clients experience after losing autonomy.

I’ve worked in agencies that serve mandated clients and I can truly say their being mandated changes everything. They stop being clients at all; instead they are treated like difficult, ungrateful children. When a clinician constantly assumes an unwilling client won’t show up or won’t be interested in material, it’s hard to overestimate the damage that causes to the therapeutic relationship. In a 2009 study of Kendra’s Law, case managers rated 54% of participants as not being “positively engaged” a full year after services began.

The above points demonstrate an odd fact: while Kendra’s Law has made treatment more available for mandated clients, the result has been that treatment has become more scarce for voluntary clients – the ones who are most likely to benefit from treatment. Every time a client is mandated waiting lists grow longer, clinicians become less available and clinic policies become more rigid. NYLPI says that this “right to treatment” for mandated clients even leads some people who want treatment to intentionally become mandated so they can get the help they need.

A stunning 41% of New Yorkers with severe mental illnesses report they needed help in the past year but weren’t able to get it. Does that mean we should have more mandated treatment? Maybe – but this treatment gap makes me question the wisdom of forcing scarce mental health resources on those who don’t want it.

I don’t know whether Kendra’s Law should be changed or repealed. But let’s be real about our reasons for mandating treatment. Let’s own the harm and benefits of it – all considerable and all very real.

In other words, let’s honor Kendra Webdale, Andrew Goldstein and the 20 year old mother in costume jewelry the New York Post didn’t bother to name.

The Weed Truck, Part I

This is the first installment in a multi-part story I’m writing for Child Abuse Awareness Month.

Ms. Tambora had had enough – of me, of the system. But I didn’t know it yet.

I don’t think she knew it either.

Ms. Tambora isn’t polite – she and her partner, Mr. Greene, are obsequious. When she answers the door, 18-month-old baby in her arms, she looks like an abused child that doesn’t know if she’s in for a hug or a beating. Sweet, kind, mild Ms. Tambora.

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Despite her demeanor I don’t feel like I’m taking advantage of her. I’m here to help.

I’m a preventive worker. I occupy a gray area between child protective services and traditional therapists. CPS contracts with my agency to provide services to families that have been reported for child abuse or neglect but who have been allowed to keep their kids. In theory, my services are accepted voluntarily. In practice, it’s often a choice between working with me or losing your children.

She lets me in, as always, with a nervous smile on her face. “Good morning, Ms. Tambora!” I say cheerily. “How are you?”

Ms. Tambora pauses for a moment, thinking. “I’m good,” she finally says.

In theory my services are voluntary. In practice it’s often a choice beween working with me or losing your child.

Today we’re talking about a domestic violence program Ms. Tambora is trying to sign up for. As we’re talking I notice she seems uncomfortable.

“You look worried.”

“I’m worried they’re going to take Helena,” she says, holding up her daughter, whom she’s clutched in her arms since I arrived.

“They’re not going to take Helena. You’re too good a mother.”

“But they took Joseph.”

I still don’t understand how Ms. Tambora lost custody of her older son, Joseph, who’s now 8. Ms. Tambora doesn’t understand it either. She only knows that a child protective services worker and two cops showed up at her door one day and “made me sign something.” The worker picked Joseph up and left. The cops blocked Ms. Tambora when she tried to follow.

Later she learned that Joseph’s father had accused her of drug use and prostitution.

The father now has custody of the child.

I know from previous visits to be careful around this topic because, five years later, discussing it still makes Ms. Tambora tearful. I like to think of myself as a traveling therapist, but honestly, I just don’t have the energy today.

“We really should figure out how to get you into this program,” I say, holding up a pile of intake documents for the the domestic violence program. “If they accept you we’ll continue this discussion, OK?”

Ms. Tambora dries her eyes with a tissue. “OK,” she says.

We finish the application and I feel satisfied when I leave. Ms. Tambora has a real shot at getting into this program, which provides domestic violence counseling, rent subsidies, legal assistance and more. They receive so many applications they basically draw winning names out of a hat.

I get to the office and I mail the application. I flirt a bit with a coworker I’d never see outside of work. I’m humming a bit when I sit down at my desk.

There’s a sticky note with a message in the receptionist’s handwriting.

“Oh Christ no.”

Ms. Tambora had been reported to child protective services for drug use and prostitution.