I was in an abusive relationship with Community Mental Health
I barely survived my first abusive relationship and it took me a decade of treatment to recover from the narcissistic abuse. Coparenting with a narcissist is a blog in the making. But I was shocked to realize that many things in my previous position were way too similar to the abuse that I survived with my ex.
The dynamics in a domestic violence relationship are about power and control. In a narcissistic abusive relationship the dynamics are even more complicated because one party derives their entire self-confidence and self worth by siphoning it from the empathic partner.
How does this relate to my previous employment? It comes back to that power and control.
From my internship to all of my employment, I was trained exclusively in community mental health. That means I worked at an outpatient office and saw clients from 9 to 5. Many of the policies and procedures I did not question because I didn’t know any different. When I became a supervisor I started to see behind the curtain.
Community mental health is mostly severe and persistent mental illness. That means severe depression, schizophrenia, bipolar, addiction. A lot of these clients are homeless and only have the clothing on their back. They are struggling more than many of us can imagine. And a lot of them have no one.
The supervisors were the powers that be control everything from the time you walk in the door till the time that you leave. They decide how much paperwork you have to do and how long you’re able to see each client, and how many clients you see. I thought this was just a requirement of being a counselor. As I started learning more about medical billing and reimbursement I started to realize we were running on a perpetual hamster wheel.
The bean counters in the back of some office decide how much you are worth based off insurance reimbursement and how many clients you can see in a day. Productivity is the amount of hours of direct client service in a week divided by how many hours you are being paid. Most productivity rates for community mental health counselors are around 50% but some as high as 90%.
That means a counselor who works 40 hours a week is required to see between 20 and 25 hours a week of direct client service. And some up to 36 hours a week. Many of these counselors are dependently licensed. That means they just got out of college and they require a supervisor to sign off on everything and supervise them two hours a week.
So a counselor who starts at 9 AM will have clients scheduled back to back throughout the entire day that have severe needs. Each of these sessions has documentation that is required and some of the intake documents are as long as 18 pages long. Oh and I forgot to mention these are due within 24 to 48 hours after the service.
So these are Masters level clinicians treating severe and persistent mental illness with high productivity requirements, you would think they would be paid very well.
I made more driving for food delivery services then I did at my community mental health position.
Insurance companies reimburse between $50-$110 an hour depending on the insurance. I can’t give you exact numbers because they make you sign a contract saying that you were not discuss contract rates.
As a community mental health counselor I was paid around $25 an hour which is less than 50% of the reimbursement rate.
So let’s do the math:
Average reimbursement rate – 70$/hr
Average productivity- 20 hrs /week
2 weeks vacation – 50 weeks a year.
= 70,000 a year.
Counselors without a supervisor status are paid under 40k a year.
That’s 30,000 that goes to the agency.
After three years of working full-time with severe and persistent mental illness I was feeling very rundown. In the Counseling world we call this burn out. But I didn’t feel burnt out. I didn’t feel un-empathetic. I felt overwhelmed. Overwhelmed by the sheer size of all my clients needs piled-up against me with very little support and training after my degree.
I sought training and specialized trauma treatment that my agency did support me in pursuing. This treatment was vastly different than the CBT world that they were all trained on so I did not receive much help or supervision with in my agency on this treatment. I had to pay for that outside of the agency.
I felt exploited.
Pushed and pushed to see more clients when my caseload was almost 100. Pushed to call clients between sessions to bill more hours. Pushed to take paperwork home on nights and weekends to get it all done.
That is why I created the Trauma Therapy Company. To make a safe place for therapists to grow, learn and feel at home.
If you would like to join our team, please email me your resume.
Kara M. Mumford LISW-S (she/they)
Managing Owner / Clinical Director
Trauma Therapy Company