Workplace Wednesday

Mental Health

Struggle no more, for you have found a safe place of healing and hope where a yearning soul is called to care for the soul of others. This call is persistent, and has led you to service in mental health.

As a Mental Health CNA, you have that deep understanding that every decision a person makes, large or small, important or mundane, will impact their life significantly when they suffer from mental health issues. In mental health, there are only two options for every decision: conquer a fear or retreat back to the safety of old habits – and old habits die hard. It is in this daily living, these most basic of choices – to get out of bed, to speak, to eat, to interact with others in any way, that will determine one’s growth or stagnation. It is not the momentous a-ha moments that dictate a successful life, it is in the mundane that we discover who we are and how we will be. Mental Health CNAs help patients see the importance in everyday choices, encourage them to think through the options, celebrate the small steps forward and understand the steps back, while maintaining a safe environment and seeing to the physical needs that the patient is unable to address in crisis.

Overview

As a mental health CNA, you will be caring for patients that are suffering from various mental illnesses, from addiction to schizophrenia. Just like caring for those with a physical illness, no two patients will be the same. Just because several people may have the same diagnosis, the effects of that diagnosis may be quite different and require different care, tactics and approaches. But having the ability to read a situation, and adapt your communication techniques, will serve you well in this setting.

“I knew well enough that one could fracture one's legs and arms and recover afterward, but I did not know that you could fracture the brain in your head and recover from that, too."

Vincent Van Gogh

Working in mental health brings very specific challenges, and great rewards. Read below for some specifics!

1. Pace

Healthcare in mental health is moderate-paced. There is a lot to do, but you need to move at a pace the patient is comfortable with. And since mental illness usually affects your ability to adapt to change…ANY change can be terrifying. So, maintaining a calm presence, communicating at a level your patient can understand and moving slowly in a non-threatening way will affect your workflow. In mental health, you have to expect the unexpected at all times. It helps to be able to go with the flow and keep a cool head.

In mental health, patient’s safety is a priority (as they may not be able to recognize unsafe situations in a crisis). In most settings, every patient will need to be physically checked on every 15 minutes around the clock. This will be the CNAs primary task in a mental health setting. Helping patients with personal care tasks and taking vital signs are also tasks that may be required.

Mental health settings are clinical environments, but are usually structured to appear less threatening and more home-like. Medical equipment will be on hand for crises, but usually kept out of sight until it is needed. Patient rooms will be sparsely furnished, designed with safety in mind and to encourage the patient to seek out common areas while awake.

2. Type of Patient

Mental Health patients are widely varied. Many patients suffering from mental illness will also have physical conditions that will require medical treatment as well. But there is a wide variety in the type of help that each patient will need. A patient with schizophrenia may also have high blood pressure. A patient with bulimia may have esophageal ulcers. A patient with prolonged drug use may suffer from an enlarged heart and arrhythmias. A patient with depression can also have kidney failure. Psychological conditions and physical conditions are often treated at the same time in a mental health setting.

3. Number of Patients

Because there is a lot to juggle in a mental health setting, they usually have a moderate patient assignment.

The number of patients you have will depend on what shift you are working, what department you are in, and what kind of help your patients need. There are three main areas of a mental health center: crisis unit, older adult unit, and rehabilitation unit where care is tailored to the specific needs of each population. In a crisis unit, patients in extreme psychological distress are monitored closely. Much of the CNAs daily work will center around keeping these patients safe, with 15 minute checks part of the routine. In an older adult unit, dementia patients with uncontrolled symptoms will need complete care until their symptoms can be brought under control with medications. Since total care is required, CNAs in this unit care for fewer patients, since there is more to do with each patient. In a rehabilitation unit, CNAs will help maintain a clean and orderly unit, ensuring that patients attend sessions, maintain the prescribed schedule and care for themselves appropriately. CNAs may moderate group sessions and encourage socialization. CNAs can care for more patients in this setting because each patient requires less physical care from the CNA.

Overall though, mental health CNAs generally perform less personal care than CNAs in a nursing home setting and less medical care than CNAs in a hospital. The work here is centered more on maintaining a safe environment while helping patients become more independent in self-care.

4. Oversight and Supervision

Mental Health CNAs like being part of a healthcare team. They work very closely with nurses and usually develop a close-knit team over time. A mental health CNA is secure in their skill level and doesn’t mind continuous nursing supervision. They are comfortable reporting their observations and working closely with other mental health professionals.

Mental health CNAs may work in other departments when there is a shortage of CNAs available to work, so they must be willing to work with a new team occasionally and provide a different level of care than they are used to.

5. Length of Patient Interaction

Mental health care is usually longer in duration than a hospital stay for a physical condition. Mental health care will often last longer than a few days, but can last for weeks or months, depending on the severity of the condition. The Mental Health CNA is generally friendly and comfortable talking with strangers, but keeps interactions within professional boundaries and does not relay personal information or interact with patients socially.

6. Schedules and Shifts

Mental Health Care centers usually run on 12 hour shifts, which means you only have to work 3 or 4 days a week, although some will operate on a more traditional 8 hour schedule. This means that most Mental Health CNAs work 4-5 days a week.

With only two shifts to choose from (day shift or night shift), there isn’t much flexibility in this schedule. Nights, weekends and holidays may be required (but usually on a rotating basis).

Schedules will vary depending on facility and department. Some will offer a set schedule that rarely varies, working the same days every week. Some will require more flexibility as the days you are scheduled will be different every week.

7. Pay and Benefits

Mental Health Care Centers are generally competitive in their starting pay (and will offer more with experience). This is not a traditional work setting that most people consider when searching for a CNA job, so they often offer a higher wage to recruit CNAs. It pays to look beyond the hospital, nursing home, home health settings.

Because maintaining a cohesive team is very important for safety in this setting, Mental Health care facilities will generally employ full time CNAs with benefits, like medical insurance, paid time off, tuition reimbursement, continuing education, staff training for new skills, etc. to help ensure workplace stability.

PRN workers are also hired in mental health to cover for full-time employees on vacation or sick and to add coverage when there aren’t enough full-time workers to care for the patient load. These PRN worker often do not qualify for these benefits, but get a higher rate of base pay instead. This can be helpful if you need a higher pay rate to take care of your monthly obligations and don’t need insurance.

8. Learning New Skills

Mental Health CNAs will need to become skilled in crisis intervention techniques, seclusion and the use of restraints for violent patients. These CNAs may also need to learn additional therapeutic communication techniques, redirection strategies and various methods of defusing difficult situations. Mental Health CNAs have to be versatile and willing to learn new skills. Every department will require a different skill set, depending on the needs of the patients they serve. Training is usually provided by the employer which makes you much more valuable as an employee!

9. Opportunity for Advancement

Mental Health Centers generally offer little in terms of opportunities to advance your career. Tuition reimbursement is possible (which means they will pay for your schooling!) but not standard.

Summary

Mental Health CNAs work very closely with a small healthcare team including nurses, doctors, therapists and social workers. A strong team dynamic is important in this setting, due to the (often) manipulative nature of the patient population. You have to be able to rely on your team members, and they have to be able to rely on you, so mental health workers must be loyal to their team members and patient with their patients. They must also be encouraging, understanding, ethical, honest and trustworthy. A strong desire to protect the vulnerable is also an asset when working with mentally ill patients, as they are often unable to protect themselves.

It pays to pick the right workplace…and your personality will have a huge impact on your overall success. Often, we have unrealistic expectations and the reality doesn’t live up to what we THOUGHT the work would be like. Knowing what to expect and making sure you have the skill set to perform well will go a long way to ensuring your success, no matter WHERE you decide to work in healthcare!