Does working as a mental health tech give a good view of the field? Worries, etc.

[gohogwild]

Hello SDN friends,

I graduated recently from undergrad and am currently working as a mental health tech (or psychiatric tech/aide, etc) in a behavioral medical center. I do 15 min checks, hospital sits, run coping skills groups, 12 hr shifts, the gamut.

Personal opinions ahead..
Thing is, I really do not like it. I work three 12hr shifts a week. I don't admire the psychiatric field It doesn't seem like people are intent on doing their best for the patients, instead they are looking to get through their 12hr shift quietly (which does make sense to some extent, since it's a stabilization facility). But also, I am not sure how much I enjoy working with patients, we have a high acuity SMI population. We also have an adult unit which is more generally depression & suicidal ideation & voluntary admissions, which is more pleasant and I found some real connection there, but also has many pts who I would classify as "attention seeking" (Sorry! Just my impression. I do understand that therapy, at it's core, is an attention seeking process and that is morally neutral!). I don't know if it's the social aspect of work (nurses make for a very 'high school' atmosphere in my experience), or if it's because being around yelling, un-redirectable pts and performing some form of public speaking (groups) for 12 hours exhausting to the point of would-be tears. Or that it's just a lot a lot of Ativan, Risperdal, and Thorazine, which also kinda puts me off. Even from the interview, I had the feeling that this job was going to put me off psych, despite loving all my classes, and research experience I've had previously (pretty limited previous clinical experience).

ALL that aside, I know that this is not a fully accurate impression of what working with clinical psych pts is like, but I know that it's not entirely inaccurate either!

I was wondering if anyone has any insight. How do I parse out what is real clinical experience, accurate to what I would experience as a clinical psychologist, and what I will leave behind as a mental health tech? Because if I'm taking most of it with me, I'm not sure I want any of it at all. That said, I don't feel like I would jump ship just because of this experience, but I have found it discouraging. Thanks.

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[WisNeuro]

Do you want to work in SPMI in the future?

 

[gohogwild]

Do you want to work in SPMI in the future?

It's hard for me at this point to give a solid yes or no as to whether or not I'd want to work with a whole group of people. But as far as the SPMI-serving institutions I've seen, nope, not interested what seems me to be a tragic dumpster fire. I would assume that there's somewhere out there doing it right, and to that I'm still open. But to answer your question, no, I've never had a huge focus on the SPMI pop.

 

[PsyDr]

I think inpatient experience is important. It allows you to see true presentations of things like mania, schizophrenia, and suicide attempts. Once you see something like true mania, you'll never confuse it for less severe issues.

 

[gohogwild]

I think inpatient experience is important. It allows you to see true presentations of things like mania, schizophrenia, and suicide attempts. Once you see something like true mania, you'll never confuse it for less severe issues.

That makes sense. Thanks for your response.

 

[summerbabe]

My last job was a staff psychologist at a VA acute inpatient unit. Now I do 100% telehealth therapy (also with veterans).

The day to day experience of these 2 jobs are so different that they are hard to compare, even though I use the same foundational skills. I spend way more 1-on-1 time with patients currently and spent way more time doing team based stuff in my last job.

The majority of jobs in clinical psych are in outpatient settings working with relatively stable populations (hopefully with relevant goals) so if inpatient/SMI/chaotic teams aren't your thing, there are tons of other opportunities.

Non-acute clinical psychologists will still occasionally get yelled at by patients (or family members), have patients that are hard to re-direct and have unpleasant co-workers. But on the whole, you generally have more stability and control of your environment.

At the same time, doing clinical work isn't for everybody. Short of academia, neuropsych to some degree, or having significant admin duties, the majority of your work week as a clinical psychologist will be client facing (24-32 hours of a 40 hr week, minus some no-shows and cancellations) with the rest being documentation/admin.

That's a lot of time spent with people providing clinical psychology services. It can be too interpersonally draining for some people (they likely would also be drained working in roles like sales). Some people have difficulties stopping work from bleeding into the personal (e.g., thinking about patients when you are off the clock). Some organizations have unrealistic expectations of their psychologists or don't provide adequate support to do a good job.
And some people are probably better suited for other types of work to begin with.

I imagine a lot of practicing clinical psychologists who are happy with their job are both intellectually curious about the content (and remain so once their formal education concludes) and also enjoy the interpersonal aspect of providing this service.

 

[smalltownpsych]

A lot of what goes on in inpatient units is not good care or treatment for anyone. As a psychologist, I have enjoyed working in those settings because I get the chance to make a difference. Psychotherapy is an incredibly effective intervention and until you do it, you really have no idea the effect it can have. Also, utilizing behavioral principles to change dynamics is useful and understanding the dynamics of why someone is using maladaptive behaviors to get their needs met, such as attention, and substituting other methods is also extremely effective. Would I stay in one long term? Not unless I was in charge because too many people,that work there treat my patients poorly and I can only fight that for so long before it’s time to go.

 

[gohogwild]

My last job was a staff psychologist at a VA acute inpatient unit. Now I do 100% telehealth therapy (also with veterans).

The day to day experience of these 2 jobs are so different that they are hard to compare, even though I use the same foundational skills. I spend way more 1-on-1 time with patients currently and spent way more time doing team based stuff in my last job.

The majority of jobs in clinical psych are in outpatient settings working with relatively stable populations (hopefully with relevant goals) so if inpatient/SMI/chaotic teams aren't your thing, there are tons of other opportunities.

Non-acute clinical psychologists will still occasionally get yelled at by patients (or family members), have patients that are hard to re-direct and have unpleasant co-workers. But on the whole, you generally have more stability and control of your environment.

At the same time, doing clinical work isn't for everybody. Short of academia, neuropsych to some degree, or having significant admin duties, the majority of your work week as a clinical psychologist will be client facing (24-32 hours of a 40 hr week, minus some no-shows and cancellations) with the rest being documentation/admin.

That's a lot of time spent with people providing clinical psychology services. It can be too interpersonally draining for some people (they likely would also be drained working in roles like sales). Some people have difficulties stopping work from bleeding into the personal (e.g., thinking about patients when you are off the clock). Some organizations have unrealistic expectations of their psychologists or don't provide adequate support to do a good job.
And some people are probably better suited for other types of work to begin with.

I imagine a lot of practicing clinical psychologists who are happy with their job are both intellectually curious about the content (and remain so once their formal education concludes) and also enjoy the interpersonal aspect of providing this service.

Thank you for your detailed response. It does make sense that a less acute population would be.. less acute. I think that I am currently still exploring to what extent I can stand being drained. Great to hear from someone with experience in VA psych on this, given the population overlap!

 

[gohogwild]

A lot of what goes on in inpatient units is not good care or treatment for anyone. As a psychologist, I have enjoyed working in those settings because I get the chance to make a difference. Psychotherapy is an incredibly effective intervention and until you do it, you really have no idea the effect it can have. Also, utilizing behavioral principles to change dynamics is useful and understanding the dynamics of why someone is using maladaptive behaviors to get their needs met, such as attention, and substituting other methods is also extremely effective. Would I stay in one long term? Not unless I was in charge because too many people,that work there treat my patients poorly and I can only fight that for so long before it’s time to go.

Thank you for adding your perspective. I agree that I've seen therapy work very well for some people, I am often surprised how well affirmative statements help people turn themselves around ("I see that you're angry" "I know this is uncomfortable for you" "I'm sorry this is stressful/not ideal"), which also brings to a point that I do not currently have the skills to help people. In many ways, as a tech, I am thrown in the mix with no skills at all. But I am sure more responsibilities (esp. 1-on-1 time), creates greater burden too. Thanks for your response!

 

[Ollie123]

Please also recognize that you are seeing approximately 0.01% of the types of settings a psychologist can work in. Your inpatient unit is not even necessarily that similar to another inpatient unit in the same city, let alone an outpatient PP, let alone one of the dudes sitting at a desk crunching numbers for the CDC who hasn't seen a patient since internship.

It is certainly valuable experience. I have pretty limited SPMI experience, but agree with PsyDr it is 100% worth seeing. I cannot begin to count the number of times even professionals think an anxious person talking at slightly above-average speed or the person with slightly greater risk tolerance than would be expected among people with PhDs and their friends is "manic". 30 minutes on an inpatient unit or in a forensic setting would likely forever recalibrate their diagnostic approach. If everyone you have interacted with in your life is between the 25th and 75th percentiles on something, it is easy to think the 75th percentile is really the 99th percentile. Seeing what the actual 99th percentile of symptoms looks like and building de-escalation skills are the main benefits to training in a setting like this.

 

[AcronymAllergy]

I fully agree with PsyDr and Ollie--having the experience would be worthwhile if for no other reason to have the opportunity to work with and help people with actual SPMI. As others have mentioned, I've seen psychologists and masters-level therapists erroneously suggest someone is manic, which has largely been because that provider has never actually seen someone who is acutely manic (or they get tripped up by someone reporting sleep disturbance, which is pretty ubiquitous in VA).

 

[PsyDr]

Please also recognize that you are seeing approximately 0.01% of the types of settings a psychologist can work in. Your inpatient unit is not even necessarily that similar to another inpatient unit in the same city, let alone an outpatient PP, let alone one of the dudes sitting at a desk crunching numbers for the CDC who hasn't seen a patient since internship.

It is certainly valuable experience. I have pretty limited SPMI experience, but agree with PsyDr it is 100% worth seeing. I cannot begin to count the number of times even professionals think an anxious person talking at slightly above-average speed or the person with slightly greater risk tolerance than would be expected among people with PhDs and their friends is "manic". 30 minutes on an inpatient unit or in a forensic setting would likely forever recalibrate their diagnostic approach. If everyone you have interacted with in your life is between the 25th and 75th percentiles on something, it is easy to think the 75th percentile is really the 99th percentile. Seeing what the actual 99th percentile of symptoms looks like and building de-escalation skills are the main benefits to training in a setting like this.

 

[WisNeuro]

View attachment 362436

It ain't got no gas in it.

 

[gohogwild]

Please also recognize that you are seeing approximately 0.01% of the types of settings a psychologist can work in. Your inpatient unit is not even necessarily that similar to another inpatient unit in the same city, let alone an outpatient PP, let alone one of the dudes sitting at a desk crunching numbers for the CDC who hasn't seen a patient since internship.

It is certainly valuable experience. I have pretty limited SPMI experience, but agree with PsyDr it is 100% worth seeing. I cannot begin to count the number of times even professionals think an anxious person talking at slightly above-average speed or the person with slightly greater risk tolerance than would be expected among people with PhDs and their friends is "manic". 30 minutes on an inpatient unit or in a forensic setting would likely forever recalibrate their diagnostic approach. If everyone you have interacted with in your life is between the 25th and 75th percentiles on something, it is easy to think the 75th percentile is really the 99th percentile. Seeing what the actual 99th percentile of symptoms looks like and building de-escalation skills are the main benefits to training in a setting like this.

Those are great points, thank you Ollie. A goal of mine going into this experience was also to be able to understand what potential future clients may have experienced when they say that they've gone through the behavioral medical system. I have seen a few presentations of mania, particularly excessively verbal people, and also quite a few presentations of schizoaffective which I had not come into contact with before -- it has also been a learning experience in just how different each presentation is, which seems obvious, but has been worthwhile. But it's also interesting to see patterns, one of them being that a large number of our pts are concerned about cameras (which is sort of kafkaesque because it's a very heavily surveilled facility). I will hold onto these learning experiences as the bright side. Thanks.

 

[smalltownpsych]

Those are great points, thank you Ollie. A goal of mine going into this experience was also to be able to understand what potential future clients may have experienced when they say that they've gone through the behavioral medical system. I have seen a few presentations of mania, particularly excessively verbal people, and also quite a few presentations of schizoaffective which I had not come into contact with before -- it has also been a learning experience in just how different each presentation is, which seems obvious, but has been worthwhile. But it's also interesting to see patterns, one of them being that a large number of our pts are concerned about cameras (which is sort of kafkaesque because it's a very heavily surveilled facility). I will hold onto these learning experiences as the bright side. Thanks.

Delusional beliefs typically have a connection to something more tangible so not surprising that in a facility with lots of cameras that there would be more delusions related to that topic. The veterans I worked with who had delusions believed that the military industrial complex was controlling them In bizarre ways. The delusion was the bizarre part. 😊

 

[gohogwild]

Delusional beliefs typically have a connection to something more tangible so not surprising that in a facility with lots of cameras that there would be more delusions related to that topic. The veterans I worked with who had delusions believed that the military industrial complex was controlling them In bizarre ways. The delusion was the bizarre part. 😊

Wow! So interesting. Makes a lot of sense, thanks for sharing that.

 

[PsychPhDone]

Hello SDN friends,

I graduated recently from undergrad and am currently working as a mental health tech (or psychiatric tech/aide, etc) in a behavioral medical center. I do 15 min checks, hospital sits, run coping skills groups, 12 hr shifts, the gamut.

Personal opinions ahead..
Thing is, I really do not like it. I work three 12hr shifts a week. I don't admire the psychiatric field It doesn't seem like people are intent on doing their best for the patients, instead they are looking to get through their 12hr shift quietly (which does make sense to some extent, since it's a stabilization facility). But also, I am not sure how much I enjoy working with patients, we have a high acuity SMI population. We also have an adult unit which is more generally depression & suicidal ideation & voluntary admissions, which is more pleasant and I found some real connection there, but also has many pts who I would classify as "attention seeking" (Sorry! Just my impression. I do understand that therapy, at it's core, is an attention seeking process and that is morally neutral!). I don't know if it's the social aspect of work (nurses make for a very 'high school' atmosphere in my experience), or if it's because being around yelling, un-redirectable pts and performing some form of public speaking (groups) for 12 hours exhausting to the point of would-be tears. Or that it's just a lot a lot of Ativan, Risperdal, and Thorazine, which also kinda puts me off. Even from the interview, I had the feeling that this job was going to put me off psych, despite loving all my classes, and research experience I've had previously (pretty limited previous clinical experience).

ALL that aside, I know that this is not a fully accurate impression of what working with clinical psych pts is like, but I know that it's not entirely inaccurate either!

I was wondering if anyone has any insight. How do I parse out what is real clinical experience, accurate to what I would experience as a clinical psychologist, and what I will leave behind as a mental health tech? Because if I'm taking most of it with me, I'm not sure I want any of it at all. That said, I don't feel like I would jump ship just because of this experience, but I have found it discouraging. Thanks.

OP I think this experience you're having is valuable.

Fwiw it's not at all the experience I've had. There's a wide diversity of settings.

 

[foreverbull]

Hello SDN friends,

I graduated recently from undergrad and am currently working as a mental health tech (or psychiatric tech/aide, etc) in a behavioral medical center. I do 15 min checks, hospital sits, run coping skills groups, 12 hr shifts, the gamut.

Personal opinions ahead..
Thing is, I really do not like it. I work three 12hr shifts a week. I don't admire the psychiatric field It doesn't seem like people are intent on doing their best for the patients, instead they are looking to get through their 12hr shift quietly (which does make sense to some extent, since it's a stabilization facility). But also, I am not sure how much I enjoy working with patients, we have a high acuity SMI population. We also have an adult unit which is more generally depression & suicidal ideation & voluntary admissions, which is more pleasant and I found some real connection there, but also has many pts who I would classify as "attention seeking" (Sorry! Just my impression. I do understand that therapy, at it's core, is an attention seeking process and that is morally neutral!). I don't know if it's the social aspect of work (nurses make for a very 'high school' atmosphere in my experience), or if it's because being around yelling, un-redirectable pts and performing some form of public speaking (groups) for 12 hours exhausting to the point of would-be tears. Or that it's just a lot a lot of Ativan, Risperdal, and Thorazine, which also kinda puts me off. Even from the interview, I had the feeling that this job was going to put me off psych, despite loving all my classes, and research experience I've had previously (pretty limited previous clinical experience).

ALL that aside, I know that this is not a fully accurate impression of what working with clinical psych pts is like, but I know that it's not entirely inaccurate either!

I was wondering if anyone has any insight. How do I parse out what is real clinical experience, accurate to what I would experience as a clinical psychologist, and what I will leave behind as a mental health tech? Because if I'm taking most of it with me, I'm not sure I want any of it at all. That said, I don't feel like I would jump ship just because of this experience, but I have found it discouraging. Thanks.

The experience you are having is very specific to inpatient techs. I was a tech as well, but for residential (although I crossed over to do inpatient a few times—my facility had both). I did the whole thing—seclusions, restraints, supervising adolescents during meals, activities, running activities myself, dealing with vomit, violence, and meltdowns. But I actually loved it. I had a great team of colleagues with good behavioral structure and the kids called you names one minute and loved you the next, but I never took it personally. The therapist was barely visible on the unit and just saw kids hour after hour and therapy and did family therapy. I didn’t actually think that seemed as fun or interesting, although it paid better. I ended up being a therapist for residential years later and it really wasn’t as fun as being a tech, in my opinion. Less spontaneity in your day and less fun working alone vs. a team.

That said, you use and learn a lot of great interviewing skills and calming/de-escalation, and sometimes kids will talk you about stuff like you’re their therapist, so you have an opportunity to develop a lot of clinical skills in that environment, even if it’s not superficially similar to psychologist jobs you’ll be doing in the future.

Working with adults and not working on inpatient is a very different ballgame and looks VERY different day to day. You see the most intense suicidality and emotional/behavioral dysfunction on inpatient, and yes, a fair share of folks with personality disorders and bipolar disorder, schizophrenia, etc. In group practices, college counseling, etc., people tend to be higher functioning and the work is just…qualitatively different. It looks nothing like inpatient. But even being a therapist in an inpatient setting isn’t going to be as intense as being a tech, usually, because you only see the clients for an hour at a time and maybe an extra for group, not seeing them all day, and they tend to not act out as much for therapists, from what I’ve seen.

I wouldn’t get too discouraged if I inpatient doesn’t seem like a good fit for you if you plan on working in a different setting once licensed—if you like using the counseling-adjacent skills you’re learning in your tech work. I’m my experience, there was more downtime as a tech than a therapist, however, which is something to consider. Therapy full-time requires constant focus if that’s what you plan to do.

Feel free to pm me if you want to talk specifics.

 

[gohogwild]

The experience you are having is very specific to inpatient techs. I was a tech as well, but for residential (although I crossed over to do inpatient a few times—my facility had both). I did the whole thing—seclusions, restraints, supervising adolescents during meals, activities, running activities myself, dealing with vomit, violence, and meltdowns. But I actually loved it. I had a great team of colleagues with good behavioral structure and the kids called you names one minute and loved you the next, but I never took it personally. The therapist was barely visible on the unit and just saw kids hour after hour and therapy and did family therapy. I didn’t actually think that seemed as fun or interesting, although it paid better. I ended up being a therapist for residential years later and it really wasn’t as fun as being a tech, in my opinion. Less spontaneity in your day and less fun working alone vs. a team.

That said, you use and learn a lot of great interviewing skills and calming/de-escalation, and sometimes kids will talk you about stuff like you’re their therapist, so you have an opportunity to develop a lot of clinical skills in that environment, even if it’s not superficially similar to psychologist jobs you’ll be doing in the future.

Working with adults and not working on inpatient is a very different ballgame and looks VERY different day to day. You see the most intense suicidality and emotional/behavioral dysfunction on inpatient, and yes, a fair share of folks with personality disorders and bipolar disorder, schizophrenia, etc. In group practices, college counseling, etc., people tend to be higher functioning and the work is just…qualitatively different. It looks nothing like inpatient. But even being a therapist in an inpatient setting isn’t going to be as intense as being a tech, usually, because you only see the clients for an hour at a time and maybe an extra for group, not seeing them all day, and they tend to not act out as much for therapists, from what I’ve seen.

I wouldn’t get too discouraged if I inpatient doesn’t seem like a good fit for you if you plan on working in a different setting once licensed—if you like using the counseling-adjacent skills you’re learning in your tech work. I’m my experience, there was more downtime as a tech than a therapist, however, which is something to consider. Therapy full-time requires constant focus if that’s what you plan to do.

Feel free to pm me if you want to talk specifics.

Thank you for sharing your all your experience, especially since you were both a tech and a therapist. My facility does not have psychologists or therapists, it's mostly psychiatrists and MSWs who do mainly social work duties like connecting pts to their next institution or back home, etc. although I am aware that they do one solid interview about what brought them to the facility, though I don't think it's therapeutic in nature. I would say the most therapeutic intervention that pts get is through the group activities (techs) and through the chaplain (though he only works one on one by request).

Thanks for sharing your experience, also, with working with adolescents. My facility is focused on adults. I agree that it's interesting to learn some clinical-adjacent skills, I think I just get irked by what reeks of a hospital trying to meet their bottom line.

 

[BuckeyeLove]

My primary employment is as a unit psychologist on an inpatient acute unit at a state hospital. Work with many front line staff. Hardest job in the hospital. PM if I can help.

 

[gohogwild]

My primary employment is as a unit psychologist on an inpatient acute unit at a state hospital. Work with many front line staff. Hardest job in the hospital. PM if I can help.

Thank you for your kind words and the work that you do.