Psychologists, psychotherapists, social workers, and other mental health professionals have the professional flexibility and freedom to work in a number of diverse settings.

Everything ranging from inpatient and outpatient hospitals, to Veteran Affairs medical centers, college counseling centers, private practices, and community health centers, among many others.

It is often said that working at a community mental health center (CMHC) can be one of the most difficult and challenging sites for mental health work, and yet it can also be one of the most rewarding experiences.

The Challenges of Working at a CMHC

Large Caseloads

One of the biggest challenges that comes along with working at a CMHC can be the large caseload that one has to manage. It is usually the case that most centers are understaffed yet highly utilized by the public, leaving clinicians with caseloads ranging anywhere from 200-300 people.

This can leave professionals burnt out, overwhelmed, stressed, and overworked, not to mention having to remember everyone’s stories, presenting concerns, and therapy goals and approaches.

Another element that goes along with this is that clients tend to be seen only once every three to four weeks, making regular weekly therapy difficult to attain.

Lack of Resources

Another challenging aspect of working at a CMHC is the lack of resources.

Centers tend to be dependent on funding through federal and state aid in addition to grants and donations. Because of this, most centers are usually struggling financially, both in the process of hiring and retaining highly qualified clinicians, administrators, and staff, as well as maintaining the facilities.

For example, maybe you are a clinician who would like to run a therapy group or two, but the center lacks the physical space to accommodate the request. Or you might be trying to conduct a thorough integrated assessment with a client, but the center lacks the materials or scoring systems to make it both efficient and financially feasible.

Also, one has to keep in mind the client’s resources (money, travel, time, energy, and effort) when making any sort of plans such as the ones mentioned above.

Extensive Paperwork and Bureaucracy

This is probably a common experience, regardless of settings.

When working at a CMHC, you are asked to document the following: any and all contact you have had with a client, phone calls, letters written, psychotherapy notes, psychiatric referrals and evaluations, release of information forms, and the list goes on.

This can add strain and workload to clinicians who are already overwhelmed with simply seeing clients back-to-back for therapy. Finishing notes and paperwork is one of the common reasons that clinicians may stay late after work or come in on the weekend, especially since notes are generally required to be completed within 24 hours of the last client contact.

Client Characteristics

One of the biggest challenges of working at a CMHC are the circumstances and characteristics that follow clients who visit the CMHC.

Clients who seek mental health services at community centers may have life circumstances that present barriers to providing therapy.

Some individuals may experience homelessness or have no stable place of living, which can present difficulty when attempting to contact clients regularly to inform them of scheduling, appointments, and treatment information.

Others may experience unemployment or lack a steady stream of income, which can make it difficult for them to pay for services, seek help, or pay for transportation.

CMHC clients may also vary in terms of education. If a client has less formal education, it may be more difficult to understand or fill out complicated materials such as paperwork, file for Medicaid, find resources in the community, or understand clinicians who use a lot of professional jargon within sessions.

Most importantly, you must keep in mind the comorbidity that can be experienced by clients at CMHCs.  Some clients may experience a multitude of the characteristics and circumstances mentioned above, making their time at the center increasingly more difficult.

The Rewards of Working at a CMHC

Experience Working with a Variety of Clients

First and foremost, the most exciting and rewarding part of working at a CMHC is the clients. You will most likely not have the opportunity to work with such a diverse and unique group of people as you will working at a CMHC.

These are people who come from all varieties and walks of life, with unique experiences, strengths, attributes, and traumas. They each carry with them their own unique intersecting social identities (race, gender, sexual orientation, religion, age, etc.), which play a major role in therapy and ultimately make it extremely fun yet challenging to get to know each of them personally and intimately.

Clients are strong and resilient in their own ways, and will challenge you to be a better clinician.

Most clients are kind and caring. They will teach you a lot about yourself as a person as well as a professional. The presenting concerns will force you to go outside of your comfort zone to try different approaches and find unique ways to relate to each of your clients.

Experience Working with Other Passionate Professionals

It has been my experience that the people who work at CMHCs are passionate, caring, and empathic individuals who truly care about the clients they work with. Generally, people have an open door policy and are available for regular consultations, advice, laughter, and an overall good sense of inter-professional support.

When starting at a center, it is important to build strong relationships with other clinicians, psychiatrists, physicians, administrative staff members, and others who your clients will be interacting with regularly. Having strong relationships with co-workers can make time working at the center more rewarding, and it can make your client’s experience a better one as well.

For example, imagine your client would like to be seen by the psychiatrist and/or physician for a medication evaluation. If you have built a good working relationship with the client’s psychiatrist and/or physician, you are better able to communicate your client’s needs to them and advocate on their behalf.

Experience Working with Severe Mental Illness

Aside from the relational experiences you will gain working at a CMHC, you can be sure that you will gain experience working with clients who experience a wide variety of severe mental illnesses (SMI).

Clients can present with a multitude of comorbid chronic disorders, including anything from schizophrenia to major depressive, bipolar, or borderline personality disorders, as well as various forms of anxiety disorders, among others. Working with individuals who suffer from such distress will challenge you and give you experiences which are unique and highly sought after when applying to work at other settings such as hospitals or VAs.

Working with people who experience SMI will force you to tailor your treatment, your approach, and re-evaluate the way you talk and relate to clients. There is a lot to be gained and learned when working with this population.

In conclusion, working at a community health center can be a daunting and challenging task, but one that brings with it a multitude of benefits and rewarding experiences, such as:

  • Experience working with wonderful people who really need your help
  • Being challenged to perform and work at a higher level, which I believe most mental health professionals enjoy
  • Experience working with some of the most marginalized groups of people in the healthcare system
  • Experience helping people with severe mental illnesses and having the rewarding feeling of making a positive difference in their lives
  • Learning good ways to communicate and work effectively with a wide variety of healthcare professionals (physicians, psychiatrist, nurses, social workers, other psychologists and psychotherapists, etc.)
  • Above all, you will become a stronger clinician because of your time at a community health center

Have you worked at or are you working at a community mental health center, or are you interested in working at one? Please feel free to share your thoughts or questions in the comments below.

This article was updated on June 24, 2022.

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