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Submitted
to the Senate Committee on Health, Education, Labor and Pensions
Hearing on Psychological Trauma and Terrorism: Assuring That Americans
Receive the Support They Need
September
2002
On behalf of the
National Association of Social Workers (NASW), we thank Chairman
Kennedy, Ranking Member Gregg, and the rest of the Committee for
convening this hearing on this important topic.
The tragic events
of a single day and their continuing aftermath have changed the
fabric of American society forever. As a result, both the
need and demand for mental health services have increased exponentially
without corresponding increases in qualified, credentialed providers
or service delivery system capacity. As the rush of immediate,
acute mental and behavioral needs subsides and with it the eventual
dismantlement of the disaster relief network of professional mental
health provider volunteers, the underlying system will continue
to struggle to provide adequate and appropriate mental health care
for adults, children, and families.
Social work is
a distinct profession with rigorous, specialized education and
training requirements, state licensure, certification, and ethical
standards. Social work professionals practice in a variety
of settings including hospitals, skilled nursing facilities, nursing
homes, mental health facilities, rehabilitation centers, schools,
places of worship, family service agencies, community organizing
and planning agencies, industrial and occupational entities, and
criminal justice facilities. Social workers hold numerous
degrees, including bachelor's, master's, and doctorates in social
work. The educational attainment level and professional experience
necessary to perform a social work position varies significantly
according to the specific requirements of the individual position,
the setting, and the target clientele. Professional social
workers are widely dispersed throughout American society, both
institutionally and geographically.
Clinical social
work is a specialized form of direct social work practice. Clinical
social workers diagnose and treat mental illnesses in a manner
analogous to psychiatrists, clinical psychologists, and psychiatric
clinical nurse specialists. In order to practice, a clinical
social worker must: receive a master's degree in social work; satisfactorily
complete 3000 hours of supervised post- master's experience in
a clinical setting, and receive a state license or certification
at the clinical level.
The Health Resources
and Services Administration identifies clinical social work as
one of the four core mental health professions, along with psychiatry,
psychology, and clinical psychiatric nursing. Of the core
mental health providers, clinical social workers comprise
the majority, 60%, nationwide. In addition, professional
social workers constitute 40% of the licensed mental health practitioners
participating in the American Red Cross Disaster Services Human
Resource System.
Therefore, social
workers will be providing significant portions of both the initial
mental health services resulting from the events of September 11,
2001 and long-term, follow-up treatment that will be necessary
to restore the ability of many Americans to function on a daily
basis.
Ken Lee, MSW,
DCSW, one of NASW's 153,000 members,
serves as part of the American Red Cross Air Incident Response
Team which was immediately deployed to New York City. This
crack team of volunteer mental health professionals has been specially
trained to assist survivors, families and friends of victims, and
first responder personnel, such as fire, law enforcement, and emergency
medicine, in dealing with a recent traumatic event involving an
aviation disaster. The American Red Cross has also asked
Lee to be an instructor for the 16 hour class that licensed mental
health professionals must take in order to enroll as a volunteer
in its Disaster Services Human Resource System.
Now in his second
tour of duty in New York City, Lee shared with me that in his professional
judgement, social workers were the practitioners best suited to
deal with disaster mental health services due to their unique training
in systems theory. "I think social work training is
ideal, because systems theory and practice can work at all levels-
individual, family, workplace, and community," said Lee. The
emphasis in social work of empowerment and linkages plays a major
role in assisting people with coping strategies.
Lee kept a diary
of his personal, first-hand experiences in responding to the World
Trade Center that I would like to share with you; a copy is attached
for your information. Although Lee has seen more than his
fair share of death and destruction through his Red Cross service
and had felt prepared for any event prior to September 11th, even
he was taken aback with the magnitude of the tragedy.
Gerald Beallor,
MSW, another NASW member, is a noted health care social work expert
hailing from New York City. He related to me that professional
social workers, working with disaster victims and their families,
are reporting significant levels of emotional trauma experienced
by survivors, rescuers, and surviving family members or friends. Widespread
generalized grief, anxiety and fear are also commonplace. It
is important to realize that those Americans with a prior history
of past trauma and loss are at greater risk for re-occurrences
of anxiety, problems with sleep and concentration, uncontrolled
anger, and other behavioral problems in response to this disaster.
NASW is greatly
concerned as access to mental health services for adults and children
eroded during the 1990's, with increasing reliance by employers,
insurance companies, and Medicaid on managed behavioral health
plans. The managed behavioral health strategy has sought
to reduce the cost of mental health care by reducing provider supply,
placing limits on the duration and kind of mental health care provided,
and establishing an unwieldy and bureaucratic infrastructure that
mental health professionals and their clients must navigate.
In many cases,
mental health provider panels are limited or very difficult to
join, which creates a shortage of providers that plan participants
may select from. The setting of arbitrary limits on the number
of treatment visits or hospital days set in advance also reduces
services. Furthermore, the treating professional is required
to spend undue amounts of time negotiating with insurance companies
for permission to provide the necessary treatment appropriate to
the needs of the patient. Although forty states have adopted
patients' bills of rights, the person with a stress-related or
other emotional disorder often still is unable to initiate an appeal
or argue for more care with an insurance company or employer. Examples
include the patient whose benefit package permits only three mental
health treatment visits, or the provider whose application for
mental health provider status on a panel takes from seven to ten
months to be processed.
The current managed
health benefits system was already experiencing momentous access
and extent of treatment issues. The exponential increase
in the number of Americans requiring mental health services resulting
from this disaster now intensifies and exacerbates those existing
fundamental problems.
NASW has identified
two issues that must be addressed in public debate and public policy
in order to meet this challenge.
- Inadequate recognition that emotional health is as important as physical
health. The inability to realize that mental health treatment,
through skilled professional counseling, pharmacology, or a
combination thereof, does help adults and children cope with
not only situation-induced stress, anxiety, depression, and
other behavioral disorders, but also more chronic mental health
problems such as bipolar disorder and schizophrenia.
Prevention
of emotional dysfunction or breakdown and restoration of individuals
to a steady or “coping” state is as essential to our well-being
and productivity and that of our children as early detection or
prevention of major physical problems such as heart disease
or cancer. Perhaps the communal pain and anxiety that
many are experiencing due to the terror attacks will be used as
a means to diminish the stigma associated with emotional problems
and their treatment.
Emphasis on the need for the business community and government
to support adequate access to mental health services provided by
qualified professionals – whether social workers, psychologists,
psychiatrists or other trained mental health professionals.
- In conclusion,
NASW agrees with recent findings that the existing mental health
care system declined during the past decade. As a result, the
current system capacity to provide mental health services will
not be adequate to meet our nation's post-disaster mental health
care needs. NASW calls upon all levels of government, municipal,
state and federal, as well as the business community and insurance
industry, to adopt short term and long term solutions that consider:
- new
financing and payment methods that recognize and adopt
parity between physical health and mental health services;
- suspension
of existing limits on treatment for stress and other
anxiety disorders;
- measures
to increase the supply of qualified practitioners through
acceptable and efficient training and credentialing;
and
- the
continued deliberate inclusion of mental health providers
and mental health training within the schema of disaster
relief for victims and first responders.
NASW looks forward
to working with you on this and other issues of mutual concern
so we may continue to enhance the lives of individuals, families,
and communities through our professional service.
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