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Testimony of the National Association of Social
Workers
Washington, DC 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 26, 2001
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.
Mental health is an issue of great importance to the entire social
work profession as social workers are highly trained professionals
who spend their entire careers helping children, adults, families,
and communities deal with adverse circumstances. All forms of social
work practice utilize a psychosocial approach, which examines the
person, group, or community within the context of their environment
and facilitates appropriate problem solving within that framework.
Professional social workers are knowledgeable not only about human
development and behavior, but also about social, economic, and cultural
issues and how all of these areas interact and impact our daily lives.
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. These mental health professionals
are distinguished from other professional social workers as Iin order
to practice, one 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, one anotherof NASW's 153,000 members, 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 reoccurrences
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.
Preventionng of emotional dysfunction or breakdown and
restorationing 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 attacks disease or cancer.
Perhaps we can use the communal pain and anxiety that many will are experiencinge
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; and
- 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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