When I was in school, professors often asked students where they wanted to practice after becoming licensed. Looking back, nearly everyone answered that question the same way: they wanted to be in private practice, whether opening and running their own office, or working in a small group practice. And I felt the same. When I thought about my future as a therapist, I only thought about the “benefits” of private practice, which included (for me): flexibility, the ability to set my own rates, choose exactly the clientele I wanted to see, and working in a comfortable office space – likely one that I had set up and designed.
No one, at least no one I recall, spoke about working in Community Mental Health. The stories that circulated amongst my classmates about that kind of working environment weren’t positive. Most of what I heard focused on “long hours and low pay,” and concerns related to burnout, bureaucracy, and broken systems. ”
There are positive aspects of Community Mental Health work, and I wish someone had encouraged me to think about the many advantages to working in Community Mental Health.
Midway through my practicum at a Community Mental Health site, I was offered a paid position, and I took it without hesitation. Today, as I get very close to completing my 3,000 hours, I’m still working there. And I love it. Former classmates are often surprised. They assume that I'm getting paid far less than my colleagues in private practice. But is that true? I'm not so sure. Although the hourly rate for Associates in private practice often exceeds $100, the Associates have to split that amount with their supervisor ( it’s rarely 50/50!) and will only make their full rate when a client shows up. If a client cancels within the 24 hour cancellation period, the Associate doesn’t get paid the full amount for that session. At my clinic, however, I get paid a salary. So, when a client is a no-show, I still get paid. And my paycheck is reliable. I get the same amount, deposited into my account every two weeks, which is comforting after paying for grad school and trying to earn a decent living. I also get regular raises, and a small bonus at the end of the year. I receive money and PTO that I can put towards continuing education and training - money that I don’t have to take out of my own pocket.
I also get benefits, like excellent health care insurance, paid vacation time, paid sick days, and a 401k. My private practice friends are lucky if they are offered these things and they often have to pay out of pocket for all of them. I also experience an advantage when it comes to billing/insurance. Because I don’t have to do it! In Community Mental Health our billing department deals with the insurance companies. I don’t have to spend any of my time tracking people down for late payments or credit cards that have been declined.
All of these things are advantages that people don't often consider when thinking about working in Community Mental health. But that’s not why I stay. The biggest benefit, at least for me, has been the clients. I’m working with some of the most interesting, resilient, funny, compassionate, loving, and generous people I've ever met. I learn from them every day, and I am genuinely grateful and blessed to have them in my life. Yes, I sometimes feel like I’m in over my head when dealing with severe mental health issues. But I have grown a tremendous amount.
Finally, I’ve come to learn something about myself. I don't like working alone! And private practice can be very isolating. I didn’t realize how much I would value the camaraderie that is inherent in a community mental health setting. But I really do. There is always someone available to talk to, to lean on, and to share experiences, good and bad. I have laughed with my coworkers and cried with them. And I never feel like I’m in it alone. But best of all, I feel like I’m making a difference every single day. And nothing else feels that good.
Are there frustrations? Yes, of course. Sometimes too many to count. But I also know that no job is free from those. And I think it’s a real shame that we so often dismiss Community Mental Health before considering all of the advantages and benefits. So, my advice to students, trainees, and Associates is to consider all aspects of the job. Maybe Community Mental Health is not for you. But maybe it is. And you might be surprised.
Rebecca Hines, AMFT and CAMFT Pre-Licenced Director at Large, went back to school after a long career in marketing/advertising and received her Masters degree in Clinical Psychology from Pepperdine University. She is excited to be less than 200 hours away from fulfilling her 3,000 hours for the BBS! Rebecca believes that everyone deserves access to quality mental health care and is dedicated to helping marginalized and underserved populations. She is specializing in trauma resolution, and also enjoys working with couples, especially when unresolved trauma for one or both partners is impacting their relationship. Currently, Rebecca splits her time between a community mental health clinic in Oakland, CA and a small group practice in Sonoma, CA.
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