Did We Cover That in Class? Important Topics for Working in Mental Health

by Miranda Rex, MA, MT-BC

It’s impossible to cover all the minutiae of every population while you are in school, especially if you are an undergraduate student. Additionally, your school may have a particular area it specializes in or is more geared toward, so the seemingly little things involved in working with each population may not be covered.

I felt like I had a great education as a master’s equivalency student at Texas Woman’s (read about that experience here), but once I started getting more involved in my internship, then once I got a job, I soon realized that there were important topics in the area of mental health that we did not have time to cover. 

If this sounds familiar to you, read on for more information about working with the mental health population!

One of the unfortunate realities of working in mental health is having to go through restraint training.

If you have little experience in this area, it can be jarring and honestly can feel a little scary. You hear about all these scenarios (hypothetical and not) and are taught how to protect yourself, other patients, and, hopefully, assist the patient in reaching a calmer state. 

Ideally, verbal de-escalation is used before a physical restraint is put into place, which is what most restraint trainings recommend. But how that happens and what that looks like varies between the different trainings, though they share similarities. Here is a list of the most commonly used de-escalation and restraint trainings:

 

Something else to consider along with restraint training is, of course, diagnoses and medications.

In my experience, what intimidates people the most is patients who are “psychotic” meaning patients whose thoughts, words, and actions are not based in reality. It’s not abnormal to feel a little shocked when first interacting with patients who are experiencing psychosis, but just know that you don’t have to be afraid. Some of my favorite groups have happened on a unit dedicated solely to psychotic patients.

One of my biggest regrets from internship was not authentically engaging with patients who had been deemed as potential safety issues. Experienced and seasoned staff knew this just meant we needed to be more alert, but for me, as a green newbie, this meant I should be afraid. This is not true, so enter experiences with these types of individuals with an open mind.

But these are not the only types of diagnoses you will run across in this setting.

Most patients who enter treatment for mental health are experiencing severe depression or have recent suicide attempts. Other common diagnoses include bipolar disorder, substance-use disorders, and trauma-related disorders. It is extremely likely that you will run across other diagnoses wherever you are, but these have been the most common in my experience.

To learn more about different diagnoses and their medications in easy to understand language, visit the NAMI website:

For more information about working with individuals with psychosis, check out this booklet from NAMI Minnesota.

 

Assessments are also a big part of mental health treatment.

Every facility has different ways of going about this, but typically creative arts therapy assessments pretty much require you to ask questions about their current hospital stay as well as their hobbies and interests. It can be difficult because often times this is one of the first things patients experience after being admitted, so you need to be tactful about how you ask some questions (e.g. drug use, questions about family) because they might not be honest, or they might be triggered, or they just might not want to talk to you. Don’t take it personally.

When writing a narrative of an assessment, or when documenting a session, using appropriate language helps paint an accurate picture of what occurred during these interactions. Appropriate language in this case basically means expanding your vocabulary so that you can describe how patients looked, behaved, and what their non-verbal communication revealed.

For example, writing a note like,

“Miranda was sad during group and didn’t do the activity.”

doesn’t tell us much about what happened or what was going on with Miranda during the session. It’s best to be concise, but provide enough information that someone who wasn’t in group could have an understanding of what happened based solely on what you wrote. 

“Miranda appeared depressed during group. She was tearful throughout and isolated herself from her peers. When prompted by therapist to engage, she shook her head and pulled up her hood. Therapist checked in periodically, but Miranda remained withdrawn.”

This is not a perfect example, but it gives you an idea of a more comprehensive view of Miranda’s actions during the group.

Here are some helpful links for writing assessments or notes:

  • Emotion descriptors 
    • NOTE: I don’t like how this describes emotions as positive or negative; emotions aren’t “good” or “bad” — they’re just emotions. By labeling them as positive/good and negative/bad, we are subconsciously labeling people as good or bad; however, the site does have good word/synonyms that are commonly used in this setting.
  • These are some helpful assessment and screening tools and have some “buzzwords” you might run across in a psych setting.
  • The Columbia-Suicide Severity Rating Scale is something one of my facilities uses to assesses suicidality for patients. 
  • The DSM 5 is also a great resource, especially if you are getting into the little details or various types of diagnoses.

Annie recently wrote a blog post about books music therapists should read this year which has some great resources.

These are some additional books that I found useful in my mental health work:

Keep On Learning

It’s impossible for a single degree program to cover everything you’ll ever need to know about every population and setting – that’s why music therapists maintain continuing education credits as part of our board-certification. Keep an open mind and a learning mindset and you’ll be surprised how much you’ll learn as a professional!

What information or resources do you wish you had access to when starting work in mental health populations? Drop your recommendations in the comments below so we can learn from you!

Miranda Rex, MA, MT-BC

Music Therapist – Board Certified

miranda@heartandharmony.com