While sitting at my desk working patiently on data entry and file review, I can’t help but hear my HSSP professor’s words echoing in my mind… “prevention, intervention, and follow-up of patient cases are essential to health care!” Professor Conrad’s course Health and Society reflected on the various forms of illness, how society defines and perceives illness, and the methods by which illness can be treated. As I read files from the 1970s, I can see how our nation’s mentality has shifted over the decades regarding mental illness and treatment. HSSP courses usually begin with a review of the historical timeline of health and health care in the United States, and so it’s basic knowledge by senior year for HSSP students that the taboo surrounding mental health persisted in our country up until 10 or 15 years ago. Recently, this trend has abated in light of the development of legislation that mandates health insurance coverage for mental health services and grants funding for non-profits focused on mental health services.
When looking through files dated before 1985, I am reminded of the lack of support for individuals who require some form of counseling or therapy, and the faulty networking between agencies involved for that matter. Initially, Emerge adopted a political agenda, operating on the belief that the response to domestic violence should be social action rather than medical or psychological intervention. The creators of Emerge were activists, not medical administrators or health care providers. Therefore, the majority of these first case files are not standardized, meaning that the folder contains errant papers, scribbled notes, and blank/missing information. Some vital information, such as the client’s date of birth or social security number(important for identifying clients who are also on probation or have pending court cases) are not even required fields on some of the older forms.
The forms Emerge uses to keep records have changed drastically since 1980. The referral source in 1980 was more likely to be a family member, informational pamphlet, or co-worker. Abuse history is brief, especially in comparison to the modernized form.
Furthermore, not all clients were interviewed in the same manner, and so information that would otherwise be useful in identifying the socio-economic status of the client was consistently left blank, which created a gap in quality of service in many cases. The purpose of the program was geared towards providing support services for victims and partners, but the consequential development of a client-base who sometimes require long-term counseling meant that Emerge had to adapt.
In contrast, the newest intake forms require personal identification information such as DOB, SSN, and car make/model. This information is relevant for clients who have been referred by a Probation Office or DCF Agency for violence against a partner or abuse of children. This form, in comparison with the 1980 version, allows clients to record the number, names, and ages of their children, in addition to the other biological parent. The older forms did not account for non-traditional families.
It is clear that a significant amount of progress has been made since the founding of Emerge. All new files have a comprehensive background on all clients – today’s files are so detailed that we request partner contact information for not only the “victim” and “current partner” but also 2-3 ex-partners. Sometimes, to provide better services for the client, we investigate incidences of violent and controlling behaviors in previous relationships. The increased demand for accurate information ensures that Emerge can follow up with victims and partners to get firsthand reports of incidences of violence or abuse. The agency also contacts victims regarding the status of the client: whether he has been attending, has completed, or has been terminated from the program. Clients can use group sessions as a form of social support, to continue to work on themselves in a familiar, comfortable setting among men who can relate, either through cultural identity, family history, or lifestyle, etc. Emerge still emphasizes a focus on abusive behavior and not on the psychopathology of the abuser. Its relevancy in the field of social services and mental health services is evident.
This unique lens of being able to see the real-time applications of my HSSP courses for the coming semester is a huge motivator. I can attest to Professor Conrad’s principle that prevention and intervention are major elements of confronting the issue of domestic violence and other mental health problems, such as co-morbid substance abuse or long-term anger/violence. I recall another HSSP course, “Perspectives on Behavioral Health: Alcohol, Drugs, and Mental Health,” which provided me with an academic background of the current problems that Emerge clients deal with: ending addiction, understanding their own behavior, coping with past traumas and current stressors. I am enthused that I can apply information from my past classes to gain a greater understanding of the clientele, such as the impact of drug use on self-esteem and interpersonal relationships. Using this knowledge will allow me to conduct thorough personal history interviews and deduce key concerns related to the individual’s progress. Streamlining my own methodology will only allow me to better serve the needs of the client and victim, which is paramount to improving the nation’s Social Services in future decades.
Reflecting on the progress that Emerge has made as a pioneer domestic violence counseling center, it is obvious that there are still a few hurdles to overcome. Emerge offers services in Spanish and for other minority groups like LGBTQ individuals, and has a much higher completion rate than in decades past. Still, client attendance records suggest that we have yet to truly validate mental health care services as irrefutably necessary in today’s world. Social stereotypes still exist that may prevent clients from continuing group counseling, as many men believe that “real men don’t need help.” Agencies like Emerge have minimal influence to enforce attendance and participation. By examining Emerge’s past, and observing the present group sessions, I believe that I have a clear picture of where we have come from as a nation and where we are looking to go in the next few decades to improve the quality and image of mental illness and health services in the United States.
Elsie Bernaiche ’15