Are you a LICENSED mental health provider? Do you work for an agency, hospital, or community based organization? DO YOU LIKE WORKING THERE? DO THEY RESPECT YOU THERE?
If your answers are Yes, Yes, No, No then you'll want to keep reading!
Entrepreneurship and Boundaries...what in the world do they have in common?!
The way work environments are set up in the US very much classify people (and their worth & value at work) by position. If you don't have a position that allows you to set boundaries as needed, at work (yes, even at work), then you are not supported in setting those boundaries...and sometimes even retaliated against for setting or maintaining appropriate personal boundaries at work.
Use these links for quick reference to each section
Boundaries with *Difficult Persons
If you follow my work, you know I often talk about boundaries. Mostly in the context of relationships with others. And mostly in the context of personal relationships with others. However, boundaries are important for other parts and aspects of life, too. Not only do we need boundaries to protect our nervous systems in difficult relationships or with difficult people (*difficult is nuanced, what’s difficult for me may not be what’s difficult for you, but difficult for someone, nonetheless), but also in circumstances, specific conversations or environments, around roles and responsibilities, around competence and ethics.
Retaliation for Boundaries at work...oh not just me?
Boundaries for these areas are more likely to show up in professional, volunteer, community organizing, slightly more ‘official’ kinds of places. And many people believe they cannot set boundaries in these contexts. And in many cases boundary setting in these contexts comes with consequences…like being passed over for a promotion because you used all of your PTO for the year; or retaliation or microaggressions for not ‘doing what everyone else is doing’; or feeling left out or ostracized because your capacity is different than someone else’s. And I get it! No one wants to experience these outcomes for setting boundaries that make sense for them and their functioning…yet in workplaces this is sadly more the norm than the exception.
Compromising Your Values to Make a Living
And then people feel stuck. Stuck in an ‘official’ position somewhere that requires them to compromise their values, beliefs or boundaries to ‘get the job done’… the way ‘they’ want the job to be done. Regardless if the way ‘they’ want the job done is unreasonable, unethical, unsafe, or unmoral. This happened to me. In my last mental health agency job. Many requirements for the outpatient clinician at this public mental health organization were unreasonable, and as a result turnover was relatively high (not surprising, it is in most mental healthcare jobs); leadership and upper management were poor and self-serving; safety, trust, and transparency did not exist; and speaking up about things that were unethical or unsafe seemed to be ignored, swept under the rug, or resulted in ‘closed doors meetings’ to discuss your comments and behaviors about this in the workplace (totally and absolutely wrong by the way, wish I had known that then…). Ultimately, it was a completely unsafe place to work. It didn’t feel safe emotionally. It didn’t feel safe physically. It didn’t feel safe financially. And, it didn’t feel safe to speak about your experiences or needs in this workplace. Have you ever felt this way at work?
Imbalance of Value between Mental Health & Other Professions
I’m sorry, not sorry, but who TF wants to work at a place like that? Seriously? If this is what was advertised for the position no one would apply, let alone accept it, at a such a low paying salary, too! Yet, this culture and experience is NOT unique to me. It is INCREDIBLY COMMON in just about any and all mental health positions. Also, a pretty regular occurrence in other healthcare professions. And in general, many, if not most, workplaces operate like this: top-down hierarchy; boots on the ground have little power and little say (and little pay) for the most grueling kind of work; lack of empathy for the provider/worker/employee being an actual human being; unreasonable demands and expectations; then retaliation/ostracization for anyone who cannot meet the unreasonable demands. It is such a messed-up cycle! Impossible to ‘beat.’ And inhumane, in my opinion. I dream of the day mental healthcare providers are valued for our amazing work, and valued as people who choose to do this work knowing the lack of pay, lack of respect, and lack of humanity that exists in the organizations employing us. I would change it all right now, if I could…but as I often say, I’m not the one in charge…Or am I?
Well, that’s what I realized. I was in a one-down, two-down, three-down position from leadership and management—and they were the ones in charge, making the decisions, that quite frankly, affected my physical well-being and my life! What happened when I addressed my concerns ABOUT MY OWN HEALTH AND CAPACITY TO MEET THE DEMANDS THEY WERE ASKING OF ME? More closed-door meetings about what I ‘can’ and ‘cannot’ say at work. No support for my legitimate safety fears and concerns. And all of this for less than $50k a year (less than 10 years ago btw). What was worse? I had nearly 9 years of career experience at this point, had obtained LCSW licensure, and was the same age with same years/level of experience as my supervisor—getting shit pay, for shit work, with shit leadership, in a shit system, that didn’t give a shit about me, Sarah, the human, underneath all the shit. Sound familiar? If you’ve ever worked in mental health for any agency, some of this, if not all of this, likely will resonate with you.
Cons for Mental Health Professionals at Agency Jobs
Let me pause for a minute and recap the pros (limited, almost not existent) and cons (so many I can't even list them all) of this position and explain my level of education and experience for the pay and the job demands, then volley it over to YOU, anyone else in any other industry or career, and ask YOU if you would accept a job with these requirements for this pay with this level of education and this many years of experience. Because I seriously doubt it. And it’s ridiculous it’s asked of us.
Job Duties:
Carry caseload of Severely Mentally Ill adults, most of which were also dually diagnosed with a Substance Use Disorder of about 45-55 clients; some voluntary, some court mandated for treatment
Complete 1 new intake a week (which added a new person to my caseload every week)
Complete 2 new intakes a week (which added 2 new people to my caseload every week) when someone on the team would quit, as we were required to fill in the gaps, adding more to the already full plate, for months at a time while they tried to find/hire new clinical staff
Attend every client’s psychiatry appointment as scheduled, occasionally required to go pick up client from home and bring to office for appointment and then return the client to home
Complete ridiculous amounts of documentation, also citing client change every 30, 90, 180, and 360 days, forever (which is impossible in the best of cases, let alone with SMI...)
Complete TDO evaluations for inpatient hospitalization for my own caseload (during regular working hours) and then also for the entire county on a rotating overnight shift, when I had zero crisis intervention training, and very limited support (this was an entire shit show that I don’t have time for explaining all the details for at this time…another blog, another day!)
Attend staff and supervision meetings a couple times a week (about 15 hours of my week consisted of meetings)
Facilitate a weekly Relapse Prevention Group
Make unannounced home visits for clients that stopped coming to appointments (uh, there’s a reason they stopped coming, I was never comfortable showing up at their house to ask them why)
If your clients happened to be incarcerated, required to go see them at the jail, on your own
Job Parameters:
Schedule? M/T/TH 8:30-5pm, 30 min lunch; W 8:30am-9pm, 30 min lunch; F 8:30am-1:00pm, no lunch
On-call Crisis shift: overnight 9pm-8:30am every 6 weeks; the only clinician on call for crisis evaluations for the entire county (one night I had 3, and no help!)
If your crisis shift was scheduled for Wed, you would get off work at 5pm (instead of 9pm) just to return to ‘work’ at 9pm until 8:30am the next morning—yes, you read that correctly. They expected you to nap/sleep in that 4 hours (okay, impossible for me) and then work another 12 hours after you worked 8 hours. Oh, but they would give you the next day off. But back to regular schedule for Friday, as if that didn’t screw up your sleep cycle and subsequent alertness once you’re back at work.
Mandatory office coverage (because I was at the satellite location with limited clinical staff, so 2 clinical staff had to always be on site) and there was a schedule for this in half day time blocks (I had 3 coverage shifts every week). Guess what? If your crisis shift next day off fell on a day when you were required to provide office coverage, YOU, the employee, were responsible for finding coverage for your coverage shifts (WTF? Like I don’t have enough to do and worry about right now, like not falling asleep driving home at 9am after I’ve been up for over 24 hours on this crisis shift-- this is just another demonstration of lack of support for mental healthcare workers)
Job Non-Perks:
No stipend for licensing renewal fees
No stipend for CEU/continuing education (required for licensing) trainings
Required use of PTO to attend outside CEU trainings or conferences
No holiday parties or end of year gifts (maybe I got a mug, maybe an umbrella one year…)
Team retreats were basically training/learning days rather than anything fun
No guarantee you could take off/vacation when you wanted (because of coverage needs/duties)
No bonuses...ever
No over time pay
Maybe a 1-2% COLA raise annually (getting a performance based raise was almost unheard of, and only added another 1%)
Really difficult ladder to reach Clinician II status, and very little reward/change in pay
Concerns for physical safety many many times due to client instability/threats to clinical staff
Shared concerns or complaints about the load or duties resulted in closed door meetings to hush staff from commiserating with each other
My Professional Experience:
High School Valedictorian
Bachelor’s Degree from Virginia Tech (Summa Cum Laude)
Master’s Degree from VCU (4.0 GPA)
2 years of unpaid internship experience (EAP, adolescent SUD, Case management, DBT team)
Part-time employment at EAP
Part-time employment at UVA inpatient psych unit
3+ years in Mental Health Skill Building (community-based MH support work—inner city Richmond, VA)
3 years Outpatient Clinician (this is last job I’ve been talking about)
2 years of supervised work (2000 hours; needed for licensure)
Paid for 100 hours (required for supervision for obtaining licensure) out of pocket (was not covered by employer without a 5 year post-license commitment to the agency—uh in these conditions for this pay? No thanks.)
Obtained licensure (paid to apply, paid to take practice exam, and paid to take real exam—none ever covered by any employer)
ALL OF THIS EXPERIENCE, WITH ALL OF THE ABOVE JOB DUITES AND PARAMETERS, AND WITHOUT ANY PERKS WHATSOEVER…
AND I was making LESS THAN $50k/annual gross salary. Yes, you read that correctly. With same education, need for licensure requirements, and ultimately the same expertise as equivalent to lawyers…yet the shittiest job for the shittiest pay with zero perks.
LAWYERS: Would YOU accept a job with these kinds of demands, with the same education and years of experience, after passing the bar, for less than $50k/annually?
How about after 9 years of paid work experience?
Right.
I sincerely doubt it. Why? Because it’s not expected in that profession. So why?!? is it expected for us? Mental healthcare providers who literally put in the same work, for the same amount of time, obtaining the same kind of proper certification to practice, make half to a third of what a lawyer would make…THIS SHOULD BE INSANE TO EVERYONE! Yet, it is EXTREMELY common practice for mental health workers.
Not only are we undervalued, underpaid, and underappreciated; we’re also undermined, uncared for, and under-guided by leadership and management in these positions…yet responsible for all the outcomes, good or bad, despite a system that doesn’t help us, doesn’t care for us, and doesn’t advocate for us.
Uncared For and Under-Guided
Not only are we undervalued, underpaid, and underappreciated; we’re also undermined, uncared for, and under-guided by leadership and management in these positions…yet responsible for all the outcomes, good or bad, despite a system that doesn’t help us, doesn’t care for us, and doesn’t advocate for us. Yet expects us to care for the most ill, most marginalized, most isolated of society...and keep coming back to do more, give more, help more, despite never getting refilled. It's impossible to work this way forever, yet it's an expectation for mental healthcare providers.
And every time I tried to advocate for myself, or the ethical principles of my profession/license to be upheld, I was hushed, reprimanded, ignored, or otherwise treated as less than or problematic. Ultimately, I had to quit because my physical and mental health were suffering…and my employer didn’t give a shit because there was still a job to be done, clients to be seen (and cared for), hours to be billed to managed care companies, and more and more intakes to be added. It was impossible to care for myself AND remain in that position. PERIOD. I was nearly completely burned out after only 9 years into my career. I was thinking of finding a new career or industry altogether. I was THAT READY to be done with mental health.
But what else was I going to do? I spent 6 years in higher education obtaining degrees to get me to this profession. I had spent my entire life working hard in school, internships, and jobs to be good at my position, to be noticeable to employers, and to land future employment. I had spent time and money (a lot of both) to complete supervision for licensure and to become licensed. I had invested well over a decade already to being a mental healthcare provider. So, if not that, then what?
Exactly. I had no idea either. Not only did all of my education and experience only set me up to be a mental healthcare clinical provider, I also couldn’t imagine doing anything else. I was good at my job. I was an effective provider for my SMI clients. I enjoyed my work with them (mostly, except the scary, dangerous ones that I didn’t get proper support with). I realized my work with clients was the ONLY part of my job that I liked. I knew I had chosen the right profession; I just hadn’t chosen the right workplace environment. Why? Because it doesn’t exist for mental health care providers at any agency, in any system—they’re all EFFED! How could I do what I enjoyed without all the bullshit?
Scary But Worth It
Entrepreneurship marched right through my psyche and into my life. Something I always kind of dreamed of (having my own practice, that is) but never knew how to materialize. And it was scary as all hell, at first. No set schedule. No set salary. No set benefits and insurance. No set co-workers. No set support.
It was the best decision of my life, hands down. Other than dealing with health insurance bullshit (the new shitty part of being a mental healthcare provider), all the shit fell away. And the bright light that was my skillset, my passion for work with clients, and my hard fought/won grit and resilience led me to a life of entrepreneurship…and the ability to set boundaries, care for myself, work within my scope, follow my ethical guidelines, choose my clients, set my schedule…and remain in the profession, a helping profession, that benefits so many (me included! Love my therapist!), instead of burnout, bow out, and move on to new career.
If ANY of my story resonates with ANYONE out there, whether you’re in healthcare or not, please consider something different for yourself. Consider something else, that may be unclear, hard at first, scary, unknown, because it may be the exact thing you need to create a life worth living, to create a life for YOU that YOU want to live.
There Is Another Way
Hear me when I say, it doesn’t have to be THAT way. You don’t have to stay in a job that drains you, makes you sick and unhealthy, doesn’t allow you to care for yourself and set necessary and appropriate limits, and doesn’t appreciate, value, or care for you or your well-being. There is another way…especially if you’re a licensed mental health professional. Now more than ever, people need mental healthcare. Now more than ever, with advancements and use of telehealth, it’s easier to start a private practice. Now more than ever, having a mental health practice is a ready-made profitable business. Just open your doors, and they will come. There are so many people in need, and so many people understanding the value of psychotherapy-- especially as Gen Y and Gen Z emerge as the movers and shakers of the time-- that filling your desired caseload is sooooooooooooooo obtainable, and likely in way less time than you think it would.
And I Can Help You!
If you want a way OUT. If you want a BETTER LIFE. If you want a BETTER JOB. Contact me for 1:1 Coaching for pivoting your skills for new careers. If you are LICENSED MENTAL HEALTH PROFESSIONAL and want a way OUT, BETTER LIFE, BETTER JOB, contact me for 1:1 business consultation and guidance for you to open your very own private practice. Yes, I can do that for you! Yes, I can walk you through everything! Yes, I did it all myself, without business classes, coaching, workshops, or a lawyer! Yes, I’ve been in successful profiting private practice for 8+ years! YES, OH GOD YES do I want to help you do the same. Why? Because I both value our profession and I value us, the people in the profession, doing all the hard stuff. We deserve better pay, better working conditions, better support, better training, better community. And we need all of this, too. Not only for longevity in this demanding profession, but for OUR physical and mental HEALTH AND WELLNESS. You, the provider, are a person, too! You, the provider, deserves to be seen, heard, and validated! You, the provider, should be celebrated, lifted up, cheered on, and supported, both as a helping professional and as a HUMAN. I can, and will, do that for you! I’m confident I can assist you in getting your practice up and running, and fill your caseload, before you know it. It’s going to be okay. You are not STUCK. There are other OPTIONS available to you. You might just need a little help from your friends (a.k.a. colleagues that get it, a.k.a. me!) to give you the boost you need to embark on an entrepreneurship journey that I believe you will never regret.
And, I’ll stick with you as long as you need for that support, as we all need support, and we’ll never stop needing support. When you hire me as your coach or small business consultant, you come into my network and you get to stay. For as long as you want. Because I’m not just helping clinicians start practices, I’m offering connection to other clinicians/entrepreneurs that get it, and will remain your support system throughout your business-owning journey. I’m creating a community for us. A safe, supportive, transparent, vulnerable, inclusive, trauma-informed and human-centered community of clinical professionals…so you never feel alone in this work, and you never question whether you have support for you, the clinician, and for you, the person with their own lived experiences of all kinds of stuff. I get you. I am you. I want to be in community with you. I want to support you, and I want to work with you! Value-aligned relationships and work opportunities are the only way I do work now. You will be seen, heard, understood, accepted, and celebrated for all that you bring.
Thanks for reading! :)
Next Steps
Now, who’s ready for a new life?
Contact me today! Let’s get this ball rolling so you can find wellness and authenticity in your work…and you never have to compromise it again!
What Else?
Join my monthly support group for Mental Health Professionals. Register here
Read about the differences in my service offerings with this Blog Article
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Compassionate Self Kits-- choose one of these digital downloads to start on your wellness journey independently. Kit Options: 1) Self-Care 2) Setting Boundaries 3) Burnout Awareness 4) Burnout Recovery Full Kit 5) Self Care, Love & Growth Workbook. Purchase here
Trauma Informed Leader Learning Guide-- get your feet wet with transforming the way you lead by incorporating trauma informed principles into your decision-making Learn more & Purchase here
Anything Else?
Check out more of my publications here and more blog articles here
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You can contact me here:
Email: sarahefobrien@gmail.com
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