The Mental Health Field of Practice

Abstract

The mental health field of practice has undergone vast changes in financing, services, workforce, policies, and structure over the past two decades. Part of these changes has been fueled by the enormous increase in acceptance of managed health care as national policy. One of the most significant shifts has been the reduction in the number of episodes that take place in psychiatric settings and the increase in those that occur in primary health care settings. In the past two decades, far more episodes of psychiatric care have been provided by primary care doctors than specialty practitioners. Another key change is the trend toward integrative care that encompasses mental health, substance use, and health. Despite these major changes, the mental health field generally remains a major source of employment, identity, and status for social workers. Social workers provide the majority of the workforce in mental health care in the United States. However, three major changes in the mental health field have shifted the locus of services from inpatient to outpatient and toward brief interventions based on evidence-based practices. These three changes are redefining and shaping the future of social work practice, education, and research in ways unforeseen just a decade ago. The contemporary challenge for the social work field is to determine how to remain current and value-driven as the entire field undergoes refinement and change.