Social work and mental healthcare: Q&A with Elizabeth Kleeman

Editor’s note: This blog post is part of an ongoing Progress Notes series featuring individuals who work in clinical psychiatry. In the following interview, third-year medical student Jessica C. Sheu interviews Elizabeth Kleeman.

Elizabeth Kleeman is a licensed clinical social worker serving as the suicide prevention coordinator at the Michael E. Debakey Veterans Affairs Medical Center. She is interested in innovative strategies that improve mental health treatments at all levels, increasing access to recovery, and overall wellness.

In the following interview, Kleeman discusses her path to social work and a social worker’s vital role on a mental healthcare team.

Q: Why did you choose to become a social worker?
A: I have a B.A. in psychology and I had actually intended to get my doctorate after undergrad. Two of my aunts, who have since retired, are social workers and the more I spoke with them about what I wanted and appreciated about mental health, the more I understood that psychology would not get me the same contact and interaction.

I barely understood how dynamic social work is as a career and practice at the time. Now, I feel more strongly about that because there is just so much you can do in the social work realm that is unique to this particular discipline.

The short answer to “why I switched” was really that I understood the opportunities and the breadth and depth of social worker positions and where the work can take you.

Q: Why did you stay in social work?
A: I stayed in social work because of the VA. The world sees social work from a very limited perspective. In grad school, there are tons of options. By happenstance, I got into the VA and I have never felt limited here. I was an intern at the VA and I’ve been here for 11 years. The opportunities that we have, creativity and positions that you can take, the services that you can offer, and the training that you can get are state of the art. The VA is the largest employer of social workers and I understand why.

Q: What do you do as a social worker in the VA Hospital?
A: I am the mental health care line special programs coordinator. I supervise the Suicide Prevention Team and the Veterans Justice Outreach Team. Those programs are staffed right now by 16 social workers. They are niche groups, which is why they are referred to as “special programs.” We actually serve the whole hospital to provide suicide prevention expertise. The Veterans Justice Outreach Team has a unique role situated as liaisons between the court, probation, and the VA or between jail and the VA.

Q: What is the role of a social worker on a mental healthcare team?
A: The role of a social worker on a mental healthcare team is dynamic. A social worker can do so much – we can provide therapy because we’re independently licensed and we can assist with case management issues, addressing the drivers for someone’s distress and thoughts of suicide, and whatever modifiable risk factors there are.

We are often consultants to the other disciplines on what impacts people’s well-being and their experience – like their marriage, their past, their childhood, their current family, their work, etc. Social justice is  truly what drives us; this helps the entire team function because it calls out the blind spots.

Social workers take the perspective of “you tell me what is wrong and tell me how I can fix it. We’ll take what we know to be true and come up with a plan.”

Q: In light of COVID-19 and current social issues, how have you been coping?
A: In lots of different ways. Talking to people, listening more than I’ve ever done before, trying to fully embrace cultural humility, and understanding what I don’t know. It’s my job to learn, to be wrong, to make changes, and to start conversations with my team. I don’t know if I would have felt safe doing that before because, in true white fragility, I have a fear of being wrong.

I started being willing to tolerate what I hear about myself and about others. The mental health care line executive and I had a talk with my staff about managing racial tensions and COVID-19 from a suicide prevention realm, and how to support patients and one another doing this work. It’s not just patients who are affected, it’s us, too – there’s a parallel process going on.

I’m doing a lot of reading, podcasting, and talking to the people who I value in my personal life.

Q: What advice would you give to others going through a hard time?
A: I’d say that they’re not alone. The mental healthline line executive always says that if you’re  in disequilibrium, that’s a good place to be because disequilibrium, although uncomfortable, does allow something to happen. No matter where you’re coming from, disequilibrium allows you to put new information in, double down on what you think, and get clear on stuff. You’re not alone in feeling disrupted.

Even in this space of social isolation, there are ways to stay connected to each other. This is something that I’m struggling with as a parent, as an employee, and as a supervisor now. You cannot artificially create touch and human connection in that way but you can come up with a middle ground for us to stay connected. Our PTSD clinical team director, a psychologist, was clear early on in the pandemic to say “you can be physically distanced but not necessarily socially distanced.”

If you’re already predisposed to social isolation due to PTSD,  depressive symptoms or social anxiety, the concern is that this could be the breeding ground for lots of ineffective behavior. Even if you’re not, being alone with these thoughts and concerns can be difficult.Be proactive,  figure out ways to stay connected with people, and stay on top of your health and well-being.

-By Jessica C. Sheu, third-year medical student at Baylor College of Medicine