Social workers underutilized resource in behavioral health services

Research Topics > Social workers underutilized resource in behavioral health services

There were almost 650,000 social work jobs in the United States in 2014. This is expected to increase by 12% between now and 2024, a rate of growth that is faster than the average for all occupations. Social workers are also one of the largest groups of professionals providing mental health and substance use services (i.e., behavioral health).

In a 2013 report to Congress, the Substance Abuse and Mental Health Services Administration suggested behavioral health care be integrated with primary care, include a greater focus on the use of evidence-based practices, and take a more person-centered and recovery-oriented approach to care. All of these fit well with social work which emphasizes the ability to navigate across multiple systems and levels of care, evidence-based approaches to care, and beginning “where the client is.” In addition, the move toward the provision of behavioral health care within the context of community health centers has increased the delivery of mental health and substance abuse treatment by a range of professionals including social workers.

Despite this, we know very little about who visits social workers for help with behavioral health issues. Previous studies looking at professional service use have combined social workers with other categories such as human service providers or non-psychiatrists. In fact, there are more studies looking at the use of clergy and primary care physicians in behavioral health than social workers.

In a study led by myself in collaboration with Dr. Robert J. Taylor at the University of Michigan School of Social Work, we describe characteristics of people who used social workers for a mental health or substance use disorder using data from the Collaborative Psychiatric Epidemiology Surveys, which is a large, nationally representative dataset.

Graph from Amanda Woodward showing professionals visited for a behavioral health problem

Over 5,000 respondents said they visited some sort of professional for a behavioral health disorder. Of these, 10.8% visited a social worker at some point in their lifetime, and 2.9% visited a social worker in the 12 months before the interview. Social workers were among the least used service provider among the nine professionals included in the survey along with nurses, healers, and “other mental health” professionals.

People who visited a social worker were more likely to have two or more behavioral health disorders, and all of those who visited a social worker saw at least one other type of professional as well. This makes sense because we know that people suffering from more severe and complex disorders, such as dual diagnosis of both mental and substance use disorders, are more likely to use services and have contact with a range of professionals over time, including potential contact with multidisciplinary teams.

We were surprised that we did not find many demographic differences because differences in behavioral health service use by race, ethnicity, gender, and age are well documented (including in our own work). In fact, we found that women were less likely than men to report visiting a social worker, which directly contradicts previous research about service use in general and the use of primary care physicians and other professionals.

This may be because a higher proportion of men in the study had a substance use disorder, and more women saw a social worker in the context of private practice. In a 2006 NASW report, only 3% of active licensed social workers reported addictions as their primary practice (compared to 37% in mental health). A third of these were men (30%), which is more than in mental health (19%) and the social work profession overall (18%). It is possible that this reflects gender differences in their client base. In addition, social workers in behavioral health clinics and social service agencies, two settings where they are most likely to see clients with addictions, are also more likely to see men (compared to private practice where 74% of social workers report a caseload that is predominantly women).

This study seems to suggest that social workers are an underutilized resource in behavioral health, despite their numbers. In previous surveys, social work is overwhelmingly associated with child welfare and homeless services. People in need of behavioral health services may simply not consider social workers as an option. Some may also have received help from a social worker and not realized it (for example, in an emergency room) or within the context of a broader health issue or stressful life event that they did not report for this study.

As a profession, we may benefit from continuing education of the public and other physical and behavioral health professionals about what we do and the role we can play in behavioral health care. Research documenting patient-centered and fiscal outcomes from social work services would be helpful. In addition, advocating for the inclusion and/or expansion of coverage for social work services in public and private health insurance mechanisms may expand use of these services.

Graph from Amanda Woodward showing professionals visited for a behavioral health problem

Woodward, A. T. & Taylor, R. J. (2018). Factors associated with the use of social workers for assistance with lifetime and twelve-month behavioral health disorders. Social Work in Health Care, 57(4), 267-283. doi: 10.1080/00981389.2018.1437104