Lessons from an Undercover Social Worker

By Emma Costain, Columbia University MSW Candidate

Most days, I consider myself an Undercover Social Worker; a sort of double agent, if you will. I work in an acute psychiatric inpatient hospital, and when I sit in on Treatment Team Meetings, I often feel as if I am undercover, being forced to hide my true identity. I listen to my colleagues (who are all mental health professionals) say the most horrendous things about our patients with Borderline Personality Disorder, utterly unaware that one of the Social Work Students in the room with them has the very same diagnosis as the patients they are insulting. I once heard a psychiatry fellow tell a resident that the best piece of advice he could offer her was to “never go within six feet of a patient,” incognizant to the fact that the person standing a few inches from him was once a patient herself, and that just by standing less than six feet away from me, he was violating the one rule he swore to live by. After attempting to lead a Social Work Group in one of the units on another particularly boisterous day, I expressed to one of the social workers that I wished we had a room inside the units to conduct groups so that we could actually hear the patient’s responses and do our group uninterrupted. Her response? “Oh no, you don’t want to do that. You don’t want to be alone in a room with those people.” The irony of the situation is that she was currently alone in a room with 'those people'. At that very moment when she said that to me, she and I - a former psychiatric patient myself - were alone in a room together.

When I say that I sometimes feel like an undercover social worker, it is because I am forced to hide the truth about my lived experiences with mental illness and psychiatric hospitalization from my colleagues. This “us versus them” mentality is a toxic dichotomy that creates an unnecessary divide between patient and provider. As someone who has been both the patient and the mental health provider, there is one thing I know for certain: You – the mental health provider – are no different than the patients you provide services to; you are not any better than the patients you are currently treating. Just because the patient is in a hospital gown today, doesn’t mean that they won’t one day be wearing the same scrubs you adorn now. And the reverse is true, as well . Just because you are wearing the gray, blue, or red-colored scrubs that signify your role as a mental health provider today, doesn’t mean that it’s impossible for you to one day be the patient wearing a hospital gown. We cannot make progress in eliminating mental health stigma if we continue the problematic “us versus them” dichotomy between patients and mental health providers. 

Hiding my true identity is exhausting. The further irony of the situation is that my colleagues often remark how impressed they are by my knowledge of various ins-and-outs of the acute psychiatric inpatient setting, oblivious that the reason I am as knowledgeable as I am is because I have been a patient more times than I can count. Despite the feeling of being undercover looming over me at all times, I know without a shadow of a doubt that my lived experiences are the very reason why I am as good of a mental health provider as I am today. The reason I am so knowledgeable about mental health and psychiatric hospitalization is because I have been a patient myself. I am able to empathize and make such profound connections with my patients because of my shared identity with them. It pains me that despite working in acute psychiatric care, my workspace is not a safe place to openly admit to my colleagues that I am both a social work student and someone with severe mental illness and a history of psychiatric hospitalization. If this is not an environment where I can be open and honest about my mental health, then what is?

If you have made it this far, I promise we have arrived at the point of everything I have written thus far. We – mental health providers – need to eliminate the “us versus them” dichotomy between patient and provider. This dichotomy is a toxic mentality that further perpetuates existing stigmas against people living with mental illness. As mental health providers, we need to be on the forefront of ending mental health stigma rather than assuming roles that perpetuate the thing we are supposed to be fighting against. This change starts with abolishing the notion that mental health patients are inherently different or inferior to those that are providing them with treatment and services. Do you remember the historic moment when Princess Diana shook the hand of a man suffering with HIV/AIDS without wearing gloves on her hands? This seemingly simple gesture served as a public display of action that Princess Diana was challenging the widely accepted misbelief that individuals with the illness could pass HIV/AIDS on to another person by touch. With just a simple handshake, Princess Diana was a living example of being the change. As an undercover social worker, I urge you to be Princess Diana. Be the change. Stand within six feet of someone with a mental illness. Speak up when you hear people spreading harmful misinformation about people with mental illness. Sometimes all it takes to fuel the momentum for social change is a gesture as small as a handshake.