In today's podcast, we talked about why social workers should be familiar with psychopharmacotherapy, legal and ethical limitations of social workers discussing medications with clients, some challenges social workers might have with agency policy around medications, and the role of social workers on a treatment team. The second interview focuses on best practices for referring clients for psychiatric medications, resources for social workers interested in learning more about psychopharmacotherapy and how social workers can think critically about psychopharmacotherapy for both adults and children. In the third interview, Kia talks about a recent qualitative research study she did to explore the meaning that medication had for residents in a psychiatric facility.
Download MP3 [23:21]
Today's interview was recorded using Skype. This is because Kia was in Richmond, VA and I was in Pittsburgh, PA. There are some pops and hisses, but not enough to detract from the quality of the interview. If you have questions or comments for Kia or me, please leave your comments below and we'll get back to you.
About Kia J. Bentley, Ph.D.
Dr. Bentley is a tenured Professor and Director of the Ph.D. Program at the School of Social Work at Virginia Commonwealth University where she has taught since 1989. She publishes, presents and teaches social work practice in mental health, especially serving people with severe mental illness and is involved in several community-based research projects. One research project concerns the meaning of and impact of taking psychiatric medication, in partnership with Gateway Homes, a residential treatment facility for adults with serious mental illness. You can hear more about that project in our third interview. Another in collaboration with colleague Sarah Kye Price, is a study of decision-making about psychiatric medication among pregnant and postpartum women.
She is the former chair of Central State Hospital’s Human Rights Committee, a state psychiatric facility in Petersburg, Virginia, the former Chair of the Virginia Mental Health Planning Council, and served six years on the Board of Virginia’s chapter of the advocacy organization the National Alliance on Mental Illness (NAMI). She has been active with the Council on Social Work Education for many years, currently serving as consulting editor of the Journal of Social Work Education and was one of last year’s winners of the “Reviewer of the Year Award.” She is an active and enthusiastic site visit chair and accreditation consultant. In the past she has served on their Commission on the Role & Status of Women for 6 years and their Commission on Accreditation for three.
Jonathan Singer: Kia, thanks so much for being here. The first question that I want to ask is real basically, what is psychopharmacotherapy?
Kia Bentley: That’s basically a term referring to the use of what they call psychoactive medication in the management of any kind of emotional, behavioral, or psychiatric concern or issue, and the term psychoactive is meant to really refer to medications that target cognition, thinking, and emotion in the brain basically. So psychopharmacotherapy refers to sort of the therapeutic use of those drugs in helping people address those kinds of concerns.
Jonathan Singer: Social workers aren’t trained in actually the anatomy and physiology like doctors are and nurse practitioners, and so I guess one of the questions might be why should social workers be educated about medications?
Kia Bentley: Well, I think that their education around psychopharmacology shouldn’t just be about medications, but the underlying premise of your question is why should social workers know more about medications, their use, and the answer is in order to better social workers. And what I mean by better is more responsive to the real life concerns of real life clients and essentially to be more compassionate, to understand the experience of their clients more fully so they can sort of more fully participate in the problem solving process with clients, and not just clients by the way, but with families and providers. So in order to be a better partner, sort of embracing that partnership model of practice where you think of practitioners as sharing knowledge, sharing expertise, that’s all about being more responsive and more compassionate. And like we know that the use of medications is you know a huge part of particularly mental health treatment but certainly in people all in all fields of practice, social workers come into contact and work with people that are taking psychiatric medications or may need to be share the option of taking medications, so we better know about that if we’re really going to be great social workers.
Jonathan Singer: So what you’re saying is that social workers work with clients who are taking medications as part of their therapeutic regimen and if we don’t know about them then we’re not really doing our job. Did I get that?
Kia Bentley: That’s right, that’s totally right. And not, they may not just be taking them they may be, I mean taking them may be an option they need to be exposed to, so social workers are going to come into play, come into contact with people who aren’t taking medications, but may need as part of the problem solving process as you’re looking at services options, or treatment options, some settings we would use that term, then social workers should be in the role of letting people know that this option exists.
Jonathan Singer: So it’s not just about a social worker understanding what kind of medication their client is on you’re saying that it goes beyond that, it’s really understanding that medication is a possibility for some clients and to be able to talk with them about that in an informed way is just as important part as knowing what those medications might do.
Kia Bentley: That’s exactly right, you know I think I make the argument in lots of places that yes they need to know the different classes of medications, and their names, and their basic affects, their basic side effects, and just so they can participate more fully with clients, families, and providers. But also, they need to know sort of social work related things, like what I psychoeducation, they need to about teaching people about medication, they need to know about how to help people manage their medications on all of these different levels, psychological levels or physical levels, they need to be able to develop perhaps behavioral interventions to help with adherence if there are some issues around adherence in some cases. So, it’s not just knowing about medications, it’s sort of applying your basic social work skills that you would use for other kinds of issues to the medication related dilemmas of clients, so the social workers is not saying oh excuse me you just mentioned medications, stop I can’t talk you about medications, when the kinds of skills that are called for in terms of problem solving and reflective listening, empathetic listening, that those sort of skills that social workers have need, can, should, ought to be applied to people, clients that are taking medications, have dilemmas, and we know they do.
Jonathan Singer: I think that’s a really interesting situation that you just brought up, a scenario where a social worker might say oh you just mentioned Zyprexa, I’m not a doctor, I can’t talk with you about that. There’s a question in there which is, are there limits that are placed on social workers when discussing medication with clients? So for example, are there legal or ethical issues that social workers should be aware of when discussing medications or psychopharmacotherapy with clients?
Kia Bentley: Well, there is one author, Jill Littrell, who argued in a great article one time about psychologists, should psychologists essentially shut-up about medications. She came to the conclusion that, no the exact opposite might be true, we might under an ethical or legal obligation to actually talk about these issues with clients because of sort of the informed consent you know, the value of informed consent saying that we have an obligation to talk to clients about, what we know about in terms of you know what sorts of choices they’re making. So, no. Basically no. Obviously we don’t practice medicine, so we’re not recommending medications; in fact the ethical issue would be, how do you talk to people about medication without coercing people into that, which would be antithetical to social work. So I take the position that we cannot be cheerleaders and advocates for medication nor should we be nay-sayers and ignore sort of the story of peoples, many peoples lives who have had a great experience and a life changing experience with medication just in the same way we can’t ignore the negative experience particularly around side effects that many people have had. So our obligation as social workers is to use what we know in being sort of a again an advocate for what the client wants and an advocate for problem solving and decision making that takes the big picture into account, or all aspects of different situations.
Jonathan Singer: Let’s say I was working with a mother and her son and the mom said well you know my kids bouncing off the walls, things are getting worse, and I say you know this sounds like something you might want to talk to a psychiatrist about or your primary care provider to have an assessment for possibilities for medications because I understand that there are medications out there that might be useful, but I’m not a provider, I’m not a medical provider so I can’t talk to you about them, but I do know that some kids have been helped by medications. Is..
Kia Bentley: Well the first thing, right when you were telling that story Jonathan, you said this mother came to you or something and said I have this family member that’s on this drug and you immediately said well I can’t talk to you about that, well of course you could talk to them about that, you could be, right then, you could’ve used your reflective listening skills and had compassion for her and drawn her out about what are her concerns and what are her feelings, and how are they mixed, and there was a great opportunity right there to embrace that issue as one that’s amenable to social work practice. And a great a social worker would know a little bit about that medication and would in fact be able to share or whip out some books that he or she might have on the table that discusses that medication or turn to her or his bookshelf and pull out a book that might be a personal account of someone who’s struggled or used that medication. So, yeah I think that that kind of thing would game and then of course then talking to the person about the prescriber, the relationship with the prescriber, who comfortable they feel calling the provider, is there any role that they see the social worker playing in connecting to the prescriber.
Jonathan Singer: Ok, so that’s really interesting because I know in my training one of the things that I was told was to very quickly let people know I’m not a doctor, I’m not a nurse practitioner, I don’t know anything about, you know I have no training in medications, so here is my limited scope of what I can talk to you about. And it sounds like what you’re saying is starting off the conversation like that can actually be limiting the vast amount of help that I could provide to a client by using my social work skills and drawing them out, and having them tell stories, and
Kia Bentley: Exactly
Jonathan Singer: Ok, now let’s say there was a social worker working in an agency like I was, where they said that’s not your job, your job is say case management or therapy, and we have psychiatrists to do that other thing. What kind of advice would you give to a social worker in that setting who has agency constraints around what the agency is telling them with regards to medication?
Kia Bentley: Well that’s certainly goes beyond this particular topic, I mean the only, it’s students here at the school particularly who say my agency won’t let us do this and my agency wont let us do that, and sort of the indictment on our professional judgment and clinical autonomy is not good, but I guess in terms of concrete what would I recommend. I would recommend a frank discussion among the staff of what are the roles that non-medical providers can play in their agency because it’s certainly not just social workers that can play roles, and what are the roles that, what medical providers play. And I think you’ll see that the roles that social workers can play in terms of helping clients and families communicate with prescribers, helping them to address some concrete issues around managing side effects in simple ways, certainly not complex for example, interactions or recommending certain types of medication, certainly dosage and all of that, that’s beyond what a social worker, that’s blurring roles if you start getting into stuff, that’s not clarifying roles, but blurring roles. So I think a good discussion and you know saying these are the roles that social workers can play, here are the roles that social workers and nurses for example can play in terms of medication, here’s some roles that social workers and others can play in terms of building perhaps if adherence is an issue, building adherence, here’s groups that social workers can facilitate around the meaning of medication, and here’s some other groups that social workers can facilitate around you know maybe an educational group around new developments in medication. I’m working with an agency right now to develop sort of a book club at this residential facility that where clients and staff were going to read a book together about medication and talk about it, just to give a couple of quick examples of things that social workers can do, but then articulating what is the role we can play given our expertise and experience and what the roles clearly are not ours to play, and that’s where we should be better collaborating with physicians and other prescribers.
Jonathan Singer: I really like that idea of a book club that’s a wonderful idea; did you come up with that?
Kia Bentley: Yes, I, we, there was, I think I did actually come up with that one, but I was working with an agency, you know I did this qualitative study with the residents there, 21 folks, and what we did basically was create a typology of meaning, seven different dimensions of meaning, and impact that taking psychiatric medications had, and then after we created these seven sort of dimensions of meaning, we looked at the results and then generated I think 12 different initiatives that we could follow-up at this agency to sort of give greater voice to the experience of people with medication, and one of the ideas was to have a book club, and I’m trying to think here, I’ll have it in a second, the name of the book that we’re, it’s a great book by a man who’s struggled with depression and he’s written several books, his name is David Carp, and the name of the book is Is it me or my medication and so the plan is for, you know how a lot of people, universities and others are doing book clubs. But why not have a book club where the staff of a mental health agency, and the residents or the clients, are reading a book together, and it’s about medication and sharing that.
Jonathan Singer: Talk about a great way to reduce the gap between the “provider” and the “consumer”, I think that’s fabulous.
Kia Bentley: Well hopefully that’s what contemporary social work is all about, is striving to do that. As you know, contemporary approaches to social work, the strengths perspective, the empowerment practice, the partnership model, all different sort of ways of phrasing different of saying that’s exactly what we need to do is be more authentic, and genuine, and sharing our knowledge and skills, while clients and families share their knowledge and skills and experience with us.
Jonathan Singer: One of the terms that you’ve used a couple of times in adherence, and I’m wondering if you could define it for folks who might not be familiar with that term?
Kia Bentley: Well, the term adherence is a health you know I guess a health term referring to how closely someone who has been health instructions or at least adherence in healthcare sticks to what they’re, sticks to what’s suggested. For example, and so the other, the term that was rejected in recent years was sort of compliance, because it implied sort of passivity, and so the term adherence was sort of shows, or at it’s at least the one I show, and other people use adherence too.
Jonathan Singer: It sounds like it reflects the idea that the person who’s taking the medication or who at least has been recommended to take the medication is an active participant in this process rather than an inert person who.
Kia Bentley: Exactly, exactly, and I’m sensitive to this issue around adherence because a lot of the literature when I first tried to get a grant to study the meaning and impact of taking medication some 10 or 12 years ago, they meaning NIH, really was pushing me to say well why do you need to understand the meaning of medication, and if you can tie it to increased compliance, then you’re more likely to get your funding and I rejected the notion. I just didn’t want to buy in that the reason that social workers or anyone should understand meaning was so those clients would comply better, I mean the sort of underlying lack of self-determination and lack of client impairment under that was not right, and so I just declined to do it, or do it in a way that was you know softer, and yes there were people out there who want to adhere better to their medications, and as social workers I think we have some knowledge and skills that can help people who want to adhere better to their medications. But I am not about teaching social workers anything about medications in order to get them to get their clients to act right and so that’s, so I’m sensitive about that issue of adherence. Yes, I think that social workers can play a role in increasing adherence, but not I you know I think I needs to be in partnership with clients and families, and that’s a little bit of a different position I think than some.
Jonathan Singer: And it sounds like it really fits in with what you were saying earlier about partnership and empowerment to say you know if this is something you want and it’s available, I will certainly help you and advocate for this, and if it’s something you don’t want then I will be here and help you navigate for you in that.
Kia Bentley: Alright, let me keep talking because that’s a great example, and I do think a partnership model is as folks at the University of Kansas have talked about is not just a client says jump and you jump, you know, it’s not like the client says I don’t want to take my medication you know I feel bad with it and you go ok thank you very much. I mean a true partnership is about the social worker sharing you know “Well listen, my knowledge of you Jonathan is here’s what happens within two days of you going off your medication, or if you’re flushing your medication down the toilet.” You know so these things might occur and also these things have occurred in other clients, however, on the other hand you know maybe if whatever, just saying that a partnership means that you do share information and that you’re sort of your regard for a client, I talk a lot about this when I’m teaching, your regard, and your caring, and your compassion for client shouldn’t be contingent on whether or not they’re quote acting right or they’re complaint or adherent to their medication, you are with the client in whatever they decide and with them meaning helping them to figure out the consequences, so like your client is hospitalized, you don’t go to the client and go see I told you, “I told you Jonathan if you didn’t take your Risperdal you were going to be hospitalized, if you’d only listened to me” I mean to me that kind of social worker should get out of the business.
Jonathan Singer: Right
Kia Bentley: You know I should go to you and be able to be with you while you’re in the hospital and be compassionate and understand why you didn’t take your medication, because of the terrible side effects that you’ve been addressing, or because of the meaning and the reminder of being a person with mental illness, that taking it has meant, and then help you deal with what’s next, and plan for what’s next, and be your partner and advocate in that.
Jonathan Singer: And it sounds like that’s one of the reasons why it’s so important for social workers to be educated about psychopharmacotherapy, because they can’t engage in an intelligent conversation, they can merely say yes or no, ok I’ll help you, ok I’ll help you not take your meds, or whatever.
Kia Bentley: And certainly to be a part of the treatment team or any kind of team, because it’s certainly not just in mental health that social workers are dealing with medications, so just yeah to be able to communicate. I certainly don’t teach students that they should know the names of medications and their pronunciations, and the names of complicated side effects in order to impress physicians, or nurses, or anything else, but rather to be a better communicator and to be a more full participant in the treatment or service team.
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References and Resources
- Bentley, K.J. & Collins, K.S. (2006). Psychopharmacological treatment for child and adolescent mental disorders. In C. Franklin, M. B. Harris, & P.A. Meares (Eds.) The school services sourcebook: A guide for school-based professionals (pp. 15-30). NY: Oxford University Press.
- Bentley, K. J. & Walsh, J. (2006). The social worker & psychotropic medication: Toward Effective collaboration with mental health clients, families and providers (3rd Ed.). Belmont: CA: Wadsworth.
- Bentley, K.J., Walsh, J. & Farmer, R. (2005a). Roles and activities of clinical social workers in psychopharmacotherapy: Results of a national survey. Social Work, 50(4), 295-303.
- Bentley, K.J., Walsh, J. & Farmer, R. (2005b). Referring clients for psychiatric medication: Best practices for social workers. Best Practices in Mental Health, 1(1), 59-71.
- Bradley, S. (2003). The psychology of the psychopharmacology triangle: The client, the clinicians and the medication. Social Work in Mental Health, 1(4), 29-50.
- Buelow, G., Hebert, S. & Buelow, S. (1999). Psychotherapist's resource on psychiatric medications: Issues of treatment and referral. Belmont, CA: Brooks/Cole.
- Floersch, J., Townsend, L., Munson, M., Winbush, V., Kranke, D., Faber, R., Thomas, J., Findling, R. & Jenkins, J. (2007, January 13) Adolescent experience of psychotropic treatment. Paper presentation at the Society for Social Work and Research, San Francisco, CA.
- Ingersoll, R.E. & Rak, C. F. (2006). Psychopharmacology for the helping professions: An integral exploration. Belmont, CA: Thomson.
- Jenkins, J., Strauss, M.E., Carpenter, E.A., Miller, D., Floersch, J. & Sajatovic, M. (2005). Subjective experience of recovery from schizophrenia-related disorders and atypical antipsychotics. International Journal of Social Psychiatry, 51(3), 211-227.
- Karp, D. A. (2006). Is it me or my meds?: Living with antidepressants. Cambridge, Massachusetts: Harvard University Press.
- Stahl, S.M. (2000). Essential psychopharmacology: Neuroscientific basis and practical applications. (2nd Ed). Cambridge: Cambridge University Press. (advanced knowledge)
- Walsh, J., Farmer, R., Taylor, M.F., & Bentley, K.J. (2003). Ethical dilemmas of practicing social workers around psychiatric medication: Results of a national study. Social Work in Mental Health, 1(4), 91-105.
- Psychiatric Medications (n.d.). Wikipedia. Retrieved May 22, 208 from http://en.wikipedia.org/wiki/Psychiatric_medication
- Wilens, T.E. (2004). Straight talk about psychiatric medications for kids, Revised edition. NY: The Guilford Press.
APA (5th ed) citation for this podcast:
Singer, J. B. (Host). (2008, June 1). Psychopharmacotherapy and social work: Interview with Kia J. Bentley, Ph.D. [Episode 40]. Social Work Podcast. Podcast retrieved Month Day, Year, from http://socialworkpodcast.com/2008/06/psychopharmacotherapy-and-social-work.html