Social Work Month only lasts a month, but it’s a fitting celebration of the vital and tireless work that social workers do all year long. To kick it off, we had a chat with Neil Pessin, Ph.D., Vice President of VNSNY’s Community Mental Health Services (CMHS).
Happy Social Work Month! As Vice President of Community Mental Health Services programs, you oversee all of VNSNY’s CMHS programs. Can you describe what that encompasses?
I’m not a social worker myself—I trained as a psychologist and analyst—but I am responsible for a part of the organization whose largest constituency is social workers. That includes everything from licensed social workers to social-worker assistants. We have more than 30 programs in CMHS, and a staff of about 500—about two thirds of which falls under the domain of social workers.
What are some of the different ways CMHS social workers help the community?
A large part of what we do is care management. Many of our clients suffer from a variety of ailments, including serious mental illness, substance use, and medical illnesses. In addition, most of our clients are alone; they don’t have adequate shelter, and they don’t have somebody who’ll nudge them about getting to their appointment or remind them to take their meds. CMHS social workers are those people in their lives. They function as care managers and health partners, making sure that clients have access to the services, benefits, and care they need to improve their quality of life. The social workers in our world are intimately involved with the social determinants of health for the people we serve. They also address critical issues that folks need in order to improve—like housing, health care, food issues, clothing, all the things that make life actually happen.
What are some of the health disparities that CMHS programs address?
The folks we care for are among the most discriminated against in the city. Most of the populations we serve are poor, disenfranchised, and unable or unwilling to access services. Some of our folks live in shelters, or are in unstable housing situations in leased arrangements by the day, the week, or the month, or they couch surf with friends and relatives. They have all of the critical needs just mentioned, but as soon as you talk about mental health issues or substance misuse they are seen as pariahs. They may have had services denied to them, and they have difficulty accessing or using those services on their own, in a positive way, to improve their health and their quality of life.
What special training do social workers need in order to work with people who have mental health issues?
That’s an interesting question, and it’s one I deliberate all the time. Social-work training is formal education, and a master’s degree in social work is useful and a good beginning for helping people prepare for this work. Then there’s on-the-job training, which addresses a lot of the critical issues our clients face—serious mental health issues, substance misuse, and the other complicated challenges. Social workers who come on board here at CMHS get a lot of support in terms of in-service training, buddy systems, and supervision—a variety of things dedicated to skill-building. But one of the most important things our staff bring to the job is empathy for the people we serve. Empathy is an inherent quality—you can’t teach it. Social workers have to come to us with both the desire and the ability to work with this population, which deserves the best care possible.
In your opinion, what is the most rewarding aspect of a social worker’s role?
Being able to provide skillful approaches to people’s complicated lives, and to do that with the reward of helping somebody move towards a more satisfying, happier, healthier life. There are definitely easier ways to make a living—but if commitment is what you’re after, and if you care about and like people, I don’t think that there’s a more satisfying way to make a difference.
What is the most challenging thing confronting social services in New York City?
One of our biggest issues has always been addressing poverty, including our clients’ inability to access the services and care that they deserve because of their economic status. On top of mental health and substance use challenges, factors such as language, race, and country of origin throw up further barriers. The ability to make a difference often costs a lot more than the powers that be are willing to spend on the population that we serve.
How has the pandemic changed the face of social work?
COVID-19 had a terrible impact on CMHS, not surprisingly—it wreaked havoc on all of our lives. We are an organization that built our reputation on face-to-face visits for decades, and then we had to screech those to a halt for the most part. It affected both our patients and our staff, which collectively made things worse. Our clients’ needs didn’t change, but we were unable to access them due to safety concerns, especially at the beginning, when there was very limited PPE and lots of fear. We scheduled visits over the phone, or—if we were really lucky—on video, but most of our patients don’t have smartphones or Internet service, so they had fewer opportunities to gain access to all the things they had before. Not only could we not encourage them in an active, face-to-face way, but many of the agencies that we rely on were also curtailing their services. There was no place to go into, no easy way to get a doctor’s visit, and you had this floating enemy of a deadly disease out there, that you could get at any time. Disease is agnostic—everybody is eligible. Those are all terrifying things. On the bright side, I’m happy to say that three of our 11 offices have reopened and the rest will be reopening soon. Five of those sites will accommodate client visits.
How has social work evolved over the years?
Social work has evolved considerably over the time I’ve been in this business, at least in the world that I travel in. Today, there’s more focus and more expertise in what we do for the people we serve, and we’ve become more skillful at creating new strategies and approaches. People with vision have become leaders, trainers, and administrators, rising to positions of power in which they can make a difference—which hasn’t always been the province of social workers in the healthcare industry. Social workers have risen to a place where there’s more strategic thinking about the care, as opposed to just administration of the care.
What is the future of social work as it relates to CMHS?
I am a huge believer in education being the door to freedom. People who grow in their job are eager to do better and to provide more, which keeps making the field better—not just in terms of service to the populations we serve, but in terms of better ways of measuring improvements. Social workers keep learning and growing, and we continue to get better at not only doing the work but at defending it. In a world where money is tight and our folks aren’t always the first people that others want to spend money on, we need to make sure we can prove that the money is worth spending and that a program is financially viable. We must go in the direction of making this a better business model, and learning how to do better research on outcomes
During 35 years leading CMHS, says Neil, “The work has always stayed exciting and interesting”
Neil’s involvement in the mental health field came about because of a “happy accident,” as he puts it. “I started out as a photographer, but it was doing assignments for magazines on political, entertainment and social events—I was always hustling to make a living,” he recalls. “One of my part-time jobs was working in the activity room of a state hospital. I got from a friend’s father, and it seemed like a better gig than loading trucks (which is what I usually did). I fell in love with the work and the patients, so I decided to follow my curiosity and I went back to school.”
Neil trained and then went on to work as a psychologist and analyst for many years, but he continually found himself drawn to doing community mental health services—“helping folks who were less able, more disenfranchised, poorer, and sicker than my private-practice patients.” To him, it was a chance to give back: “I grew up rather poor and was lucky enough to have people believe in me,” he says, “and I wanted to give that opportunity to others in some fashion.”
Then one day, he got a call from a VNSNY board member, asking whether he’d be interested in starting a mobile crisis program. “I said I’d take the job for a year,” Neil remembers with a smile. “That was 35 years ago!”
Neil was the first person hired by VNSNY to provide mental health services, the first person to make a visit to a client, and the first person to put a mental health team together for VNSNY. “That was the mobile crisis team—which was the beginning of CMHS,” he says.
Since then CMHS has continued to grow, spreading out over the city and adding new and more complex capabilities. Today, it encompasses 30-plus programs with many different ways of providing services. As an administrator, Neil adds, he doesn’t see patients anymore, but instead is “the person who directs traffic and encourages new growth.” At the same time, he’s as energized as ever to be part of the CMHS team.
“I work with an amazing team who are devoted to what we do and for whom we do it, and I rely on their passion, hard work and creativity,” he says. “The work has always stayed exciting and interesting, and it’s also made sense for me personally. CMHS has always met my mission to be of service to populations who usually don’t get access to mental health professionals with a high level of training and education. I’m happy to be able to provide that.”