Tag: mental health

Caught in the DEI & Health Equity Crossfire?: The Current State of the Social Work Compact

The Social Work Licensure Compact is again on the move. However, will it stall amid the current DEI and Health Equity crossfire spanning the US? What will the impact be to other licensure compacts, such as those for nursing, medicine, psychology, and others?

As the current state legislative session is in full swing, I thought it was a good time to review the status of the Social Work Compact. We entered the 2025 session with 24 states previously passing the Compact: Alabama, Arizona, Colorado, Connecticut, Georgia, Iowa, Kansas, Kentucky, Louisiana, Maine, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, North Dakota, Ohio, Rhode Island, South Dakota, Tennessee, Utah, Vermont, Virginia, and Washington State. The Social Work Licensure Compact Commission is advancing the formal infrastructure with the current target date for implementation by Fall 2025.

As of the time of this writing, 18 more states have stepped up with new legislation to advance the compact further: Alaska, California, Florida, Illinois, Indiana, Maryland, Mississippi, Montana, Nevada, New Jersey, New Mexico, North Carolina, Oklahoma, Oregon, Pennsylvania, South Carolina, Texas, Wisconsin. 

The Compact Landscape

There is considerable workforce commitment to advance compacts across every discipline. Contributing factors include workforce mobility and for their patient populations, along with telehealth popularity. The current state tally for compact passage across other professions includes: 

A Clear and Present Danger

Let’s get one elephant out of the corner of this room. There has been pushback by several states against the Social Work Compact due to inclusion of a requirement for passage of a standardized licensure exam. That is a valued discussion, though not the focus of this blog article.

The immediate concern to compact passage involves those states with what may be considered as more liberal rather than conservative practices or vice versa depending on your viewpoint. To practice in any compact member state, social workers must abide by laws, regulations and scope of practice of the state in which the client is located. As a result, concern has been expressed over any potential liability of workforce members should their interventions be counter to emerging legal practices for the state. Precedents for these concerns have already been defined through legal actions against our interprofessional colleagues across medicine, nursing, and other behavioral health professionals in some states. There are equal concerns about practitioners contacting ICE to report patients who present for treatment that may be undocumented. These actions are counter to professional standards previously addressed in my blog article on this topic several months ago, To Report or Not Report: Mandatory Duty to Warn for Case Management (though applicable intel for all professions). Of primary concern are states that:

  • Do not allow abortion or limit emergent medical attention to the mother in emergency situations where the health of the individual is at gross risk (e.g., miscarriages)
  • Do not allow or limit provision of resources to minors of their families for the purpose of obtaining out of state abortions in the instance of child abuse or exploitation
  • Do not allow or limit provision of resources to adults or their families for the purpose of obtaining out of state abortions for any reason including for rape, incest, or other sexual assault or intimate partner violence; this might also include providing of the morning after pill or other medical treatment guidance. 
  • Have restrictive reproductive health limits for treatments (e.g., in vitro fertilization), or other medical treatments (e.g., stem cell transplants). 
  • Do not allow or limit gender-affirming care or the provision of information on such care to minors 
  • Do not acknowledge transgender rights and access to necessary care
  • Do not acknowledge the value of concordant care across vulnerable and traditionally marginalized populations
  • Enforce cuts to Medicaid and Medicare Advantage plans that limit access to or deny services that promote patient, family, or care-giver self-sufficiency and wellness (e.g., durable medical equipment, home health care, skilled nursing facility)
  • Limit access to substance use disorder and medically-assisted treatments 
  • Do not allow use of language specific to diversity, equity, inclusion, belonging, accessibility, health equity, social justice and any aligned terminology 

There are endless examples of other concerns, along with emerging legal cases against the workforce. Some states are engaged in lawsuits against practitioners for denying emergent medical care to patients hemorrhaging from miscarriages, with mortality rates unnecessarily rising from this level of negligence. Maternal deaths in Texas have risen by close to 60% following the abortion ban. An Ohio women who suffered a miscarriage at 22 weeks of gestation in her home and sought treatment at a local hospital, initially faced criminal charges. As if the trauma of her health experience was insufficient, she was then charged with a felony; a judge ultimately dismissed the case. There are countless other similar situations. 

Moving Forward

As noted in my prior blog article, there have always been caveats to a professional’s legal and ethical obligations when religious, cultural, or other values and mores have the potential to obstruct effective care of a patient. In those situations, a safe handoff to another professional is indicated. These caveats carefully balance patient right to autonomy, self-determination, and do not harm with practitioner values. Yet, despite these protections, compact expansion has still gotten caught up in the latest values- and cultural-backlash. 

Mental health demand in the U.S. has never been higher. Given the pent-up demand for behavioral health and other services, social workers and other professionals must be able to practice across state lines. Compact expansion and social work ethics must not be allowed to suffer due to these current realities. 

Managing the Doomscrolling Dichotomy

Doomscrolling (or doomsurfing) is a recent addition to Merriam-Webster and other dictionaries: addictive surfing or scrolling through bad news, even though negative in scope. The dynamic is impacting rising numbers of persons across the globe, along with their physical and behavioral health; this includes the professional workforce. Here are 5 ways to manage the doom scrolling dilemma.

A versions of this article was initially published by the CGI Newsletter, and appears with permission.

You have a break in the day and decide to catch up on your favorite social media feeds;  suddenly it’s 30 minutes later. What began as a look at your BFFs Facebook feed spiraled to viewing headlines, graphics, and disturbing images of recent events. You are sucked into a vortex of posts across platforms and apps, distracted from everything on your calendar: social, occupational, or education activities. Emotions bubble up: anger, bewilderment, frustration, rage, sadness. You become unable to focus, sleep, and feel crispy around the edges. Welcome to the world of doomscrolling: a dynamic impacting rising numbers of persons across the globe.

What it Means

Doomscrolling (or doomsurfing) is a recent addition to Merriam-Webster and other dictionaries: addictive surfing or scrolling through bad news, even though negative in scope.  Society has been exposed to a pervasive cycle of negative news these past two years including the pandemic, cultural, racial, and ethnic disparities, and the recent Ukraine crisis. It becomes easy to get caught up consuming mass quantities of online news in a single sitting.

The impact of these events on our wholistic health is telling. Growing studies speak to rising incidence of severe anxiety, depression, and psychological distress from over-consumption of pandemic-related media (Bendau et al., 2021). Daily social and traditional (e.g., new portals, magazines) media use exacerbates onset and exacerbation of depression and post-traumatic stress disorder (Price et al., 2022). Poor mental health negatively impacts sleep, putting further stress on the immune system; the interconnection between psychopathology and chronic illness is well-documented in the literature (Isvoranu et al., 2021).

The professional workforce walks a slippery slope with the doomscrolling dilemma, particularly those in behavioral health, integrated care, and related roles. Practitioners are faced with increasing numbers of patients seeking treatment for anxiety, depression, insomnia, and other symptoms related to the negative news cycle. Yet, each practitioner, is also a human being, striving to set limits on their own over-exposure to the media. Balancing professional self-care with respect for patient autonomy and rendering of effective treatment becomes the sharpest of double-edged swords. Professionals must limit their (over) exposure and potential collective occupational trauma, while intervening effectively with patients: an ethical dilemma of its own!

Why We Do It

            One quick answer is, misery loves company. Reading about negative events validates negative feelings felt by individuals. The more one seeks to satisfy this need, the more doomscrolling advances to addictive habit. Striving to stay informed about current events devolves into a vicious cycle where stress increases and cortisol levels rise. A myriad of health issues can result: increased blood pressure and glucose levels, migraine headaches, insomnia, or autoimmune disorders (e.g., lupus, multiple sclerosis, rheumatoid arthritis, Sjögren’s syndrome).  


What to Do About It

Here are 5 strategies to inform your efforts:

  1. Limit Social Media Bandwidth: Read one article in the morning, listen to a podcast from that favorite platform (or news outlet) you trust. 
  2. Take Social Media Breaks: Don’t get sucked in or your energy will be sucked out. You may stay off social media certain times of the day, or for longer periods of time (e.g., during the workday, weekends, or for several months).
  3. Use Body Scanning, Breathing, and Other Trauma-informed Tactics: Doomscrolling can trigger prior traumas. A colleague recently shared how use of trauma-informed interventions made the difference, for both clinician and patient. Regular body scans are an asset: take that nice deep breath, then start at the top of your head and move down your body. Note any sensations that appear: ringing in your ears, pressure around or behind your eyes, a tight neck or back, tingling in your chest or gut. 4-7-8 breathing is an asset as well. 
  4. Sleep Hygiene Strategies: Doomscrolling and insomnia are a dyad. Sound strategies that address both disruptors include:
    • Declare a screen-free sleep space.
    • Keep traditional items nearby, such as a notepad or book. Jot down thoughts that wake you up or read to tire your eyes without using a digital screen.
    • Detox devices by turning off notifications and removing apps; block apps and distracting websites using Freedom or other like-platforms. 
    • Avoid heated or emotional posts within an hour of bedtime
    • Keep screen-free hours one hour prior to bedtime and over the sleep cycle.
  5. Stay Proactive and Consistent: It is easy to fall off the Doomscrolling wagon. Stay vigilant; like any addiction, it won’t take much to fall down the rabbit hole and re-engage. Take control of doomscrolling before it takes control of you!

Have other thoughts? Feel free to add them below!