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Within the vast field of mental health, there are individuals who, while able to live independently, require some assistance in managing their day-to-day activities. A mental health case manager provides just that, offering support to those in need as they navigate their routines.
We had the opportunity to speak with a case manager based in Washington. His work involves supporting a diverse group of individuals, all of whom need assistance with everyday tasks, such as grocery shopping, managing medication, attending doctor appointments, and more.
Could you share a bit about your current role and how long you've been in this field?
I work as a case manager for an Intensive Out-Patient (IOP) program at a mental health agency in Washington state. We serve individuals who experience more severe symptoms than the average person. Imagine a person who falls somewhere between 'the disruptive, shouting homeless individual' and 'the quirky uncle who believes he was abducted by aliens'—that's the kind of population we assist. It's a wide range, and some days are challenging, with clients yelling, while other days, things are calm and relaxed.
In short, my role is to assist clients in meeting their basic needs. I'm a mix of taxi driver, professional grocery shopper, and companion for doctor's appointments.
What inspired you to pursue this career path?
Throughout high school, I had many friends struggling with various mental health issues like depression, anxiety, and self-harm (most people probably knew someone with similar struggles back then). I wanted to support these individuals, so I decided to study psychology. My first psychology class was captivating, and I continued my studies in college. I believed I could make a small but meaningful difference and get paid while doing so.
What steps did you take to secure your job? What kind of education and experience were necessary?
To become a case manager, you'll typically need a liberal arts BA or BS, with majors like psychology, sociology, anthropology, or social work being popular choices. You also need at least one year of related experience. Technically, all you need is to be an 'Agency Affiliated Counselor' (as explained in the next question), but the more education you have, the higher rates you can bill, which means more earnings for both you and your agency.
After college, I began working in direct care with men with severe autism. Over time, I advanced to managing several assisted living facilities. However, I didn't find the field fulfilling, so I began searching for opportunities in the mental health sector (which usually requires prior experience). Eventually, I landed an interview with my current employer and used my experience working with autistic men and managing staff as a substitute for case management experience.
Do you need any specific licenses or certifications?
In Washington state, you must become an Agency Affiliated Counselor, which is relatively easy to obtain. You'll need to complete four hours of HIV/AIDS education and sign a form confirming that you're not a criminal (e.g., not an arsonist or thief). You'll also need the approval of the agency where you work. Typically, after securing a job, you'll have 30 days to apply for this credential.
What are some aspects of your job that people don't see? How do you actually spend most of your time?
Most of my day revolves around driving, whether it's transporting clients to medical appointments, running errands, or helping them with daily tasks they struggle to manage on their own. On average, I drive around 35 miles a day within the city, spending approximately two hours daily behind the wheel (excluding my commute).
A lot of my time is spent on the phone or handling paperwork behind the scenes. Every interaction with a client needs to be recorded for billing purposes. It's crucial for the agency's survival—without proper documentation, the agency would go bankrupt and be unable to assist anyone.
What misconceptions do people often have about your job?
Many people believe our job is overwhelmingly difficult, that it's enough to drive case managers to the brink of madness. While it's certainly stressful, it's not as hard as it seems. The key is having patience—dealing with clients whose challenges interfere with their daily lives requires tolerance. Whether it’s listening to a rant about the government or helping someone who takes ages to express a single thought, patience is the key virtue.
What are your average work hours?
I typically work just over 40 hours a week. Thankfully, the agency I’m with does a good job of monitoring employees to ensure we don’t get overwhelmed. As I mentioned earlier, patience is key in this role. However, if you consistently work beyond 40 hours a week without taking breaks or vacations, the stress will definitely catch up with you, and before long, you might find yourself on the other side of the case manager-client relationship.
What personal tips and shortcuts have made your job easier?
I rely heavily on technology. From using my smartphone to check emails while waiting for a client in a doctor's office, to tracking my time and mileage with documents, and setting digital reminders (on my phone) for all the things I need to remember. Any tool that helps me streamline my tasks is a must-have for me.
Here’s a piece of advice for future case managers: never take things personally. Clients might shout at you, insult you, or even try to physically harm you, especially when they’re unwell (often because they've stopped taking their medications). It's not about you; it's their condition speaking. They're likely expressing frustration with their symptoms, not with you as a person. It’s like trying to have a calm conversation while suffering from an intense migraine, but this time, the pain is emotional. So, keep in mind: don’t internalize the behavior of your clients.
What do you do differently from your coworkers or peers in the same profession? What do they do instead?
I don’t really do much differently than my colleagues because our clients benefit from consistency. At our agency, teamwork is key, so we all need to be aligned when it comes to how we interact with clients. If there’s anything I do differently, it’s the tips and tricks I mentioned in the previous question.
One thing that makes me stand out is my physique. Most of my coworkers are petite women, and since this field is predominantly female (I’d estimate about 75% of the people in this field are women), my large size sets me apart. This also means I get more sexually aggressive clients, as they tend to avoid acting inappropriately towards someone of my size and gender. I’ve been told it’s helpful to have a man on the team for this reason. However, my size can also work against me—some clients are intimidated by it or feel that I don’t appear ‘warm’ or ‘nurturing.’ Additionally, some clients have a history of abuse from men and experience PTSD, so there are a few clients I can’t work with due to extreme anxiety or paranoia when around men for extended periods.
What’s the worst part of the job and how do you deal with it? I’m sure it takes an emotional toll when a client is struggling.
The worst part, for me, is doubt. A particularly tough example is when a client dies from exposure (which sadly happens more often than many realize to homeless individuals). It’s hard not to ask yourself, 'Could I have done something differently? Is their death my fault?' That’s the difficult part, dealing with the rawness of it. Thankfully, client deaths are rare, but when it happens, I remind myself that at the end of the day, my job is to offer clients better choices and encourage them to make positive changes. I can drive them to the doctor, but I can’t force them into the car.
It’s especially tough when a client’s struggles seem self-inflicted. Substance abuse, for example, is a common issue that often accompanies other challenges. Another tough situation is when a client falls into a 'med-compliance spiral.' They begin to distrust their medications, stop taking them, and their symptoms worsen, leading to a destructive spiral. Ideally, they return to taking their meds or, in the worst case, voluntarily end up in the hospital before their actions result in something illegal or dangerous.
Like any job, dealing with the bureaucracy can be a real pain. The paperwork I mentioned earlier is often time-consuming and monotonous, but it’s ultimately necessary.
What’s the most enjoyable part of the job?
The little victories are what make the job fulfilling. It’s the moments when a client, with your help, decides to quit methamphetamine and save money to buy a new guitar. Or when you finally figure out the right medication combination that helps a client regain control and begin job hunting. There's also that bittersweet feeling when you manage to navigate the system and get a potentially dangerous person detained. It’s a tough situation when you know a client is heading towards disaster, and all you can do is try to involve the authorities before something serious happens.
As a side note, it’s extremely difficult to have someone involuntarily committed (detained) these days. It used to be that if someone was screaming and threatening to kill people (even with a weapon), they could be detained for their safety. It made sense, right? Someone who’s not in their right mind and posing a danger to themselves or others should be placed somewhere safe until they’re calm, sober, or on the right medications. Now, a person has to be covered in their own feces, running in traffic, and threatening to kill people (while holding a weapon) just to be evaluated for detention. This is because psychiatric boarding was recently ruled “unlawful” in Washington State, and no funding has been provided for alternatives. Look it up or reach out to your legislators.
Every so often, we get to do something fun with clients, like taking them on a group outing to a park. Those are always enjoyable moments in an otherwise demanding job.
What kind of earnings can one expect in your profession? Or, what is the typical starting wage?
A new hire can expect to begin at around $14 per hour, with incremental increases of about $0.75 each year until reaching a maximum of approximately $26 per hour. Having worked here for a while, I fall somewhere in the middle of that range.
How does one advance in your field?
Generally, to advance in mental health, obtaining a Master’s degree is necessary. Bachelor’s level case managers work under the supervision of a licensed mental health professional (MHP). Moving into an MHP role typically requires a Master’s degree, though in some rare cases, your agency might grant an exemption if no one else is available for the position due to sudden staff changes.
What aspects of your job are often overvalued or undervalued by others?
As I’ve mentioned earlier, many people don’t grasp the sheer amount of work that happens ‘behind the scenes.’ For instance, getting a client into a nursing home can be a complex and challenging process. From an outsider’s perspective, it might look something like this:
Declare that the client needs a nursing home placement.
Wait for time to pass.
Client gets placed in the nursing home.
What people often fail to recognize is that Step 2 isn’t as simple as it sounds; it involves a lot of work—countless phone calls, numerous doctor appointments, and a great deal of extra assistance to ensure the client remains safe while waiting for the appropriate care to become available.
On the other hand, I often encounter individuals who overestimate the level of patience required for this job. For me, being patient with individuals suffering from mental illness isn’t difficult; I understand the constraints their symptoms impose and adjust my approach accordingly. Plus, it helps that I’m compensated for my patience.
What advice would you offer to those looking to enter this profession?
Read through this entire interview and ask yourself: could I handle this job? Honestly, that’s the best advice I can offer. Also, make sure to prioritize self-care. This job can really drain you emotionally, so it’s vital to make time for yourself (pick up a hobby!) and leave work at work. Everything will fall into place eventually. I could easily work 16-hour days, seven days a week, and still wouldn’t get everything done. Knowing how to prioritize is key.
Knowledge is truly powerful in this field—it really is. Get to know your clients; understand which ones can handle errands like shopping independently if you need to leave suddenly, and familiarize yourself with their usual behavior so you can tell when someone’s health is declining versus when they’re just having a rough day. Understand your teammates too—know their schedules so you can rely on them when necessary, and vice versa. Also, be aware of their strengths so you can switch clients when one isn’t working out. Lastly, know the rules of your agency—follow them and apply common sense. If you’re uncertain about what to do in a situation, escalate it to a supervisor. Reach out to your boss, discuss the matter, and find the best solution together.
This interview has been edited for clarity.
Career Spotlight is a series of interviews on Mytour that highlights everyday people and lesser-known professions—ranging from doctors to plumbers to aerospace engineers, and everything in between. If you want to share your career story, email us at [email protected]. Photo by Photographee.eu (Shutterstock).
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