Responding to hidden abuse: a role for social work in reforming mental health systems

Clients in a state-funded intensive case management program, most of whom were identified as heavy users of acute care and psychiatric emergency rooms, had undetected brutal life experiences: 50 percent were adult children of alcoholics, and many were sexually and physically abused as children or adults. None had been asked about or appropriately treated for these aspects of their background. Statistical analysis indicated high levels of correlation between exposure to alcohol abuse in the family, physical or sexual abuse, repeated hospitalization, and contemporary suffering. Social work can use this and related data to make mental health systems more responsive to clients' needs at both the clinical and systems levels.