Had no idea it was like this. Hats off to you and folks like you that spend their effort on others in such a drastic way, even if only for a few years. That is more than most of us could ever emotionally handle. Thanks for your input and shedding light on this issue.

K&R.

EVERYONE should read this.

25 years in State work. My caseload is community followup with a primarily forensic population.

As long as you do your job and everything goes well, no one even knows you're out there.

But if something goes wrong, the headlines are a source of great discomfort for your agency and someone will be asking you a lot of questions real soon. It's a high stakes game.

And of course they just keep cutting services and raising expectations.

Thanks for staying so long!

Recording a beer! a missed medication dose... I suppose they are trying to assess non compliance..

But the work load, the judgment calls where everything is a grey area, operating in a zone of economic desperation



Living in Ontario..where health care is a covered... We are so lucky...

So the why of the records and reporting goes back to a previous generation, when public mental health was somewhat better funded, more focused on addiction issues, and given earlier drug regimens, booze could be a serious problem. Tri-cyclics and early anti-psychotics were incredibly dangerous when mixed with alcohol, and the standard treatment for addiction was the ____ Anonymous model, which requires abstinence. Those policies were written then, but treatment has changed, meds have improved, and we've moved past Just Say No and DARE and _A is no longer the gold standard. But the policies didn't change. Some were mandated, some were just "the way it's always been done."

Here's the other key -- my area was comfortable economically as a whole. Both the correctional system and the public mental health system were used as clubs against the lower class as a means of profit extraction and a means of control. That's why the Powers That Be don't want a healthcare system like yours -- it empowers the individual, who is then much more likely to demand that other imbalances be addressed.

We're getting closer to parity. Just not fast enough.

Do the best you can,,,while we pull the rug out.

I call this one more form of violence, against both you and your clients.

Thank you. The Los Angeles Project 50 and other studies shows that homelessness and associated mental health issues may be headed off through permanent housing and care at a genuine savings to the city. Support and care are very important and they are NOT supported as you detail, by red states and politicians. For-profit prisons are, however, so make the connection, everyone.

Thank you for your caring efforts on behalf of those who need your work. I'm so sorry for your suffering as a result. Please help us be safe from even "well-meaning" democrats who would seek to use force and "lists" upon us (the same people offering these "solutions" would hopefully scream if the "tea party" demanded the exact same thing).

You may enjoy reading more about Project 50's positive results here:

http://www.democraticunderground.com/10022007213

We're seeing more integrated, structural shifts slowly coming on line, and I expect that to ramp up in the next few years as my generation comes out of the trenches and into leadership. We Xers tend to be very practically minded, and the advantage of feeling alienated from existing systems is that we're willing to abandon what's broken for something that can be proved to be objectively better. But also not being idealists, we'll take incremental change, and we're data-driven.

The prison industrial complex and the insurance industrial complex... Those are the big dysfunctional structures.

*punishment* & setting people up to fail, not rehabilitation -- & even if it were about rehabilitation, there is little hope that most people in that situation would ever be able to channel into decent stable living wage work.

My friend said she would *never* work for welfare, for example, because they are basically trained to find ways to deny their clients needed services.

It is so fucking criminal. Criminal not only to the clients, but to the people like yourself who go into the system wanting to help people.

I suggested to a recent PhD psychologist student interested in the public policy end that practice might be a good start, now I feel kinda bad about giving such advice.

If someone is ultimately interested in the public policy aspects of public health, that person has to be in the trenches, at least for a while. One can only assess the true state of the system by seeing how the system affects those with the least power . The best advocates we have know the system from the inside -- because their experience has made it visceral for them.

3 visits to the nice shrink in the leather-upholstered office with fresh flowers, and everything is resolved in 30 minutes?

Honestly. TV has warped our minds. We've lost our collective grip on reality. It's like a bad Twilight zone episode.

This!

Well, the hospital was private in the sense it wasn't owned/operated by a government. Not private in the sense of one of those little hospitals/clinics that are now actually ADVERTISING on television and online (at least they are here, I've seen several TV commercials for a couple of different ones). The hospital I was at, I don't want to name names because it is too much of a clue to my identity, is Michigan's largest private health system (to my knowledge, might be surpassed in total beds by the Detroit Medical Centers system, but not by much if it is). And trust me, it's no down on it's luck, urban hospital. This place is upscale, everything about it screams "big bucks" coming into the system, even the psychiatric program. The facility is ... breathtaking is the word that comes to mind, like a city unto itself, all kinds of services and amenities -- valets, concierge, shopping area, food court in addition to enormous cafeteria, florist on site, big chapel, etc, you get the picture.

And, with all of that money flowing in from patients and their insurance companies, I found some things quite lacking in their Partial Hospital Program, and other things done really well. Mostly, it seemed to be the staff, good or bad, that was the difference. I could tell who really gave a damn about their patients and their jobs, and the ones that were just phoning it in at best. The "house doctor" I saw during this period, not sure of the right term, he was WAY too old to be a resident or attending, was a total, useless idiot, not helpful, not supportive, I actually had to almost fight with him on meds, on getting my stay extended a few extra days so I could "finish out the week", and so forth. Weird, I hated going there, was terrified, once I kinda calmed down it became a bit of a sanctuary, didn't want to go out and face the real world so I extended it a few extra days beyond the original plan. Thank God my Blue Cross covered it.

Mostly, though, the other patients really broke my heart. I honestly, IMHO, was not really "there" in the sense I didn't feel I needed that type of program, I could have been treated adequately on a strictly outpatient basis, since I wasn't going anywhere, and I was the only one who even knew of my approaching a psychiatrist for treatment, so it's not like I was dragged there against my will. But, due to circumstances beyond my control, i.e. a physician I later found out had an absolutely terrible reputation among patients per a number of those "rate your doctor" sites, I was pretty much coerced against my will into doing this day program under threat of "or else." Which is why it was so traumatic to me, to think that I approached this doctor, based on reputation of this hospital system which brags in their extensive advertising campaign about how superior their physicians are, with the tagline set to dramatic music of "Do You Have a ******** Doctor?" -- to think I went to her looking for help and support, and left an hour later under threat of "psych ward or I have the cops show up and throw you in the back of a squad car in cuffs and take you against your will" -- that almost literally destroyed me. I had no "suicidal intent" when I went into that office, I was damned, damned close to really doing it when I left. But, water under the bridge. The hospital program, once I calmed down, helped a lot, and it really did "fast forward" this thing for me, I'm sure I made progress a lot faster, and began to repair the damage this woman did to me faster, because of it.

Back to the other patients, it seems most were caught in this spiral of "buying into it" so that their lives were permanent mental health crisis and that is what they lived for. Multiple suicide attempts, multiple hospitalizations. It was heartbreaking. I can understand that people GET sick, many of these conditions, probably all, have a neurobiological basis in the brain, but what I can't understand is why people would buy into it, wallow in it, some almost seemed to wear it as a badge of pride. And make NO EFFORT to get out of it. Don't get it. Anyway, not me. I'm never going back to that, I didn't have room in my life for ONE mental health crisis, and, Oh Hell No, never again.

Sorry I keep ranting about this on post after post, but I was one of the "bigger" things that has happened to me, in a life that was far from easy, and I guess it just helps to get it out.

You know how in pro-choice circles we say, "trust women"?

In advocacy circles, we're just getting to that point of saying "trust the patients."

I agree that advertising is a problem -- across the board, but in healthcare and mental health care especially. One, it diverts essential funds. Two, it's manipulative, and is most effective in situations where the target of the advertising has the least defenses against it.

I'm really glad you got effective help, and I'm sorry it came wrapped in a big ole shit sandwich. And if nobody else has said this... It's perfectly reasonable to feel ambivalent about your experiences; ambivalence is a sign that all sectors are working.

I'm always leery to read replies. Most are kind, supportive people such as yourself, but some are ignorant haters. Thanks again.

Yes, the circumstances were hard, the outcome very good. I feel like I've been given a fresh start in life, I have a great therapist, and I found a doctor who is just the opposite of the first one, kind, considerate, personable.

Both my brothers had/have serious episodes.

One lives in a county that has half way decent support sytems.

The other lives in a county with next to none.

Drugs are our emergent care tools. Think about them as a cast for a broken leg -- the bone has to heal, but afterwards, there's physical therapy to repair the damaged soft tissue and atrophy. Until the bone is healed, nothing else can be fixed, and trying to rebuild the soft tissue with a broken bone will make the soft tissue damage worse. Not to mention HURTING.

Drugs are also our long-term management tools -- like glasses, or insulin. No physical therapy will fix myopia, and nothing will convince a pancreas to produce insulin after it has quit.

Drugs are tools, but because we can't see how the brain is mending -- unlike a broken bone -- on an xray (though we're getting close with fMRI) each patient ends up being zir own personal experiment. And yes, it's frustrating when nothing seems to work. I think of it as everyone in the world running a slightly different version of a computer operating system, and trying to install a patch. Most times, the patches work -- but some people are using an obscure Linux distro, or still on MacOS 7, or Windows 3.1 because those systems work most of the time for them.

When we find the right drug therapy, it provides the patient with support, to take time to deal with either the habits of mind that have helped trigger the dx, or to come to terms with a long-term chemical issue and re-establish functional habits within the new limitations. (As in, I have to grab my specs every @$%*&^% morning if I want to get from bed to bathroom because I'm really near-sighted. As in a bi-polar II dx means learning more functional ways to cope with stress and backing away from substances that can trigger an up or a down. As in a major depression dx means de-programming the negative subroutines that have infected the system.)

But in public mental health, we're essentially the ER -- not the place to be getting long-term and preventative care. So yes, we give out SSRI and neuroleptic "casts" as the first line. In private care, insurance companies limit the number of visits and usually charge far more than the co-pay. Imagine a brittle diabetic trying to get zir condition under control, but the insurance says only ten visits a year, and no labwork. We know that drugs alone aren't the answer, but the systems we have to work within (and again, if we go outside, we're likely to lose our ability to pay rent and possibly our ability to practice at all) are set up to make our jobs more difficult. Drugs offer a better chance of improvement over nothing at all.