Good evening friend. So It's been a while but I decided after much time in my new position I needed to summarize a little essay of my own. For thew
few who remember me, I have completed my Masters in Clinical Psychology and am licensed here in my home state. Currently I work as a Crisis Clinician
II. My job is to go to the emergency rooms (we have two) and determine the severity and quality of people in crisis and basically decide whether or
not someone gets admitted to a psychiatric unit or is released and offered resources on the outside.
I know this simple little explanation of my position probably makes me sound like the devil incarnate, I can assure it is a necessary evil. I have the
utmost respect for medical doctors and nurses but feel they do not have enough specialized training in emergency and routine mental health care. This
is of course not to suggest a fault on their part, rather to point out that they are indeed medically trained and not expected to diagnose and
determine mental health crises like I and my colleagues were trained to do. Really it's tantamount to me trying to diagnose a medical illness by
reading tests. I wouldn't have the slightest clue
So...with that said. I have a VERY serious problem with mental health treatment and disposition in this country.
To put it bluntly, in my personal and professional opinion, our mental health system is broken. Whether or not is broken beyond repair is another
discussion but it is indeed broken.
I figured I could approach this in two ways. I can detail and list out what is wrong with our system or I can share some stories that describe in
picture how our system is failing.
Let's begin with a VERY important statement...
Despite my left-leaning ways, I am not blaming this on either political system
This is not meant to be an attack on the right, the left or the middle. Rather I wanted to discuss how we could fix this
So let me share with you a story.
Last week we had a woman bring her daughter in. She wanted her daughter hospitalized because she thought she was manic and mentally ill (her words). I
interviewed this girl and found no real mental illness to speak of but her mother insisted that she be hospitalized (which I will spoil the ending for
you...I didn't hospitalize her) but she fought and fought and eventually I set her daughter up with a counselor and her suggested family therapy as
Another story involves a gentleman who I see typically at least once or twice a week. He enters the ER, tells me he is suicidal and begs to be
hospitalized. This man is very behavioral (meaning he has behavioral issues and is shelter seeking as opposed to being mentally ill). Shelter seeking
basically means a patient who just wants to be hospitalized so they don't have to care for themselves. Arguments could be made about why this
attention-seeking behavior exists, but again...another discussion for that.
So these two little blurbs may seem innocuous at first but consider the few issues we have here.
In story one we have a mother who has the legal power (in most cases) to basically hospitalize a child when in truth the mother is pouring extreme
negativity on that child. The frightening disconnect between this woman and her daughter was mighty indeed. Through interviewing all involved it was
discovered that mom was "tired of her daughter" and wanted the mental health system to take her off her hands for a bit.
In story two, we have a chronic abuser of the mental health system who wants only to be taken care of and has no interest in accepting responsibility
for his issues.
So where does this and other stories leave the lowly clinician? It leaves us frustrated and bound by sometimes vague legalities.
Generally speaking there are two ways to hospitalize someone
1. They go voluntarily in which case we do a light amount of paperwork and life is good
2. We as clinicians strip the patient of their legal rights and hospitalize them involuntarily.
In option one and two, one of four things MUST be present to hospitalize
1. They have to be an imminent danger to themselves (suicidal)
2. They have to be an imminent danger to others and MUST have a specific target (homicidal)
3. They have to be in a psychotic episode so that they are unaware of their surroundings (psychotic)
4. They have to be a danger to their vegetative and life-sustaining needs, meaning they are so mentally ill they cannot wash, use the bathroom, eat or
sleep properly (non-self-sustaining)
So when we need to hospitalize, the client is taken to the ward and treated and reasonably speaking usually improve with medication
Now here is where it gets ugly fast
Upon leaving, the patient rarely has any responsible party to assure they are taking their medication or following up with treatment and even when
they do follow up, our insurance system seems to believe all therapy comes in a neat little tidy and SMALL cognitive package. What do I mean by that?
Most insurance companies will listen to my diagnosis and look at a chart to determine how many sessions a client will be covered for. If by the end of
those sessions they aren't completely healed, well then they are often SOL. You'd think the package of coverage would be lengthy but it is often very
brief; sometimes on the order of 10 sessions.
As a therapist, I am a trauma/anxiety specialist. Anyone with any knowledge of therapy knows that it is very few and far between that a patient can
come fully to terms with complex trauma and serious issues in ten sessions.
Our hands are tied so we have to make a decision. We act ethically and try to cram treatment of a lifetime of woe and illness into ten sessions, or we
act unethically, lie and misdiagnose someone severely, thus ruining many things for their future. Stigma sucks...
I personally in internship and practice have acted in both manners and I will tell you now that each action makes me ill to my stomach.
The "best" part of all of it...all these issues are being made more frightening by the rampant closing of state hospitals and mental health treatment
So I guess I'd love to open up discussion...have you any experience in this realm? What they heck can we possibly do to fix these problems?
Again, I'd really like to keep partisan values and politics out of this
Thanks for reading
edit on 16-4-2014 by KyoZero because: (no reason given)