December 17, 2012

.On working in mental health...

Time heals all wounds.  And if it doesn't, you name them something other than wounds and agree to let them stay. 
.Emma Forrest in her memoir.

After the horrific tragedy in Newtown, there's been passionate discussion about what went wrong, what factors were most at fault, and what can be done to help prevent such a violent event in the future.  Everyone seems to be hurting together for these families.

Part of that debate is the long-standing challenges in mental health.  Working in community mental health, I see so many of these issues first-hand.  Daily, it's a struggle not to drown in the psychological and emotional needs of people in crisis, especially with such limited resources currently available in the mental health field.

As an intake counselor, it's a weary load to be responsible for initially assessing clients and determining an appropriate treatment plan within 50 minute appointments.  Take into account the amount of people served on a daily basis in community agency settings where insurance is few and far between and finances are an enormous obstacle (i.e. to afford therapeutic services or the astronomical costs of psychotropic medication), and it's just a small picture of some of the challenges faced by those on the front line.  Also throw in the amount of time spent shuffling through clients who may be malingering, whether to fraudulently obtain disability benefits, or for some other secondary gain.  Also add to this the follow-up necessary to actually maintain a level of stability in these client caseloads, with little pay, high stress, and high staff turnover... and it's no wonder burnout is so rampant in this field.  It's easy to become desensitized and demoralized when working in mental health, but at what cost?  The liability is high, and the rate of relapse higher.  There are so many obstacles on both ends of client and clinician to link people to the mental health services they need, and even more challenging when it's not what clients want or feel is necessary.  It is never easy to have to commit someone involuntarily, nor having to help guide families through such personal challenges.  And unfortunately, many times help comes as a reaction to an event, when prevention would be much more successful.

In my opinion personal support is vital, but prevention and early detection is key.  Availability of resources.  Knowledge of treatment options.  Reduction of stigma. Empowerment of clients and their families.  Advocating for self and the people you love.  And not just listening to people in need, but actually watching and noticing their behaviors too.  It's easier to ignore or push aside slight, worrisome comments with "it will get better" or "you just need to move forward," but until there is systematic change, we will continue to flounder to keep people well in a challenging world.

It. is. just. all. so. frustrating. and. sad.  I've always been dedicated to the cause, but this great suffering has reawakened my fire and the small part I may be able to play in the struggle.

P.S. To better understand severe mental illness from those who have lived it, I recommend reading Your Voice in My Head and An Unquiet Mind.  Also, this TED Talk is a haunting account of living with Schizophrenia, and this TED Talk helps to build understanding on hearing voices and living with the impact of trauma.

P.P.S. To hear another opinion about coping with the challenges of mental illness as a family member, please read this article.


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