This is Emergency Services as its Defined on a Community Services Boards' Web Site

Emergency Services/Crisis Counseling is a State mandated program. This unit provides short-term crisis counseling and referrals to individuals on an emergency basis. Emergency and crisis response services include: telephone interventions; face-to-face assessments and evaluation (including pre-admission screening); psychiatric consultation and other clinical consultation about mental health, substance abuse, and special populations which include children, adolescents, geriatric, people with mental retardation, and individuals involved in the forensic system. Emergency Services/Crisis Counseling is staffed 24 hours a day, 7 days a week.

Everything on this website has been thoroughly examined, reviewed, evaluated, and ultimately approved by The Citizens’ Committee for the Advancement of Rational Thought and Actions in Virginia's Mental Health System….

Things Sure Aren't What They Used to be..Conditions Sure Have Changed

coming soon........

Monday, April 21, 2008

I Quit!!!!!! I've had it. This is My Last Entry......

OK, folks, I've had it. I had an epiphany of sorts tonight and realized that my babblings, rantings, and ravings are not going to change anything.

A few years back I remember being embarrassed to have to tell people we no longer had outpatient counseling. Then the bed do you say to a parent, spouse, friend, that well....there are no beds, however we can have your loved one arrested for a somewhat-bogus minor charge and at least they'll be off the streets.

Now...well, this is almost too much. Yes, we can provide them a bed in a psychiatric hospital (maybe) but when they get out we aren't going to do anything. Nope....absolutely nothing; no case psychiatrist, no medication....absolutely nothing.

I remember many posts ago writing about When is a hospital not a hospital...... well folks, that's where we are now. When is a CSB no longer a CSB. As far as Mid-Mountain is concerned, they have arrived. They are no longer a CSB. I'm sure that those of us who are left...all of us who are trying to provide services to the mentally ill, will do the best we can....but folks, there ain't much left and coworkers are leaving like rats abandoning a sinking ship. And, yes...our ship is about to go under.

If I were a mentally ill person in our city....I'd abandon ship also and move on to another town or city. It couldn't be any worse anywhere in the commonwealth. Hey, we've hit rock bottom and there seems to be no relief in sight.

This is a grim situation...something needs to be are some ideas....

When situations and circumstances dictate, governments have a provision for declaring Martial Law. The Mid-Mountain CSB, needs to do something similar. The agency is going down the tubes: circling the drain; and the wheels have come off the wagon.
Surely, if there is a person at the helm…well, not sure what’s going on there.
Anyway. Where to start?

First off, we need a hierarchy of conscience (no, has nothing to do with Maslow), this is somewhat similar to women and children in the lifeboats first. Simply put, we need to decide what population most needs our help and is most deserving and direct our limited resources towards them. At present drug users are still, to the best of my knowledge, able to go through the intake process and receive services.
Soooo, may I pose the question. If a severely mentally ill person and a person (yes, I will try to use a little restraint here) who is using crack both show up at the same time and only one can be helped, who should we help, and why? OK. Good question.
I doubt we could find many severely mentally ill people who made themselves that way. I don't think the severely mentally ill get up one day and say, Hey, I want to be mentally ill. May we accept that the mentally ill person is innocent so to speak of creating his illness? Well, I will. Now the person using crack. Hmmm. OK, I know a lot of you have bought into the old, gosh, using crack is a disease.... and you're entitled to believe whatever you want and that's fine; however, you can't dispute that using crack is a criminal act that makes a person a criminal (please restrain yourselves, don't want to hear any, Yeah, buts...thank you). Soooo, assuming the SMI person isn't breaking the law....we have one coming to us who is a criminal and one who isn't. One who caused his circumstances and one who didn't. Should being a criminal in any way figure into who gets the services? Also, keep in mind few folks who use crack work....and just how and where are they getting their money to buy crack? Hmmm. Yes, I know you all are on the collective edges of your seats and are waiting for me to tell you how to turn this ship around....and I will. However, you're going to have to wait until the evening of April 21st. Will be back this evening to finish.
As promised, I'm back.
OK. BTW, there's two aspects here. One, what to do now.... And two, what we must do in the future to get things back like they should be. OK. Here goes.
Without going into a whole lot of philosophical contortions, I'd say, that if two people are seeking treatment and there's only going to be one person served, except for some possibly unusual extenuating circumstances, most of us would go with the person who isn't a criminal. The person who had no control over their illness.
Sooooo, if that's the case, what do we do now? Yes, given the situation we're in. Using a war or soldier metaphor, when they're storming the ramparts, every one's a soldier. And, that's where we are folks.
Also, often when we're faced with a situation, a problem, we can look for a way to make something work or a way to make something not work. You guys had better be thinking about making something work.
The priority until things get a little more settled will be guaranteeing the folks in the project get the services they need....the follow-up with case managers and psychiatrists. That is the priority.
All of Them/They who aren't producing something...not working with our customers, are going to be told, ordered if you will, to man the ramparts. Yes, if they have the minimum qualifications, I believe it's a bachelor's degree, they can start carrying cases. Yes, they'll be training as case managers.
All case manager supervisors will immediately start carry cases.
Hmmmmm. I think I forgot to mention that all meetings will be cancelled and no more scheduled. It's obvious they aren't accomplishing anything as the ship is sinking and the water is just coming in more, no meetings. If you have something to say that'll help us serve our customers and provide the services we're supposed to...hey, send out an email on one of your Blackberrys.
Effective immediately all substance abuse intakes will stop (don't whine, they'll start back when we're able). Whatever time the substance abuse folks have will be spent doing intakes for the mentally ill.
Effective immediately, any case managers who want to work overtime may. Nope, Them/They ain't gonna make a big deal out of it. No meetings. Nothing. Send all of the case managers an email.....and, yes they can set their own overtime hours. Folks, you gotta stop being morons. Step back, get out of the way, if you ain't working and producing...keep your mouths shut. If you are one of the Them/They, look where you've gotten us.
Once we get things sorted out here, we're going to try to find out how all of this happened. And, folks.....some of you Them/They may well be pulling the equivalent of mental health KP (for those of you who haven't been in the patrol) and may lose a stripe or two.
Now, a little good news.
Our Crisis Stabilization and Detox Unit that can’t detox. I’m assuming that there’s still a doctor over there and at least a few workers. Until we can get things going again, all project folks being discharged from hospitals, who don’t have an open case, will be sent there. Hey, there’s a doctor there and the other folks can act as case managers at least for the present time. It could be run somewhat like MSU…that is, supply meds and a doc.
OK folks, this is part one. Did I miss anything? We now have a way of serving the needs of the most needy and most worthy. Hey, that’s a step in the right direction.
Though this should have been discussed above…another aspect of possibly deciding who gets services in times like this, is the possible consequences of what happens when someone doesn't get services. Let’s see, the SMI person starts decompensating, having psychotic symptoms, and ends up in the hospital again. The crack user continues to use crack...which in all likelihood they're going to do no matter what.
I'm sure I've missed some things here and have some grammatical errors, but frankly, I'm whipped...just downright tired....and tired of metaphorically beating my head against the wall.

Till the next time......

Saturday, April 19, 2008

Hey, how about a TOPLESS DAY!!!! Also Co-occurring and no wrong doors!!!!

Yes, from the agency that just keeps giving....good old Central Mountain CSB has done it again.
OK, I will admit that part of what I'm writing about is third-hand so to speak; however, several of my coworkers confirmed that they were sent a memo saying...OK folks, listen up....a memo that stated there will be no more intakes for case management when our clients are discharged from hospitals after being hospitalized using Project Funds. Those those of you who may not remember, one of our state's rocket scientists, several years ago, decided they were going to close the state mental hospitals and give the savings (from the closures) to the communities so that local bed space could be purchased (of course there were no local beds [this has already been covered]).
Anyway, (Hey, I've been working here twelve years and sometimes I get confused) where was I?
Let's say we happen across an actually mentally ill person who needs acute know, inpatient treatment in a psychiatric hospital (as opposed to the crackheads and reprobates trolling for someone to take care of them). OK. Now up until a while back, here's how it worked.
A client couldn't see/have a psychiatrist unless they had a case manager. Also, couldn't have a case manager unless they'd been hospitalized twice. They/Them finally learned that the two times criteria was just too absurd.... Anyway, that all changed.
The client goes into the hospital. Discharge day they are sent to the CSB. They have an intake, are assigned a case manager and psychiatrist. Hey, that works well. They have ongoing care and don't run out of medicine.
Soooo, now I guess the folks go in the hospital. Discharged to the street. Finish off the few pills they were discharged with, decompensate, and yep.....go back in the hospital.
It's also my understanding that the crack house, my term of fondness and respect, for our drug treatment center is still taking intakes. Well, ain't that nice. Yes, bring in the ole criminals and give them treatment....but, let's spit on the mentally ill.
Just about enough to tick you off......
Where was I?
Oh, yes. It's going to get better.
This is Mental Health month. We had the old walk for the mentally Ill, wear ribbons for the mentally ill........... and now folks, yes, what we've all been waiting for,
Funny Hat Day......yes, folks, May 1st is Funny Hat Day (for the mentally ill). That's right. Wear your funny hat to work. And, we're going to have folks judge it and there'll be winners and losers and gosh it'll be so much fun and remember this will finish up or begin the month for mental illness awareness. Dang. Why didn't I think of that?

****** Here's the official announcement....honest.****************

As an activity for Mental Health Month, we will have a Funny Hat Day on May 1st. The sites participating are XXXX, VVVVV, NNNNN, & LLLLL. Judges will be at these sites to judge the hats. The staff with the funniest hat will win a prize.


OK. Where the hell did this come from? Did Them/They pull on the pipe too hard? Did They/Them forget to exhale? Something in the water down there?
Let's get serious, here. Who came up with this Funny Hat Day? And, how did they come up with it?
Hmmm. Did They/Them form committees? Have fifty meetings? Hmmm. Or, did they task (love that work) it to someone or some group. Or did one of They/Them just have a spontaneous creative moment? Oh, well.
Hey, if this indeed was tasked to some poor scmuck...well, my apologies (to the poor scmuck); however, it is providing a good laugh in a bizarre kind of way. You may notice that the goofy hat day is an activity for mental health month.

How in the heck can this be reconciled? We have no counseling services, we have no case management services (which means, I guess), we have no psychiatric services, and I would imagine we have no way of providing medications (Hey, doncha need one of them psychiatrist fellows to write one of them prescriptions?).....Ready for a horrible pun, It seems we're going to hang our hat on The Goofy Hat Day.

OK. It's May 1st. Yes, Goofy Hat Day. And, yes, I'm sure at least someone will show up with a goofy hat.

Now, we're parading around in our goofy hats and a mentally ill person comes to our office seeking help.

Gosh, sir or madam, nope ain't got no services for you, but, hey, you're welcome to hang around and see the goofy hats. You're suffering extreme mental distress? Hey, see that hat over there, that's a pretty funny one, ain't it.

You're having visual hallucinations. Hmmm. Sorry, maybe you better not come in.

Changing subjects. They/Them came out with this No Wrong Door Stuff! As I best remember it They/Them said that no matter what services a person sought at any of our sites, they would be welcomed with open arms and taken care of. Yes, if they were using crack (Hey, is that still against the law? No stupid, it's a disease.) we wouldn't send them to the old drug center, we would embrace them and provide whatever they needed (or demanded as the case may be). That's a pretty good one. It would seem that if a citizen is seeking mental health help today...hey, they ain't no doors and if they could find one it'd be bolted shut.

Well, I'm tired of writing and am going to quit for now. I'll tackle the co-occurring stuff later.

Now, what's this about topless? I almost forgot. Why not a topless day instead of a goofy hat day? Or, like a flash, how about a goofy hat and topless day. Hey, at least the mentally ill who might happen by seeking services might get a kick out of it. Yeah, topless with your goofiest hat and yes, there will be judges. I'll leave up to the judges as to well....hmmm... what they're going to be judging.

Till the next time.......

Wednesday, April 16, 2008

YOU DID WHAT!!!!!!!!!!!!

I was in an OK mood when I got to work...but, it sure didn't last long. One of my coworkers, who will not be mentioned by name (The second letter of her first name is E and the last letter of her last name...well, might be R.), authorized the citizens to piss away more money by authorizing CL #772345898 XCV5554443243 inpatient treatment. Before I waste too much more time on this....well, let me just say that in fifteen years he is right up there for all time sleazeball, criminal, malingering reprobate.
Oh, this is cute. The ER doc didn't feel comfortable putting his license on the line. Hey, that's his problem. Dang, what a.....(calm down) screwed up (wanted to use the F word) business.

Tuesday, February 12, 2008

For years activists and protestors have tried many ways to make their points known. Here is my way.....

Mahatma Gandhi is perhaps the most famous for going on a starvation protest or hunger strike. Many before and after him have tried this method to draw attention to their complaints and grievances. Sadly, during the Vietnam war many monks set themselves on fire. Folks have chained themselves to trees, laid down in front of trucks transporting toxic materials....well, you get the idea and the list goes on. Anyway, as I best remember, somewhat spontaneously and for no known reason...most likely out of my ongoing frustration, I fired off a note to my boss with copies to the other bosses, saying that until old Mid-Mountain CSB treated me fairly, equitably, and reasonably I wasn't going to get a haircut. Yes, I work directly for boss number three and indirectly for bosses numbers one and two; boss number three works directly for boss number two and indirectly for boss number one; boss number two works directly for boss number one; and, hey….not sure who boss number one answers to…no telling. Hmmm. By the way, as usual I never heard from any of them… Bosses number two and three have both seen my new hair but neither have commented. Oh, well. (Hey, you guys, still love you.)What a way to protest, hey? At my age not sure what other folks think, if anything. If they have an opinion, I guess they're saying, What a sad commentary, an old whack job trying to look cool.
Well, I guess it's been three or four months...and no haircut yet....and of course still not being treated fairly, equitably, or reasonably....sooooo, I guess the old no-haircut protest will continue. Hey, here's how I look. Yes, it's getting pretty long. Look carefully and you'll see that I'm also going bald. Hey, will old Mid-Mountain give before the baldness wins? Stay tuned..... BTW, if you click on the snap it gets big and you can better see the bald spot.....

Friday, January 18, 2008

Mom, if only you could have lived long enough to know that I'm now a Professional.....

I remember many years ago my mom would always say, Why don't you get an executive job? We never discussed exactly what that meant, though I'm sure in her mind it was at a minimum, a stable job with decent pay where I could wear a suit and not have to get dirty.
Anyway, old Mid-Mountain CSB, in order to try to weasel out of having to pay us overtime, call us professionals.
Great, hey. I'm now a real professional. I think my mom would be proud; however, I'm sure she'd be ticked off at Mid-Mountain for cheating (is that too strong a word?) me out of what's due (yes, my overtime).

Here's the U.S. Department of Labor's definition:

To qualify for the learned professional employee exemption, all of the following tests must be met:
• The employee must be compensated on a salary or fee basis (as defined in the regulations) at a rate not less than $455 per week;
• The employee’s primary duty must be the performance of work requiring advanced knowledge, defined as work which is predominantly intellectual in character and which includes work requiring the consistent exercise of discretion and judgment;
• The advanced knowledge must be in a field of science or learning; and
• The advanced knowledge must be customarily acquired by a prolonged course of specialized intellectual instruction.

Now, good old Mid-Mountain wants it both ways. They tacitly admit to the above definition.... advanced knowledge...predominantly intellectual in character and which includes work requiring the consistent exercise of discretion and judgment...acquired by a prolonged course of specialized intellectual instruction.

Wow, that sounds like a pretty skilled person. Maybe even a valuable person. Hey, this is someone who goes into the community and makes decisions and causes things to happen. Wow, again. Yeah, and you ain't gotta pay them overtime.

Of course, when old Mid-Mountain decides to make changes that effect these professionals...these highly trained they ever consult with them to get their input (I don't like this word used this way....why can't they/them use suggestions, advice, something like that? input should be used when you're talking about an input jack on a computer...but, hey...they/them most likely say, Let's do lunch, and heck, they may even tell you what their sign is)? You know the answer to that one.
Yes, they have the skills and knowledge to act independently and be responsible for their decisions...held accountable for their actions...but, hey, they aren't knowledgeable enough to know what kind of so-called training they need; they aren't knowledgeable enough to make suggestions about procedures that would make their jobs easier and more efficient; no one (them/they) has ever asked their opinion about anything.....nothing! But, hey, when it's paycheck time....yep, these folks are professional. That they are.

Well.......I could go on and on...but no more time will be wasted here. I think you guys have the idea, hey?

CCARTAVMHS Welcomes two new Board Members

The Citizens’ Committee for the Advancement of Rational Thought and Actions in Virginia's Mental Health System….proudly announces the addition of two new board members. JBS and BR will bring with them new and fresh perspectives. We are all looking forward to working with them.

Congratulations and welcome aboard....JBS and BR


Also, please note the photo of our adjunct members, who, as always, provide valuable insight into some of the issues that we have difficulty dealing with. Yes, they usually do stay in the background, so to speak, however, we did want to recognize them publicly for their tireless work and dedication...... The Bored of Directors.......CCARTAVMHS

The Wheels are coming off of the ES Wagon.....

Yes, the lug nuts are loosening up...the wheels are starting to wobble, and it's only a matter time before it all crashes and burns.
January 18, 2008....More soon....

Alienation in the Work Place.......

January 18, 2008......Coming Soon.........

Sunday, January 6, 2008

Don't shoot fish in a barrel....hmmmmm...

Hey, I just can't help myself.
You know, all the news that's fit to report and then some. A recent post was about the hospital that isn't. Well, have another for you.
OK. Here's the deal. A dear friend, whom I've known for over fifteen years, recently opened a crisis and detox center. She worked her butt off on this project. She did it from the ground up....writing procedure manuals, buying the furniture and stuff and hiring a 24-hour staff. Yep, mental heath folks, counselors, nurses, and hey...yes, even a doc.
Yes, I think you might know what's coming..... Hey, it ain't her fault. Honest.
Yes, the detox center can't DETOX! No need to say anything else........

Hosed Again!!!

To appreciate this in its proper context, you may want to take a look at the Carpenter Ad below. Yep, the one where the full time carpenters don't get overtime, time and half for holidays, and so on.
Well, they've done us one better. Just when we thought the limits of unfairness were finite...dang, if They didn't hose us again. Yes sir, now employees, other than carpenters of course, are getting differential pay. Yes, folks. That they are.
How does that work?
Well, if you work late at night or weekends you get more per hour.
Don't the carpenters get the extra pay?
That doesn't seem fair.
No, it doesn't.
Why don't they do something about it?
Not sure if I can answer that one. You see, They don't seem to be accountable to anyone. And, besides, they have far more important things to do.
Things far more important than treating the carpenters fairly?
Oh, yes.
For instance, what would be more important than treating the carpenters fairly?
The meetings. You don't know about the meetings?
I'm confused, what meetings?
The meetings that They have.
And the meetings are more important?
Oh, yes. That's the most important thing in our company. The meetings.
Ah, I'm a little confused. What do they do in the meetings?
Come now. You don't know?
Actually, I don't.
They meet. Get it. They have meetings and meet.
Oh. Hmmm. I need to think about that for awhile. I think if I were a carpenter, I'd a minimum...a little discouraged. What are the carpenters planning on doing?
I'm not really sure; however a few have mentioned that they just might be carpenters elsewhere. A couple have started oiling their AK-47s (just joking)...though as a group we're trying to keep everyone calm.
Well, it'll be interesting to see how all of this ends.
Yes, it will.

Tuesday, December 18, 2007

Delusions: Do we lock people up who have them? And, should we?

Coming soon....

When is a Hospital not a Hospital?

Is this a trick question? Not really...but, anyway, here goes.
Though I am not sure of the procedure that must be followed to open a hospital, I'm assuming that you must meet with some type of a state commission. Making further assumptions, it would seem that you'd have to show a need; yes, prove to the commission that the community where you want to open this hospital, has a need for it.
We, speaking for the citizens, would hope that there would be at least a speck of good intentions... that is, that the folks opening this hospital would actually want to help the people in the area that they will be serving. You know....Hey, we're doctors and we're here to help and serve you. Yes, we went to medical school because we are concerned about the maladies, sicknesses, and illnesses that plague us and we want to help.
From the standpoint of the folks who own the hospital, they want to make money. Hey, nothing wrong with that. The question is, can the two find a synthesis of sorts? Can the two goals both be met, which at times would seem to be at odds with each other? Let's see.
Oh, yeah...back to the initial question...When is a hospital not a hospital?
Naively, I will ask this. If something can't do its job, so to speak, is it still what it's supposed to be.... OK, a car is something that provides transportation. If a car can no longer provide transportation, is it still a car? That is, if it has a dead battery, flat tires, anything to keep it from providing transportation, can we really say it's still a car?
OK. On to hospitals....
Now, what would seem to be the elements, so to speak of a psychiatric hospital? That is, if we were to say we wanted to open a hospital, what would we need to have before we could call it a hospital?
A way to provide room and board. Yes, we need a bed and food. We need folks to care for our patients; doctors, nurses, and other staff to provide treatment and maintain a safe environment. Yes, there are others to maintain the building, kitchen staff, and so on..but, for our purposes we'll break it down to three elements; doctors to accept and treat the patients, beds, and the staff for treatment and safety.
OK. A week or so ago I needed to find a bed for a twelve year old girl. This girl had no health problems and had insurance. This girl was not in need of special staffing (one-on-one) and didn't have behaviors that would put other children at risk. One of the few that I've seen lately that would seem to be the perfect patient. Sooooooo, would our local hospital accept her? Nope. Why you might ask? Were they full? Nope.
Out of the three elements mentioned above they only had two. They had a bed and staff, guessed it......No doctors!!!!!!!!!!!
So folks, in my mind, this was no longer a hospital, though when they answered the phone, that's how they identified themselves.
The twelve year old girl. What happened to her?
Well, yes, we did find an actual hospital who admitted her. Unfortunately for her family, it was three hours away.
The folks at the local faux hospital should be ashamed of themselves.....

Monday, December 17, 2007

If our agency became a construction company, what would our ads for carpenters look like?

Just for a moment or so, I'm going to pretend that our agency became a construction company and emergency services became the carpentry unit. If we were honest and forthright, here's what our ad would look like when we were trying to hire additional carpenters.

Wanted Carpenters

Established company wants to hire carpenters. Other than one other smaller company our pay is the lowest. Our benefits are the worst in the carpentry business.

However, whether you have carpentry experience or not, if you have a masters' degree in biology, we will pay you more than our regular career carpenters.

Please note, that we at times hire part-time workers. And yes, we pay them more than our career workers, if they work holidays.

I guess we need to tell you that at times we don’t have nails for you. And, at times we don’t have hammers. And at times, we have neither. Yes, we know that for most carpentry work these are necessitates; however, we’re sure you’ll be able to…well, you know. Handle it.

Don’t be discouraged by the lack of hammers and nails; remember, we have new trucks for you so you can get to the job sites in comfort.

Please rest assured that we are having meetings about the lack of hammers and nails. We’ve formed several committees; however, until we have more meetings and form more committees…well, just do your best.

As we are sure we’re going be inundated with job applications, we’ve setup a phone bank. Please call 1-800-NoThisAin’tAJoke

And, remember our motto, Fairness to All……..

PS. In fairness (remember, we’re the fairness company), we also need to let you know, when you work overtime we aren’t going to pay you…and, there has to be at least one carpenter available 24 hours a day.

Wednesday, November 21, 2007

Crackheads vs The Mentally Ill........Who gets better treatment???

Recently a mother took her fifty-year old son to County Memorial General, one of the largest hospitals in the region. She told the ER staff that her son had not taken his antipsychotic medication in some time and was making absolutely no sense and so on.
An ER doc saw her son briefly and then a psychiatric nurse evaluated him. The nurse requested that we see this gentleman. The nurse reported that this gentleman is grossly psychotic, not able to function , and so on...and not able to make an informed decision about treatment. (OK, you need to remember this part as I'll be referring to it later.)
We get there and agree with the nurse's assessment and start trying to find a TDO bed. (Do you all rememeber...TDO...Temporary Detaining Order?) OK. Hospital A would not take this gentleman because he has Medicare and the free-standing days are exhausted. Hospital B basically just doesn't want to be bothered. Hospital C has no beds. Now, hospital D...well, they seemed they would accept him; however, they jerked me around for over and hour and then declined.
Now, the ER staff knew we were looking for a bed. And, they are used to it sometimes taking more than a day to find one. Anyway, the next morning we found out the son left the ER. Nice. The hospital says this person must be detained and so on and the person is allowed to leave.
OK. Right up front, the hospital has no legal means to force this person to stay at the hospital; however, from a practical standpoint, knowing that the person needs emergency psychiatric care, the hospital could have at a minimum put a sitter in the gentleman's room. (Note, a sitter is just what it says...someone who stays with the patient and who can discourage them from trying to leave.)
I won't even go into the rest of what happened in this case... Quite unpleasant.

OK, same hospital, same ER staff.
A crackhead (don't get all riled up--my dictionary has this word) shows up and says, I'm going to kill myself if I don't get help. Now, keep in mind that using crack is against the law. Yep, it is. And furthermore, keep in mind that few crackheads work. Sooooo, where do the crackheads get the money to buy crack? Good question. I'll let you use your imagination on this one. Ever had your car broken into? Ever had your home burglarized? Ever been knocked on the head and awake to find you no longer have a wallet? Well, you get the idea.
OK. So this criminal comes to an ER, of course he has no money, and of course he'll never pay the hospital bill, demanding, yes, demanding that you provide him with room and board. Actually, they are extorting money from the hospital and the bill is ultimately paid by, guess who? Yes, ladies and gentlemen, for those of us who are silly enough to go out there and work, we're picking up the tab.
Additionally, most likely 90% of these...well.....anyway, are on probation or parole and yes, smoking crack does violate that.
Trust me on this one, over 95% of these folks do not want help in trying to quit using crack. Period. Nope, not going to debate it with you.
Why are they at the hospital? Out of money. Drug dealer after them. Court appearance coming up and they want sympathy or some such thing. The just stole the 5th TV from their family and got kicked out for the 99th time. They used their mom's ATM card and got caught. Or, they just want to take a break, you know, have someone bring them their food and give them a place to stay or hideout for awhile.
Now, this is the good one. I have never heard of a crackhead just outright killing themselves. Period! Yes, a handful may die because of too much crack and cardiac problems or some such thing. However, I've never heard of one to say, I can't get help and kill themselves. Please, if you know of one out there, let me know.
Remember the poor mentally ill fellow mentioned above. Yes, the one that left the hospital. Yes, the one the hospital didn't provide with a sitter. Good.
OK, now we come to another good part.
In a way it would be funny if it wasn't so pathetic and such a waste of money. Yes, you see them propped up on a gurney and we, yes ladies and gentlemen, we are paying for someone who will sit next to them. Hey, the last thing the old crackhead is going to do is leave!!!! They want that free (to them) room and board.
And, so it goes!!!!!!
Hey, I'm tired of writing this one....and getting a little ticked off.

Tuesday, November 20, 2007

Mid-Mountain CSB-You most likely wouldn't want to request rocket designs or have your brain worked on here.....

First off, if anyone stumbled across this site and doesn’t know what CSB is...well, its Community Services Board. Yes, these are the agencies around the state whose job it is...well, they are charged with the responsibility of supplying mental heath and substance abuse services for the folks in the community that they serve. Anyway, where was I? OK. Stay with me on this one as I'm sure you will see the logic that is escaping me. Here goes. If you want to be an Emergency Services' Worker in the Commonwealth, you must have a masters' degree (social work, psychology, and so on) and become certified. No, becoming certified is not the equivalent of SEAL training, or training at Quantico to become an Embassy Guard, or becoming an Army Ranger. The certification process goes something like this; read some stuff, watch some videos, sit in on few evaluations, do a few evaluations, and have a supervisor watch you do a few evaluations. Now, this in no way denigrates the folks who do this frankly the job is a real....anyway, it sure ain't easy folks. Yes, a lot of it is routine and requires little thinking; however, the tough cases will just about do you in. (Let's get this in some perspective.....any of us who are not in Iraq or Afghanistan being shot at and blown up because of the bozo in the White House, basically have it made.) Where was I? Oh, yes. There are some folks who were grandfathered in who do not have a masters' degree. Yes, these were the folks working as ES workers who had, I think, at least three years experience. Hmmm. Now, until a few months ago we were paid overtime and also paid time and a half for working holidays. Noooooooo, there was no pay differential for working the late night shifts or weekends which seems pretty common in the market place. All of a sudden They decided that we would no longer be paid extra for working holidays and that we would no longer be allowed to work overtime. Again, pay attention here. This confuses even me and hey, it’s my job.

They say that we have to juggle the schedule, that is, if I work two hours over...then I need to come in two hours late at some point to avoid overtime. Hmmm.

OK. By the very nature of the job, we will work more hours than scheduled. Period. That's an absolute. As an example, we can be tied up as many as five hours working on one case. As an example, let's say I'm working a 4PM to midnight shift. Further, let's say that we get a police call at..hmmm...11:30PM. OK, we respond to all police calls immediately. Lots of important one being that, there ain't that many officers out there Protecting and Serving. Yep, everyone is shorthanded.

Anyway, so I go. Let's say I work on the case until 2:30AM.

You really need to pay attention here....... OK, a shift is 8 hours. Sooooooo, I have now worked two hours over, which means that I need to come in two hours later on a shift to make everything OK. Really pay attention now... OK, let's say I'm employee A. Now, so that I can come in late on my next 4PM shift, employee B worked from 8AM until 6PM. Hey, OK. That solves the problem. Well, now employee B has worked overtime so he or she must come in two hours late on a shift or leave two hours early. Folks, I'm sure you've gotten it by now. No more on this one.

More good stuff coming.

We have folks who work part-time. Though I could be wrong on this one, it's my understanding that they get paid time and a half for holidays. Hmmm. What can I say. Part time workers get paid more than full time workers. I guess They think it's OK.

Another good one. We have a worker who was full time with ES (grandfathered masters) who decided the grass was greener and took another job in our agency. The person soon realized, Hey, I want back in ES. Again, listen carefully, no I'm not a magician...and I doubt there's magic going on here....sooooooooooooooo, this person says, Hey, I screwed-up...I made a bad decision. Let me back.

Well, THEY (yes, the old they) said, No way Jose, you don't have a masters degree. But, your Excellency, I'm certified. Serf, we don't care. But, we will allow you to work for us part-time.

Your Excellency, why is it that I can work part-time, needing the same credentials, but can't work full time.

How dare you question our decision. Anymore outburst and we'll boil you in oil...or something.

OK. Back to the no overtime policy. Yes, another one that you need to pay attention..... The person who was full time, quit and took another full time position in the agency? Remember? OK. He is full time at his job....and, he can work part time in ES. How does that work? We can't work over time...but, he has full time job and then works more hours in ES....the time that he works in ES is surely over the time of a full time schedule in the person's regular job. Is that not over time??? Hey, maybe this is all a dream...nightmare...or, something....

All of this would seem to bring a new meaning to twisted logic........

Thursday, October 4, 2007

Ahhhh, We're Moving Again...

Presently our agency has three sites or offices (that I know of). The building we are in also has most of the case managers (these are the folks who deal directly with our clients) and the doctors.
Sooooooo, where are they moving us???? They are moving us to the building with the substance abuse folks. Not sure how far away it is....but, it surely isn't around the corner. I mentioned in an earlier rant that we are inputless. Even though we are the ones out doing the work no one ever asks us anything! Should they? Well, even if they don't care what we think it would be nice if they at least pretended sometimes. Even though we're a social-work kinda agency sometimes I wonder about it all. And, I'll mention the GE Light Bulb experiment again. Oh, well. Where was I?

Now, who made the decision for this move? I of course am clueless...and besides I'm sure it's none of my business even though I've worked for this agency for eleven years!

OK. Let's list the reasons to move or not move:

Not to move......

(1) The police station and magistrate are one block away. Let's see, why is that valuable? OK, the obvious. It's not unusual for the officers with someone to evaluate to go to the station and request a screening. Hey, we're one block away.
(2) Often times there may be a reason for us to come back to the office while working on a case. In those times the officers again go to the station and wait for us. Yes, still one block away.
(3) Sometimes it's quicker to do all the paperwork in the office and then go one block to go before the magistrate.
(4) If we're calling around for hospitals it's easier to be in the office with your coworker helping...and, yes, then we're a block away from the police station and magistrate.
(5) Though it doesn't happen daily, we often times go to our lobby to screen people or to try to calm things down if one of our clients get upset.
(6) Case mangers come down to our office on a regular basis to discuss their clients. Often times they fill out a crisis form in case their client comes up. This way we have information on them. (Yes, I know, they could FAX it.)
(7) The psychiatrists are in our building. Yes, they occasionally come to our office to discuss one of their patients.
(8) Our office is closer to one of the hospitals that we visit on a regular basis.
(9) None of us want to move! (No, I am not naive enough to think this matters.)
(10) We like our cleaning lady who cleans in the evenings.
(11) There are a few others that I could mention, but I won't........ (Not that I think anyone will read this.)
(12) We may be further away from our favorite Chinese restaurant. If we are no longer able to go there, their income is going to go down and they will be financially harmed. They are nice people and we don't want that.

Reason(s) to move....

(1) We'll get to work in the same building with Ruth C.
(2) We'll be closer to one of the fast-food fish places (see twelve above).

So, in summary, how does it all look? Well, as I often mention....I'm sure I don't have the big picture (does anyone?). That said, it would seem that when we move (they surely won't change their minds) all of us will be less efficient and, we will be putting our friends at the Chinese restaurant in financial peril.

OK. You guys in the know? Why are we moving?

Remember: Hell is the absence of logic!

Thursday, August 30, 2007

Ah, So Much For Government Efficiency

OK. We have eight full time and four part time employees. So, let's just say there are ten employees. Now, we have two supervisors. Their official titles I will not put here; however, these are folks who we call when we need certain types of admissions or on the rare occasion of a difficult case we're trying to take care of. The unit basically runs itself and we rarely, other than getting an admission approved, ask for supervisor-type help. Neither of these folks..well, go out in the field. In other words, they don't produce our product, so to speak. They are both delightful and well liked by all of us. In fact, if we were given the choice of who we would have for two supervisors, we would chose the ones who we have. That's about as nice a compliment as you can give....
However, their entire working lives are made up of going to meetings. Yep, meetings......and meetings...and meetings.....well, you get the idea. Sadly, from the perspective of those of us at the absolute bottom of the food chain....nothing ever changes. It all just continues on with the same ongoing daily problems. I guess in fairness, I must say that the overall environment that we work in just doesn't lend itself to change. Beneficial change would come by all of us involved in the process, hospital staff, police officers, paramedics, and so on getting together and working on making the system as efficient and smooth working as possible; the primary goal being to serve the mentally ill of the community. Oh, well.....
Where was I?
OK. While I'm well....venting a little, maybe....
It seems changes in our working and office environment come from above...yep, those folks who are so removed from what we do that they haven't a clue. But, they will make changes without asking anyone for, what do they call that, oh yes, input. Yes, you might say that we at the bottom are inputless, that we are. So polices change and they physically move us around....and hey it all stays the same (except our office might end up where we don't want it). You might wonder if those folks know of The GE Light Bulb experiment.... And, as of this moment, we have a supervisor to worker ratio of five workers per supervisor.
I guess some might quip, But, hey, what would happen if they weren't going to all of those meetings? Hmmmm.....interesting question. Oh, well. Enough for now.....

Sunday, August 12, 2007

Let's See, A Serious Mentally Ill Person has Been in Your ER for Over 72 hours, You Have a Bed but are Going to Try to Have Him Arrested?

more to come....

Who Takes What??? Insurance, Insurance, Insurance.....

OK. You have a mentally ill person who needs to be in a hospital. Now, what?
Private hospitals will generally take most commercial insurance. They'll also take Medicare if it's not exhausted (Medicare allows for about 180 lifetime days in a private hospital. When those days are used the person must go to a medical surgical hospital.) Sometimes they'll take people with no insurance if they have an agreement with The Community Services' Boards for the area. Under some circumstances the tax payers of Virginia will pay the tab.
Some hospitals out of the area will not take someone unless you guarantee at discharge someone will pick them up.
If the person is retired military or a military dependent...well, there seems to be two kinds of TriCare or whatever they are calling it today. One type you must go to a military hospital if there is one nearby and they have a bed. The other type you may use anywhere.
Medicaid is only accepted at medical surgical hospitals. Well, that's not entirely accurate.. Medicaid allows younger people, I believe under 20, to go to private hospitals.
Ah, then there's FAMIS....not sure exactly what it is...but, seems to be sort of like Medicaid; however, you can only go to a medial surgical hospital. In fact, we're told that if a person with FAMIS goes anywhere else they lose their insurance.
Sooo, there you have it.... I think.

The Night I Felt Like Walking Away

It was a cold, dark, stormy night, and it had been raining steadily for several hours.

more to come....

Sunday, August 5, 2007

When the Planets are Aligned and the Stars are in Order...No Telling What Will Happen.....Yes, There can be a Random Cosmic Event......

Unfortunately, cosmic events can be good or bad. This one didn't work out that well. Let's see where it all started. A lady called concerned about her brother who has a mental illness. It seems that she had been caring for him, so to speak, for the past twenty years. And, during that time he had exhibited no psychiatric symptoms of any kind. In fact, he didn't even have a case manager. He had a psychiatrist who he saw once a month. Yep, this gentleman had been stable for many years. No hospitalizations for over 20 years.
Anyway, his sister reported that a couple of weeks ago he had fallen down the stairs in their townhouse. He had a severe leg fracture that required surgery and pins.
His sister reported that since he’d been discharged from the hospital (for the problem for his leg), he had stopped eating with noticeable weight loss, was drinking beer daily, refused to take his medication and was ongoingly exhibiting symptoms of mental illness.
She said that he told her he was working for the CIA and that they were after him. Yes, the Mafia was after him. He had also refused to wear the leg air-cast-device that he had been discharged with. Additionally, she reported that he kept talking about winning the lottery. Because of this 180 degree change in his behavior, she asked that we evaluate him.
When I got to their home, he basically confirmed what the sister had stated. In fact, he said he needed to get to the hospital so that "a" doctor could give him $200,000,000. He wasn't clear as to why a doctor would give him that much money and he wasn’t able to give me the name of the doctor. It was obvious that this gentleman was grossly psychotic. And, as you may remember, a person can be detained for being substantially unable to care for self, which this gentleman was. Mr. Smith was completely unaware of his situation and circumstances, was unable to make needed decisions about his welfare and well being, and was unaware of his need for emergency psychiatric care.I called one of our local hospitals, one that had GeroPsych unit, a unit for older folks. Generally, age 55 or older. Yes, there was an available bed. Soooo, now I had to get the gentleman to the emergency room (ER). His family was exhausted, having dealt with him for over a week. For several reasons, I thought that it best to get the paramedics to take him to the hospital emergency room (ER). Sooooooooo, I called the paramedics. When they arrived I introduced myself to The Captain (can’t remember his last name)....a young fellow...most likely not much older than 30. I briefed him: psychiatrically stable for over 20 years, now thinking he was a CIA agent and so on. Also, mentioned that he wanted to go to the hospital to see a doctor so that he could get his $200,000,000. Anyway, I introduced The Captain to Mr. Smith. Mr. Smith, this is the fellow who is going to take you to the hospital to get your $200,000,000. Mr. Smith smiled broadly and seemed pleased. The first words out of The Captain’s mouth; Mr. Smith, what day is it?
Hmmm. Mr. Smith is grossly psychotic and The Captain asks, What day is it? Oh, well….not sure what he’d do with that information.I knew I had to get out of there. Captain, would you please take Mr. Smith to County General ER? They know he is coming. They have a psychiatric bed for him. Just need to get him to the ER to get him medically cleared.
I'm not sure I'm going to transport him......
Hmmmm... I thought I do need to get out of here. I explained that we were overwhelmed with business and I'd be in my car catching up with some paperwork.
A while later, The Captain, three other paramedics, and two police officers came to my car. The Captain said, He's medically stable and there is no reason for us to transport him. Hmmmm. I explained that I was going to get a TDO. Has he been evaluated, he asked? Yes, I evaluated him. He will be TDO'd and there is a bed waiting for him. One of the cops piped up, Do you have papers (meaning, do I have TDO papers)? No, I can't get those until Mr. Smith gets to the ER and gets medically cleared. There is a bed waiting for him.
The Captain, then said, Well, the family has agreed to transport him to the ER.
At this point, I knew I was whistling Dixie. He and the cops acted as though they never transported folks to the ER because of mental problems.... which of course is not true. Routinely paramedics take folks to the ER for a variety of nonmedical reasons; they take drunks, crack heads, older folks who are demented, and the mentally ill. These are the times that you feel like whippin’ out the old AK47 and blasting away. Hmmm. Thankfully, I didn’t have an AK47......
Sooooooo, off goes the family...frazzled as they are, to the ER. I followed up with the psychiatric nurse. Trying to stay abreast of what is happening to Mr. Smith.
Hmmmmm. When he gets to the ER his pulse is 157.....and his labs are not within normal limits (WNL). Nice. Anyway, he is admitted to medicine. Yes, he is so medically unstable that he is admitted to the regular part of the hospital. He was not medically stable enough to go to the psychiatric unit. Nice. But, of course, the old Captain had stated there was nothing wrong with him and that he was medically stable.
An interesting aside, if you will. Here is a fellow that I stated meets TDO criteria. I stated that because of mental illness he is no longer able to function outside of a hospital psychiatric hospital. It would be interesting to see how The Captain would explain things if on the way to the ER, being driven by his family, Mr. Smith had jumped out of the car, or had gotten out of control and had caused an accident. Hmmmm. Nice.
Folks, it's going to get better......
Now, keep in mind that this gentleman was taken to the ER because of a complete mental status change. Yes, for 20 years or so this gentleman had no psychiatric symptoms. When he was admitted to the hospital, he was talking about a doctor, whose name he didn’t know, who was going to give him $200,000,000......and he was a CIA agent and people were after him and were going to kill him.
It gets better or worse depending on your viewpoint.....
Mr. Smith was admitted on a Monday, let's say. Wednesday evening I get a call from his sister who is frantic. She said that the hospital called her son (without talking to her), and said he needed to pickup his uncle. Yes, remember, this is the fellow who is grossly psychotic. Yes, this is the fellow that I had alerted the charge nurse that he was coming in...and also alerted the psychiatric nurse...yes, the nurse was the one who said they had a bed they were holding.
His sister said when she got home from work, Mr. Smith was naked, had taken off his leg brace, had cut it up and put it around his neck…and there were some other things he was doing. Additionally, his sister told me he was refusing to go back to the hospital.
Now, here is the dilemma. There isn’t a legal way of forcing him to go to the ER.
My only hope at this point is to get the psychiatrist on call, to accept Mr. Smith under a TDO. OK.
Listen closely, we’re coming to the best part of the story. I called the psychiatric nurse who is on duty. Yes, C$%6&8% %#@9N, RN, is working. Hi, I tell her what had happened with Mr. Smith and ask that she call Dr. Jones and get him to accept Mr. Smith under a TDO.
Oh, I can’t do that, you have to have him MEDICALLY CLEARED!
Let’s see if I understand this. Mr. Smith comes to your hospital. The hospital was alerted that as soon as Mr. Smith was medically stable, he would be detained to the psychiatric unit. For whatever reason, your hospital discharged this man who was still grossly psychotic…discharged this man who you had been told was going to be detained….you did this. Now you’re telling me he has to be medically cleared after you wrongly discharged him from your hospital a few hours ago. Medically cleared?
Yes, folks, hell is the absence of logic…and I could feel the heat. Writing this, I feel the urge to say some really naughty things…however, I will restrain myself….though I’m not going to cancel the order for the AK47.
Yes, that’s what I’m telling you……he must be medically cleared.
OK. Now what? If I hadn’t evaluated Mr. Smith within the past 72 hours I could seek an Emergency Custody Order (ECO). This orders police to pick up a person and take them to the designated site so they can be evaluated. I could have had Mr. Smith taken to the ER using this order. But, this wasn’t an option.
Can you imagine what Mr. Smith’s sister is thinking about this time? Every screw-up that could have been made was made….and now what, who is going to help her???? I was running out of options……..
Oh, well.
In desperation, I called police dispatch and tried to act as casual as possible as if what I was going to ask…I did every day.
Hi, this Robert Martin at Community Mental Health. I need your help. Would you be so kind as to send a unit by 128 Elm Street, pick up Mr. Smith and take him to the County General ER? I’m working on a TDO but need to get him to the ER for medical clearance. Have the officers call me if there is a problem.
Gosh, I usually love the cops, and this was another one of those times. Yep, they took Mr. Smith to the ER.
The next day when I got to work I found out that Dr. Jones, the psychiatrist, refused to admit Mr. Smith to the psychiatric unit. The doctor claimed he had too much energy.
Nice, because of this, we had to find another hospital that would accept him, and the police had to take Mr. Smith to the other hospital. Yes, the planets were definitely aligned for Mr. Smith and his sister…..

Tuesday, July 31, 2007

How do You Know Whether or not Someone Tried to Kill Themselves? How do You Know it's Not a Gesture?

Good question.
Too bad trying to kill yourself isn't like high blood pressure.....
Too bad there's not a suicide cuff that can be strapped on and pumped up... But, of course there isn't such a thing.
A few things that might give some insight into the intent, if any. Did the person think whatever they did was lethal? If a person took pills and felt that they would die, whether the dose was lethal or not, that might well be an attempt to die.
How did anyone find out? You know, if they took a bunch of pills, how did they end up at the emergency room? Usually, the person calls someone. Is that an attempt to die? No. Of course, the problem is, they may have taken enough pills or what-have-you to cause physical damage. They obviously didn't want to die (they called someone) but their behaviour is so reckless that they may pose a danger to themselves.
Someone who drinks a lot poses a danger....not that they necessarily want to die or kill themselves, but the drinking can dull everything to the point that they don't know what they are doing. They pose a danger to themselves as they may accidentally take an over dose or play with a gun....and so on.
OK wise guy. What in your opinion constitutes an attempt to kill oneself?
An easy example. Fred and Sarah have been married for 20 years. In the 20 years Fred has worked for the same company and his schedule is as predictable as the trains in Singapore. He leaves the same time every morning and returns home the same time every evening.
Give or take a few minutes, he, for the last 20 years has left his home at 8:00AM and give or take a few minutes, he returns home at 5:30PM. As usual, today Fred kissed Sarah goodbye, and left their home at 8:02AM.
As soon as Fred leaves, Sarah grabs a bottle of vodka, and scoops up all of her medication in addition to everything that's in the medicine cabinet, aspirin, Fred's heart medication and so on. Every pill she can find. She puts on the hifi to a classical music station, sits in the middle of the living room floor and starts taking the pills and drinking the vodka. A couple of hours after Fred leaves, Sarah is sprawled in the living room in a coma-like state.
Fred, in the meantime, realizes that he forgot an important presentation that he has to have for an afternoon meeting. He speeds home and finds Sarah unconscious.
Yes, ladies and gentlemen, that is truly an attempt.

Monday, July 30, 2007

So and So Tried to Kill Themselves......Is it a Cry for Help? Most Likely Not....

First, you need to define, tried to kill oneself?
Sadly, most of the poor folks who do want to kill themselves, well...they kill themselves. They normally don't call someone. It would also seem that if someone, for whatever reason, has decided that they are going to kill themselves, it may well be impossible to stop them.
Most of what is seen in the emergency rooms and most of what emergency services sees....and other folks in the community, counselors, fire fighters/paramedics, police and so best are gestures. My small dictionary says in part, a gesture is...something said or done for its effect on the attitude of others.
We often say, So and so tried to kill themselves. It's a cry for help. Well, it might be, but it's most likely a cry to manipulate? What are you talking about? Good question.
Normally, the person who makes a gesture wants to bring attention to themselves. They want folks to know that everything isn't going like they'd like. Someone can be extremely depressed and this is their way of letting people know. Some people sadly, learn that a gesture is a way of getting attention and they do it over and over. That they do.
Many folks do it to try to manipulate. There's something in their environment that they want to change. Most likely 60/70% of gestures have a boy friend or girl friend element to it.
So and so just broke up and this is their way of trying to get the person back.
Sometimes the gestures are the equivalent of a magician's misdirection. Yes, the person is trying to move the focus from one place to another. As an example, let's say Fred, on the way home with his pay check, decided to blow it on crack. So, he gets home and his wife or girl friend is rightly...well, mad and so on. Sooooo, attempting to move his wife's ire from his bad behavior, he claims he's suicidal, rushes to an emergency room, lays up on a gurney, and hopes his wife will come by and feel sorry for him. And, so it goes.....

The Statistics for People Who Attempt to Kill Themselves are Most Likely Grossly Inflated

First off, where do they get the figures? Well, I'm not sure but it would seem the only place would be from the triage sheet, or something similar.
Obviously, anyone who makes an attempt to kill themselves or who claim to be suicidal, comes to the emergency room. Normally the first person who they see is a nurse who gathers information: why are you here, any allergies, taking any medications, any health problems, and so on.
So, you might ask, what constitutes a suicide attempt or what does it mean if someone says they're suicidal? On a most likely daily basis, I would imagine that larger hospitals have folks come in with scratches or superficial cuts in the wrist area who claim, they tried to kill themselves. Is it reasonable to assume that they did try to kill themselves? Nope, with a few exceptions.
If someone actually plans to kill themselves and have never cut on themselves before, it's possible that the pain that's caused when they start to cut, stops them. Yes, it's possible that they want to be dead....and merely stopped because of the pain. There are few folks who fit in this category....few. However, when someone in this category can be identified, they may well pose an imminent danger to themselves.

Saturday, July 28, 2007

Drinking Too Much....Disease or Bad Behavior.....?

There are many people who consider alcoholism or drinking too much to be a disease. There are also many people who consider problem drinking to be caused by behavior and poor judgment.
There are also some folks who state that alcoholics are weak willed; sort of the morally bankrupt of our society. In fact, some folks would say it doesn’t hurt to have a few drunks around so we can see how we don’t want to be.
The AA model as well as many experts “in the field” consider people who drink in a manner that labels them alcoholic to be suffering from a disease. I guess before someone calls something a disease they should at least have a definition of what a disease is.
While I am surely not a doctor, nor do I claim to have medical training or medical knowledge, it would seem that a disease is something like cancer, diabetes, heart disease, and so on. These are maladies that we can identify through tests. And, while I’m sure that we can show some causal relationship between, say smoking and lung cancer, in general we think that we have little control over having a disease. That is, we have little or no control over getting or having a disease or getting rid of it once we have it.
Well, we’re all entitled to think what we want, but I’m on the side of saying that alcoholism or problem drinking is behavior: Period. We are alcoholic because of our drinking behavior not because we have a disease that we have no control over that makes us drink.
Now, even if we say that alcoholism is a disease and that once we start drinking we have no control over still starts with our picking up the bottle...and, that folks, is behavior.
One of the major problems of calling our problem drinking a disease is that it makes us not responsible...I mean, do you blame people who have cancer for getting it? No. Do you blame people who have heart disease if it doesn’t go away? Of course not.
Do we blame people who drink more than they should and their drinking causes them problems? Well, if you aren’t, you should. Period!
It hasn't been that long ago that we called people who drank too much, bums, drunks, dead beats, and so on. I’m not suggesting that we use these terms for everyone who has a problem with alcoholic but we have sort of made it more legitimate by referring to those behaviors as substance abuse problems. Hmm. Uncle Harry, who drinks a fifth a day and beats his wife isn’t a drunk...he’s, yep folks, he’s a substance abuser who’s suffering from a disease.
Before going further one thing should be clarified. There are people who suffer from organic diseases that for all practical purposes virtually makes it impossible for them to use sound judgment. That is, the way they are effected renders them incapable of using sound judgment or doing any type of problem solving. There are many people in our society who suffer from organic disease who just don’t have the capacity to understand the consequences of their behavior. That said, I will follow up that these people are in the minority. An extremely small minority. And, if you’re one who is in this minority you surely wouldn’t be reading this.
There is also a population of seriously mentally ill people who are also incapable of understanding the consequences of their behavior. And, their judgment is more particularly impaired when they stop their psychiatric medications or mix alcohol with the medications. Here again, if you’re seriously mentally ill, I doubt that you’d be reading this.
And, herein lies one of the problems with calling problem drinking a disease...these are just hapless victims of a terrible degenerative disease who basically have no control over their situation. Yeah, that’s what many people who call themselves alcoholics would have us believe; and, want us to believe.
Anyway, don’t get too hung up on the disease vs. behavior argument about drinking unless you’re trying to excuse yours or others boozing. All you have to do is assume responsibility for your behavior, drinking and otherwise, and you are headed in the right direction.

Saturday, July 21, 2007

Why are the Mentally Ill in Jail and Criminals in Psychiatric Hospitals?

OK, calm down and take a deep breath. First to the mentally ill in jails.

more to come

The Project...The Grand Plan

A few years ago, just as the bed shortage reached critical mass, someone decided that the answer to the bed shortage was yes, partially close down the State's hospitals. Hmmm. The thinking was that, Hey, we reduce the number of beds at the state level and send that money to the communities. The communities could then purchase their beds locally. The mentally ill could stay close to their communities and therefor be close to friends and relatives. Additionally, it would make discharge planning easier, the services these folks would receive would be local.
I think though there were most likely good intentions here, possibly one thing wasn't factored it, so to speak. At the time this change was made, there was a bed shortage...that's right, everyone was having a difficult time finding beds for the people who needed inpatient, let's close some state buy your own. Well, let's see...there are no beds....we're going to close down some of the beds at the state hospitals....and, we'll buy the beds, where? No comment.

Thursday, July 19, 2007

There's a Psychiatric Bed Shortage...Why Is That?

Hmmm. I'm not sure if there's an easy answer to this one.... Let's see. For reasons that I can't fathom, several hospitals in our area have closed. Yep, shut the doors and that's that. If you assume that most parts of the country have an ongoing increase in the population, you would expect an increase in the population of the mentally ill who may need hospitalization.
So, we have fewer beds and more people needing beds. Hey, ain't gotta be no brain surgeon to figure that one out.
See the other posts about what can be done and what the communities are doing.....
Also, see the post about who needs to be in a psychiatric hospital... And, the post about what it takes to get admitted to a psychiatric hospital.

Are There any Problems out There?

Funny you should ask. Yes, there are a few.
There is an extreme shortage of inpatient psychiatric beds. Yes, it's an ongoing problem, having the mentally ill who need to be hospitalized...and no beds or no one willing to accept them.
If a doctor requires medical clearance and the person isn't in an emergency room and doesn't want to go, that is a problem. Surely, if you can force a person against their will to go to a psychiatric hospital, can't you force them to go to an ER? Nope.....
Most likely well over 95% of the police officers and paramedics are quite accommodating in assisting with patients who need hospitalization; however the few who aren't are a pain in the butt. Often times an officer will say, You got papers? (meaning TDO)...implying that they can't act without the papers.
Will cover the above in more detail.

I Don't Buy This no Bed Business! Surely You Can Send These Folks to the State Hospital....

That's a good'd think so, wouldn't you? After all, isn't the State supposed to provide treatment for those who have no insurance or have no other hospital to go to?

more to come.......

OK, This is the One. Yep, Joseph Heller is Turning Over in his Grave.....

OK. Listen carefully. A mentally ill person is seen on the street at the request of the police department. OK. Just for the sake of this illustration we will assume that this person is seriously mentally ill and needs immediate hospitalization. Hmmm. That sounds simple enough. OK..... still with me. OK. Call hospital A, B, C and there are no beds. Call hospital D. Yes, they have a jillion beds. However, they request medical clearance. Hey, nothing wrong with that. They want the person to go to the emergency room, have lab tests and such to make sure they have no serious illnesses that would make them not a candidate for a stand alone hospital.
OK. Listen carefully. It is possible to get a Temporary Detention Order...that has at the bottom a check that says, a direct quote from the order, "For medical evaluation or treatment as may be required by a physician at the temporary detention facility."
OK. That seems to make everything, OK. Well, it doesn't as the hospital says, Hey, get them medically cleared and we'll see whether or not we'll admit them. Hmmm.-
Hmmmm. Let's see. If the hospital says, Yes, we'll accept with medical clearance the mentally ill person can be taken to an emergency room to have whatever tests are required. If the person is medically compromised so to speak, they will be admitted medically and that's that. They will not go to the psychiatric hospital.
However, if the hospital will not accept them subject to medical clearance...nothing can be done. If the mentally ill person states they won't go to the ER, the police have no legal way of taking them...and, ultimately, they will be released to the street. That's a pretty good system, hey...

Want to Know What Might be a Secret About Stand Alone Hospitals?

OK, folks. Just between you and me. There may not be no doctors in a stand alone hospital..... Hmmm. Ok, don't panic. Let me explain.
No doctors, what the heck are you talking about???
Calm down.
Yes, the doctors come in the morning and make their rounds. Yep, see the patients and so on....write orders and such. But, they are pretty much outta there by noon.
Well, who in the heck is left if there are no doctors? Hey, relax. There are some nurses.
If there is a medical emergency the person is sent to the closest emergency room.
Hey, just because they ain't got doctors there 24/7 doesn't mean you shouldn't go there. Just thought you might like to know.

Are all Psychiatric Hospitals the Same? Well, Yes and No.....

Think you can say that there are two types of psychiatric hospitals. There are the medical surgical hospitals that have a psychiatric wing. You know, these are the hospitals with emergency rooms and they operate on people.
Then there are the stand alone hospitals. The private hospitals. Yep, these are the ones that have no affiliation, so to speak, with the full-service medical surgical hospitals.

When a Hospital Says They Don't Have a Bed... What does That Mean?

Hmmm. Good question.
(1) There is a patient in every bed that's in the hospital.
(2) There are empty beds but no staff to cover them. What the heck does that mean? Well, there has to be a certain ratio between staff and patients....sooooo, if a hospital is low on staff, they will not be able to admit more patients even though they have empty beds.
(3) This is a good one. We have lots of staff, in fact, they are falling all over each other....and we have a thousand beds....but, we have no doctors to admit. Where are the doctors? Not sure...on vacation maybe....don't feel like taking anymore patients...who knows. Isn't there anyone in charge at hospitals? You know, someone who runs the day-to-day operation of the hospital? You would think so.... Why doesn't that person hire more doctors? That would seem logical, wouldn't it? Hey, sometimes we just can't look for logic, can we?

Let's see. I own a Chevrolet dealership. I'm looking out over the lot. People are streaming in wanting to buy a car....and, there aren't enough salesmen to wait on them. People are streaming in and then leaving going to other dealerships to buy cars. And, I'm just going to sit there? Sure. You bet I'd get some salesmen in there....right away.

Obviously, the hospitals operate in a little different way.....

Wednesday, July 18, 2007

Who Needs to be in a Psychiatric Hospital? This is Different from Who is Actually in Them......

My opinion. Who needs to be in a psychiatric hospital?
The seriously mentally ill who have decompensated. Yes, these are the folks who have possibly stopped taking their medication and are exhibiting psychotic symptoms. They could be hearing voices, seeing things, delusional, and so on. Folks are seen on a regular basis who are receiving messages, sometimes through the radio and the TV...people who know that the FBI and CIA are after them, people who think they are God, and so on.
Though, sadly, there are many folks out there who have what we generally call fixed delusions; that is, delusions that just seem to never leave; for many mentally ill people the symptoms exacerbate themselves when they stop taking their medication.
These folks need hospitalization so that their medication can be regulated and possibly adjusted, modified or changed, in the hopes of having their symptoms diminish so that they'll be able to function outside of the hospital environment.
Anyone else who needs to be in a psychiatric hospital? Yes.
Sadly, some folks become so depressed, so emotionally devastated, that they are no longer able to function. Often times they have stopped bathing, stopped eating, and not unusually, never getting out of bed....sleep all the time...never sleep....and so on. Then there are the folks who may have had an event in their life: death of a spouse, or family member...or possibly an ongoing battle with depression.....separation from a loved-one or spouse, loss of a job, the threat of becoming homeless...and so on.
These folks also may benefit from being in a hospital, in the hopes of getting them going again.

Where Can a Person be Evaluated?

Just about anywhere. Typically will be at their residence, "on the street" usually at the request of the police, hospitals, jail (rarely), schools, juvenile detention, halfway houses, adult residential facilities, emergency rooms, nursing homes, churches.... Where won't a person be evaluated? Sort of case-by-case decision; however, just about unheard of to go to a person's place of business unless the request is by the employer.

How Does a Hospital Accept a Person Who is Being Detained?

Good question. As with anyone who is going to be inpatient in a hospital there must be an accepting physician. This is a doctor who is willing to accept the responsibility for the patient and to call treatment orders to the nursing staff.
How does the doctor decide whether or not he wants to assume this responsibility?
Though there may be some variations, the normal procedure is for the evaluator to call the hospital and describe the case to one of the staff: could be a nurse or a counselor. That person in turn calls the doctor and presents the information. The doctor can refuse, accept, or ask for more tests or information. For example, let's say there's a history of heart disease or diabetes, the doctor may request at a minimum blood sugar and vitals. The doctor may ask for anything they want (more on this later).

Can a Police Officer Take a Person into Custody Just Because They are "Crazy"?

Yes. The code basically states, That any law enforcement officer, based on their own observations or the reliable reports of others, feels as though the person needs to be evaluated for emergency hospitalization, they may be taken into custody and held for not more than four hours. This is known as an Emergency Custody Order, even though a paper order hasn't been issued.
Within the four hours, the person must be evaluated and if the person is going to be TDO'd to a hospital, it must be done within the four hours.

Involuntary Psychiatric Hospitalization....

What happens if someone needs psychiatric treatment, and they are either unaware of the need, refusing treatment, or not able to make an informed decision?
All states have a method or way of having someone admitted against their will. And, this is one area that Virginia does well. Some states allow any medical doctor to sign someone in...other states extend that to licensed social workers and other licensed counselors.
In Virgina, a person must be evaluated by a representative of the community services board. Each board has an emergency services unit that is responsible for performing the evaluations. Interestingly, none are medical doctors; in fact, some who were grandfathered in have bachelor degrees. About 12 years or so ago the Commonwealth established a certification system. Now an evaluator is required to have a masters degree and go through a not difficult certification process.
Why is this system better than most? Even though these folks are aware of the potential liability in what they do, they are not driven by it. Medical doctors are always aware of the potential to be sued for their actions or lack of acting. The emergency services' worker often time acts as an advocate for the person who everyone is saying needs to be detained. Their job is to look for the least restrictive alternative to detaining someone.
Routinely emergency room doctors and psychiatrists ask for patients to be screened. Their motivations are usually wanting someone else to be the one who makes the decision as to whether or not a person will be allowed to go home.
The typical request is sort of like this, "I don't feel comfortable with discharging them."