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 situation....how 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 manager.....no 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 done....here 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 rapidly.....so, 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 service....kitchen 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?
OK.
Let's say we happen across an actually mentally ill person who needs acute care....you 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 professionals...do 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

GC
RF
TL


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?
Nope.
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. They...ah....meet. Hmmm. I need to think about that for awhile. I think if I were a carpenter, I'd be....well....at 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.