Yes, this was the same picture as the below post from less than 4 weeks ago,
Well, just to remind readers without duplicating from above said post, I don’t think the intended concept of Community Mental Health Clinics will serve responsibly, simply because the whole process is so skewed to just giving people what they want, which defeats the purpose of mental health care. And now, here in Maryland, there is serious talk about making marijuana legal, and with the logarithmic growth of primary addiction patients already inundating mental health services to treat substance abuse/dependency, just imagine what the surge of pot smokers who experience new/pronounced mental health will do to such clinics?
As I wrote earlier last year how psychiatric private practice is now dead, here are the nails for CMHCs, bit simplified as I am tired and having to prepare for another week of being a drug dealer for dozens of patients at the current clinic:
1. Addiction patients as noted above.
2. Personality Disordered patients as a primary diagnosis, who are not only over medicated as medications won’t treat a personality disorder problem, but, I know in my heart that many psychiatric medications are contraindicated in Axis 2 disorders, and not just the controlled substance ones. Antidepressants and antipsychotics can really disrupt such patients, but, another post in and of itself.
3. Providers who can’t say no, who won’t say no, and don’t know how to say no. Oh, and providers who won’t hold patients accountable for poor choices and follow up uncooperation. After all, therapists are just the go between for setting up those “Med Evals”, eh?
4. Administration who makes psychiatrists glorified janitors, hires anyone who claims to have a skill in providing therapy, and considers support staff anyone with just 2 arms and legs and a head who can speak basic English and show up for work. Note NOT on time is not an essential for employees these days. It’s just about billing and making sure not to run afoul of state/federal guidelines as set for clinics.
5. EMRs. I think anyone who has either had to type or been sitting on the other side of the desk and staring at the back of a computer screen understands what this means. How many seconds of eye contact in an office visit have you had as a patient with a psychiatrist using EMR these past couple of years?
6. Medications. The primary purpose, and now with samples dwindling in number and access, the beginning of rioting once patients finally accept that free meds are a past concept. I am not going to address the frank drug seeking, see 1. for the addiction component, and that is already a short form answer.
7. Change. Or really, no interest in change. With the logarithmic growth of SSI and SSDI applications for treatable illnesses, and how so many are being approved, what is the interest to get better? This is a nail at one end of the coffin.
8. DSS and the Legal System. State interferences and forensic referrals are also growing, again, logarithmically, and what does that do for invested providers who are trying to treat just those people who actually want to come to the clinic? Isn’t it fun to have to meet with patients who are told “if you don’t see the psychiatrist and take meds, you will a. lose your kids b. go off welfare c. go back to jail d. go to prison e. be hospitalized, albeit briefly as there are no hospital beds to access these days for extended periods of time.
9. Perhaps really 8a., but, being asked to treat chronically ill patients who have avoided Conditional Release or Assisted Outpatient Treatment, these are patients who should remain chronically hospitalized and yet, thanks to that mutli-syllable word we all know and love as deinstitutionalization, are forced on the CMHCs. And forget expecting ACT programs to step in and be effective substitutes, because they are being inundated with the forensic population who are bumping the real intended targets of the chronically mentally ill.
10. Finally, fellow physician colleagues who have no clue what to do in order to be responsible and effective advocates for the system. Nah, I have worked with people who would honestly write any prescription for a patient simply because the patient asked for it, and then write for polypharmacy that would kill an elephant, but, many of these patients coming in and taking literally dozens of pills at times have been desensitized and developed remarkable tolerance to survive the prescription pad encounter, but now it is the Escribe computer link. Oh, and the charting by many of my colleagues, well, they better hope they are never in court having to defend themselves and asked to read something by the plaintiff’s lawyer that turns out to be what they wrote as an alleged contact note.
Let me give you an example of some I have read in the past 4 years, a bit compacted, but, that was the note:
“S: pt with no complaints, stable, no side effects of meds
O: mental status unchanged, no abnormalities new or problematic.
P: continue as planned, medications for 3 months.”
That has been an actual progress note by colleagues these past years, both in CMHCs and even in private practices. Oh, and you get a copy of a medication sheet that is just a continuation of ” Meds A, B,C as is for 3 months”, no strength, no quantity, sometimes even the spelling is undecipherable, or better yet, they forgot they made a medication change and still document a medication the patient has not been of for months. One time, for over a year!
So, there are your 10 nails, 4 on each side and one each in the middle of each end. Where do you want this buried?
Next to shame and humility, common sense, and pride and ownership? Oh, I am sorry, those are unmarked graves, so I guess when you start digging, hope you don’t hit another burial site. Don’t worry, our predecessors who buried those other things probably didn’t even put them in a coffin, so, we are being at least a bit more respectful here!
Final comment, if you are going to a CMHC and aren’t seeing a therapist at least every 1-3 months, you are violating the protocol for standards of care set by all states for mental health care. So, you should ask yourselves, how are you seeing a psychiatrist alone for months to years and not worried about it? I’d ask the clinic, but, you wouldn’t like their answer.
Thus until I find one that not only gives me the right answer, but practices it as well, I am just a temp. Sorry to any patients who see me for care in your travels, but, at least you now know why it is temporary.
Hey, remember, it will be unmarked!