Why is so much of the health care system set up for consumer failure?
My doctor referred me to see another doctor. She made an e-referral, "shared" my e- Medical records, and told me all I had to do was set up an appointment. Technology is great, I thought happily. I had no idea that I was about to enter the scheduling Twilight Zone.
Consider this sentence in a message left on my voice-mail hours after I initially called to set up an appointment:
"Then we'll mail you a questionnaire and when you fill it out and mail it back we will review it and then call you to make an appointment. So call back and let me know if I should send it."
First of all, you'll mail a what? I'm not taking the Pepsi Challenge. I'm going to see a doctor. Second of all, I had already called and left a message in the "scheduling" box. Which I was only allowed to do after I did an intake over the phone with someone from Registration. Clearly, I want an appointment. Send the questionnaire if that's a real thing. Why do I need to call back a third time?
Surely I had misunderstood the voice-mail.
The next day when I called I was told the questionnaire had not even been sent to me yet since they had not heard from me. I asked why I needed to fill out a questionnaire and was told "so we can determine which practitioner you should see." At this point I reiterated that my doctor had submitted a referral for a specific doctor in their practice. "That is the practitioner I should see," I pointed out. The secretary told me I still needed to answer the questions and mail it back. There is no way to fill out the form online. I need to receive it, fill it out, mail it back, and wait for it to be reviewed before I can schedule an appointment.
This is insanity to me. In an age where robots perform surgeries, where computers can play Jeopardy, and where I can have ice cream delivered to my door UNTIL 4AM and pay for it with a credit card, why am I watching my mailbox? Don't they know I am rarely home? That I have two jobs? That I just ran out of stamps? Am I being referred to see Dr. Quinn, Medicine Woman? *
As I stood in the hallway at work, trying to let the anger go, it made me think of my patients.
- If I can barely navigate this ridiculous back and forth of voice mails, phone calls and paperwork, how hard must it be for someone without a home? A phone? A voice mailbox? A mail box? Even if a homeless man or woman has a mailing address (and many do), often it is not accessible to them 24/7.
- Add on the fact that seeking help for anything other than acute injury is not going to be a priority for someone on the street, and you have a real barrier to compliance for appointments related to chronic life threatening problems such as diabetes, cancer and AIDs.
- Forget appointments to screen for early signs of disease, such as yearly pap smears for females or colonoscopies for people over the age of 50.
- Plus, when I finally get an appointment I am likely to write it down somewhere, be able to take a (paid) day off from my job and I will drive my car to see the doctor. A homeless man or woman is likely to forget the appointment, or just blow it off due to lack of transportation or the need to be somewhere else at that time (taking care of an infant, standing in line for a bed or food) or in some sad cases, abusing substances to mask physical or emotional pain).
That's why Healthcare For the Homeless programs are so important nation-wide. It's not about cheaper access to services or free care. It's about access to services at all. It's about organizations that can offer rides to the disabled war veterans to get to appointments, or who will help an illiterate woman fill out pages and pages of complicated forms in order to get social security benefits. It's about teams of people who will meet with folks who have been through too much trauma to deal with the type of rejection sometimes faced by patients waiting for care. Just think, I've had to call this woman's office three times so far since my PCP made the referral for me. People with mental health issues, social phobias and histories of being abused probably would not have made the second call, if they made the first one at all.
So as I continue to try to get in touch with Dr. Mike** I am thankful for the structures in place in my life that I often take for granted that will assist in me eventually getting an appointment. And I vow, not for the first time, to do my best every day to address every patient issue that I can, or to put the patient in direct touch with someone who can help them. It can't always happen. Things get busy. Patients get blown off. Especially ones with minor complaints. We triage, we prioritize. But I can try my best.
Because unless I create the care I wish to receive, the system is going to stay broken.
In the meantime, Nurse Sassy Lionheart suggested I just get on my horse and gallop the questionnaire back to the office. You know, to speed things up.
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* Gosh I hope so. And I hope Sully is there. mmmm.. Joe Lando circa 1996.. That helps. No more anger. Only wild and free "courtship feelings." ****
** Not her real name, obv, but I am assuming she, like the real Dr. Mike, will be bold, outspoken and have all kind of new ideas she learned at the Women's Medical College of Pennsylvania.***
*** If not, this was so not worth it.
**** No disrespect, of course, to Joe Lando's current wife and children. I am glad it worked out for you all.
Showing posts with label community health. Show all posts
Showing posts with label community health. Show all posts
Thursday, February 17, 2011
Monday, March 22, 2010
i'm so glad that trouble don't last always
"There's a gospel choir from BC downstairs," I told the patient as I thumbed his dilaudid into a paper cup.
"You mean BU," he said, "Think about it. Gospel from Boston College?"
"Why not?" I asked, puzzled. He took the pills and swallowed them with a grimace.
"Catholic music isn't that happy," he pointed out. "I'd know - I'm Catholic."
I grinned as I headed downstairs, remembering how my mother would often roll her eyes and ask me why the adolescent choir at St. T's never sang anything she could clap her hands to.
Down in the Atrium a modest crowd had gathered to hear the (BU) Choir sing. Another RN waved me over to where she was standing, "They just did that James Taylor song I love."
The choir launched into a spirited number with the rhythmic hook "I love you more than I did the day before." I was suddenly reminded of a day I had spent not too long ago also listening to a gospel choir - a day I never wrote down, so I made a mental note to store as many details as I could when I got home.
We were in the tent. By 'we' I mean myself, the other RN, the two interpreters, the 36 patients, and 20+ family members I had grown accustomed to sharing space with. The air was buzzing, not just with talking but with the noise of music being played over amplifiers.
"You coming with me," said one of the patients I was closest to - a 21 year old with post quake bilateral above the knee amputations*, a wicked grin and a penchant for wheelies.
"Where?" I asked.
"To the program!" he answered and flashed that smile I had begun to count on to punctuate everything he said.
I declined, and away he rolled, all style and flair. I moved on the task of finding a thermometer.
"Hey, come on," said my translator noticing that I was standing still, "you have time and we'll go."
He took me by the arm and we exited the back of the tent. We walked along the barbed wire fence strewn with laundry, passing small children who stopped to openly stare at the blanc as we went by.
We passed the row of tents and our feet beat on the rocks as the music got louder and louder and I began to make out voices. Up past the small building for less acute Tent City patients and around a corner there was a small yard. A stage had been set up, and on stage were the same men in suits who had come into my tent to sing that morning. Off to the side there were several other groups of well dressed men warming up.
It was a Gospel Festival.
Their audience sat in old fashioned wooden desks, the kind with the chair and the wrap-around arm. They had been taken out of the school rooms and set up here. The yard was stubbed with short fat grass, but was mostly rocks and dirt. Friends assisted their wounded loved ones to navigate crutches and wheelchairs over the ground to find preferable vantage points. I spotted Mr. Smiley and his sister, but they didn't notice me.
Like everyone else they were completely wrapped up in praising and singing.
"This is the Gospel Program," the interpreter said next to my ear. I moved out of the way as two men entered the yard flanking a woman with one leg using crutches. They guarded her as she found a place to stand in the shade. A cool breeze blew on our backs, and rustled the green leaves against the sky. The men sang of everlasting love into their microphones. Men and women clapped their hands or nodded along as children played tag, shrieking happily like children do when they are outside and no one is telling them to be quiet.
Not for the first or last time that week, I was amazed at how much joy a community can contain after enduring so much grief.
Back at work watching my patients dance in their seats, I thought it again.
--------------------------------------------------------------------------------------------
* "Look!" he exclaimed when we met, "we're the same height!"
"You mean BU," he said, "Think about it. Gospel from Boston College?"
"Why not?" I asked, puzzled. He took the pills and swallowed them with a grimace.
"Catholic music isn't that happy," he pointed out. "I'd know - I'm Catholic."
I grinned as I headed downstairs, remembering how my mother would often roll her eyes and ask me why the adolescent choir at St. T's never sang anything she could clap her hands to.
Down in the Atrium a modest crowd had gathered to hear the (BU) Choir sing. Another RN waved me over to where she was standing, "They just did that James Taylor song I love."
The choir launched into a spirited number with the rhythmic hook "I love you more than I did the day before." I was suddenly reminded of a day I had spent not too long ago also listening to a gospel choir - a day I never wrote down, so I made a mental note to store as many details as I could when I got home.
We were in the tent. By 'we' I mean myself, the other RN, the two interpreters, the 36 patients, and 20+ family members I had grown accustomed to sharing space with. The air was buzzing, not just with talking but with the noise of music being played over amplifiers.
"You coming with me," said one of the patients I was closest to - a 21 year old with post quake bilateral above the knee amputations*, a wicked grin and a penchant for wheelies.
"Where?" I asked.
"To the program!" he answered and flashed that smile I had begun to count on to punctuate everything he said.
I declined, and away he rolled, all style and flair. I moved on the task of finding a thermometer.
"Hey, come on," said my translator noticing that I was standing still, "you have time and we'll go."
He took me by the arm and we exited the back of the tent. We walked along the barbed wire fence strewn with laundry, passing small children who stopped to openly stare at the blanc as we went by.
We passed the row of tents and our feet beat on the rocks as the music got louder and louder and I began to make out voices. Up past the small building for less acute Tent City patients and around a corner there was a small yard. A stage had been set up, and on stage were the same men in suits who had come into my tent to sing that morning. Off to the side there were several other groups of well dressed men warming up.
It was a Gospel Festival.
Their audience sat in old fashioned wooden desks, the kind with the chair and the wrap-around arm. They had been taken out of the school rooms and set up here. The yard was stubbed with short fat grass, but was mostly rocks and dirt. Friends assisted their wounded loved ones to navigate crutches and wheelchairs over the ground to find preferable vantage points. I spotted Mr. Smiley and his sister, but they didn't notice me.
Like everyone else they were completely wrapped up in praising and singing.
"This is the Gospel Program," the interpreter said next to my ear. I moved out of the way as two men entered the yard flanking a woman with one leg using crutches. They guarded her as she found a place to stand in the shade. A cool breeze blew on our backs, and rustled the green leaves against the sky. The men sang of everlasting love into their microphones. Men and women clapped their hands or nodded along as children played tag, shrieking happily like children do when they are outside and no one is telling them to be quiet.
Not for the first or last time that week, I was amazed at how much joy a community can contain after enduring so much grief.
Back at work watching my patients dance in their seats, I thought it again.
--------------------------------------------------------------------------------------------
* "Look!" he exclaimed when we met, "we're the same height!"
Monday, February 15, 2010
Tom's of Maine Contest
The Tom's of Maine community voting project continues. You can vote for up to five clinics once a day until March 12th. Please go to the Tom's of Maine website and vote for Boston Healthcare for the Homeless.
We would like to put the $20,000 towards a new initiative to target the dental health of diabetic and HIV/AIDS patients.
We would like to put the $20,000 towards a new initiative to target the dental health of diabetic and HIV/AIDS patients.
Monday, January 25, 2010
H1N1 Update
The media may have backed off the story a bit, but H1N1 continues to be a problem in the U.S. Please, please get vaccinated, especially if you come in contact with people who are likely to have complications as a result of infection from this strain of flu. Remember, per the CDC, most of the deaths have been children and non elderly adults.
BHCHP is offering another public flu clinic on Wednesday, January 27th from 10am-1pm.
Jean Yawkee Place, 780 Albany St.
Please pass it on to anyone you know who may be at risk for spreading H1N1.
Thursday, January 21, 2010
Stand With Haiti
Haiti Needs You
Please don't stop praying and donating. I know I sound like a broken record but I can not imagine how frustrating it must be save so many people from the wreckage only to lose them to infection because the antibiotic supply is so low right now. Please send money if you can.
Yesterday the aftershock took even more lives and created complications for rescue efforts.
Let's continue to stand in solidarity with Haiti and to offer them support as far reaching as we can afford.
Monday, January 11, 2010
..if you just smile
Tom's of Maine is one of my favorite companies because I have loved their products for years and I love their commitment to community. As many of you may already know from talking to me or browsing through Facebook, right now Tom's is getting ready to grant five different clinics a $20,000 sponsorship. And they have decided to let communities vote to determine the recipients.
You can go onto their website every day from now until March 12th and vote for up to five different clinics.
Annnd... (here's where I come in) the dental clinic of Boston Healthcare for the Homeless is one of the clinics in the running. Specifically, they are being considered for their initiative to create more support for HIV/AIDS and Diabetic patients.
As of right now they have two locations (Pine Street and Jean Yawkey Place) where our patient population can easily access comprehensive dental services from cleanings to denture fittings.
If our dental clinic is awarded the sponsorship they'll be able to hire a new dental assistant who will be specifically working to provide fluoride treatments and oral hygiene education to patients with HIV, AIDS, and diabetes who are at risk for serious health complications otherwise.
This paradigm shift towards primary preventative healthcare would be huge in stopping very avoidable oral health issues from snowballing into major medical problems.
Please. Please. Please. Take the time to go vote for BHCHP. And maybe a couple other clinics whose ideas you like, too. And remember you can vote every day, for up to five different places.
This kind of financial support in the hands of the dedicated programs listed on the Tom's website can only lead to good things happening for quality, accessible care.
Tuesday, October 6, 2009
Flu Prevention Video
Last spring I was approached by some folks at Boston Healthcare for the Homeless for some creative assistance. They wanted to make an educational video clip, short enough to be looped, to use in clinic waiting rooms. So this is the video we came up with.
The clip features the music of Stroamata, and the acting talents of some of BHCHP staff and clients.
The clip features the music of Stroamata, and the acting talents of some of BHCHP staff and clients.
Thursday, September 10, 2009
Healthcare on the Brain
On 8/31 cuts were made to Commonwealth Care causing 31,000 legal immigrants to lose health care coverage.
On October 1st they will be enrolled in CeltiCare, but in the meantime they are being covered by Health Safety Net.
The problem is that there is a myriad of services not covered by Health Safety Net including outpatient non-urgent services. Which means chemotherapy, dialysis, and other important therapies can not be paid for. In many cases, this will mean termination of therapies until Oct. 1.
Fortunately for the percentage of my patients that these changes effect, they have someone to go to bat for them. Administrators at BHCHP are willing to work with the Office of Medicaid and Commonwealth Care to try to cover treatments on a case by case basis until the transition period is over.
Hopefully they will be successful. It's one more reason why I love where I work, the fact that people are consistently ready to go above and beyond to advocate for every person's right to health care.
I worry about the people who don't have anyone to advocate for them. The young, or elderly or non English speaking or mentally impaired legal immigrants who are not part of our system. I hope their doctors are also speaking up for them. Everyone has a right to the care that they need.
And without getting any more political, that's all I have to say about that.
On October 1st they will be enrolled in CeltiCare, but in the meantime they are being covered by Health Safety Net.
The problem is that there is a myriad of services not covered by Health Safety Net including outpatient non-urgent services. Which means chemotherapy, dialysis, and other important therapies can not be paid for. In many cases, this will mean termination of therapies until Oct. 1.
Fortunately for the percentage of my patients that these changes effect, they have someone to go to bat for them. Administrators at BHCHP are willing to work with the Office of Medicaid and Commonwealth Care to try to cover treatments on a case by case basis until the transition period is over.
Hopefully they will be successful. It's one more reason why I love where I work, the fact that people are consistently ready to go above and beyond to advocate for every person's right to health care.
I worry about the people who don't have anyone to advocate for them. The young, or elderly or non English speaking or mentally impaired legal immigrants who are not part of our system. I hope their doctors are also speaking up for them. Everyone has a right to the care that they need.
And without getting any more political, that's all I have to say about that.
Sunday, May 3, 2009
Swine Flu peeks through windows, scares the children
At work on Thursday we had a nursing meeting regarding the plans for when H1N1 starts showing up in Boston.
At church Saturday night a well meaning priest recommended that we not shake hands during the Peace Offering "due to recent, er, events." The Peace Offering is the part of a Catholic Mass where we "offer one another a sign of Christ's peace." Hand shaking is the status quo (oh, New England), but kissing cheeks, hugs* and hand gestures are also accepted in some folds. The priest laughed when he said it, and we laughed too, but no one touched during the Peace Offering. I rolled my eyes heavenward. There are several probable cases in Boston, but none confirmed yet. No one in the church had so much as sneezed during the entire service and here we were, offering peaceful eyebrow raises and head nods at each other.
Like the people in the Bible who don't allow lepers to walk on the same side of the street. You know, the people we swear we aren't.
"To be fair," said a coworker as I relayed my frustrations Sunday at work, "you know that people can be contagious during the prodromal phase. You're contagious for twenty four hours before symptoms. And we don't know a whole lot about why this kills healthy people off."
I think that the public paying more attention to personal hygiene is never a bad thing. If this teaches people to cover their mouths with their elbows when they sneeze, I'll be thrilled. If it means more parents will immunize their kids, I will do dance. But I'm afraid that instead it's just teaching people to distrust one another. (Here's an inconclusive article from CNN on social distancing.)
But let's go back to where I started. Although I would discourage hysteria, I have my concerns. But my concerns are based on knowing that it will spread faster through the homeless than it will through other patient groups, and that a lot of them just won't be able to handle it.
Although incidence is on the decline, anyone who reads a newspaper can tell you exactly what we learned in nursing school: "pandemics trend in waves." Now is when we start to plan for a viral resurgence in August or September.
We're talking daily about emergency preparedness, and while I don't know that we will ever have to execute any of the planning, I don't mind it. It's not a bad exercise for any of us. And it's sort of inspiring to see it all kick in. I hadn't thought about half the things we're thinking about. Like, how to get a homeless person over to McInnis if he or she is infected. An ambulance is a real waste of resources, but will cab drivers agree to take sick people? Can they legally refuse? It raises a ton of interesting questions, and I think people thrive when they're asking questions.
Part of my job as a nurse, as I was reminded by the DON, is to stay as educated as possible, and to make educated and objective decisions on a day to day basis. This obligation then extends to a responsibility to educate other people so they too may make unbiased, informed choices. Think you should pull your kid out of school? Great. I'm here to tell you the statistics of confirmed cases at your child's school. Thinking about listening to Biden telling people they shouldn't get on a plane? I will be happy to sit with you and explain how droplet transmission differs from airborne transmission** so you can go ahead and buy that ticket. Want to go to work even though you have a fever, aches, and a productive cough? I'll call your boss for you - you're staying home and drinking juice. But that's what I would tell you about any virus, any time.
And if you don't want me to hug you at church I won't. But I think as long as we all wash our hands, we can at least shake on it.
-----------------------------------------------------------------------------------------
* I like hugs. It's not as disarming as a kiss to most new englanders, but it gets the point across.
** Jeepers, Biden, it's not TB!
"If one of our guys gets it," the DON quoted the medical director, "a hundred of them will."
It's true. The current recommendation for people who think they have the flu is to stay home. Not to go the doc or to the ER where they may infect other people, but to isolate in their home with plenty of fluids and rest. If symptoms get very severe, people should then call the ER, where they would be triaged immediately.
So when it comes to homeless people there's a problem. They have nowhere to isolate themselves. Most of them sleep in shelters, mere inches away from other people. Many of them are substance abusers or mentally ill and unable to take care of themselves. Many of them are compromised by other diseases, including HIV and AIDs. How do we stop the spread of the flu through this community?
At church Saturday night a well meaning priest recommended that we not shake hands during the Peace Offering "due to recent, er, events." The Peace Offering is the part of a Catholic Mass where we "offer one another a sign of Christ's peace." Hand shaking is the status quo (oh, New England), but kissing cheeks, hugs* and hand gestures are also accepted in some folds. The priest laughed when he said it, and we laughed too, but no one touched during the Peace Offering. I rolled my eyes heavenward. There are several probable cases in Boston, but none confirmed yet. No one in the church had so much as sneezed during the entire service and here we were, offering peaceful eyebrow raises and head nods at each other.
Like the people in the Bible who don't allow lepers to walk on the same side of the street. You know, the people we swear we aren't.
"To be fair," said a coworker as I relayed my frustrations Sunday at work, "you know that people can be contagious during the prodromal phase. You're contagious for twenty four hours before symptoms. And we don't know a whole lot about why this kills healthy people off."
I think that the public paying more attention to personal hygiene is never a bad thing. If this teaches people to cover their mouths with their elbows when they sneeze, I'll be thrilled. If it means more parents will immunize their kids, I will do dance. But I'm afraid that instead it's just teaching people to distrust one another. (Here's an inconclusive article from CNN on social distancing.)
But let's go back to where I started. Although I would discourage hysteria, I have my concerns. But my concerns are based on knowing that it will spread faster through the homeless than it will through other patient groups, and that a lot of them just won't be able to handle it.
Although incidence is on the decline, anyone who reads a newspaper can tell you exactly what we learned in nursing school: "pandemics trend in waves." Now is when we start to plan for a viral resurgence in August or September.
We're talking daily about emergency preparedness, and while I don't know that we will ever have to execute any of the planning, I don't mind it. It's not a bad exercise for any of us. And it's sort of inspiring to see it all kick in. I hadn't thought about half the things we're thinking about. Like, how to get a homeless person over to McInnis if he or she is infected. An ambulance is a real waste of resources, but will cab drivers agree to take sick people? Can they legally refuse? It raises a ton of interesting questions, and I think people thrive when they're asking questions.
Part of my job as a nurse, as I was reminded by the DON, is to stay as educated as possible, and to make educated and objective decisions on a day to day basis. This obligation then extends to a responsibility to educate other people so they too may make unbiased, informed choices. Think you should pull your kid out of school? Great. I'm here to tell you the statistics of confirmed cases at your child's school. Thinking about listening to Biden telling people they shouldn't get on a plane? I will be happy to sit with you and explain how droplet transmission differs from airborne transmission** so you can go ahead and buy that ticket. Want to go to work even though you have a fever, aches, and a productive cough? I'll call your boss for you - you're staying home and drinking juice. But that's what I would tell you about any virus, any time.
And if you don't want me to hug you at church I won't. But I think as long as we all wash our hands, we can at least shake on it.
-----------------------------------------------------------------------------------------
* I like hugs. It's not as disarming as a kiss to most new englanders, but it gets the point across.
** Jeepers, Biden, it's not TB!
Monday, February 2, 2009
Mental Health Rant
The more I thought about the Goldfarb the more upset I became. Watching the video over and over didn't help.
Many people who believe they do not have issues with mental health (whether they do or not is another story) consistently downplay the significance of mental illness in our society. This attitude is not often actually put into words by educated people. No one who knows better says "They should snap out of it" or "It's their own fault anyway." But we feel that way sometimes anyway.
I work with people with mental illness every day. Still with all my experience, exposure and education I sometimes catch myself transmitting the message "Why can't you just knock it off?" and even when it's not directed right at the patient (maybe it's in a venting session with a co worker) it's always a harmful stance to take. It perpetuates a myth that all people are always in control of how they behave. They are not*.
Shutting down funding for Mental Health programs is like ignoring that people have arms.
("Hello, we are a hospital that only treats anything NOT having to do directly or indirectly with your arms.")
So is the practice of insurance companies denying authorization for mental health services.
("This insurance policy does NOT cover your arms. Sign on the line.")
What would you think if you went to a country where that was the case? You'd probably come to the conclusion that arms are not valued. They are considered expendable. People in that country for some reason just really don't need to worry about arms. For some people, it's because they have never had problems with their arms. So there'd be a lot of fine, two armed people. But then there'd be a ton of people with one or no arms just from minor injuries like broken fingers or infected lacerations.
Denying mental health services sends the message that this entire branch of medicine is less legitimate or important than others.
This is a dangerous message for health care companies and the state government to send because American society in general these days already sends very mixed messages about mental health. On one hand, we are more educated and comfortable about mental health than ever. Characters on popular TV shows have therapists, women are no longer diagnosed with 'hysteria,' when they cry, and men are encouraged to share their feelings with their wives**. On the other hand, women and men alike are feeling the pressure to save face. Think about how much the media harped on Hilary for crying when her polls were down. No one wants to see you break down when times are tough. People are expected to power through and write a book about it, produce some angry music, or create a stand up routine. Anything less is unacceptable. And yet... Oprah continues to have a tv show.
Depression, personality disorders, mood disorders, it's all neurological. It's physiological. It's very, very real. Whether the help is medication or therapy or a group or a program help is needed.
Providing mental health services is imperative for successful preventative health care. People who feel safe and happy drink less, smoke less, do fewer drugs, commit fewer crimes, and reach higher levels of self actualization. To go back to the arm analogy, what do you think will happen to all those people with disabled or missing arms? They will have to be supported even more by the people who do have arms.
I know you can't fix this. You can't re open the Goldfarb. And the money is just not there. But please try to be aware of how you view mental health. Our minds are amazing. I love my brain. If you are blessed with one that works well for your purposes please don't pollute it with bias against minds that need some help. And maybe do some thinking about how to fix these problems.
-----------------------------------------------------------------------------------
* If you want to fight me on this I will probably ask you to meet me at 10 Shattuck Street in Boston. We can stand next to the preserved skull of Phineas Gage and have it out.
** Ugh. Ugh. Ugh. I apologize to my queer readers for this incredibly hetero sentence, but my writing is limited by my scope of experience. I would definitely welcome some guest writing on the subject of Mental Health in the Queer Community if you have some thoughts to share.
Many people who believe they do not have issues with mental health (whether they do or not is another story) consistently downplay the significance of mental illness in our society. This attitude is not often actually put into words by educated people. No one who knows better says "They should snap out of it" or "It's their own fault anyway." But we feel that way sometimes anyway.
I work with people with mental illness every day. Still with all my experience, exposure and education I sometimes catch myself transmitting the message "Why can't you just knock it off?" and even when it's not directed right at the patient (maybe it's in a venting session with a co worker) it's always a harmful stance to take. It perpetuates a myth that all people are always in control of how they behave. They are not*.
Shutting down funding for Mental Health programs is like ignoring that people have arms.
("Hello, we are a hospital that only treats anything NOT having to do directly or indirectly with your arms.")
So is the practice of insurance companies denying authorization for mental health services.
("This insurance policy does NOT cover your arms. Sign on the line.")
What would you think if you went to a country where that was the case? You'd probably come to the conclusion that arms are not valued. They are considered expendable. People in that country for some reason just really don't need to worry about arms. For some people, it's because they have never had problems with their arms. So there'd be a lot of fine, two armed people. But then there'd be a ton of people with one or no arms just from minor injuries like broken fingers or infected lacerations.
Denying mental health services sends the message that this entire branch of medicine is less legitimate or important than others.
This is a dangerous message for health care companies and the state government to send because American society in general these days already sends very mixed messages about mental health. On one hand, we are more educated and comfortable about mental health than ever. Characters on popular TV shows have therapists, women are no longer diagnosed with 'hysteria,' when they cry, and men are encouraged to share their feelings with their wives**. On the other hand, women and men alike are feeling the pressure to save face. Think about how much the media harped on Hilary for crying when her polls were down. No one wants to see you break down when times are tough. People are expected to power through and write a book about it, produce some angry music, or create a stand up routine. Anything less is unacceptable. And yet... Oprah continues to have a tv show.
Depression, personality disorders, mood disorders, it's all neurological. It's physiological. It's very, very real. Whether the help is medication or therapy or a group or a program help is needed.
Providing mental health services is imperative for successful preventative health care. People who feel safe and happy drink less, smoke less, do fewer drugs, commit fewer crimes, and reach higher levels of self actualization. To go back to the arm analogy, what do you think will happen to all those people with disabled or missing arms? They will have to be supported even more by the people who do have arms.
I know you can't fix this. You can't re open the Goldfarb. And the money is just not there. But please try to be aware of how you view mental health. Our minds are amazing. I love my brain. If you are blessed with one that works well for your purposes please don't pollute it with bias against minds that need some help. And maybe do some thinking about how to fix these problems.
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* If you want to fight me on this I will probably ask you to meet me at 10 Shattuck Street in Boston. We can stand next to the preserved skull of Phineas Gage and have it out.
** Ugh. Ugh. Ugh. I apologize to my queer readers for this incredibly hetero sentence, but my writing is limited by my scope of experience. I would definitely welcome some guest writing on the subject of Mental Health in the Queer Community if you have some thoughts to share.
Sunday, February 1, 2009
One Step Forward, Two Steps back for low income Mental Health
A short time ago I wrote about MGH's decision to put a substantial amount of funding towards a collaboration between the Department of Mental Health and Boston Healthcare for the Homeless.
This article today in the Globe brought some disheartening news: because of the state's budget cuts the Goldfarb is shutting down. Surely some of the clients from the Goldfarb will be able to get mental health services from BHCHP, but not all of them. This is terrible news for those clients, but also for society in general. Crime rates WILL go up, and public morale will continue to fail.
This article today in the Globe brought some disheartening news: because of the state's budget cuts the Goldfarb is shutting down. Surely some of the clients from the Goldfarb will be able to get mental health services from BHCHP, but not all of them. This is terrible news for those clients, but also for society in general. Crime rates WILL go up, and public morale will continue to fail.
Wednesday, November 26, 2008
On Needles
I had a talk with one of my patients who is a former heroin user. I asked what he thought of syringe exchange programs. He said he has utilized them in the past to protect himself and others. I was really happy to hear that.
I am completely in favor of safe needle disposal and syringe exchange programs. I have never in my life met a drug user who stopped because she couldn't find clean needles, nor have I met someone who started abusing IV drugs because a needle exchange program made it easier.
I have however met many very sick people who have contracted illness and even died as a result of sharing contaminated needles. I have also known people who have gotten stuck with a needle improperly disposed of. Although the highest risk occupation for this is clearly medical workers it could happen to a garbage collector, or a janitor in any public area like a T stop or a McDonald's. Or even you or me if we didn't look or think and pushed down the paper towels in a public restroom down, or if we didn't watch our step in a park or on the beach.
Most programs involve participants filling out a registration form. This helps clinicians who work within the program to track their clients. This helps the Department of Public Health to get information about the incidences of drug use, disease and co-morbidities in a population that would otherwise never step into a doctor's office. These programs, where they are instated, also give clients access to things like treatment programs, counseling, and confidential HIV and Hepatitis testing. All of which they do not have otherwise. Why? Because none of these people became drug users because they are well adjusted people who easily form good working relationships. They are paranoid and mentally ill in many cases, and engaged in illegal activity in EVERY case which makes them hard pressed to even go to the ER when they are hit by cars never mind call up and make yearly appointments with the doctors you or I go see.
This is all a part of a philosophy we call "Harm Reduction." Because yes, yes that lady is using heroin, but now she is using heroin and has a doctor she trusts and he got her onto birth control pills so she doesn't have a heroin baby. And yes, that guy is on heroin, but now he is also seeking a treatment program. We save people from contracting the AIDS virus and from passing it on. We offer other options.
Until we can stop treating people with mental illness and addiction as if they are sub human we will never solve the problems which plague our entire planet, our entire humanity. It is not going to condone any drug use any more than the existence of narcan condones it.
I am completely in favor of safe needle disposal and syringe exchange programs. I have never in my life met a drug user who stopped because she couldn't find clean needles, nor have I met someone who started abusing IV drugs because a needle exchange program made it easier.
I have however met many very sick people who have contracted illness and even died as a result of sharing contaminated needles. I have also known people who have gotten stuck with a needle improperly disposed of. Although the highest risk occupation for this is clearly medical workers it could happen to a garbage collector, or a janitor in any public area like a T stop or a McDonald's. Or even you or me if we didn't look or think and pushed down the paper towels in a public restroom down, or if we didn't watch our step in a park or on the beach.
Most programs involve participants filling out a registration form. This helps clinicians who work within the program to track their clients. This helps the Department of Public Health to get information about the incidences of drug use, disease and co-morbidities in a population that would otherwise never step into a doctor's office. These programs, where they are instated, also give clients access to things like treatment programs, counseling, and confidential HIV and Hepatitis testing. All of which they do not have otherwise. Why? Because none of these people became drug users because they are well adjusted people who easily form good working relationships. They are paranoid and mentally ill in many cases, and engaged in illegal activity in EVERY case which makes them hard pressed to even go to the ER when they are hit by cars never mind call up and make yearly appointments with the doctors you or I go see.
This is all a part of a philosophy we call "Harm Reduction." Because yes, yes that lady is using heroin, but now she is using heroin and has a doctor she trusts and he got her onto birth control pills so she doesn't have a heroin baby. And yes, that guy is on heroin, but now he is also seeking a treatment program. We save people from contracting the AIDS virus and from passing it on. We offer other options.
Until we can stop treating people with mental illness and addiction as if they are sub human we will never solve the problems which plague our entire planet, our entire humanity. It is not going to condone any drug use any more than the existence of narcan condones it.
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