Friday, October 17, 2008

More Cuts and our Mental Health System

I've been a psychiatric nurse since 1993. Since then, every year, in every facility I've worked (whether it be one of those for profit psychiatric mills, or working for the State as a case manager, or working for a faith based hospital doing psychiatric evaluations) there have been cuts to program and staff.

We (mental health practitioners) are simply expected to do more--with less...year, after year, after year. After year.

Got to work today, to find our staffing ratios have (yet again) been cut. Four of us, now do the work of five people. And we were introduced to the concept that a non-licensed staff will be available to help us. (should we clap for joy?). Which means that the four licensed staff, will (upon hire of the less qualified--and cheaper--worker) become three licensed staff members.

And year after year, the Clients who come into the hospital are more acute. More violent. Sicker. Plus the consequences that we have an aging mentally ill population which also have medical problems along with their mental illnesses.

Where I think this is really going to is Barbarism. As more mental health units close through out the country...and the ones still open have staff reductions to the point of being dangerous to work there (which it already is---mental health workers have one of the highest injury rates---higher than police officers)---fewer mentally ill people will receive treatment.

They will just be left to die. Suffer. Starve. And die they will---like the homeless man who was consumed by fire in his cardboard box last week outside of Los Angeles.

Or they will be imprisoned (but that's too expensive). Nope, they will be left for dead. Given a bus pass to another city, county, State,Region. Bus therapy we call it. Survival of the mentally fittest.

Curious that just when a recovery movement began in earnest in this country in the early Nineties--a real paradigm shift---when we finally saw that "Yes, you can have a good life and be Schizophrenic" (revolutionary idea!); that's when the cuts started to happen. Better drugs did become available in the early nineties. More importantly, a social movement to empower the mentally ill started then. And thus, we see Schizophrenics getting PHD's.

But recovery takes money. And treating long term, chronic conditions is not something we have mastered within our health care system. Acute crises intervention....yup, we do that well. Treat long term Chronic conditions like diabetes or Schizophrenia---that we do not do well.

Why should we care? These folks are scary. Anti-social. Bizarre.

No. They are humans with a treatable disease. The only thing that prevents recovery is stigma, inexperience of the health care establishment, social supports and our incredible ability to look the other way. Wash our hands of it. Empty out the asylum like Ronnie Raygun did.

The mentally ill are there for us to increase our compassion. And to learn. Be humbled. They deserve better....

In the meantime...we mental health workers will do more with less. And our injury rates will climb. More of us will die. And so will the mentally ill.

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