The State of Mental Healthcare


I currently work in the community mental health setting.  A setting that is primarily funded by state and federal dollars and primarily serves low income, high need clients.   Clients that seek community mental health are usually those that are ill to the point their disorders and symptoms interfere with their ability to function in a work or school setting, many with a history of incarceration or hospitalization (in my experience there is little difference between these two, both revolving doors of shitting care and overmedication), but with regular care and appropriate support would be able to live like “normal” people.  Unfortunately, rarely is this care ever provided consistently or appropriately.

Since I started working in my field, I’ve pretty much rotated between working in schools (alternative and traditional) and community care.  But my disgust at how the system fucks some of, not only the most needy clients, but some that could have massive potential if they were given proper care.  Children with learning, behavior, and sensory integration disorders are routinely put on the back burner in schools, not receiving proper assessments or interventions.  They fall behind a little bit more every year until they are failing, their sense of self and identity become defined by failure.  The risk factors add up, one after another until they become absorbed by the mental health and education systems that failed them in the first place.

For individuals with chronic mental illness, thought disorders, personality disorders, severe emotional disorders, or developmental disabilities the bureaucracy  that is mental health is worse.  Wait lists of many community mental health centers number in the hundreds.  Social workers, whose caseloads should be no larger than about 20 in order for them to actually help the individuals they serve, are usually closer to 50-60.  Psychiatric hospitals deal with overcrowding by over-dosing clients on sedatives.  Hospitals rarely provide treatment, instead the have settled for assessment, stabilization, and providing guardians/family with a list of recommendations so vague they can hardly be followed.  That list usually includes a recommendation for individual therapy, psychiatric medication consultation, and case management….at those community mental health centers with the hundred person wait list.  This leaves a 3-6 month gap in treatment in which clients are left to their own devices.  Some, depending on the severity of their symptoms and the level of dedication of their support systems, can manage to go back to some semblance of a life, perhaps a job or school.  Others, however, cannot.  They will cycle in and out of crisis care and hospitalization, most end up in prison.  Millions self-medicate with street drugs, leading to addictions and worsening of the core symptoms.

Then you get to the systemic problems caused by this failed system.  Families are effected, parents, children, siblings, grandparents.  Because lack of treatment leaves them so ill they cannot hold a job, they are forced to go on disability.  Not only does that have an economic impact, but it leads to boredom and decreased motivation to get better.  Mentally ill individuals are viewed by others as lazy, dangerous, or stupid, which has an impact on their own self-image and sense that they can do something more with their lives.  Constant failed attempts at getting help lead many to give up.  Institutions and psychiatric hospitals that could have provided treatment (the level and kind of treatment provided is a completely separate issue) have been replaced by prisons.  Most mentally ill are still placed in general population, provided little to no treatment outside of medication, and eventually released with no resources.    Again, we cycle back to economic and family impacts.  The cycle repeats year after year.

Our culture likes to put mental health on the back burner.  As a society, we think the mentally ill are mentally ill.  They cannot be helped.  We think this because it is what we see.  Chronic mental illness equates to stupidity, laziness, and criminality.  But this comes from what the system has done to mental health care.  And it is also self-perpetuating.  If we think about the mentally ill as dirty, stupid, homeless criminals, we can accept their lack of care.  They are the “other.”  They’re not like us and they don’t deserve our federal dollars because they will always be that stupid, gross, crazy person.  So, it become easier for us to ignore or be okay with the lack of mental health care.  The media’s portayal of the shooter from the Colorado spree is perfect.  He was crazy, therefore he was dangerous and must be locked up.  This must also apply to all other crazy people.

There are thousands of trained therapists and social workers dying for work.  People go into this field wanting to help.  They have ideas and dedication, they just need the funding.  Every time I see a mental health center or service be closed down, funding cut, etc, I go a little crazy inside.  Where do politicians think this will save money?  They are leaving high need adults and children without care and vulnerable to everything I already talked about.  Funding cuts for mental health will lead to an increase in crime and dependence on federal disability money.  Many of the clients they put out want to work and want to contribute to society, but they need continuous support to be able to function.  With that support, they can do amazing things.

So, fuck you bureaucracy.  And shitty run around that causes crime and death.

A note about relationships and neuroses

I don’t often get sentimental, but I’m feeling it today.  You know your relationship is pretty solid when both partners can have neurotic breaks in the same 24 hour period and support one another as they are forced to the brink of tears to face neurotic fears.

Stardate: Yesterday afternoon.
I had been having crazy stress/panic attacks/my life is ending/I’m hopeless I don’t deserve a life in the first place…things…I was going crazy because grad school has ruined me.  But then, boyfriend is like “Hey!  Let’s go to Navy Pier and ride the Ferris Wheel!”  I was skeptical and gave him a shifty-eyed look because he’s terrified of heights (ok, in his words, he “Does’t like” them or he “Respects” them).  But he took me out to breakfast and we went on the Ferris Wheel!   Now, this sounds super fun and relaxing, and, to me, it was!  But the entire like  ride up, he was cringing.  White knuckled to the side of the seat, eyes closed, doing some breathing exercises the whole way up.  I was trying to be supportive and happy at the same time because I FUCKING LOVE FERRIS WHEELS.  Once we hit the top and began the descent, he loosened up and was jolly again, cracking jokes about how people belong on the ground and how we don’t respect gravity in our hedonistic culture.  It was a sweet little moment.  Then I bought him a much deserved margarita.

Stardate: Today, sometime this morning/afternoon-ish.
We were fully aware there was a mouse in our house.  This uninvited little fucker was driving our dog nuts.  The poor hound would just stand in the kitchen howling and pointing.  We knew something was wrong when we smelled death yesterday.  A full scale inspection of the kitchen was done following the dog’s lead and we finally found a dead mouse under the fridge.  Once boyfriend wrangled the dog into the bedroom (so as to not allow him to maul the dead creature for invading his home even though it totally deserved it!), this rodent, that had no right to exist in the first place, had to be disposed of.  Now, I fucking hate all pests.  I hate centipedes.  I hate earwigs.  I fucking hate mice.  I fucking fucking fucking HATE them.  But our maintenance guy was out of town and this was a two person job.  So, as boyfriend uses the broom handle to grab the disgusting, gross, piece of crap that calls itself an animal, I had to hold the dustpan with my double layered latex gloves.  Amid my shrill cries of disgust and shaking, he swept it onto the dustpan and I carried it out to the dumpster then ran away like a pansy.  He cleaned while I refused to touch him.

So now, boyfriend and I have seen each other at our lowest, most whiny, pathetic state–sober.  We’ve seen each other be neurotic and insecure when we’re drunk but that’s different.  I believe we are now stronger as a unit.

Also, the dog earned a beach hot dog for his hard work.  And!  On his way home, he killed a centipede in the apartment entry!  He is truly the Urban Hunting Hound.

Terrible things you consider when you realize you have to pay back student loans. Pt. 1

I realized I hadn’t written in  a long time.  I’ve been in a lazy/lamenting mood lately so I decided to take a page from my dog’s book and lay around the house watching Monster Quest for a few days—by which I mean weeks.

I just realized that in a year, I will be on internship, after that I will be forced into the real world.  I have spent the last 20 years of my life in school, straight.  No breaks.  The last 9 have been in college/grad school (I started taking college classes when I was 16 because I was awesome enough to qualify for a program and I hated high school).  But now, after accumulating a fuck-ton of debt and a small amount of knowledge, I realized that I have  to have a real job and pay my bills out of real money, not loans, and pay the previously mentioned loans back!  WTF?  I have no delusions that they will be paid off by the time I die.  I’ll pay the minimum until I die and be content.

But then, today, I had this fantastic idea!  I can sell my Eggs!  I can get up to $35,000 for one!  What the fuck!  I’m feeling I can get a pretty solid price for a tall, blonde, athletic, high IQ’d chick with a doctorate!  I may be making terrible statements here, but when you are suddenly faced with the real world, shit gets real and you realize the pointless things that matter to the WASP culture that would probably want my eggs.  My only defects are being near-sighted and clumsy, and having a penchant for science fiction.  And I don’t even smoke!  If anyone is interested I’ll just pretend I don’t drink as much as I do when they meet me.  Let’s face it, my genes are going to waste due to my phobia of pregnancy.  Someone should benefit from them.   And if they can benefit from my genes and I can benefit from their money, it might just be a perfect world.

I’m also working on a scheme with the boyfriend about letting me have  a sugar daddy.  Because if I get a sugar daddy, I can boyfriend’s sugar momma.  Think in layers here people!  Again, everyone benefits!  Except the idea of boning old people.  I don’t like that.  hrmmm….Let me work this one out a little more.