Feeling Bad

I have been feeling bad lately.  Let me explain.

I work as a supervisor in a mental health program.   I manage other clinicians, nurses, and psychiatrist who serve people with severe mental illness.  It is a stressful job by itself and involves a lot of therapy, case management, medical follow up, consultation, traveling, etc.  It is a job that not anybody can withstand or even consider taking, because it is not a typical mental health facility.   The program is based on the PACT model (Programs of Assertive Community Treatment) and it involves intensive psychiatric and rehabilitation services , similar to what clients receive in psychiatric hospitals, but in the community.  So you can imagine the amount or work and tension that we often experience in trying to help individuals with paranoia, delusions, disorganized thinking, and poor social skills remain living in their homes.   Even though I may be describing it as a difficult job, it is very self rewarding.  We are actually helping people stay away from institutions and jails simply because of the severity of their illness.  We are helping them live normal lives like the rest of us.

But I recently started feeling really bad about my job because of the way the company sometimes treats our staff.   They are not usually paid the salary that other facilities and hospitals in the community pay their clinical staff, plus they started hiring more bachelor levels so that the  cost of hiring people would be less.  So the competition has been an uphill battle which results in a high turn over rate.

Since I started working for this PACT program in 2011, we have had two full time doctors, and recently two part times.  The two part time psychiatrists  shared the case load of a total of 101 clients.  The last two psychiatrists were working under a contract  instead of being regular employees.  But unfortunately , one of the two part time doctors decided to move out of the state for a better paying job (its usually  because of the money) and we found ourselves planning to have one part time doctor cover  while starting to recruit for another doctor to take over the other half of the caseload.   The situation became more complicated when the company advertised the position and found a candidate who was willing to work full time instead, as a regular employee.  Having a full time practitioner is what the PACT model is based on primarily and it facilitates the overall function of the program.    So needless to say, the company had to make the difficult decision to “get rid of the part time psychiatrist” so that we can officially hire the new full time practitioner (who happens to be an ARNP who can do the same type of job as a psychiatrist).   Of course, letting the remaining part time psychiatrist know was the hard pill to swallow.  Not to mention informing the clients (once again) that their psychiatrist was resigning and they were going to be seen by a different practitioner.   Our clients who all suffer from a severe and persistent mental illness, are already marked by difficult times in their lives, and change is one of the most difficult experience which can exacerbate their symptoms.

The CEO of the company is the one who negotiates with psychiatrists and makes the final decisions about which psychiatrist to hire.  My supervisor and I interviewed the new candidate and we liked her, but the CEO was the one making the decision about moving  forward with her, meaning that the part time psychiatrist who was still working with us had to go.   Part of me said we were doing the wrong thing… that we should’ve looked for a another part time psychiatrist so that we wouldn’t have to lose the one we already had.  I was informed that the CEO would then speak with the part time psychiatrist about our plans, which I was glad I did not have to do, although I wished we could have done something different so that we can keep the part time psychiatrist.  But that was not my decision to make.

To make matters worse, last week, the part time psychiatrist approached me and asked me about what the company was planning to do with her if they find a full time practitioner.  I was dumbfounded and caught off guard, not knowing what to say at the moment.  I thought that the CEO had spoken with her about his decision already,  but it turned out he had not informed her yet.  So I had to tell her the truth at that moment, I don’t believe in lying or hiding things from people, especially staff people who work with me.   But I also told her that the CEO should be speaking with her about the matter in more details soon.  So, understandably, the part time psychiatrist seemed upset and said she will just resign.

I felt as big as an ant.

Here we are, literally getting rid of a part time person, a human being with a family to feed and a career to keep, so that we can replace her with a full time person who will take her place to “serve our clients.”  The company has a budget to keep, so having one full time psychiatrist was more financially convenient.   I understand the technicality and the business part of the reason why we need to make this decision.  But the human side of the matter sucks.

So I feel bad.  I feel we made a mistake.  I wish I could have done something different and prevent having to get rid of the part time psychiatrist.  I wish the CEO would have contacted the part time psychiatrist early and offer her to stay with maybe less hours, but still stay working with us along with the full time ARNP.

But it is too late now.  She decided to suddenly resign , sooner than what the contract mandates.  I can understand her anger and frustration. I also understand the need to have a full time practitioner who also has more flexibility with traveling and visiting our clients.

So I am split in half, feeling glad that we found a full time practitioner soon;  but still feeling bad that we lost a very good psychiatrist and made her upset in the process.

At the end of the day, the ones suffering the most are our clients, who will have to face another change of providers.  And most likely run the risk of  increasing their symptoms of mental illness because of this transition they are forced to face.

It’s hard being a supervisor sometimes.

 

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Identifying with the Self: Part Two 

 I had a counseling session with one of my clients.  She is a cutter and was questioning whether or not she would be getting any better in her life.  She was comparing herself with others who also receive therapy and who seem to be getting better faster. My client thought she was not improving like she should and asked about the concept of PTSD and resistance to treatment.

I try to explain to her that PTSD involves living in the past after a traumatic experience… versus learning from the past without necessarily reliving the past.  When we experience PTSD , we tend get stuck in the past and not move forward.  When the pain is avoided then we continue to experience PTSD and continue to relive the past and experience an emotional cycle which is nourished by substance-abuse, self harming behavior, and depression.

On the other hand, when we learn about the past, we develop new skills and we develop new ways to cope with the upsetting memories.  One of the ways is to talk about it, process feelings, write about it, and accept the fact that the pain was done.   When we choose to develop new skills and process feelings by accepting the pain, then we begging to acknowledge that it was a difficult time in our life and be able to move forward with new skills.

And then there was the question of why she is still cutting when she’s in her 50s now, when most of the cutters are either teenagers or young adults.

Then a lightbulb turned on in my head. I asked my client who she would identify as and she could not answer the question.  She first said “I’m already in my 50s why am I asking this question now? ” Then I asked her to not think about her current age but to focus on the question itself : who am I?

The observation that most cutters are teenagers or young adults gave me the idea that, since she has always been dependent on others to tolerate her who she is and what to do with my life, that sounds almost like what teenagers and young adults do in the early lives.

Basically my client is experiencing what most teenagers and young adults experience : finding their identities in life, facing the unknown after depending on the parents.  My client said she always depended on her parents and she was taking care of and nourished as a child even during her adulthood.  This can explain why she has difficulty identifying who she is now in her 50s. I explained that most of us experience the same identity crisis in different times of our lives. Most of us identify with what we have been assigned to be, for example our names, our ethnicity, our gender, and our religion. But we ultimately face a time in life, usually during young adulthood, where we start questioning  our assigned entities and find our own identities. And maybe that’s what my client is experiencing at the present moment.

Like I mentioned in my previous post, we mostly live inside our heads. Inside our thoughts and perceptions. We rarely get out of our thoughts and face reality. We don’t usually live in the present moment.  But we rather stay living inside our heads.  Inside our minds. But we rarely step aside and start perceiving ourselves as we really are.

Have the rest of us done the same thing in our lives?  Have we taken the bold step of “peeling the onion” all the way until we find our true selves?

In my own experience , that “true self” remains a mystery.  It remains a great part of the unknown, which is why I tend to ignore it and replace it with all the entities I have been taught to identify with.

I have learned to identify with being a Hispanic middle age male, an American, a mental health professional, a  Florida resident, a parent, a husband, a son, and many other entities.  All of these I can question and deny if I choose to.  What I have not identified with as much is what can never question or deny.

My true self.

But what is the true self?  Is it simply being human? Being a person? After all, isn’t that what we all have in common? Identifying with being Human beings ? Anything else could be used to separate and segregate us.  But being humans could only keep us united.

A day at work

imageHere I am. Just coming out of a counseling session with a client who is feeling depressed and physically tired and sick.  He lost both of his legs due to diabetes and he has no hope for the future .. He used to be a great man, he used to educate  other people about history and writing.  But now he does not have any hopes of doing any of that again ..  He is afraid of dying .

Yesterday I saw another client with schizophrenia. His apartment looks like a total disaster , but he is content with his chaotic life.  It is his norm.

The other day  I saw a woman with PTSD with psychotic features.  The voices tell her to cut herself but she tries to ignore them .  She says it is not easy to ignore.  She tries meditation and walking to cope .  But she has been abused and threatened so much in the past that it has become part of her life to be anxious all the time .

I hear all the stories when I go visit the clients that I see. I feel bad at the moment but as soon as I leave,  I go back to my routine. I go back to my own life with my own problems.  Because if I don’t temporarily leave it behind, I may not have a life of my own.

And the next day I do it all over again.

Involuntary Help

As a Licensed Mental Health Professional, it is not easy to have the responsibility of involuntarily admitting a mentally ill person into a hospital.  It is basically taking the person’s right to refuse treatment away from them, and putting them under treatment without their consent.   Definitely an uncomfortable task.  These are people who may otherwise end up harming themselves or others if they don’t receive mental health treatment right away.  Because of their mental illness, the person is making irrational decisions about themselves, to the point of expressing suicidal thoughts.  But it is not an easy thing to do.

I sometimes wonder if we are doing the right thing by forcing people into institutions.  Sometimes I think if we actually have the right to dictate someone else’s level of care without their consent.  It’s like telling a child that we are going to take them to the dentist whether they want to go or not, because they have cavities and we don’t want their teeth to fall off.  The child may not care about their teeth, but we are caring for them.  But I am actually talking about adults here.  Adults who professionals have decided that they are “insane” by putting a label on them such as “Schizophrenic”, “Psychotic”, or “Delusional.” So we categorize them as people who cannot help themselves, so we are going to help them by locking them up on in a hospital.

We don’t always do this.  Most of the time, we refer them to outpatient services in the community.  Most of the times, we provide counseling, rehab services, and education.  But there are a few times when we have to get out of the comfort zone and force people into locked units until the professionals agree that the person is stable enough to go back in the community.

I don’t know for sure.  Maybe I am exaggerating by writing so much about something that may be obvious to everyone.  But I guess I am just thinking outside the box for a moment, and looking at the big picture.  These are human beings, just like you and me, who deserve a decent life.  But, for unknown reasons, they are forced to live a life of confusion, disorganization, fear, and disorientation.  I have done this kind of work for almost 10 years, and I am beginning to realize how inhumane involuntary admissions to hospitals appear sometimes.

What do you think?