Posted on by WanderingNation

When Patients Don’t Deserve Care

As a therapist at a community mental health provider. this is a question that is very challenging on an ethical level. One of the biggest challenges that I face is with patients who either don’t want care, are violent/belligerent or are a combination of all of these. Often, these patients have been through the mill of services – in and out of jail/prison, chronically suicidal, and spit out by every mental health provider in a 100 mile radius.

And then they are referred to me.

These referrals come from people who are out of options, who are at their wits end as to how to provide care for these individuals. Whether it is people who are chronically addicted to some substance, have a personality disorder, or just don’t want help (which is a lot of people), I am the one who gets the call when there is no one left to call.

When I get these calls, I can confidently say that I always want to help. Is it an ego thing? A “big heart” thing? Am I perhaps too naïve? Whatever it is, I always want to add them to the caseload.

When they do get added, it is very quickly that I realize why they were referred to me, and refused services from so many other organizations in the process. They are angry, aggressive, belligerent, intoxicated, and a plethora of other things that prevents me from being able to help them, if they even want help in the first place.

When the violence, anger and belligerence starts, though, I feel at a loss. These individuals are justifiably angry in many instances. They have been abused, mistreated, refused service and generally thrown to the wayside by every societal apparatus that we have at hand. And I do not blame these apparatus’ when they do throw these people away! Many of these individuals are fundamentally broken people, and beyond the help that I, or the wonderful people that I work with can provide.

As a therapist, I often have to come to the conclusion that I am unable to help these people, and that it is only a choice on their end that will allow them to become able to accept help, when it does eventually come to them. But as a Catholic? It is extremely difficult for me to accept this. Christianity is the religion of the broken and the castaway. It is the religion for those who have been shunned by the society in which they are a part. So how do we help these people? These people, who refuse the assistance of secular society, often justifiably so. These people, who are so often simply beyond the help of secular society. These people, who deserve to be accepted by those of a religious heart?

I do not have an answer. But I had to ask the question.

Posted on by WanderingNation

Mental Illness

The other day, I was working at a community mental health center in eastern Washington, and it was my turn to teach the lesson for that day. In these lessons, we are allowed a large amount of free reign, and on this day I decided that I would start the day by asking each of the participants what they were grateful for.

Before going into what was said, I think it would be helpful to give a little background. The group that I lead is one comprised of adults, most over the age of 40. Some of the held manual labor jobs, some were criminals, some were lower management and some are severely mentally disabled and unable to hold a job whatsoever. What is interesting, however, is that they all come to this group for the same reason – so that they can improve their mental health. While it is partially from the lessons that these clients hope to improve their mental health, I believe that the most significant gains come from the simple fact that these clients are in a safe place, away from the usual dangers and triggers that the rest of the world almost constantly throws at them. The vast differences in their life experiences is something that, when I began, I thought would create a gulf between the clients, causing them to focus on what made them different and not on the things that they had the same.

What really caused me to pause on this day was when we started with our gratitude journal. Every day, before beginning the lesson that I had planned for the day, I start with a gratitude journal, asking the clients to tell me one thing that they are grateful for since the last time that we met. The answers usually are about family, the people who take care of them, football or their animals. While these are all good answers, they can become a little routine. This day, however, one of the clients stated that he was grateful for his mental illness. Not only was this a very unusual answer, but it was one that took a significant amount of introspection. Before I had a chance to ask this client more about what he meant, the statement was met with quite a bit of resistance by many of the other clients in the group. Everyone else had a very understandable distaste for their mental illnesses, as they had the understanding that it was these illnesses that caused their difficulties in life, and were the reason that they needed assistance in their lives.

After listening to their statements of doubt, I asked the client who had stated that he was grateful for his mental illness why that was the case. He gave no reason – he said that he did not know. A bit disappointing, isn’t it? Perhaps, however, it is better this way, at least for you and me. While it would be a bit too much to state that we all have some form of mental illness, I do not believe that it would be inaccurate to say that we all struggle with some form of inner demon. Depression, anxiety, addiction, whatever it may be, there is some struggle that we will have to grapple with, and this struggle against our demons can cause us quite a bit of pain; can cause us to resent those demons. What if, however, we learned, like the client, to be grateful for these demons, even without knowing why?