Friday, October 30, 2009
Let Them Eat Cake? No! Let Them Make Tea!!
I work with people (adults and children) who have chronic complex PTSD and dissociative disorders, many of whom self-injure, and many if not most of whom have suicidal ideation, and some of whom are actively suicidal. Meaning that sometimes they act on their thoughts.
When I, as their clinician, think they are a danger to themselves or others, part of a safety plan we've put together includes going for an evaluation at a hospital or crisis center. I don't just send people to the ER on a whim, because that would be, well, idiotic, would it not? Generally, I try to speak with someone there to express my concerns, and my familiarity with my patients' patterns. If they listen to me.
Lately, that hasn't been so much the case. And I am discovering many of my colleagues are having similar experiences. Seems like, more and more, people who should be inpatient are not being admitted, whether it's because of having poor insurance with poor benefits, or I'm not sure what.
It is often very hard for people who are a danger to themselves or others to admit that. So the act of actually going to an ER and saying, yes, I have been having those thoughts, and yes, I am afraid I will act on them, is really quite a step forward, clinically-speaking. For someone to respond to that admission in a trivializing way, as in the "Oh, it's not so bad, why don't you just go home and make a cup of tea" (which actually just happened, I kid you not) gatekeeper incident, is completely unacceptable.
Obama, who is quite ready to spend on physical infrastructure (roads, bridges, etc.) needs to spend money on shoring up our social infrastructure -- mental health and child welfare, doing it from the bottom up, not from the top down. More services, not fewer. More services for the most endangered.
Are we hypnotized, as a nation, by some weird gender-biased kinda frame? Bridges and roads are visible, strong, real and manly and tough? Minds are invisible, weak, fickle, unreal, not truly existent, thus unworthy of making a top priority?