Crisis Prevention

This post flows from having read a recent article called “I am Adam Lanza’s mother in the Huffington Post. It was not written by Mrs. Lanza, but by Lisa Long, who has a difficult 13 year old son. We are not just taking about a bratty child. He is a child that she frequently has to take to the emergency room for threats of suicide or against her and his siblings. Her other children have an emergency plan of how to get to safety if he starts to act out. She has to collect all the sharp objects in her home and carry them with her.

She gave up her career as a free-lancer to get a job with benefits to get the help she needs for her son, although it sounds like there aren’t the resources they need that are actually available (or even that exist), let alone are covered by even “good “insurance. She cannot predict what will set her son off, or how a day will proceed. She wants help for her son. She needs help for herself and the rest of the family as well; I suspect that most of the resources go toward helping her problematic son. What must it be like for the siblings in such an environment, let alone the parents?

I have worked with clients who want help for difficult children, but have few places to turn. As these children grow into adults, there remain few resources. Also, most families struggle with the thought of residential treatment for their child or grown child. They worry that facilities, if available are more jail-like than treatment like. So they keep their children home and cope (and hope) as best they can.

So many conversations need to happen about how we allocate resources to the disenfranchised (read: people who do not contribute economically): the elderly, the mentally-ill, children, physically or multiply handicapped. Ask a special-ed teacher how much extra she or he gets paid for the additional education or certifications that they obtain to be able to help special needs children. Ask the aides in these classrooms how much they get paid to have special training, learn to restrain children, get spit on and have to change diapers.

Ask a specially trained social worker, therapist, counselor, psychologist or psychiatrist how much extra they get paid to their specializations by insurance companies. If you wonder why there are few of these specialists in your managed care network or the Medicare and Medicaid networks, again, ask if they are reimbursed at a rate that pays their office and business expenses, let alone leaves anything over for personal income.

Yes, you will find dedicated and well-trained clinicians in clinics. I wonder if you were able to look at the books if you would see how much of the client care is subsidized by the few clients who pay posted fees and by grants, gifts and happen at faith-based sponsored agencies that don’t depend on clients as the main source of their income.

I recently heard about a community based agency that services primarily the homeless and people recently released from jail or on parole. I wonder what kind of professionals can actually work at places that pay salaries barely over minimum wage, and often offer only part-time hours and no benefits.

If you’ve worked with a private therapist, and think the rates are too high, well, maybe they are. What are you getting for your investment? The clinician’s expertise, experience and education, as well as working with someone whose caseload isn’t so enormous that she or he can barely remember your name, let alone have the time to devote to knowing you well enough to support you with a treatment plan that helps educate you, move you into action and guide and support you to live the life you deserve.

My purpose and intention here is not to justify what private therapists charge, or say you cannot get excellent treatment at agencies. Not by a long shot. My intention is to have the conversation begin and generate action in changing the mindset about mental health, and meeting the needs of clients and their families before the crises hit. My hope is for changes in the delivery system for services that are realistic, long-term, empirically-based and affordable.  That are crisis prevention rather than crisis-management.

I’ll save my rant about what insurance companies charge for coverage and what they then pay out, how they mete is out and how much even the best companies don’t pay when you have a serious illness, physical or mental.

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