With wee little petri dishes, and tiny test tubes...

line from hospital records...

"There have been little laboratory investigations performed."

I'm picturing something like this:

Sending out an SMS

I have been supporting a client for the past month and a half exclusively by text message.  Has anyone else done this sort of thing?  Usually we would discharge a client if we went more than 30 days or so without face to face contact, but in this case the client is at a high risk for suicide, so we wanted to try and stay connected any way we could.

And it seems to be paying off.  He finally consented yesterday to go to a hospital - not just any hospital mind you, but one hospital in particular, in the next city.  If we could send him in a taxi (not something we normally do) and if I could guarantee that they would admit him, and guarantee they would be "better" than the other hospitals in our area.  I told him no way I could do that, but I did get approval to send the taxi.

I'm glad I did.  The admitting psychiatrist actually called me this morning to get some history and let me know my client would be admitted.  This is unprecedented!  Last time I sent out the local Mobile Crisis team and they took him to our local hospital, they had discharged him before I even got back to work in the morning!  I know there are lots of reasons this may have happened, but it's still very frustrating and also compromised my therapeutic relationship with the client.  It's so rare that hospitals follow up with us in this way.  The psych even stated that he could see this client needs long term care more than a hospital stay, but was willing to admit him in hopes that we can facilitate that while he's in.

I love when things work out this way.  It remains to be seen of course what will come next with this client, but so far so good.  And after I worried that my texts were just floating in the abyss, probably not affecting him at all.  It's still not my favourite way to practice, but just goes to show any connection is better than no connection.

What a great start to my long weekend, happy summer everyone!

Mental Health *headdesk* Moments

How how HOW does a client who tried to kill himself TWICE this week and was brought in to hospital BY THE CRISIS TEAM, who found him intoxicated and holding a knife get discharged from emerg without ever getting admitted?!?!?

Insight

from hosp records:

"The patient stated that she was also worried about all the other patients, that they were given unhealthy food and carbohydrate loaded food."

In the doctors assessment notes and the referral we received for this client, she was presented as being a trouble maker, difficult and bothersome.  She called every hospital administrator she could track down to complain about the hospital food.

Sounds to me like she just knows what's going on!

What Makes Me Happy

This is about a client I had when I first started this job. I may have reflected on this story before in my blog, so bear with me if it sounds familiar.

He had been in the system for years, and had previously been supported by a coworker who left for another job.  He was a young man with schizophrenia and developmental delays.  He lived with his family (who wanted the best for him) including his grandmother who brushed his teeth for him even though he could do it himself.  It is fair to say there was a lot of learned helplessness going on.  

I was a little more eager and a lot less experienced then.  This man was more ill than anyone I had worked with previously.  My normal tactics did not work.  We were down to real basics - getting him to remember who I was, and remember his appointments.  Our appointments consisted of me trying desperately to make some kind of conversation while he was more interested in watching soccer or getting me to take him out for pizza.  All the while granny is knitting in the background and making me hyper aware of my youth and inexperience.  

I don't remember what the incident was, but somehow he ended up in hospital.  The family and I worked with the doctors to get a med review and he was started on Clozapine.  While he was still admitted I advocated to get him in with our ACTT program (Assertive  Community Treatment team - a more intensive level of support than what I provide) and he was accepted, so I never really saw him after his discharge from hospital.

Until one day I was in the waiting area of a psychiatrists office with another client.  I recognized this man's sister and then he came out from his appointment.  He looked me straight in the eye and said "Hi Nectarine" and then proceeded on his way.  

That was it.  But it was so much!  This person, who had met me at the door with a blank face week after week, giggled when he couldn't remember my name for months over a year prior at this time had said HI and addressed me by name!  He now attends one of our drop in programs and I see him over there from time to time.  Every time this same thing happens.  He says hello to me the same way, and then walks away.  It's all I'm likely to get, but it's so much.  It makes my day every time.  

Will this client continue to recover?  Probably.  Will he recover to a level that other people find "normal"?  Probably not, but to me, all the work he and his supports have done is so worth it to bring this human being out of the bubble his illness and medications had put him in.  I'm grateful to have been a small part of it.

x2

Double whammy at the hospital today.  Two of my clients are there, and there is a case conference for one today, so I'm going to try to visit the other afterwards.

In one case, the client was doing so well and getting a lot of things going on in his life.  So many things in fact, that I believe he stressed himself out to the point of triggering a psychotic episode.

In the other case, the client has been unwell for a while, but this is the first hospitalization required in over 10 years.  Sigh...

At least both have been moved out of intensive and onto the general psych unit.

Venting x2

*

Twice in the past few days I have called the hospital Mental Health Outpatient Clinic to get an update on my client's waitlist status. 

Twice I have been informed that the client is not even on the list!  They have no record of a referral. 

In one case this client's doctor told him he made the referral in October.  In the other, the client told me her doctor referred her last summer!  This client is brand new to me, so we're off to a busy start.

The outpatient clinic has a four month wait list.  They both should have been seen by now.  Now I am trying to help each sort out what happened.

GRRRRRR

*I do not endorse this method of stress relief.  If you are feeling upset, talk to your counsellor.  If you don't have a counsellor, call your local mental health services you might get one in a year or two.
In the meantime just try not to throw anything at anybody.

Operator, what's wrong?*

The fax came through, but the page must have twisted or crumpled a bit, because the extension number was obscured.  Tried to guess at the number, but guessed wrong (sorry to have bothered you ma'am). 

Called the main line of the hospital and gave the new "automated voice system" a try, but the computer figured that "Andrea" was close enough to "Angela" and patched you through wrong again.

Called the main line, pressed 0 for the operator to ask a real person.  They gave you the extension for the department, which didn't even match the 4 out of 5 numbers you could read on the original document.  Spoke to a very nice lady who told you no, you need to call our downtown location.  Gave you that number, and you give it a whirl.

Another helpful sort answers the phone only to tell you:
1) the person you want to speak to is not in today
2) the whole department closed half an hour ago &
3) you'll need a new release of information before you speak to the person you've been trying to reach anyway.  The one you have is out of date.

Aaargh!

*I dial stupid number all day long! 6060-842

Who Are the People (with Mental Illness) In Your Neighbourhood?

Source: http://bit.ly/qASsuQ

There are a lot of stereotypes and assumptions out there about “who” mental illness sufferers are. No matter how many celebrities write books with “revelations” of suffering bipolar or PPD, or how many families contain at least one Crazy Aunt Mary many persist in believing that mental illness is the domain of the poor, stupid, homeless and criminal.

There is plenty of critical thinking and anti-oppression analysis we could do to figure out why people think this way (and why many with mental illness are vulnerable to becoming poor, homeless etc) but I haven’t the energy/time for that right now.

If any one needs proof that mental illness is something which affects people from all walks of life, they should spend just 5 minutes hanging around the local out-patient centre or treatment clinic.

I accompanied a client to his psychiatrist appointment today at Local Hospital out-patient clinic (I know! I said I’d never go there again, but reality bites). Someone who didn’t know him would see that he is a family man (his wife was with him) is middle aged, and might guess that he is an immigrant (English is his second language).

While we were there I spotted a familiar face that took me a second to place. A woman I recognized from my old neighbourhood - she spent a lot of time hanging around the back alley, lived (sometimes) in a nearby crack-house, and often stopped people to ask for change on the sidewalk. I used to try talking to her sometimes, but it was difficult because her tongue was always protruding (possibly a med side effect or a symptom) and she would usually walk away when I didn’t have any change to offer.

On the way out of the office I recognized a woman I know from my family’s church. She’s a white, upper middle class professional who goes to bible study with my mom. I have actually run into her once before in a psychiatrists office when there with another client. We nodded to acknowledge one another and she seemed happy to leave it at that. We did this once again, adding a smile, when encountering each other at the hospital.

In the span of that five minutes I came across people from a wide cross-section of my own life, and who covered a good range of social locations.  And I know it’s not just me.

Helloooo Nurse (is there anybody in there???)

Me (on the intercom/phone thingy outside Local Hospital Mental Health Unit) : Hi, I'm Nectarine from Community Mental Health. I called earlier and one of my clients is here. Could you buzz me in so I can see her?


Nurse: Uh, I'm sorry ma'am, visiting hours begin at 4:30.

Me: I only work until 4:30. I'm not here to visit.

Nurse: I'm sorry, we don't allow visitors until 4:30.

Me: I understand that.

Nurse: I can't let you in here.

Me: Can I speak to my client?!?

Nurse: Who did you say you were again?

Me: I'm her case manager. From Community Mental Health.

Nurse: Well, I guess I can let you in.



*the magic door finally opens to admit Nectarine, and she approaches the fishbowl impenetrable force field nursing station and waits patiently outside the plexiglass for about an hour 4 minutes before Nurse emerges.*



Nurse: Uh, can I help you?

Me: Can you direct me to my client Janey Sad?

Nurse (looking me up and down): Where's your ID badge?

Me: We don't have ID badges, I can show you my business card. This is not my first time here.

Nurse scans my business card.

Me: So can you show me where to find my client?

Nurse: Don't you know? I thought you said you'd been here before?

Me: Uh, yeah, many times to see different people. My client just got here, I don't know which room she's in.

Nurse: I guuueeess I can show you.



*Nectarine follows Nurse down the hall where she opens the door to a patient room*



Nurse: Yeah, this lady is so confused. She's naked, you can come in.

Me: I think I should let her get dressed first...

Nurse (to patient): Helloooo! This worker is here to see you. THIS LADY IS HERE TO SEE YOU. (to me) Come on in...

Me: Uh, are you sure this is my client? That doesn't sound like her.

Nurse: Who?

Me: Ms. Janey Sad.

Nurse: Ohhh, this is Janey Nothere. She's sooo confused.



*another staff member kindly interrupts*



Staff: Did you say you were looking for Janey Sad? She's right here in the activity room, I'll get her for you.



*Nectarine meets with Janey (Sad) who is relieved to see her. Nectarine then waits twice as long outside the fishbowl nursing station, loudly but politely saying "Excuse me" before someone finally buzzes her out the door. She decides right then and there that she will personally drive all clients to Nearby Hospital in future as she is swears she is never coming back to Local again.*

"The Longest Day" or "What am I doing here?"

Note: meant to post this last night, but was too wiped

I am sooo tired today after doing practically nothing.

First thing this morning I went with a client to the Courthouse to attend a free legal clinic. It is one of those places where you take a number then wait. And wait. And wait some more. Three hours later we saw the clerk for about 5 minutes (she was very helpful) before we got out of that place.

5 minutes to eat my lunch (yay! what luck!)

Afternoon spent tracking down the next client (inner monologue: I just saw him just yesterday, and rearranged my schedule to help him out today, wtf is the big idea disappearing now grr), then taking a long drive through traffic to get him to a treatment session at a downtown hospital. That clinic was running late so we waited. And waited. And dozed off….*snork* wha? What happened, where am I? Oh, and waited…I brought a book this time, so at least I was entertained when he finally went in for his appointment. And I waited. And texted my boss to beg her mercy for missing a team meeting I was supposed to be at right that minute. 2.5 hours spent before we left.

Then waded back into traffic for the long slog to get him home. Only to turn around and head right back into it to finally arrive at MY home where I try to reflect on the ways that I helped today.

What a day.

Jaded

Is this a hospital?

No, we’re a community agency.

Are you a doctor?

No, I’m not a doctor.

Hm, maybe I won’t hate this place after all…

Standard of Care

I’ve been absent.

Thanksgiving weekend was spent mostly in bed, feeling sick. I took the Friday before and the Tuesday after off work, all for a stupid little cold.

I think work burn out had something to do with my reduced immune system.

One of my clients has recently been diagnosed with cancer, and I’ve been putting a lot of energy into supporting him. Practical stuff has been taking up most of our time – getting to appointments, arranging new supports, making sure he has food in the house. I saw or spoke to him 2-3 times every day for about three weeks.

One bright spot in this experience has been visiting the oncology unit. That sounds so wrong, but wow! What a difference from the mental health units! Prior to this, they were the only parts of this particular hospital I had been in.

I walked in to a sunny, bright reception area. The nurses’ desk was open, and there was somebody to greet me, who actually looked me in the eye, and didn’t just pretend that they couldn’t see me through the glass while they type away on their computer. In fact, there was no glass! The nurses were happy to admit me in, without having met me before.

They came over to check on my client while I was there speaking to him. The nurse introduced herself, and talked about how we could support him together. My client had lots of space and privacy (well, as much privacy as a curtain can offer, but still…) while he received his chemo treatment. When leaving, the nurses told me to call if I needed any information.

I did call later in the week, and someone got back to me the same day with helpful information. The following day when I went in with my client, the nurses remembered who I was, and helped us right away with what we’d come for.

Everything about this experience is the polar opposite of how things go in mental health.

It really makes me wonder about how the treatment of these different (although some times the same) patients is valued, and what are the expected outcomes.

Family Dynamics

So last week I received a referral from one of the hospital social workers for a new client. I called the social worker, because sometimes the client is still in the hospital, and we can meet them there. It tends to really increase our chances of a successful follow up.

This client had already been discharged, but the social worker gave me some additional background and his impressions of the client (patient in his case, I guess). He tells me that this client was recently diagnosed with schizophrenia. He’s a truck driver, lives alone, his family is all in the US, but they are very supportive.
His father is a psychiatrist. His sister is a doctor. The other sister is a social worker. His brother is a development worker.

And I can’t help but wonder how the onset of a serious mental illness would play out in the family dynamics. Is it more frustrating than usual for the family to feel like they can’t help him? More importantly, how will this affect the client? Will he feel that understanding and support from his family, or perhaps like a failure and an outcast?

I know that it is not unusual for families to be challenged or seriously disrupted by something like schizophrenia. Feelings of failure and disappointment crop up on both sides of the equation.

I know that most of us have someone in our network of friends/family/acquaintances who has a mental illness. I have people close to me who live with/have survived eating disorders, alcoholism, SAD and more.

This case just struck me as particularly potent.

Totally, Illegible.

Could somebody please, PLEASE make it mandatory already for all hospitals and social sevice agencies to use typed notes? This is the 21st century! I can't read your scrawl! I'd scan the offending documents as an example, but I can't even read it well enough to be sure I black out all the appropriate areas.