A ghost in the machine

Before I get started, I want to be clear that the different agencies do very valuable work in helping people with substance abuse problems, sometimes with very limited resources. While it may not seem like it sometimes, the amount of effort that is put into this by case management staff, peer support staff, therapists, and doctors is sometimes quite a lot. This does not always equal success. Sometimes the way the system is structured seems to put up roadblocks, and sometimes a person in need of help may not be ready to accept it. There are also many people who have been able to get their lives on a better track, and this is among the reasons many of use would like to go to work day to day. That being said, there are some ridiculous aspects to substance abuse diagnosis. Those of us who are not licensed as a therapist or doctor or social worker, may be told by our supervisors to diagnose clients with a substance use disorder, even though the use may be light. So, if the person say...

Picture yourself as a case manager, or a peer support staff, in the Southern Arizona behavioral health system, at one of the agencies. (“Agencies” refers to those organizations that have been called Comprehensive Service Provider, Intake and Coordination of Care Agency, or most recently, Health Home.) It is around October or November of 2015, when the regional behavioral health authority (RBHA) changed from CPSA to Cenpatico Integrated Care. You still have your regular duties, and now on top of that, the new RBHA has new training requirements. Conveniently, these can mostly be met using an online training system, which can be checked by Cenpatico to make sure you meet the requirements. Not so conveniently, there are quite a lot of new trainings. Also not so conveniently, your agency might only give you a small amount of time to take these trainings, which if properly done take longer than the time the agency is giving you. Or, your agency may require you to do all of your regular dut...

Imagine you are sitting in a conference room at the agency you work at. It may be 8 AM, 9 AM, or whenever the agency decides that it is time for morning meeting. You might be required to have your caseload list handy. That is, the most current list of everybody on your caseload, printed off the electronic health record system. You did remember this, right? The 5 pages of the list, stapled together, with highlighter marks showing which of the 150-250 people you have contacted so far this month. It's the 21st century, Excel spreadsheets can be used to track this, but you can't access a computer for this at the morning meeting. It's nice to have a chair to sit in. The walls of the conference room may be some shade of yellow, or tan. There may be a carpet with some stains, or the floor may be the faux-wood that looks a lot better than stained carpet. It's nice to have air conditioning, but for some reason it's either too cold or too stuffy in the room. You might feel li...

Someone once said that laws are like sausages. If you like them, you don't want to know how they're made. The same could be said about the workings of the public mental health system in Southern Arizona. There are many dedicated, caring people working in this system, doing a lot behind the scenes to serve the clients of the system and make the whole thing work. There are also a lot of money problems, and problems with how the system itself is set up and how it works. You usually see only the front end presented to the clients and the public, and do not see the workings of the sausage factory that the system often turns into. At some point, someone having a bad time may need to get help from this system, and find out that the way the system is set up can lead to frustration getting needs taken care of. This is usually not the fault of the hard-working people on the front lines of the system-- the crisis workers, the case managers, the peer support staff, the therapists, the nu...

A frequently heard thing is "my case manager keeps changing" or something along those lines. High turnover is the field is a fact of life, and it affects not just case managers (i.e. recovery coaches), but also peer support staff, therapists, and occasionally the psychiatric providers. I've heard your frustration, and I've had to respond in some way that's okay by my employer. One of the major reasons your case manager may leave (or get fired) is stress from the agency. One of the biggies for this is billing. Your case manager is under a huge amount of pressure to bill enough so that the agency does not fire her or him. One agency may call it "productivity," another agency may call it "metrics." It boils down to having to bill enough to your insurance, to justify their jobs. This is a balancing act. The agency ultimately needs to have money to stay open, and the case manager (or other staff) usually cares about you, but also has to make sur...