Where are we in this change process or meeting people where they are at!

What do you do when a consumer you have not been able to engage in office or home visits says “I want to work”? This could be a case manager’s worst nightmare. You may have people who don’t want to talk with you, have to be tracked down in order to ensure that they are taking their medication and are being exploited in their living situations. But they utter that brief concise statement.

This scenario may be played out across Milwaukee as it has undoubtedly happened  in several other counties across Wisconsin.There is a new benefit being introduced in Milwaukee to help boost the number of people with mental illness and receiving benefits who are working. That final clause is very important because there are many people not tied to benefits but still able to work. But it is a struggle and sometimes there can be pain. In recent weeks I have been hearing about supported employment and wondering how it would work. I am assisting several people at my agency who are seeking employment, mainly through DVR.

What I don’t have is contact with an employer to whom I could connect a consumer. Also, the employment plans are supposed to be created by the DVR counselors. Everything must change, nothing stays the same. That’s the song I originally heard years ago on a Quincy Jones cd and more recently I heard it at the First Unitarian Society of Milwaukee. Someone, if not me, will soon be connecting our consumers to employers. DVR and Milwaukee County will be assisting in this process and no one can be turned away if they utter that simple phrase, “I want to work.”

So, where are we and are willing to offer what people say that they want from the system?

 

 

 

Peer support: the missing link

I read the Milwaukee County Behavioral Health Division crisis services manual yesterday at work. The manual drafted last year a couple of sentences about the importance of peer support in targeted case management. However the manual lacks clarity in explaining how we will be better able to link consumers to community services than we did previously using a strictly clinical approach.

I expressed my concerns with a supervisor today who explained that part of the reason that the manual left a lot of areas vague was to give programs greater flexibility in how to use peer specialists. Also it seems that we have a wide range of skill sets and interests. I have a fairly broad range of interests although not everything is easy to measure. For example I am interested in motivating African-American men and that shows in my approaches with them. This may include going to the library, talking about particular topics and raising questions when the team is discussing African American men I have been assisting.

I worry that younger men may be left behind through sheer laziness or killed for being in the wrong place at the wrong time. Or killed by the police in one of their so-called stop and frisk you for having dark skin games.

I squirm in my seat when BHD lags behind in including discussions of peer roles in its training.  Fortunately in our discussions at work we do talk about the team and bringing issues to all of us about what we are finding in our work. I am able to have my input and we cooperate with one another much more readily now that our roles have been more clearly defined. I hope that the experiences we are having in the field will be reflected in next year’s BHD training. Much better than having two dozen peer specialists squirming in an auditorium.

 

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What to do about mild depression?

The commercials all show people happy and carefree after one or two magic anti-depressants. In reality the story is much more complicated. For one thing a mild but persistent depression is hard to spot and even more difficult to treat. If someone is clinically depressed you can tell because they can completely shut down. It’s hard to get them out of the bedroom, not to mention out of the house. It imprisons you whereas a mild depression can feel like wearing an ankle bracelet. You can go to work but you won’t enjoy being there and then you come home you may retreat into alcohol.

Functionally depressed sounds similar to the term functional alcoholic because you can find yourself spiral downward on the weekends or other times when you don’t have any other responsibilities. Not drinking is difficult because there is so much drinking portrayed in the media. There is the cliche of the police heading to a bar after their shift, for example. There was the loveable Charlie Harper a character on Two and a half men portrayed by Charlie Sheen. He was healthy as anyone on the planet despite his many drunken episodes. Sheen’s off-screen episodes led to the death of his character.

There is wine shared at the family dinner table on Blue Bloods where the leading characters are white Irish Catholics. In that spirit,  I gave a co-worker a big bottle of wine for the holidays.She gave me a gig kiss.

So, watching these scenes made it difficult for me to stop or even cut back on drinking. That’s why I put reducing my alcohol intake at the top of my plan for overcoming the blue funk. Next up will be joining some activities like the Victory Garden Initiative which seems to have swept over Milwaukee. It would be interesting to explore the possibility of creating a garden in my neighborhood. And thirdly I keep hearing about how flexible the feds are on student loans so that will be my next step, I am going to pursue getting my student loan payments reduced to a certain percentage of my disposable income.

I don’t see going to get another anti-depressant as a feasible option. Not everything can be fixed by taking a pill. I also need to stop dwelling on past mistakes that I’ve made because there’s no way I can fix them.

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Still lurking around

Well I have finished just barely half a year at my agency. In another lifetime I was involved in evaluation: qualitative and quantitative. We are finishing up a report for our funders about the impact of my working and so I created a chart showing who I had been working with though one of our programs and what I had helped people achieve. I also asked the woman who recruited me whether one of the achievements could have happened without me. Obviously it was an unfair question, so I asked anyway.

 

I think that people often try things but whether they stick with them is an entirely different story. We may suggest that people do something but whether we can take the time to show them may be different.

 

I am excited about my work and it is interesting to see how things look on paper after the idea of peer support was presented. Our agency has definitely embraced the concept. Occasionally I have struggled to figure out exactly what I was supposed to do. But I am still lurking around.

 

I got a message from a friend on Facebook about a monthly meeting involving the Mental Health Re-design. There is an Action Team talking about expanding peer support and increasing the pay. I would have an interest in both of those areas. I want to speak up because my opinions are unique, like me.

 

I will have to check and see whether I have any time to spare. It’s just a couple of hours per month. I discovered that I am a little obsessive. I kept trying to figure out how much time I spend working with people last week until finally I figured out  the problem. We have a fast paced scene. My work involves those aspects of wellness that don’t involve medication or physical exams. The case managers were struggling to complete what they had to do so after a while they welcomed me.

 

So life goes on and recovery happens, ever so slowly.

 

A cat lurking in the grass. (Photo credit: Wikipedia)

 

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The voices are speaking again

I checked my email the other day and there lo and behold was the latest copy of the New York City Voices. This journal of consumer views had lain dormant for a while. But now they have arisen. I eagerly printed it out and shared it with a co-worker at the mental hospital. Then I also spoke about it to members of a group that I conduct. I will also try my co-workers at the community mental health program. The journal is mostly people sharing their recovery stories. That helps to broaden the usefulness and scope beyond New York. I was asked to contribute a story about veterans. Which was my initial focus. I did not have time. But I am wondering whether it might be possible to talk about my dual role working in community mental health and a hospital.

 

This is very ironic for me because of my longstanding campaign against diagnosis. There is also a deeper issue. My late brother was hospitalized many years ago. Long before any of the more modern focuses on helping people in the community. My brother was not helped and the decision to hospitalize him haunted my mother for decades.

 

I have a friend who also had a sibling who was hospitalized repeatedly. In that case, the person ended up badly as well. Then of course there was the infamous One Flew Over the Cuckoo’s Nest. My mother read the book for an assignment in college. She had some trouble understanding it. But I learned that the concept was very racist and sexist. The white men  were being emasculated by the nurse and held captive by the tall African-American men who were the orderlies. I never recall seeing the white psychiatrists who were the real power behind the hospital. Nor did I see the drug companies who were experimenting on people’s minds.  And wasn’t it ironic that only a Native American could save the white man by freeing him from the harm of electroshock therapy?

 

Given all this history, why would I want to enter the dragon and why should I want to share this potential horror? Are things really different? I was surprised to learn how diverse the work force is is at the Milwaukee Behavioral Health Division. I have also witnessed the impact of contracting out. The guards and the housekeeping positions are now performed by non-county employees as a budget cutting measure. Most of these workers are African-American. I have no idea what the Office of Consumer Affairs did before it was contracted out but that is where I work.

 

There is a County employee, who is a patient advocate, working in the office, as well. Then there are the nurses, cnas, social workers, occupational therapists and psychiatrists. I will have to study them a little more but I suspect most of the psychiatrists are white and many of the cnas are African-American. Many of the patients are African-American and there are interesting racial dynamics. A white patient referred to me as “brown man”, making no attempt to figure out my name. I told her we needed to end the conversation. There are white and African-American patients cursing at staff. And yet I slowly see signs of recovery.

 

So, this would be interesting to present in some context within the boundaries presented by confidentiality. I wonder if NYC Voices or some other publication would want to know.

 

One Flew Over the Cuckoo’s Nest (film) (Photo credit: Wikipedia)

 

Billing is how we get paid

I am growing in my professionalism and take great pride in the progress notes I write about the people I am assisting. But my latest focus is about something I touched on a few weeks ago. What made it possible for peer specialists to begin earning livable wages was the factor of billing for our services. So I want to make certain that I am billing as accurately and completely as possible. For those who want to do peer support without doing progress notes or billing, I won’t discourage you but I doubt that you can sustain yourself on that kind of strategy.

I paid very good attention in the documentation class that I took at Milwaukee Area Technical College. And I encourage my co-workers to read my notes and critique them. Part of the process of creating the notes involves estimating the amount of time we spend on each person. We work directly with people and on their behalf and we have to account for all of that time, otherwise we are doing ourselves a disservice.

As I am writing I am completely aware how very different I am from when I began my professional career as a librarian. I was a government employee and I could take work home and not be all that concerned with who was paying the bills. Suddenly, by chance I became involved in a grant proposal to help fund a program to improve our student retention. That was the beginning of my journey toward billing. And away from the ideology that had guided my early adulthood. That is probably why professionals rarely make good revolutionaries. We would have to develop a kind of split brain mentality separating our work lives from our political ones.

Having said that, the best way we can uphold our ideals of offering well funds peer support is by being as good with the numbers in our computers as we our in using our words with our peers. There is no shame at all in being able to pay the bills. In fact, the only shame would be in not making the effort because we were too afraid.

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The more we offer the more they resist

One of the most frustrating and contradictory parts of the community mental health field is that for a hard core individuals in crisis, the more services that are offered, the more they will resist. Show them opportunities to lives comfortably in an apartment and they will still show up at the psychiatric crisis services claiming to be homeless. If you listen, they will stop talking. If you walk away they will say you abandoned them. It was a common them in the report on the Milwaukee mental health redesign that people ended up in crisis repeatedly not because no one reached them but because they resisted being reached.

When we talk with candidates we need to find out their ideas and views about mental health because these problems will not solve themselves. We have families struggling with their relatives and going back and forth over whether to put them out or go look for them. Sometimes you can’t even find these individuals to be able to offer them help. I’ve seen people scream obscenities at their case managers. In peer support training we are told to roll with resistance, but in some cases, the resisters just try to roll faster.

By the way, we are used to talking with people about Medicare and Social Security as programs to assist the elderly, but they can be lifelines for people experiencing sever mental illness. Together with food stamps and section 8 housing vouchers they are the core of protection was can offer people. There are various levels of housing available that we can assit people in obtaining. The most important program around is people. People as peer specialists, family loved ones, friends and fellow travelers. Maybe the bus driver, the librarian or aother non-mental health professional who encountered a person in distress while on the job. How did you respond? What did you say?

Sometimes it can be like pulling teeth to get people to tell you what is on their minds. It may also be an unpleasant experience because of the person’s poor hygiene. Get over it. There but for fortune, go you or I. So even though this entry started out sounding rather bleak, upon further reflection, I know that I will still keep trying.

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Eating on the drug company dime, part deux

 

I had a busy, very effective day at work, visiting people and talking with them about their issues. I took one to a local center where I wrote on the sidewalk, “Peer support is great.” And no asked, “what is that old character doing with that chalk in his land?” Imagine that!

One of my more interesting moments came when I learned there was a drug company hosting a lunch at the office. My favorite motivator, free food! I finished my morning notes and got my lithe brown body into the Batmobile. In an instant I was presented with a choice between different sandwiches, sodas and snacks. Does the phrase all of the above sound familiar?

Don’t worry, I saved a couple of sandwiches for dinner. Now, where was I? Ah, yes, after (naturally) dropping some change on the floor and looking like Joe Doophis III, I recovered in time to hear an informal presentation about a medication. As it happened, this drug is competing with an anti-psychotic I had recently learned about. What was more helpful was that I learned about the effectiveness of the medication in a way I could accept. I still asked questions and I felt the answers were more satisfying than the ones I had received a couple of weeks ago.

Don’t get me wrong: I still hear the voices of people who would like to be free of these drugs. I take a couple of pills but they ar for physical conditions, so I’m not against all medications. After the lunch, I got back into my car and provided wonderful, empathetic listening, which I believe is the secret ingredient in recovery.

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Being change agents

Today I was in an all day training sponsored by Milwaukee County Behavioral Health Division called NIATx. It is intended to help introduce rapid changes into the substance abuse/mental health programming offered in Milwaukee County. It brought together consumers, peer specialists and clinical staff. Surprisingly I found that a peer specialist with my former agency had been hired to work in a targeted case management program. We did not really get along together but what was interesting was that we ended up seeking a change from the kind of peer support we had been offering. I told him that frankly I wanted to influence the thinking of case managers.

As a bonus I also met with a consumer with my agency and told her I was glad she had attended the event and I wanted her to feel her ideas were welcomed. I talked with her about the difference between the community support program and targeted case management. And I mentioned the new community linkages and support program and the comprehensive recovery services which Milwaukee County may begin offering to consumers. Community linkages will be provided through an agency called LaCausa  to reach people with recent in patient mental health treatment. Milwaukee County has taken steps to reduce   the number of rapid re-hospitalizations people experience.

It is my belief that the system can be reformed to begin including peer run services. At the training I was told there is a peer run targeted case management agency in Dane County called SOAR. The nurses, psychiatrists, peer specialists and others one encounters have all been consumers of mental health services. Why shouldn’t we be able to do something like that in Milwaukee County? And at some point, can’t we look at other peer driven services as an addition to what we are offering people? In our traditional way of thinking we are told to expect scarcity and that we can have services run by clinicians or services run by peers but not both. If I’m a change agent, why can’t I promote both types of service delivery systems?

Since I was at that meeting I have met people who are working with SOAR. One of the Grassroots Empowerment Project board members works with SOAR. She told me that the agency has an excellent racial diversity. When I was on Linked In, I met someone who had recently been hired by the agency. It would be an excellent idea to visit SOAR and explore how they work and whether their model could be adapted here.

My ideas continue to evolve. In the new model of strength based mental health we use the stages of change to look at whether the people we are assisting have have decided whether and where to make changes. Two of the main areas involve education and employment. I find so many people who dropped out of high school and have slowly begun going back to school. One of my prize pupils is taking notes, studying, going to classes and making me proud. I have some more at potential students who are taking placement tests and talking with me about enrolling. I may have many students by the time I reach my one year anniversary with out agency.

Similarly, I have people who have survived the DVR waiting period and are now ready to develop employment plans. This will improve my credentials as a change agent. The road will be uneven and steep but the rewards will be many. Forward. This is not your father’s mental health system. This is ours.

Now the real work begins

Having spent the past 2 days learning about men’s issues in dealing with trauma the next step is how to apply this information on the job. And more importantly in my personal life. I love to read and there were a lot of books recommended including works that dealt with relationship issues. I know that the co-worker who attended the training with me was very enthusiastic so I expect she will recommend that our agency followup on this. And there will probably be interest from a few other agencies so we could partner with one or two of them on a proposal.

Meanwhile I will be walking into the office today with a good haircut, and a clean shave, which was my first order of business. I spent time talking with a friend about the difficulty she was having with her relationship. It seemed that she had a lot that she wanted to vent. Tonight I will devote time to my relationship and go to the Y. It’s time to build a better me.

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