In the Profiles in Tremendousness series, I borrow an idea from the Daily Show with Trevor Noah to celebrate the best of the worst in mental health care. In this edition, I’ll take a look at some of the weird shit that’s gone on in places where I’ve worked, proving yet again that common sense really isn’t very common.
I used to work for a short-term crisis intervention outreach team. Because we were rarely in the office, each day the main office phone line was forwarded to one of the team clinicians’ cell phone. Then the powers that be decided they were going to transition this program into part of a new psychiatric urgent care centre they were starting up. Because the secretary would be answering phone calls that came into the urgent care centre, they wanted her to get practice on the phones ahead of time. So they decided to have her answer the phones for the crisis intervention team, even though 90% of the time there would be no clinical staff around for her to transfer the calls to. I brought up how potentially dangerous this was; what if a client called experiencing suicidal ideation? This was pretty realistic given that we were, after all, a crisis intervention team. Was the secretary supposed to talk the client through it? My email to the team was met with a derisive response from management that dismissed my concerns (and me in general, for that matter) as entirely unreasonable. So I guess it was supposed to be up to the secretary to help out people in crisis… Why not, right?!?
So, confidentiality. It matters. But at one place I work, there is a pervasive lack of understanding of where and when confidentiality applies. They are mad for initials, to the point of utter insanity. In emails and in client charts, staff are regularly referred to by their initials; no one ever stops to think that not only do staff not require confidentiality, but quite the opposite; staff are responsible for the care they provide and if things ever went sideways it would be crucial that the staff involved be identifiable. Also, staff will use a client’s initials when documenting in that same client’s chart. I asked some coworkers about this once, because it’s completely ridiculous; the client’s name is firmly, permanently attached to their own medical record, and it’s asinine to think there’s a “confidentiality” issue using the client’s name in their own chart. All these coworkers could come up with was that they’d been told it was necessary in case the medical record was ever subpoenaed. Great, so the management who should really know better are spreading idiocy en masse.
Now, I could rant at length about this photo, but instead I’m just going to let it talk for itself.
Interestingly enough, this is a “recovery program”, although apparently management thinks I’m just too darn recovery-oriented. I told management that I believe clients are the experts in what they are experiencing… Gasp! Well, that’s just not acceptable! After all, we’re the nurses who know best, and who are they?! … I believe in empowering clients…. Gasp! No, they need us to tell them what to do! … If a client asks for a prn medication, including a benzo, and I think it’s appropriate because they’re experiencing distress, then I’m going to give it… Gasp! No, we don’t give benzos here! … But the client has a doctor’s order for it … Gasp! But you still shouldn’t give it! Benzos are bad!
The non-recovery recovery approach leaves me frequently shaking my head.. Clients are regularly discharged to places they don’t want to go, including cities they don’t want to live in, because “the team” decides that’s what’s most appropriate. There are arbitrary rules galore, and if a client isn’t falling into line, they meet with “the team”, which from what I can gather is like the bloody Spanish Inquisition: a roomful of “the team” stacked up against a defenceless client.
If I sound bitter, it’s probably because I am. This kind of insanity is everywhere, but it really runs rampant at one of the places I work now. Unfortunately, a change of job isn’t feasible right now for a number of reasons, so all I can do is soldier on. And maybe try to find a little humour in it wherever I can.
My book Making Sense of Psychiatric Diagnosis breaks down the different categories of DSM-5 diagnoses, explaining the diagnostic criteria and providing first-hand stories of the various illnesses. It’s available on the MH@H Store, as well as Amazon and other online retailers.