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Mon Dec 17, 2012, 10:51 PM

Wanna see what some mental health providers are thinking right now? [View all]

This is a lightly edited (mostly to remove personal identifiers) piece that appeared a few minutes ago on a professional therapists board. I provide it here without additional comment of my own.

I'm very wary of the remarks I am seeing and hearing advocating for better mental health services. If your experience is like mine, you have come to feel that publicly funded mentally ill patients are among the most needy, and the most demanding; poorly compliant with treatment; protected from being required to reimburse clinicians for their failure to arrive at appointments; needing substantial amounts of unpaid collateral contact; at high risk for treatment failure; I could go on. If we provide service to these clients outside a clinic, we can expect to spend a fair amount of time advocating for ourselves to be reimbursed what we are promised, which is less than any private pay patient or any other insured patient, even with Medicare having recently cut all of our pay by nearly 10%. People are implying that if only Nancy Lanza had shepherded her son toward a therapist, all would be well. I have become vociferous in pointing out that we are not as omnipotent as the public and the press would like to believe.

We are quite vulnerable treating high risk patients. I fear that as we sit poised on the edge of the fiscal cliff with demands for reduced entitlements, behavioral health providers will be subjected to a double whammy of increased and unrealistic expectations combined with diminishing resources for ourselves and our most vulnerable clientele.

If you treat a person and that person becomes a killer, you're going to have a rough time ahead of you. You may well be seen as inept, malpracticing, failing to warn, failing to properly dx., failing to provide a proper standard of care. Treating borderlines is sometimes regarded as a dangerous profession. Treating people who feel homicidal can be a nightmare, though I admit that we need to do it.

As a practitioner, I feel ill-equipped to work with violent or potentially violent, anti-social and borderliney clients - as soon as I sense that that is what I am dealing with I am in dread... "What is this person going to do to me? to my family? to my fellow building mates? to my practice? to themselves? to others? to my ability to earn a living? to my free time? How dangerous are they? S**t!" I am frightened of them - how can I help them? I know what they are capable of. Because I do not have any other practitioners working with me, because I have no office staff - I am not inclined to work with dangerous types. Nor do I feel I have been properly trained or prepared to do so despite what most would consider a top notch counselor education program, having 2 licenses and always at least doubling my CEUs each year, participating in 2 local professional organizations and multiple forums.

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Reply Wanna see what some mental health providers are thinking right now? [View all]
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