I've majorly violated my one big New Years' Resolution for this year, which was to live 12 months with no major life changes. In this case, though, I think a major life change was needed for my health (see previous post) and the health of my family. (A husband and a dog is a family.)
I've resigned from my job as a child and family therapist with the community outpatient mental health clinic. Hearing Shoes say (over and over and over and over), "We can sell the house, babe. We'll move back to Portland. It will be ok." made me realize how much sadness and grief and stress this job was bringing into my home.
It hit me really hard about a month ago when Shoes said quietly, "You can't go on like this. This depression is eating you alive."
Depression? Well. Not really. I mean, sad and stressed out and trying to rely on God's promises, but I know that I didn't match the clinical criteria for depression. You gotta watch how you label mental health around a therapist. But the fact that Shoes was
experiencing my situation as depression was a bit of a shake up. I have more to say about the job I'm resigning from, but I'm looking for a graceful, diplomatic way to own my truth and not slander the agency. And I will probably wait until I've fully left to write that post.
Before I resigned, though, I accepted an employment offer from a parent agency in a town a couple hours away who was looking to expand services in my county. So. I am still a child and family therapist. Now, I am a child and family therapist who will be providing intense, in home therapy to families who are either: 1) At imminent risk of losing their children to Child Welfare; or 2) Having their children returned to them out of foster care. This is gloves off kind of stuff. The kind of therapy that happens as a last chance resort to try to keep families together.
I'm going from one intense agency to another, I know. Here's the thing though. With the new agency, my maximum caseload is 2. 2 families. Now, each family gets 10 hours of in home therapy a week, but I will never be assigned more than 2 families. And paperwork is written into my work agreement. And here's the thing that my heart is the most grateful for:
I will be working from home. I will not be away from the house 12-14 hours a day. The implications this has for Shoes and I is huge. We might actually have space to start thinking about human children. We'll see.
I have 3 more client days at the clinic. This has been tough. Due to the very high turnover at the clinic, I am the 3rd or 4th therapist these kids and families have had in the last 12 months. These families are upset, and understandably so. It has taken all of my professional energy and clinical skills to be able to hold their disappointment, irritation, frustration, fury ... and grief and loss ... while experiencing my own. I have never ascribed to the school of thought that I, as a therapist, should be a blank slate. Especially not when working with kids and families with a history of trauma and attachment issues. (No worries, I'm not letting myself fall apart. It's been several days of lots of emotion, though.) It's also been incredibly difficult to professionally, yet with empathy, respond to statements such as, "That agency must be a really terrible place to work if they can't keep any of their therapists"; or; "I don't know where you're going after this, but it has to be better than (my agency)." (That last one was from a professional I respect and admire.)
I've been working almost every day, many hours a day. My last day with the current agency is Wednesday, and on Thursday and Friday, I'll drive up to the parent agency for initial training.
If anything, the past 9 months has taught me how important the health of the agency is in social work / social services. That's obvious, right? Maybe, but it's really difficult to assess that in an interview. I know to ask more questions early on now. I know to ask for what I need. I know to ask, "What makes a person a good fit for this agency?". Maybe I won't always get straight answers, but I can only do what I can do.
It's beautiful outside right now. I went into the agency this morning and worked on cleaning up client files. And then Rosie and I went to the dog park. It's time to start putting this behind me. It's time to start remembering why I wanted to become a therapist.
Oh, social work.
I have a dear, dear friend from graduate school I remain very close to. (That sounds more committed than it is - I've only been out of grad school for 9 months). We chat, he tells me about social services in Portland, I try not to get too homesick.
One of the things I love most about this friend is we both have a commitment to non-violent, respectful discourse. There is so much room to disagree and to think out loud ... because, in part, we are absolutely certain of the other person's heart and we know beyond a shadow of a doubt there is absolutely no attack on the other person in our differences of opinions.
This is our current discussion:
I'm exhausted. Whiney, I know. I'm supposed to work about 40 hours in my 4 day week, but lately it's been at least 50. Part of that is due to the switch over to kid therapy and taking on a new caseload (and a set of not so greatly kept files). Part of that is due to the fact that our community has no resources.
What does that mean, no resources?
When I lived in Portland and worked at the kid therapy clinic in NE Portland, we had resources. We had hospitals we could hospitalize kids to. We had 2 psychs in office to do med management. We had an Intensive Home Based Services team that was able to spend several hours a week with one family - helping them with case management and doing in home family therapy. We could refer parents to detox. We could refer families to homeless shelters. Sometimes it was tough getting families into services due to wait lists ... but they were there. There was hope.
We all know I'm not in Kansas anymore.
The nearest psych hospitals are at least 2 hours away and detainments can take up to 6 hours apiece. We have had an ad out for a psychiatrist for several months and there has been very little interest. Additionally, the interest that has been shown has only been for adult team ... getting local psychs to work with children is next to impossible. No IBHS team here. That's my caseload. And I'm full. As in, I have back to back 50 minute sessions scheduled all day long. That's tough to balance when the parents have more needs than my kids, because I see the desperate need for wrap around services ... and I can't offer that to them ... which kills me. There are no detox centers in my community. Nearest one: 2 hours away. There are no homeless shelters in my community. Nearest one: 2 hours away.
My dear grad school friend said, "Well, that's how it is here (in Portland). Things are tough all over."
I have absolute empathy that it's tough. It's tough for all of us. We're doing what we can with what we have, and it's never enough. I so understand that. But I don't think it's the same. For me, having worked in both communities, I can safely say that rural social work is tricky tricky. At least for me. We had a couple of case managers attend a SOAR training in Vancouver (WA - right next to Portland) recently, and they came back with their eyes wide open. They liked the training, but didn't feel it was necessarily useful for them. Why? "Because there are so many services over there. I mean, like, so many. We don't have any of that over here."
People are people. Social work is tough no matter what. I go out on a 181 to a house in rural Eastern WA and the cops are pulling firearm after firearm out of the house because people own multiple firearms out here. I go on a home visit and have to walk past people doing drug deals on the street. Some of the same safety concerns exist. Not all of them, and I get that. And I appreciate people who are doing the work in urban communities.
On the other hand, though? This is what I got to do this week:
* feed baby goats to establish client rapport with a new client
* hold baby rabbits, same purpose
* go on a walk in the beautiful valley by the river
* continue to establish close relationships with community colleagues (always a good idea to hold the only service providers in town close to you)
* see the fields start to turn a lovely shade of spring green on my drive in
It's just different.
I don't know how long we'll be out here.
I do know that it's greatly expanding my skill set.
I also know I sometimes that expanding my skill set is exhausting me.
Blessed be. It's different for all of us.
It still hasn't really left me, and I am in no way personally tied to the events in Newtown, Connecticut. (Not personally tied other than being a member of the human race, and thus, my heart breaks accordingly to the pain all families involved struggle with.)
I sat on our couch, with Shoes on one side of me, Dog on the other, sobbing quietly while we watched hours worth of news coverage. Shoes teared, too. There came a point where he softly said, "We have to get out of this house for awhile."
Because we knew we couldn't not watch. (And even as we left, we were fully cognizant that we had the choice to leave this pain for a bit.) As we drove away, we talked about when the words "mental health services" and "gun control" would pop up.
This post is about mental health services.
Gun control might be a different post.
I might skip gun control altogether.
We'll see.
The phrase that brought on this posting is the phrase: "We need better access to mental health services in America."
So before we start, let's be honest about myself as a writer. This post is in no way unbiased. I am a 34 year old, Caucasian, middle class, heterosexual woman who holds a Masters Degree in Social Work, specializing in community outpatient mental health. As a human being, I hold a ridiculous amount of privilege and cultural capital. I say that because I recognize it and I want to invite you to honestly call out my biases as you see fit if you choose to comment. I am completely open to that.
I know some of my readers have counseling backgrounds, but for those of you who might not, community outpatient mental health translates to: I provide counseling services to a population who is assisted by Medicaid/Medicare.
When Adam Lanza heartbreakingly caused so much pain in Newtown, one of the first things I heard was, "Isn't it a shame, the state of mental health services in this country."
1. Yes.
2. Let's be careful.
Let's be careful because the coroner is still waiting on the results of Adam Lanza's toxicology report to see if there might have been any psychiatric medications in his system. Initial reports seem to have initially suggested that Adam had Asperger's. Let's be careful - AND - let's be clear.
Disorders on the Autism Spectrum are not mental health disorders. Disorders on the Autism Spectrum are developmental disorders.
Violent behavior is not a characteristic, necessarily, of people who have disorders on the autism spectrum; while violent behavior may occur in people who have an autism spectrum disorder, the aggressive behavior is often directed towards the person him/herself and is often a result of being unable to effectively communicate needs, wants, frustration, etc.
Ok. We're good with that distinction, right? We can move on? It was slightly tangential, but it irritated me to no end to hear news sources incorrectly link autism to mental health disorders.
Now. Let's talk about the state of mental health services in my area. (Because I don't know what it's like, but I might be able to guess, in Wyoming. Or Texas. Or New York. Or Delaware.)
My agency is drowning. We are drowning in a crush of people who need mental health services. Our intake numbers are high. After intake, there is most often a waiting list to get on a therapist's caseload. Often times I have 6, 7, or 8 back to back appointments of ongoing therapy clients a day, which often get CANCELLED because we all cover crisis mental health calls as well. Here's the shocking thing: there are only 22,000 people who live in the county I primarily work in and just 2,000 people who live in the other county we serve. The State of Washington estimates it takes between 2 and 3 years for mental health workers to gain enough of the required hours to apply/test for mental health licensure. At my clinic, we average about 1.5 years. Even though the population is so low, the need is so very high. We have a disproportionately high number of people who live below the federal poverty line, are addicted to drugs/alcohol and who have severe (SEVERE) trauma histories.
Mental health services work best when there's a wraparound component, right? We do have a chemical dependency team at our agency. They are truly fabulous. We do not have a detox center in all of the county or a homeless shelter. Remember Maslow's hierarchy of needs?
So, tell me, in this rural county that has almost no services, how exactly I am supposed to address higher order cognitive thinking errors when what many of my clients are truly focused on is where they are going to sleep tonight in the 5 degree weather. (This is when I start to miss Portland, because, even though the homeless shelters could be difficult to get in to, they still existed. They were there. And many churches opened warming centers in the winter.)
Here's another thing. The clients we help qualify for Medicaid or Medicare (either food stamps or medical or TANF or SSI, etc.). There's an entire population of people we have to turn away because they exceed our limited income / state assistance requirements, yet, they find the cost of a private counselor to be overwhelming. We have a tiny grant to assist us with people who barely exceed the financial qualifications but can't afford a private counselor; I don't feel like talking numbers, but even that is insufficient.
The state of mental health services in America?
It's in shambles, dear hearts.
The boat is sinking and we're using teaspoons to try to empty out the water that's pouring into said boat.
I work with a talented group of mental health therapists. Seriously, show-stoppingly talented. Sometimes we work 32 hour shifts. We do not get paid well. We barely have benefits. We try to work on re-paying our student loans, but ... ha ha. We want to meet with our on going clients. We want to do the work.
There are barely any resources to do the work.
Often it seems like there are barely any benefits to doing the work.
Reaching 2 years as a therapist at my current agency is considered a true milestone.
So what do I do?
I write letters to congresspeople. I am there for my clients. I am there for my co workers. What do I do? I keep going to work every day, 12 hours a day. I pray a lot. I believe for the best a lot. One of the scriptures I hold on to from my old church days reads, "I would have lost heart had I not believed that I would see the goodness of the Lord in the land of the living." And so I believe that the goodness is for the living. The here and now. That change is possible now.
I want to end on what might seem to be a random note ... and that is: who is it that is needing mental health services in America? Who are
those people who need therapy?
I would like to introduce myself as a consumer of mental health services. I have struggled with anxiety intermittently for years (currently doing well with a combination of relaxation techniques and mindfulness approaches). Had therapy on and off in the past. Have taken a medication in the past (I almost identified which one, but then, remembering one of the goals of this blog is to NOT diagnose, treat or recommend, decided against it) for anxiety. I come from a family who struggles with severe depression. Many of my dear, many, and sweet friends have had: anxiety, depression, bi-polar, trichotillomania, ptsd, adjustment disorder, schizophrenia .... Who are these people who need mental health services?
It is all of us. We all do well when we all do well. So when we talk about the state of mental health services in America, I would like to remind all of us that we are not just talking about people I serve in community outpatient mental health (people who are -
quite erroneously - all to easy to demonize and blame for their problems). I am speaking about myself. My family. Possibly you. Possibly your family. Your neighbors. Your friends.
The state of mental health services doesn't look too hot. (I went to graduate school to be able to construct that well educated sentence.) But those of us on the inside do it anyway. And many of us will continue to do it. But if you yourself are concerned and you're wondering what could be done, do me a favor.
Do not get caught up in fear. Do not get caught up in demonizing people with mental health issues. (After the shooting, I had a FLOOD of calls from my regular clients, in tears, mindful of the fact that they have been consumers for years, asking if people really believed they were going to hurt them.) Do not suggest that all mentally ill people be hospitalized. Or jailed. If you'd like to be constructive, contact your state assembly-people and ask them, as they look at what budgets need to be cut, to consider the long range impact of cutting mental health services. If you'd like to be constructive, call some of your local mental health agencies (county mental health is often a good place to start) and ask how you might help.
And be well. And speak kindly. And act lovingly. To others, and also yourself.
That is also constructive.
... but it happens. All the time.
In 2008, I entered my first little courtship after my divorce. It was kind of cute. It lasted for maybe 10 cute little weeks. I respect the man it was with. We had different ideas about life. We had different ideas about where our little courtship was going. He broke up with me twice. But I was ok. After the 2nd time, it was high time for me to move on.
I'm not sure we agree on what happened (which is code for I'm pretty sure there is large disagreement about what happened). We have a lot of mutual friends, but this boy and I, we don't really talk anymore. It still feels a little awkward. But who's to drag things out? I moved to Portland and got on with my life.
I got this job in August and found out I would be helping to cover mental health services for not one but TWO rural counties. The other county is partway between here and the Vineyard Town. The other county is the boy's hometown county.
Now.
This isn't really a problem. Several of my present co workers know the boy's family, and know him, and have heard a little about what happened, but I don't waste a lot of time explaining myself.
It was four years ago.
It's all good and fine until you've driven to this other rural county three horrendous times in one night to cover crisis. I put 250 miles on my car that night (and 250 hard miles on my SOUL. Just kidding. Kind of.). In the morning, when I was getting a client ready for transport at the hospital, the county ambulance's team came in and who should be in charge?
The boy's father.
He gave me the look that said,
I think I know who you are and I think I know what happened. I was going to do the polite rural thing and re-introduce myself, but there just wasn't time. It just wasn't appropriate as we were discussing what type of restraints, if any, would be helpful.
Funny how in these rural counties you never fully put your decisions behind you.
I came home the next day and told Shoes, who laughed heartily and said, "Oh man. Who would have known that this would keep hanging around you?" Shoes doesn't care so much. He likes this other boy. Thinks the entire situation is amusing.
So here I am.
Back in Rural E Washington.
And even though I purposefully did not return to the Vineyard Town, the Vineyard Town still has a hold on me.
Well, blessed be, I suppose. Next time I'll just tell Bob the Ambulance Driver that I remember who he is. That's another rural thing, I think. You just have to own it and be out with it.
Horizontal linkages and such. Theory right down into practice. Sigh.
Only, it is.
But, it's not.
This is about community, but in my weird rambling way that you all are very used to, it's going to take me a bit to get there.
(Disclaimer: I understand all of the criticisms about football and I respect those opinions. This is going somewhere different, though.)
Shoes and I moved to Rural (RURAL) E Washington this year. Most of you know that. Our rural E WA town happens to have a major PAC12 University in it. Random, right? Our town's regular, non student population is about 30,000 (but the county's population is just over 40,000). This is, as I've said before, a company town.
(Editor's update: Shoes firmly believes that the year round, non student population is only about 7,000. I can't find this data anywhere, but Shoes is rarely ever incorrect about these things.)
Shoes grew up here, did his undergrad here, has always wanted to come back here.
Well, we're definitely here.
Shoes grew up watching Cougar Football. As in, season ticket holder with his father since Shoes was in the 3rd grade. I made him miss the first home game in something like 15 years last year when I asked him to go to a wedding with me in the Vineyard Town. I don't think I've been forgiven yet for that.
When Shoes was in law school in Seattle, he came home for every home game. When he worked in the Vineyard Town, he made every home game. When I moved to Portland, he did not come to see me on home game weekends. During my school breaks, I went with Shoes and his father to home games when possible. I'm not a veteran Cougar Football Fan. But, I have been going as I've been able to for 4 years now, and I went to all but one home game (and we went to one in Las Vegas!) this year.
Shoes loves Cougar Football.
Many WSU students and alumni love Cougar Football.
But in the past several years, Cougar Football has brought nothing but heartbreak.
You who follow the PAC12 know this.
They've turned "Coug" into a verb. A derogatory verb. As in, "They're going to
Coug it." (That does not mean things are going to go well.)
The school even adopted a new slogan a year or so ago: Undefeated Fan. (Because the team, well ...)
WSU hired a fancy new coach this year at the tune of 2.2mil a year. (Don't start. You'll be preaching to the choir.) At the beginning of the year, Cougar Fans were hopeful. Waiting. Anticipatory.
The season did not go well.
Defeat set in.
And then there was the Apple Cup.
Most state universities have this, I think -- some type of rivalry game between major universities. Apple Cup (because Washington grows Apples, right?) is WSU and UW
(and please don't get them mixed up because blood may be drawn ...). The last time WSU won was in 2008. I wasn't even dating Shoes then. We went this year, of course. We always go. Even when it's in Seattle, we go. We weren't expecting much. It hasn't been a good season. Shoes has been saying things he doesn't at all mean (things like, "
I'm done with Cougar Football. This is BS.") ESPN scheduled the game the day after Thanksgiving in a town where students LEAVE for the holiday. We were also expecting a low turn out.
And this is what happened. Fast forward to about 12:47.
Apple Cup 2012, WSU over UW, 31-28 in OT
(I tried to embed. It was disabled. Humor me, though, it's important to the real point of this post, which I promise ... I'm getting to ...)
I've posted about this many, many times, but the one thing I've always missed in my life is the experience of having a home town. A tribe. A tradition. Something I belong to. When Furney scored that winning field goal, something electric fried the entire stadium. Well. The Coug Fans anyway. The UW Marching Band stood there with their clarinets hanging from their fingertips and their mouths open, stone silent. Who could blame them? It was a surprise to all of us. Shoes (who is slow to show emotion) was literally jumping up and down with his hands on my shoulders shouting and complete strangers were hugging.
This is something they belong to. They shared in ownership of the experience of the entire season, and then shared in the experience of the win.
I've been having a hard time in this little town. And again, I've spent lots of time in rural communities, so it's not just that's it's small. Although it was just a football game (and in the big picture, it is, in fact, just a football game), it spoke to something that has been running through me for a long time. The need to settle down. The need to develop roots. The need to share in something and belong to something.
Coug Fans, I think, know this. (And let me just say that whomever shoved
UW player Sefarian-Jenkins does not represent the mindset of the fan base.) They belong to the each other. They belong to the University. They belong to the team.
Are there more important things in life than football? Sure.
Are there more important things in life than finding your own tribe? Maybe.
Are there more important things in life than sharing in life with others? World peace?
I'm not a Coug. But I do find myself settling into this shared experience and connecting with others. Maybe this company town has something for me, after all. Maybe here, which in many ways tops the list of odd places I've lived, is where I'll start to settle down. Maybe this is the start.
Isn't that a novel idea.
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