A Typical Fifteen Minutes in the Public Mental Health System

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From my now defunct website, 2004, but still valid:

 

You are a psychiatrist, and you have fifteen minutes to hear this story, solve the problem, write prescriptions, and a do a progress note.

 

You meet for the first time a country-bred boy or girl raised to believe the American work ethic:  Work hard, and you will succeed.

 

Mike goes to work for a mill or factory, drives a truck, does welding, wiring, carpentry, or plumbing for a large company or contractor.  He loves what he does, but pressure to perform, conflicting demands, long work hours, low pay, and personality politics lead to stress, dissatisfaction, anger, and a constant sense of being exploited on the job.  This makes him impatient with details in situations where one slip-up can cause an irreversible, work-related injury.  He gets hurt on the job.

 

Pre-paid "benefits" and workmen's compensation kick in, complicating the problem with confusion, delay, hoops, and other obstacles designed by the insurance company or the government to keep as much of the pre-paid money as possible.  Meanwhile, our injured worker must try to get some benefit from the "benefits" that tied him to a demanding and unfulfilling job, and prevented him from leaving.

 

Now, to extract some return on his investment, he must appear as sick as possible; otherwise, health care for him is not a "medical necessity."

 

Obviously, he can't work.  If he tries to work at all, third party payers might claim treatment isn’t "medically necessary" after all.  So between doctor's appointments, tests, procedures, surgeries, and medications that are prescribed because that’s what insurance will pay for, he lounges on the couch and watches TV.

 

He eats, drinks, and smokes more.  His joints get stiffer as his gut gets bigger, and pretty soon he is wheezing on his way to the refrigerator.

 

Now, he really has something to complain about.  He's on pills for hypertension, cholesterol, diabetes, and pain, and he's depressed.  He goes on pills for depression, too, but they don't help, so he binges on alcohol, gets into a fight or a wreck and gets hurt again.  Meanwhile, his debts pile up, his wife is threatening to leave, and his children are in trouble at school.  He escapes into alcohol, crack, or television and becomes more accident-prone.

 

He applies for Social Security Disability, which he has earned through back-breaking labor.  To qualify for disability, he must convince his doctors and other treatment "providers" that he is not fit to work.  Bills continue to mount, as bureaucracy drags its feet.  He can’t mow his mama's grass for fear government spies will see him doing something useful and deny his claim. 

 

He watches more TV, gets more depressed, and the downward spiral continues.

 

Unrelenting debt and overhead tie him to a merry-go-round of desperate measures to meet obligations.  He hasn't the time, concentration, or resources to reconfigure his career when his personal world is in chaos.  He watches more TV, eats, drinks, and smokes.  He convinces himself and hears from everyone around him that he is worthless, hopeless, or just plain pitiful.  A loser.

 

He can’t afford payments on the truck he bought when he was working, and he can’t afford the gas.  The truck is repossessed, handicapping him further, because he no longer has transportation to any work he might get.

 

The threat of homelessness becomes real, because shelter is expensive. He stays with relatives, friends, or lives out of a car or camper.  As frustration mounts and self-esteem plummets, he alienates everyone close to him with outbursts of temper, violence, theft, or other anti-social activity.

 

Under this scenario, our workman has little chance of climbing out of his rut.  If he doesn't end up in jail or kill himself first, he becomes dependent on the state and gets his monthly check, provided he doesn't work very hard.

 

Thus he is assured a roof over his head and a few amenities, but he has signed away his right to pursue gainful employment.  Once again, he is duped, because he thinks he has won.

 

But he hasn’t because Medicare and Medicaid are ensnarled in bureaucratic tangles, and the government is bankrupt.   They compensate by raising the bar on disability qualifications, so our hopeless victim no longer meets criteria for his check.  He must get even sicker to qualify for government assistance.

 

Your fifteen minutes are up.  What is your solution?

 

Comments

Stone-Eater Friedli Added Jul 13, 2017 - 4:40pm
There is none. He should have checked in what society he lives earlier and left the place. I really have no other idea. Unfortunately most people realize too late that they don't have a future at home and emotions keep them from immigrating.
 
Because fighting such a system is impossible nowadays. You give yourself up or you go abroad. Many Europeans do that. They easily find work or create a company anywhere else, because they speak several languages and have work experience.
The Burghal Hidage Added Jul 13, 2017 - 4:40pm
Punt
The Burghal Hidage Added Jul 13, 2017 - 4:56pm
Sent you a reply on WP Kat, dont know if you saw it.
 
It seems, as you have oft lamented, that the solution to mental health matters is medication. That in large measure is an underlying cause to the opioid/heroin problem. The system has conditioned people to the idea that medication is the solution to their problems. When they get frustrated jumping through the hoops the self medicate. When it becomes to difficult to obtain the pharmaceuticals they resort to a cheap and plentiful supply of heroin instead. In many communities it is a real crisis. When I was young heroin and junkies were something you had to go to New York or LA to find. 
It is shocking how many rural communities have been seized by this.
Stone-Eater Friedli Added Jul 13, 2017 - 5:01pm
The system has conditioned people to the idea that medication is the solution to their problems.
 
*clap*
Dino Manalis Added Jul 13, 2017 - 5:14pm
Workers need work, because unemployment leads to more problems and unpaid bills!
George N Romey Added Jul 13, 2017 - 5:16pm
Katharine the suicide and overdose rate is soaring for middle aged people.  Between inadequate medical care and a bad job market (if you believe the government stats on unemployment I have some lovely snake and alligator free land to sell you in the Florida Everglades). 
mark henry smith Added Jul 13, 2017 - 5:32pm
Mike needs a good lawyer, not a psychiatrist.
 
Just kidding. This is why we need a public health system that doesn't make judgments about the reasons for getting treatment, but just treats when treatment is needed. If we had a public health system like Canada, Mike could go back to work doing whatever he's capable of doing, mowing mom's grass, or growing grass, and not fear being found out or arrested. And grass could help with his pain and depression more than alcohol, but it would not help his wheezing much.
The Burghal Hidage Added Jul 13, 2017 - 5:51pm
Mark if you want a public health system you pay for it. The big problems we have in medicine now can be attributed to the oceans of bureacracy and regulations from both the government and the insurance companies. If we are truly talking about health care, not health insurance, here is a novel approach. Instead of turning it all over to a collection of pinheaded scolds in some goverment bureau why not have the medical professionals run it? You know, the people who know what they are doing? The way it used to be?
Stop looking to government to be the solution to everything! Honestly! Look at their track record. How could you possibly believe that they could do anything other than take a bad situation and only make it worse?
The Burghal Hidage Added Jul 13, 2017 - 5:54pm
The prevailing mentality on the issue of healthcare in this country is like the Scotch-Irish curse: one half wants to get drunk and the other half doesnt want to pay
George N Romey Added Jul 13, 2017 - 6:49pm
Its not a question of running it but paying for it.  Our healthcare system as dysfunctional as it has become from health insurance still runs fairly well.  Leave the medical professionals in charge and fund it from taxes.  Quite simple.  It works for police and firefighters, right? When was the last time you saw some government flunky telling a fire fighter how to best put out the fire.  In fact, studies show that most doctors would be fine making less if they had more freedom to treat patients as they see fit not some pencil pusher trying in an insurance company.  
Phil's Personal Perspectives Added Jul 13, 2017 - 9:32pm
It sounds like the same story over and over again.  Elected leaders have been telling us for quite some time if we lower taxes and eliminate the safety net which is inundated with "fraud" the world will be perfect.  I believe every word here is true and some of it actually happened.  How do we fix it?   We need solutions not ongoing monologues.
Katharine Otto Added Jul 13, 2017 - 9:49pm
Burghal and George,
 
The AMA sold doctors out with Medicare, which is insurance.  The system has gone downhill from there. One problem is that the whole system turns on the doctor's signature, meaning nothing gets done if a doctor doesn't order it.  And the paperwork is out of control.  This is a method to make a human being accountable for risk, but it takes time away from seeing patients.  People complain and blame the doctors.
 
Another piece of the puzzle is that people--Americans, anyway--have been seduced away from personal responsibility for their own health.  It's a control tactic (according to me) to keep them sick and dependent. We tend to forget health is the natural state, and the body is a marvelous homeostatic mechanism, capable of self-healing to an enormous degree.
 
 
I contend the system needn't be as costly as it is. Most costs go to overhead, like insurance (including medical malpractice and hospital liability insurance), expensive equipment, labs, and other overkill that people have come to believe constitutes good care.
 
Why aren't people taught about the body beginning at a young age?  Instead, they passively subject themselves to professionals rather than trust their basic wisdom.  Well, the professionals are just "practicing," and know much less about healing than the public expects.  An almost mystical aura surrounds the doctor role, and they have definitely played into it.  Fact is, doctors aren't that much smarter than their patients, and it's dangerous to believe they are.
 
Still, I agree professionals should be in charge of health care, simply because they know the system from the inside out, and most really do want to help their patients.  That the lawyers and politicians are making decisions is akin to practicing medicine without a license.  They should be personally sued for medical malpractice.
Katharine Otto Added Jul 13, 2017 - 10:01pm
Stone-Eater,
Unfortunately, I tend to agree.  I've long considered leaving the US for a second-world country, where the lifestyles are simpler and more personal.  Maybe my friend Mike in the story should learn French or Spanish (or Russian or Chinese).  
 
Our bodies are our most valuable assets.  If we could learn to appreciate that, maybe many of the problems would resolve themselves.
 
Mark Henry,
Maybe Mike should move to Colorado or another rec pot state.  My WordPress post goes into the current "Opiate Crisis" and mentions the psychiatric community is taking a fresh look at the therapeutic potentials of drugs like marijuana, LSD and psilocybin. (katharineotto.wordpress.com).
 
 
Dr. Rupert Green Added Jul 14, 2017 - 7:28am
Is there learned helplessness somewhere here? Wonder if back pain can stop someone from sitting at his/her computer and make money. Then again, the schooling for such a job will be necessary. Excellent article that provides a perspective that many do not have. "It sounds like the same story over and over again.  
I parrot:  Phil's, "I believe every word here is true and some of it actually happened.  How do we fix it?   We need solutions not ongoing monologues."
 
I disagree, however, with the limiting of monologues if he is speaking about ours. Solutions can be generated from our monologues. Those who may think our voices cannot have an impact had better study Trumpism.
 
The first time I came to this country and had a tooth extraction, I was given 30 pain killers. I did not use them. Thirty years later, and at age 62, I take no pills.  Of course I do not smoke, do drugs, and such. I exercise.
 
My teaching job is not backbreaking, I know the benefit of living/working in another country, and the demand for foreigners with specialized skills. 
 
I now know the value of my teacher's union aided pension. Indeed NYC teachers have a million dollar pension. It is not as good as that of fire and police personnel, but we do not have the dangerous jobs they do.
 
Still, I ponder how foreigners can come to this country illegally and work in the shadows, with no health insurance, and eventually send children to college and own houses.  Survival of the fittest or the adaptable and the smacking out of the weakest?
 
Shit happens in nature that are essential for survivals (e.g., forest fire and its death and destruction), but as humans we cannot tolerate it happening to us.
The Burghal Hidage Added Jul 14, 2017 - 8:03am
Dr. Green -
 
I have read some of your other material and wanted to say thank you for sharing your perspectives.
 
Not to stray too far off topic, but your observation on illegals is interesting. I am not an advocate for open borders, but for different reasons than most. Illegals may in some instances be the beneficiaries of some government benefits, but there are more Americans taking these benefits. Whether they are legal or not the success of so many, as you have noted, is a demonstration of a certain darwinism, isn't it?
Conventional wisdom dictates that a growing hispanic population is to the benefit of the democrat platform. I think that is a risky gamble. Culturally most hispanics I think will grow wise to empty promises.
Leroy Added Jul 14, 2017 - 8:06am
You pretty much nailed it, Doctor K.  And, I would probably add in there a spouse who doesn't understand and demands to maintain the same lifestyle.  It all adds to the pressure.
 
Seems unjust, so, like Mark suggested, you head to a lawyer.  He's glad to take 33 1/3% of what you are already entitled to.  He can do absolutely nothing for you and still take his cut.  If he works hard, he may be able to get you more, but he has to get you at least 50% more before you even break even.  You have to pay for all the additional diagnostics.  How does the lawyer do better?  Connections.  There are doctors who will do as he asks.  It's a quid pro quo system.  Money doesn't have to change hands.  With all the rules and regulations, the odds are against you and you will likely be poorer for it.
 
They tell you that you will get 2/3rd of your salary tax-free.  You think that you will be ok, only to learn there is a cap and you receive closer to 1/3rd.
 
If you are not a faker and do what you can, the system works against you.  You already said that.  And, it is true.  Even if you want to work, maybe the company won't let you.  Maybe you are told to stay at home.  Once the required period of absence expires, so does your job.
Katharine Otto Added Jul 14, 2017 - 11:38am
Dr. R,
I think learned helplessness is endemic.  How many people (and animals) just give up when they get knocked down too many times?  I've claimed that in the US we feed failure and punish success.  It's as though "equality" means dragging everyone down to the lowest common denominator.  
 
However, the tendency to kick people when they are down is equally damaging to individuals and society. The pack instinct seems to take over, and people do things they wouldn't do alone.  
 
It's hard to generalize, because I immediately think of exceptions to everything I write.  To me, whether someone is legal or illegal is irrelevant.  All are still human beings, with human dignity, and the basics of health care--food, clothing, and shelter--are only expensive if you're supporting the overhead of out-of-control bureaucracy and incessant war, among other things.
 
 
Katharine Otto Added Jul 14, 2017 - 11:51am
Phil,
I agree we need solutions, and if you're referring to monologues that re-hash the same thoughts over and over, I agree about monologues, too.  I know lots of monologuers who don't seem to know how to listen or to consider points of view other than their own.  
 
I believe solutions lie within the problems, should we choose to see.  It seems everyone is so focused on the problems that the solutions seem out of reach.  
 
Since I began working in psychiatry, placement has been the most significant contributor to the mental health problem.  Someone who has no safe place to lay his head is generally unable to function in any forward-going capacity.  When the move began in the 1970s to de-institutionalize psychiatric patients, they ended up on the streets, and their number is growing.  
 
I also think about all those homeless veterans, when the VA facilities I've seen are enormous, on acres of land.  Why doesn't the VA take care of its own? Housing--even just a dormitory room--doesn't have to cost much.  I suspect the lack of housing is one reason so many people are in jails and prisons. They have nowhere else to go.
Dannl Yoder Added Jul 14, 2017 - 2:07pm
Gee, Katherine, The phone rang and I have onkyy three minutes left.
However, as one WB poster aptly said, " Freud made it clear, that a cigar was sometimes just a cigar"
I think that your delimna hers is just a delimna. Hope that helps.. Dang phone ringing again..Hello?
No this not the suicide hotline.just do it and shut up
Phil's Personal Perspectives Added Jul 14, 2017 - 2:49pm
Katherine,  I suggest we need to start by looking at the actual health care benefits the affordable care act created.  If people could eliminate the political biases that we each possess for one day.  The ACA is 2300 pages because it is comprehensive.  Since the first of the year many beneficiaries of ACA suddenly realized that they are beneficiaries.  The haves do need to share in this health care effort.  Our Congress needs to stop seeking ways to give the wealthy a tax break and the insurance industry a protected status.  ACA may have problems which we can fix if we have the mindset.  All of us need to understand healthcare is not a privilege for the rich.
Ari Silverstein Added Jul 14, 2017 - 2:49pm
“work hard, and you will succeed.”
 
There are no guarantees in life.  Sometimes our good fortunes is more to do with luck than anything else.  Hard work can only increase your chances of success. 
 
“Unrelenting debt and overhead tie him to a merry-go-round of desperate measures to meet obligations.  He hasn't the time, concentration, or resources to reconfigure his career when his personal world is in chaos.  He watches more TV, eats, drinks, and smokes.”
 
We all begin life debt and overhead free.  To the extent debt and overhead become unrelenting we only have ourselves to blame.  Drinking, watching TV and smoking are not how responsible people deal with strife.  So it doesn’t surprise me one bit the person’s world is in chaos. 
 
“Your fifteen minutes are up.  What is your solution?”
 
Who is the “you?”  The person who’s life has spiraled out of control, or me, the individual watching this person’s life spiral out of control?  Or are you speaking from a public policy standpoint?
Dannl Yoder Added Jul 14, 2017 - 3:02pm
@Ari. " sometimes, our good fortunes is more to do with luck than anything else."
Good point. Being born in Appalachia sure was fortuitous.
Being born in Palestine sure was luck.
Being born in Selma sure got the grill smokin'!
And you, Silver spoon, can we have your good luck story? You watching other lives spirel out of control, that is all Germans did.
Dannl Yoder Added Jul 14, 2017 - 3:06pm
And Ari, other than your opined whine, did you have a point?
mark henry smith Added Jul 14, 2017 - 3:23pm
Katherine, I am so gratified to be a party to your posts. Your perspective is as refreshing as a soothing breeze.
 
My comment about Mike needing a lawyer was facetious. Lawyers want a crappy system with lots of bureaucracy. It gives them so many more areas where they can find fault. This is where the blanket lawsuit comes into play. Sue everyone, culpable or not, basically throw the **** and see what sticks. And insurance companies, in tragic cases, even if fault can't be proved, might pay a settlement rather than go to trial, because it has been shown that juries are often persuaded to give huge awards on scant evidence, because no one wants to see a child suffer. And the industry makes a game of victimization.
 
Look, I have a friend who for years tried to get into accidents, kept a lawyer on retainer, because he'd been diagnosed with chronic neck and back problems. The condition didn't seem to hamper his golf swing, but as soon as anyone tapped him, he was in court wearing all kinds of braces, having all kinds of "experts" attesting to his suffering. And almost all of the people I discussed this with said he was smart. Why not get the money if you can? Who's it hurt?
 
All I could do was shake my head.
 
Over treatment, under treatment, the bureaucratic nightmare, the mindless use of antibiotics, pain meds, doing tests just because the fear of litigation hangs constantly in the shadows. The forces that benefit greatly from this system aren't just going to give it up because the government gets out of the way. They'd love that. It would give them even more power.
 
You want to change this for the better? Start with a center that gives out a health card for all citizens that can track all services they get, public or private, so we can really know how people are being treated and how the money is being spent.
 
And I agree with all of those who say that individuals have to have skin in the game, have some responsibility for their own health, but one of the huge problems is the unhealthy environments we allow people to live in, congested, bad air, bad water, bad food choices. We condemn so many of our citizens to poor health.
 
And a more healthy environment, doing practical things to limit auto traffic in urban areas, limiting spraying of toxic chemicals, bringing healthy alternatives to fast-food ghettos and teaching people about healthy eating and healthy living from day one just makes sense. But there are industries that thrive in this environment and they will fight tooth and nail to stop change.
 
Let's remember that a healthy environment isn't just good for us humans. It's a benefit to all creatures and I think they deserve consideration too in addressing health.
 
    
Michael B. Added Jul 15, 2017 - 12:28am
Funny, I knew someone that dovetailed with the post very closely, but got filmed by private detectives doing various physically-demanding things while supposedly being incapacitated; his court case didn't wind up going in his favor.
 
I think Otto von Bismarck summed it up very well:
 
"The real grievance of the worker is the insecurity of his existence; he is not sure that he will always have work, he is not sure that he will always be healthy, and he foresees that he will one day be old and unfit to work. If he falls into poverty, even if only through a prolonged illness, he is then completely helpless, left to his own devices, and society does not currently recognize any real obligation towards him beyond the usual help for the poor, even if he has been working all the time ever so faithfully and diligently. The usual help for the poor, however, leaves a lot to be desired, especially in large cities, where it is very much worse than in the country."
Katharine Otto Added Jul 15, 2017 - 10:39am
Thanks for all the responses, folks.  The problem of work-related injury is common, and there are no easy solutions.  Yes, some people do learn to work the system, but the system itself is dishonest.  And even if someone doesn’t drink, smoke, or do drugs, medical problems can ruin a person psychologically and financially, especially when bureaucracy delays promised help.
 
Probably no one would argue with the idea that the whole system is dysfunctional, but I’m in the minority that believes insurance—especially for routine care—only makes it worse.  Congress is composed of at least one-third lawyers, who are practicing medicine.  If they were threatened with personal medical malpractice lawsuits, as individual doctors are, they might back off.  The costs are out of control because big business (insurance, pharma, and biotech, for instance) and institutional lobbyists are angling to create massive dependency and generate huge profits.  The individual gets squeezed by all the profiteers, and this is the state of one-size-fits-all medical care.
 
To suggest individuals take more responsibility for their own health is not punitive.  It shows respect for individuals’ adulthood and right to self-determination.  Our bodies are our most precious assets, yet we have been seduced into paying others to take control, then resent it when they do.
 
Yes, we should teach children (and adults) about nutrition and self-care, but people learn best from example.  That schools have backed off of teaching physical education, and practical skills as in shop (not just for boys), and home economics (not just for girls), means kids never learn basic body maintenance if they don’t learn it at home.
 
Mark Henry, I appreciate the validation.  I sometimes wonder if anybody cares.  I don’t necessarily expect people to agree but hope to stimulate thought outside the traditional boxes.
Dannl Yoder Added Jul 15, 2017 - 12:17pm
Katherine: very thoughtful piece and exceptional in form.
May I offer some meager approach?
There is no answer to modernization.
In my community we had a blind man. We took turns plowing a large tract of garden so that he and wife could eat and put up for winter, feed horse and chickens, and have plenty to sell for cash. This is a community effort, not simple for a lone volunteer..once a year, our Bushoos would go to the hospital with a stack of bills ( from individual  visits, surgery and deaths) they would barter to to pay all in s lump sum. If works.
Are our people OK with this?
Yes. You see, we do not expect our neighbors to pay for HBO, 4 wheelers, Trucks and spending money as many do on welfare and insurance.
It is illogical.
On the other hand, insurance companies would bring in Federal killers armed with badges, tanks and snipers, if the hoi paloi try this at home.
Katharine Otto Added Jul 16, 2017 - 8:20pm
Dannl,
I'm all for the communal approach.  I gather that in cases like this, the helper(s) and helpee(s) know each other and participate voluntarily, as functional families might do. "Many hands make light work," as my mother used to say.  Also, shared overhead costs each individual less.
 
What discourages me about our system--not just mental health, but the social system as a whole--is that it is so de-personalized.  People pay taxes to support a government that then presumes to take care of, and take credit for, social benefits.  Now, even churches and charities--which used to help the helpless--have become non-profits and look to the government to provide the care.
 
As you correctly point out, big government and industry do everything they can to interfere with efforts at self- or community-sufficiency.  And, they really hate bartering, as it's so hard to track and tax.
 
Dannl Yoder Added Jul 16, 2017 - 8:29pm
The depersonalized system..thought provoking Katherine. Perhaps this had a starting point way back when?
Katharine Otto Added Jul 16, 2017 - 9:34pm
Dannl,
I don't know how or when it started, maybe forever ago. The advice, "Don't name chickens you plan to eat," from one of my chicken-keeping books, comes to mind.  It's the idea that predators can't afford to become too attached to their prey.  
 
Obviously, I'm no fan of government that taxes everyone to provide special favors to some (whether corporate welfare or social welfare or government itself).  Eliminate the middle-men, say I, and perhaps family and neighbors will have more time, energy, and incentive to help each other. 
Doug Plumb Added Jul 17, 2017 - 2:02pm
Clearly he needs councelling and moral guidance. Fifty years ago his congragation would have seen the problem and his preacher would have provided that guidance that comes from wisdom of the ages. Now we only have stupid, even if he does get councelling, it won't be from a moral authority.
Doug Plumb Added Jul 17, 2017 - 2:11pm
People are immature and even mature people need support once in while through the difficult times. Our society doesn't provide this and the families have been ruined along with conventional support structures.
  Kant writes on many of the points here regarding the overdependence we have on professionals in "What Is Enlightenment". Not only is he one of the worlds greatest philosophers, but his writings are packed with little tidbits of a wisdom that almost reaches into the beyond.
Dannl Yoder Added Jul 17, 2017 - 3:27pm
"Don't name chickens you plan to eat"
Succinctly stated.:)
Maybe that extends to giving people names.?  Just a thought.:)
Doug Plumb Added Jul 17, 2017 - 4:32pm
@Ari re "We all begin life debt and overhead free."
  We are born into debt and babies must accept vaccines as a consequence of being debtors, otherwise parents could refuse vaccines or ask docs to prove their effectiveness or make the doc responsible. None of this is possible because the baby is made a debtor by the parent who requests that the baby be a surety for a bond which is backed by a promise that everyone knows cannot be kept.
  Also, there aren't any lawyers, only attorneys.
Dannl Yoder Added Jul 17, 2017 - 4:46pm
@Doug! Wow! You are impressive! "Berth Certificate" anyone?
 
Katharine Otto Added Jul 17, 2017 - 8:56pm
Doug,
I wonder how helpful counseling would be.   A peer support group may be more helpful.  Having been a psychotherapist, I have come to doubt its effectiveness. The artificial setting makes it seem so contrived, and the one-on-one approach prevents seeing the larger picture, such as the living environment, other contributors to the problem, relationships, etc.  
 
I haven't read Kant, but agree with the idea that we rely too much on professionals, and the professionals as a group seem too full of themselves to be credible.  
Dannl Yoder Added Jul 17, 2017 - 9:50pm
@Doug. My compliment was real. I re read it and wondered if it appeared as sarcasm. No way.:)
John G Added Jul 18, 2017 - 2:59am
Romey. ts not a question of running it but paying for it.
That's the opposite of the truth. 
The question is are the real resources available?
A currency issuing government by definition has no financial constraint. And it's just fucking stupid to keep saying it.
 
The Burghal Hidage Added Jul 18, 2017 - 4:08am
Kat -
 
Re professionals...
 
I believe this attributed to Will Rogers originally:
 
Remember that the Titanic was built by professionals; The Ark was built by an amateur
 
wsucram15 Added Jul 18, 2017 - 7:22am
Social Security disability is VERY hard to get now. You have to be disabled not to where you dont think you can work, but where their team of people via a system of codes, think you cannot work.  Also get an attorney.
It is temporary and if you remember that, get the help you need medically and get on your feet as best you can.  Find something you can physically or mentally do and move on with your life, you have 3-5 years.
Thats my 2 cents...btw, its really difficult to do, but it is possible.
Katharine Otto Added Jul 18, 2017 - 2:32pm
wsucram15,
Thanks for the insight on Social Security Disability.  It has probably gotten worse since I worked in the system. Also, I've found the social workers in these systems spend most of their time getting people on SS Disability, and, when they can, make the managing agency the payee.  
 
G. Romey and John G.
I believe we could get much better value for the money we already spend, if the system got its priorities straight.  Currently, only a fraction of the money goes toward actual treatment.  Most goes to administration and the sub-contractors who manage the individual facilities.  I suspect there's a similar arrangement for many social programs, like HUD, in which the presumed patients or clients are used to justify an army of government or quasi-government administration jobs.
 
Doug,
I don't understand the connection between vaccines and debt.  Are you saying being born in the US makes you a member of the future generation that will be expected to pay on the national debt?  
 
Burghal,
My point exactly.  I've always believed people have the ability to be their own best therapists.  I regularly advised patients to keep journals.  Therapy generally consists of helping people find words for their feelings, which journals and writing do.  They are free.
 
And Dannl,
Not naming people you plan to eat pretty much summarizes my view about the absentee bosses, who want to squeeze as much power and profit as possible out of the arrangements.  They are amazingly disconnected from the workplaces they manage, even when their offices are on-site.
 
 
Tubularsock Added Jul 18, 2017 - 6:59pm
Well Tubularsock would suggest that Mike take a gun and wound his mental health administrator with his expressed intent to kill! But just wounds and then gives up to the police.
 
He pleads guilty and lives a contemplative life in meditation.
The state will provide for him and he can pursue his interests with the assurance that he will be taken care of but he’ll have to occasionally misbehave so he can maintain his lifestyle without the chance of that pesky parole looming over his lifestyle.
 
And now Tubularsock knows what you are going to say, “Prison? Who wants to live like that?” ........... On the outside it’s called a job with no benefits!
 
See how easy it all is if you think Tubularsock Thoughts!
Dannl Yoder Added Jul 18, 2017 - 7:04pm
@ tubularsock
Excellent think piece.
 
Katherine: spot on!
Katharine Otto Added Jul 19, 2017 - 12:00am
Tubularsock,
I've worked in a prison, too, and there are those "institutionalized" prisoners who like the three hots and a cot without responsibility.  It keeps them off the streets.  Our Mike might just have to commit a crime to get housing and free medical care.
Dannl Yoder Added Jul 19, 2017 - 9:54am
Katherine,
I have also heard that jose comes across the border South of us and needs to get to prison in order to obtain rites of passage, his tattoos and Gang name, where he will also learn a language Aborigines called " finger talk" do you know anything about that?
Katharine Otto Added Jul 19, 2017 - 10:59am
Dannl,
No, I don't, but when you have a bad system, people learn how to work it to advantage.  The only "finger talk" I know of is giving the people "the finger."  There's also the finger language deaf people use.  
Dannl Yoder Added Jul 19, 2017 - 11:12am
Katherine, OK. Thanks for your input. I read somewhere that prisons were infested with Gang members and yadda yadda...Mexico... Yadda yadda..rites of passage..yadda yadda...,:)
Tamara Wilhite Added Jul 19, 2017 - 10:46pm
You're leaving out any type of personal responsibility. Job is long and hard? Why not find a different job? Social Security contributions continue in any position, and health insurance is commonly available.
If you cannot stand the work anymore, why not invest in training of some type to move up?
Instead, the script is "he starts, he's trapped, he's injured, more trapped". He's oppressed and only pressed down harder, and that's not true unless you believe it is.

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