Haunted By The Lack Of Support

I am not sure that this is the right place to express my feelings about the events that occured just 24 hours ago, but I have to write about it.  Of course I am writing about the school shooting in Florida.  First of all I would like to express my condolences to the families and all of the victims.  No one should experience something like this.  Children should be safe in school and no parent should have to worry about whether there child will come home from school.  No one should worry about going to an event and not know if something horrendous will happen there.

Anyway, as you probably know I have worked in mental health much of much life.  I have worked on both sides.  I did an internship at a forensic hospital when I was getting my Masters.  I was just talking with my neice about how guilty I felt when we met in the classroom to discuss our cases and experiences.  Another student was on the other side of the spectrum and was working with a mother who had a daughter that was brutally murdered by a “friend”.  I, on the other hand, was working with suspected murderers.  Many of these people are mentally ill and did what they did when responding to command hallucinations.  Of course that does not excuse them from doing what they did, but it is more understandable when you know this.  My neice was saying that she felt sorry for the kid that committed this unthinkable crime yesterday, and it certainly does not excuse him, but in reality it, too, is more understandable if you know what he was experiencing.  The news today said he had lost his adopted mother recently which may have been a contributing factor.  I am not condoning what he did.  He is a monster, but he is, also, a troubled person that obviously needed mental health.

The system failed.  I have seen this over and over in my many years in behavioral health.  The state and federal system fails to allow the mental health staff do their job.  How?  Let me tell you about the case that has haunted me for many years, and maybe I let the ball drop, too, but first let me tell you what happened.

I worked as an RN in behavioral health at a homecare agency for the last 18 years of my career.  As the years went by, the rules became more and more stringent.  Every visit had to authorized by either medicare at first and then it trickled down to the state level which is known as medicaid or T19 in this state.  Getting autho became more and more difficult to obtain.

I was assigned to this case, which was a young man with a diagnosis of psychosis.  He had been inpatient for awhile to restabilize him on medications.  One of the reasons for the referral was to ensure that he take his meds, since when he did not he destabilized again and became more psychotic.  When he was on meds he was without symptoms and able to function in society.  However, as with many psych patients he did not like the side effects of the meds and he felt good on the meds, so he figured he did not need them, and stopped taking them.  One of our tasks was to see him everyday to administer his meds ensure compliance and to moniter his symptoms.

When I admitted him to our services I asked him if he heard voices (had hallucinations which is a symptom of psychosis).  He said that he did when he was not taking his meds.  I asked him if the voices were positive or negative.  He said they were negative.  I asked what they told him.  He said that they told him to hurt other people.  These are known as command hallucinations and are usually obeyed as their is a consequence if they don’t.  For example, one of my patients in the forensic  hospital had attempted to kill his father and he did so because the voices told him that if he didn’t he would die.  Anyway, my next question to this new patient was whether he did as the voices told him.  He said that he tries as hard as he can not to, but sometimes he can’t not follow through and he goes after the other person or people.  We then talked about the meds and how they control his symptoms and how important it is for him to take them.  His reasons for not taking them are what I mentioned above.

His meds were ordered for twice a day; once in the morning and again in the evening.  I told him I thought we should see him twice a day to ensure he takes them as he should.  He did not object and said that was fine with him.  The orders from the doctor were for once a day which meant that I would have to get him to order twice a day.  I did not forsee that to be a problem and when I talked with him it was not.

However, there was a problem.  The problem was with the State, who was paying for his care.  I was sure that would not be a problem as the patient admitted that if he is not compliant the voices tell him to hurt other people.  The other reason that I was so sure that they give me autho was because it was right after the other horrible massacre at Sandy Hook had just occured.  I was wrong, however.  They denied it.  We could see him once a day and even an appeal did not help.

I notified the doctor and told him that we were going to have to discharge him as it was not a safe situation.  They were free to try another agency and appeal to the state, but we could not continue to see him due to liability concerns.  We had no way of ensuring that he was taking his evening meds.  So, we discharged him.

I went to my supervisor about this and asked him to help.  However, he did not and told me to go ahead and discharge him.  I could not believe that I was not going to get any support from him.  I have mentioned this in other posts.  Support needs to start from the top, but most often does not.  Even going to the next level did not help.

I then decided that I needed to do something or bring this to someoned else.  Our family knows a state representative fairly well from boyscouts, so I asked a family member to ask this person if I could meet with him to discuss this problem.  I could not believe that the case was denied by the state when 26 little children and staff had just been killed in another Ct city.  How could they deny this when he clearly said he was unable to control his actions if he did not take his meds.  Anyway, the state rep said that he could not help as it happened in another town than where we lived and that his responsibility was to the town where we live.   I was very surprised at his response.  I am a constituent of this town and he couldn’t even listen to my concerns and advise me.  We live around the corner from each other, so does he not have a responsibility to me?

At this point I just gave it up and moved on.  However, it has always haunted me.  Yes, I probably let the ball drop, too, but where is the support and here we go again.  Seventeen children are dead in another state.  When is there going to be support for Mental Health and for those needing it and those providing it?  How many more have to die before there is support on any level?  I still can not believe it and especially right after Sandy Hook.


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