When ACS refers a case to us, there are certain things they want done. (Most often, these are things we don’t do. But that’s for another blog…) A lot of times, it’s counseling for domestic violence, sexual abuse, or substance use. These don’t apply to everyone. But one thing is constant. Everyone in the family–parents, kids, household pets–should have a psychiatric evaluation.
I’m rarely against an evaluation. It can’t hurt, right? Well, I guess anything can hurt, but the professional would have to be a real idiot. Surely there aren’t any of those. I think our kids are overdiagnosed and too often prescribed serious psychiatric meds but evaluations…why not?
There are a few problems, of course. Some parents don’t agree with them, some kids think it means I think they’re crazy. The number one obstacle, though?
Where the fuck are they supposed to get this done?
With the health care debate raging in this
backwards ass country, I keep hearing about these “free clinics” that one supposedly trips over on any stroll through the ghetto low-income side of town. They’re doing free well-child visits and tossing out birth control like Gobstoppers at Willy Wonka’s factory.
Unfortunately, they don’t exist. Most of those “free clinics” actually charge Medicaid. You can get urgent care, not ongoing treatment.
This is also true for mental health clinics. In my first months on this job, I thought they were a myth, like Sasquatch, or the G train. But they’re out there. They’re just hard to find. It’s especially hard to find one that takes your insurance. Sure, everyone has Medicaid, but most people also have supplemental insurance. This place takes straight Medicaid, not Health First. This place only takes blah blahdiddy blah…
Most unfortunately, we don’t have mental health staff here at anonymous agency. We’re social workers and case workers, but no doctors. I can do family counseling, play therapy, which is all good stuff, but I can’t prescribe Ritalin. No matter how much I may try. This means that we have to refer out.
Until recently, we had a connection with a nearby mental health clinic. They came by when they felt like it to collect our referrals, and our clients were able to get appointments within a couple of months. To be honest, I thought they did supbpar work. But we had to take what we could get.
That relationship was terminated for some reason that hasn’t been explained to any of us because we’re not important. Now, we’re back to the old referral process.
Agency names have been changed for my amusement.
I call Shining Time Mental Health Station to refer a nine year old girl and a thirteen year old boy. Their mother is also to be evaluated, but I don’t mention that at first, as I don’t want to seem greedy. No one answers, so I leave a message. I do this fourteen days in a row, while also leaving messages at Miss Kitty Fantastico Memorial Mental Health Center and St. Mungo’s Center for Nonmagical Mental Maladies. No one will answer me, and I start to take it personally. I leave decoy messages, telling the intake worker that she’s won a sweepstakes and needs to call me immediately, or saying that I’m holding her puppy hostage. Nothing. That woman does not care about her imaginary millions, or her puppy.
At some point, I give up on St. Mungo’s, because they don’t take this family’s supplemental insurance. Miss Kitty Fantastico is no longer seeing children. That leaves me with one in their area. Oh god.
Finally a coworker sees me sobbing into the phone, and mentions that she has a contact at Shining Time, who might help. I get my hopes up (always a mistake) and call. Of course, this person is a domestic violence specialist only. Could you encourage their dad to stop by and rough up the mom? OK, in that case I can’t help you. Let me transfer you to our intake worker.
Next, I try the child study center at St. Anastasia Beaverhausen Hospital. I call their general intake number, and am given the option to press one for the diabetes program, two for women’s health, three for dental, all the way to nine for foot problems, but no child study center.I start cursing into the phone, hoping that this will cause them to connect me with a real person (it works with FedEx) but all this gets me is some looks from my coworkers. I hit zero for all other calls, and am told that my call is very important to them, but there are six other callers ahead of me. After an hour, I begin to doubt the importance of my call. Someone answers. I ask for the child study center. She transfers me to the foot center. I ask for the child study center. Foot lady transfers me back to the lady who transferred me to her. I finally get the child study center after three more rounds, only to be told that they aren’t accepting new clients for five months. Can’t I put my kids’ names down now, that way in five months they can have an appointment? No, it doesn’t work that way, because we say so. Oh.
While I’m chasing my tail, there are children who need help and aren’t getting it. Counseling, play and art therapy, are crucially important to their well being, and I do that. But when there are things like PTSD, ADHD, bipolar disorder, or a family history of schizophrenia going on, they need to see a doctor.
People in need can always walk into the ER. We always hear this from people who don’t want to pay for our frivolous health care, and it’s true. They can walk in, sit down, and wait for hours. Wait, and wait, and wait. Often they choose to leave. Generally, if they aren’t actively suicidal, they don’t get to stay. I once got frustrated enough that I asked a mobile crisis worker if I should wait to call back when my (pregnant, schizophrenic, drug abusing, cutting, but not presently suicidal) client was setting herself on fire.
In retrospect, that was too far. This is not how we get what we want.
If a client is admitted, they’re often transferred to a different hospital, particularly if they’re a child. Depending on insurance, this can take forever. Not literally, but just about. There’s a sort of time suspending limbo you enter when you walk into an ER.
One of my teen girls who had attempted suicide more than once wound up being sent to a notoriously unpleasant (to say the least ) psych hospital in Brooklyn. They had an available bed and would accept her despite not having insurance. Her mother was afraid to send her there, and didn’t want her to be two and a half hours away, but she did it because she had no other choice.
I don’t think I need to point out the irony that the mental health system in the Bronx has driven me a bit insane. I’m glad I get to absorb this frustration for the parents I work with, honestly, because I can’t imagine that they could do this on their own while also worrying about everything else going on in their lives. But it’s infuriating to see how difficult it is to get someone help. Are they a danger to themselves or others? Yes, but not enough of a danger. Come back when something tragic happens, so we can all blame the parents for not having done enough.
We are tragically failing our people in need when the only way to get (temporary, kinda-ok) treatment is to be brought in slitting your wrists.
I wish I could end this by offering a solution. All I can say is that we need more, and we need better. Prevention is almost always the answer, says the preventive worker. Maybe if some of those earlier evaluations and mental health treatment could happen, we’d be taking fewer trips to the ER.
But what do I know.