Monday, December 17, 2012

On 'We Need to Fix Mental Healthcare in This Country'


The last several things I've on my Facebook (the NYT column on guns and civil society, the Atlantic's "The Secret History of Guns") been in regards to guns.  Now, a thought on another aspect of the circumstances in this country which contribute to the epidemic of mass murders.

People keep saying 'we need to improve our mental health system.'  This is true.  We've done terrible things to the funding of our state mental institutions and mental health care.  We need to work on our mental health infrastructure.

The oft-posted HuffPost article by Liza Long highlighted a rather interesting fact; it's hard to put someone in an environment where they can get serious treatment for violent psychiatric disorders other than by incarcerating them.  I can't claim to have a better alternative.  I can't say 'this must change.'  But I can say that this seems extremely counter-productive and needs re-evaluating.

But the infrastructure of hospitals and mental health providers is only a part of the American mental health system.  Another critical part is social workers.

I think you'd have a very hard time finding more than a very few social workers in this country who have a workload close to resembling what it's designed to be.  They are hopelessly overloaded.  I reckon it's damn near impossible for a social worker in this country to give most of their cases the time each are due.  The pay is miserable.  The hours (something along the lines of 24/7) are miserable.  The work, while often highly rewarding, can be utterly soul-crushing.  Did I mention the pay is miserable?

How ought we fix this?  Better incentives to work as a social worker?  Better pay? Benefits?

Perhaps.  But I can't see these as being very effective.  Being a case worker is just so incredibly difficult.  So thankless.  So trying.

A whole bunch of the young folks who enter programmes like Teach For America aren't able to carry through for the whole duration of their programme, and even more don't keep on teaching.  Working with at-risk kids can just be so rough.

And teachers are just confronted with the shit that comes up from cracks in the ground.  Social workers are called upon to plunge directly into said shit.

Moreover, history doesn't provide a very promising picture when it comes to maintaining additional investments in our mental health physical or human infrastructure.  Social workers and mental health facilities are often some of the first victims of austerity.

This isn't a very optimistic post.  I don't have solutions.  I might be grossly misunderstanding the situation of social workers in this country.

But the role I've carved out for myself as a participant in our nation's political discourse is not as a solutions man.  It's as a problems man.

Because when you don't understand all the problems, when you don't see all the factors contributing to something being FUBAR, when you don't see all the brushstrokes in the picture and all the stars in the constellation of shit, what hope do you have of finding a decent solution?

To our the leaders of our nation's political institutions and the mental health community, and to the social workers who serve as grunts wading through some of the worst things humanity has to offer; Godspeed.