Saturday, November 6, 2010

The Thin Sane Line

A strange thing happened when I was in my early twenties. I found myself at a local psychiatric hospital eating lunch on the lawn with patients. I was an employee with a newly minted degree in English and an absolute inability to find a writing job that paid enough to feed me. I was fortunate to find a job as a clerk typist at Western State Hospital in Steilacoom, Washington. I was hired as a temporary during an interim search for the retiring clerk typist. During lunch on the lawn one afternoon, something dawned on me. I am not so different from the patients. None of us are.

Police often speak of the "thin blue line." I think we ought to think of mental health as "the thin sane line." It's not that uncommon that normally healthy people get pushed over the edge by life events and find themselves at the mercy of our mental health system. Lately that system is pretty fractured nationwide. The resources for those who have mental health issues have declined severely. The number of assaults against homeless mentally ill people are at an all time high. In Pierce County, Washington, the solution has been to bring in the HMO of mental health, Optum Health. While Optum promises to make improvements in our mental healthcare system, one hundred and thirty county mental health workers have lost their jobs. Some have been hired by Optum, but at a fraction of their previous salary. One might say Optum is the WalMart of mental health.

Optum's "recovery" model of mental health is a bold one. It's based on the model brought forth by the founder of Alcoholics Anonymous (AA). The premise is this: employ those who have battled mental health issues to assist those who have mental health issues. It's a great premise, but one that if examined carefully is honestly based on economy. You no longer have to have a degree to be a mental health professional in any county that uses Optum as their mental health provider. You only have to have one year in recovery from a mental illness. Then, after taking a forty hour course you must pass a test to become a "peer specialist." Again, this system has benefits and pitfalls. Like AA, it is likely true that the best people to support anyone with a mental illness are those who have suffered one themselves. If we are honest, that surely includes most of us. Who hasn't suffered a depression after a loss of some kind? But the pitfalls are numerous.

First, the wages are significantly lower for those without degrees. The starting pay for a peer specialist is thirteen dollars per hour. That's actually not bad considering you don't even have to have a high school diploma. However, this has put those with degrees out of work. It has also placed those with high skills out of the profession of mental health care entirely. The impetus for this change has been a national campaign from the President's New Freedom Commission On Mental Health which states the system should be consumer and family driven. Again, this is a fine premise, but the reality is hitting our county quite hard. There is not a psychiatrist in the county that will accept Medicare or Medicaid for psychiatric treatment. Pierce County, like many others, has medication management teams only. Consumers go into these agencies and discuss medications only. So, like our nation as a whole, we have become a pharmaceutical dispensary machine. Even these dispensary agencies have had it with the Medicare and Medicaid billing issues. Some have gone out of business.

I went to the forty hour training to become a peer specialist. There were so many positive things about the training. Gone is the idea that some "expert" tells you as a consumer what to do. Instead, consumers have a say in their own treatment. That's not so bad unless you are in such denial about your condition you cannot make decisions about your treatment. Alas, Optum has a system for that as well. Consumers draft their own plan about their own treatment should they become incompetent. Again, a fine premise as long as you know how to write and articulate such a complex matter.

What bothered me about the training though was the complete and utter disdain for those who have become trained experts in the field. There was a collective anger in the room against anyone who has obtained post high school education. This anger led to my removing myself from the room as if I was some sort of alien being. I have a master's degree in education with emphasis in special education and psychology. Does this mean Optum will shun me? Well, certainly this company would not compensate me for my educational level if ever hired. And what about my colleagues? Would they also shun me as I walked along the hallways of their new facility?

It seems to me we have a dumbing down going on in this nation as a whole. Education is not really valued. I have heard tea partiers rage against our President calling him an elitist. There is no doubt our President is an articulate and educated man. I am not certain why this is held against him. The last time this country held collective anger against the educated was during the McCarthy era when those deemed "intellectuals" were literally stripped of citizenship. I see it going on again. Like others, I am alarmed.

I stayed at my job at the psychiatric hospital until the union made it clear I was not welcomed. The then director welcomed my skills and was heartened I had a college education. The union did not share this enthusiasm. I was told I was displacing other people from the job. I was pulled into a bizarre conflict going on with the union and the state. I also found this later as a teacher. While standing in the staff lounge at the school where I taught, I began to recite a poem. My then colleague said, "I had no idea a special education teacher would know anything about poetry." It dawned on me that I was a stranger in a strange land: America the dumbed down nation. We still don't invest in public schools to the degree we should. We still don't hold our children up to the standards of other nations. And now we have a much more poorly funded HMO running our local mental health care system. These are strange days indeed. -Alison Whiteman


NineInchNachos said...

Thanks for inspiring another cartoon!

Tacoma Gawker said...

Sure! Glad to have at least one reader!

Tacoma Gawker said...

Say, I try to make comments on your page but get looped around...put in e-mail....password (but may have forgotten it) and it spits me back in a loop. I love your comics!