I
woke up to a grey Saturday, the sky, a pane of dullish ashen, the sound of
planes going towards La Guardia or Kennedy, descending bellow the cloud line, as
they approached their destinations. The street was quiet from the dining room
table at which I wrote, the constant “hum” from highway 278, a block away, only
heard from the other side of the apartment. In the house, all slept and I got
up to complete some notes, an unending and infernal part of my job, the clichéd,
yet so apropos “bane of my existence”.
I
am a clinical social worker at a hospital’s mental health clinic situated in Brooklyn,
a non-profit, still somewhat independent, a unique institution with no formal
affiliation. This makes little difference, I know, for I speak to other
clinicians who practice at other hospitals, private, public and city run. It
matters little. We have all become assembly line workers in the factory of
mental health.
I
completed the three short notes, from a week before, lest they “lock”. When
they lock, it sets in a process, an obligatory reminder email, from one of the
managers, “cc’d” to at least five other people, all supposedly important, all with
laden titles, full of acronyms whose meanings are unknown to all, but the
proprietor, yet add gravitas to a name and a role in the factory. As I was writing, after a well-rested night,
with the day full of promises ahead of me, I realized that the content, the
depth and the writing were unlike that of most other blurbs, that provide a
summary of a person’s mental status. No hasty, badly composed sentences, repeated
ad nauseum, a sort of rubber stamp to ensure that the hospital is reimbursed
for a patient’s psychotherapeutic visit.
As
a clinical social worker, I spend 30 or 45 minutes with individuals and using
various methodologies, I attempt to bring solace, clarification or just provide
some company to the many troubled souls that struggle to rid themselves of daemons,
bad choices, and bad marriages, mean children and mean parents, poverty, and
racial, gender and legal oppression. I am humbled to be the trustee of horror
stories and strive to lighten the load of trauma and misery. Each individual a
universe, unique and rich in diversity and exceptionality, each encounter a
rich tapestry of interwoven tales, brought to life by their words, at times
almost poetic and lyrical, most often devoid of joy, devoid of life. I put much
effort into comprehending and grasping the full of the person’s potential as
well as possibilities. I toil to fulfill the other responsibilities, the
bureaucratic drudgery, the clicking of endless buttons on a form, the phone
calls, the emails, the forms.
I
am a unionized clinical social worker, paid to work 35 hours a week, with two
15-minute breaks and one-hour lunch. That’s the hypothetical, the agreement
between my union and the hospital. Yet, I take no such small breaks, eat a
harried and hurried lunch when I eat at all, and carry a load of on average 100
people, for whose lives I am partially responsible. I see them at the clinic but
inevitably bring home paperwork to complete. At the facility, I put in at least 50 hours and
live with a constant dread of not having clicked a button, of not having made
another phone call, of overlooking the sadness in someone’s eyes, of not fully
paying attention, of not having been totally and completely present and
mindful. I write rushed notes, just the obligatory, no depth, no conveyance of
the interaction that just transpired. My mental health and that of many of my
colleagues becomes compromised, the risk of burnout or empathy fatigue is high,
yet the machine hums along. Every day, every hour, I strive to provide the best
clinical and empathic care. Nonetheless, I am always behind on paper work, risking
disciplinary actions. No one speaks of the quality of the work, as it’s all
about quantity. I am privileged to work with a mostly exceptional group of
professionals, and I love what I do. I have also been witness to shoddy and
rushed work, clients who deserve better but don’t know what to expect.
The
turnover rate in psychiatry is very high, where constancy is most needed. We
appear surprised when sequential Wars on Drugs and on Depression and on Obesity
are wars lost. We do not invest in prevention and we run the workers into the
ground. Mental health work is not valued in this city, it is not valued in this
country. Yet, this is a profoundly unwell society and the signs abound. Mental
health cannot be run on Fordism, with increased production, in less time and
with less resources. There are plenty of resources, but they are all going to
the pharmaceutical companies who charge 10 times as much for the same
medications in this country as they charge in the European Union and other
parts of the world. We have vice presidents of vice presidents, sub-directors
of sub directors. We have more bean counters than we have beans. We are
overseen by so many agencies that most clinicians do not know who does what,
when, and how. Those too, are profligate with acronyms. Our mental health
system is very ill, and the people who most suffer are those who most need it.
Anytime, you hear of how many people died from overdoses or from suicide, look
up a few statistics. Connect the dots. Follow the money.
By
the way, in way of clarification, my license does not protect me. I have a
license so that the clients are protected.
Manuela P. Mage, Woman, Mother, Jewish, Companion, Social
Worker, World Citizen, Friend, Reader…