Knitting the Sweater While Wearing it...reflections from Miles Kramer

I couldn't leave this buried in the comments.

In response to Julie Kelley's post. Miles Kramer said...

I hardly find it a surprise that a break from the "Safety Net" spent in the one place where folks who fall through the chasms in the net are sure to end up was a reinvigorating experience for a safety net warrior. Not only do people count on us to provide safety net health care to all those in need, but the realities of our failures, waiting lists, treatment delays, service line stratification's and payment silos become quite clear at the back door of the jail on a Thursday or Friday night around 10:00 pm.

Correctional health has been, and ought to continue to be a significant part of our mission as a safety net institution. The clinical complexities and the microcosm of social inequities in health care and social service access are readily apparent in the correctional setting.

From women incarcerated for participation in the interstate commerce of drugs and sex to the mentally ill, too sick to ask for help, too stigmatized to be deserving of help until they become the very crazed murderer society has long ago decided they are destined to become. You'll see it all in jails.

I'm very proud that you went to "my gemba," and spent time in service of not only the under-served, but the comfortably ignored.

It will forever offend me that we send out advanced life support emergency services (sometimes even helicopters!) for the most acute medical events and the S.W.A.T. team for the most acute psychiatric events.

You did good in the jail! You now know that America already has a great model of single payer healthcare for all; all 2.2 million Americans incarcerated today. That's more folks behind bars with constitutionally guaranteed health care than the populations of North and South Dakota, Vermont, Alaska and Montana combined!!!

The follow-up to the "New Asylums," Aired earlier this month, it's called "The Released." On a day you're feeling strong, give it a watch . . . suffice it to say that being freed from prison for most is just a temporary decent into the impossibility of accessing the American Mental Health System . . . just long enough to return to the waiting arms and warm embrace and their state's department of corrections. Lather, rinse . . . repeat.

So for now, those of us in jail will continue to look up to the safety net above us with admiration for all they do along with a deep longing that they'd do more before patients come to our hotel, some to die, some to struggle, most to leave and come back again and again.

We'll Leave the Light on For Ya . . . .

Miles