Tuesday, May 12, 2009

Knitting The Sweater While Wearing It

~Posted by Juliette Kelley~

Sometime in late 2007 I burned out. I can’t recall the exact moment but my best guess is that the culmination of my career charring flare was during the holidays in late December. My job had become so far disconnected from patients and the system of care that I knew I could no longer be effective for the patients, staff, or myself. So, I went to jail – literally.

Literature shows that the most important part of job satisfaction is the knowledge that the employee makes a difference. That’s not to say that equitable pay and working conditions are unimportant. But what gets most people out of bed in the morning is knowing they are part of a structure that makes the world a better place. I had not been feeling connected. Furthermore, as a member of the hospital’s burgeoning System Redesign Team I became exhausted by my inability to fathom how our system of care could ever be retooled and redesigned, given the local, state and national priorities.

I was fortunate enough to engage in a clinical hiatus as a Mental Health Clinician in the Martinez Detention Facility, or as most of us know it – the county jail. It turned out to be the perfect place for me to become reacquainted with the purpose of public systems and my career within them. Several years ago, the PBS series "Frontline" featured one of their programs on "The New Asylums" pointing out that jails provide most of mental health care in the country. In addition, unlike most of the nation, in jail, health care is a right. But far too often this access is frequently too little, too late.

What I learned from my time as a jail therapist is that regardless of the desire for redesigning, retooling, blowing up and rearranging our system of care, our patients often have nowhere else to see a doctor and get treatment. Rather than creating a false dichotomy of redesigns or provide good care, the job of the clinician is to knit the sweater while wearing it. In other words, make change happen and let clinical practice guide the changes. There are plenty of things wrong with public systems, but we must continue to provide necessary services while collecting data, looking at best practice, building teams, asking patients what they want.

I am returning to hospital administration at the end of the month and I will continue to work in the jail on a limited basis to ground myself in clinical practice. With a breath of fresh air and perspective, I will see you all very soon. I can hardly wait to show you my new sweater.

1 comment:

  1. 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 stratifications 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 murder 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 . . . .