~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.