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Mental Health and Addictions: The kind of Good, The Bad, & The What the Hell

Hello. My name is Roxann Camparone. Most people call me Rox. I run a private practice in Winfield IL. This is my first ever blog. I decided to write this blog today because I wanted to talk about things on the front lines of treatment. In addition to being a licensed mental health professional (LCSW), I am also an addictions professional (CADC), a distinction that I have had longer and have probably more accolades in than general mental health, despite being a specialist in both areas for the past 25.5 years. Anyway, this summer I have had some real highs and lows with clients in my practice in the mental health, addictions and cooccurring disorders areas. One thing I have learned or re-learned is that the system for these clients is broken beyond belief. The lengths that clients have to go through to get the proper help that they need is unbelievable. A prime example is an addictions client that wants to get into detox, cannot get into detox without being intoxicated. They cannot be admitted if they drank earlier that day, they have to have drank within the last hour or 2. The other part of that is that there are 4-7 day waiting lists to get into detox programs. Anyone that has spent time with an addict knows that you have a finite amount of time to get them to agree to go to treatment. So, this waiting period is counter productive. Then I remember, when I worked at a local Chicagoland program that would discharge clients from Detox (5-7 day program) and put them on a 30-60 day waitlist for a 28 day Rehab program. Clients would be required to call daily or they would fall of the waiting list. Many of them would need to be detoxed a couple of times while they waited to get into rehab. Then when I worked in a Drug Court program, I remember another local Chicagoland program had a waitlist for clients that was 90 days minimum. Same set up, call in daily. Except, they had an automated system. Clients, never talked to a person, they punched in a code. I thought about it for a while, any client that can stay clean for 60 or more days, does not make ASAM criteria (the standardized criteria that addictions professionals use to place clients at the appropriate level of care) for rehab services. The whole thing is crazy. The mental health side isn't much better. Especially for adolescents. Adolescents have to fail at like a bunch of inpatient treatment. So like be hospitalized 5 or more times in a 6 months. Hospitalized=go to the psych ward and stay a week. Because if your child is suicidal, they are only going to stay a week in the hospital for an attempt on thier lives, until the crisis is stabilized. Then they will be transferred to PHP (partial hospitalization program), which is a day program for 2 -4 weeks, and then stepped down to IOP (intensive outpatient program) which is 12-9 hours a week for 2-4 weeks and discharged. Upon discharge you may be given a referral to a psychiatrist (if you have Medicaid, good luck getting one) and a therapist (unless you are referred to me, good luck, you will be on a waitlist again or get someone that doesn't know what they are doing). Which is why most of these kids fall through the cracks. These seriously messed up kids need residential services. Which is longer term inpatient treatment services. With a team of professionals working together on these kids' issues. Laser focusing on thier issues. Residential programs can be 30-90 days and up to 6 months if they are done correctly. Some can be longer depending upon the child's issues. SASS is suppose to follow these kids, however, they are understaffed and underpaid. They are also hardly ever alerted until the kid is on thier 6-7th hospital stay. Then you have to have a pushy parent to get anything from them. They have resources to give. They will pay for your child to go to a DCFS kid warehouse residential for the next couple years and not get better. They will not help you if you have insurance and you find a residential placement that will help your child thrive. Even if you are asking a help with a month or a couple weeks. However, they will help with sensory items once the kid gets out of residential. And Equine therapy. But not any positive, non warehousy residential placement. Why? I could not tell you. It is a mystery that continues to haunt me. Finally, there is the issue of psychiatric hospitalization in the first place. I have just come off of working 12 years in a hospital without a psych unit and with the nearest psych unit being over 35 miles away. One thing I can say is that something has to be done about that system. The longest I ever saw someone stay at the hospital I worked at was 2 weeks in the emergency department. He made the criteria every day, without fail, because he had no grasp of reality and often stated that he would harm himself or others. He was the real deal. Not everyone is this guy. Many times patients that met criteria 2 days earlier, don't make criteria on the 3rd day. Which means they have a chance of being released. That always made me nervous. Not that every person should be kept, but there were certain people, I didn't trust what they said. One thing I have notice in my time in this field is these kind off things have not gotten better they have gotten worst over the years. 911 caused a lot of trauma for people, that we as a nation have never recovered from. The on going shooting, have continued to cause trauma for pockets of people where it happens and where it has happened before that time. The election of Donald Trump to a certain extent has caused a level of trauma among some people. For several months after the election, people were coming into the emergency room with severe anxiety/panic attacks. In some cases, people became suicidal, because of the election and had to be hospitalized. I'm sure the 2020 election is going to re-ignite that wound. Substance use has been substantially up since 911 and related to economic downturn. I'm sure there was an increase in substance use related to Trump's win in 2016, but data was not generated that I was aware of at this time. Anecdotally, people appear to be getting sicker than they have been in years. Ten years ago, I asked the question/statement to a peer regarding the level of toxicity we were seeing in clients. I noted that I remember girls my age in the early 80's engaging in self-injury. Burning and cutting things in thier arms. It was rare, but it happened. I think about, what if that girl had a daughter that engaged in self-injury in the late 90's-early 2000's as a teen. Then she had a daughter, and that daughter is a pre-teen-teen, and she is self-injuring. That is 3 generations of self-injury. We can actually start studying this for a gene, nurture/nature, behavior patterns that may be passed down, does the cutting evolve, does it get worst/better, is it more a compulsion/addiction, does it morph into something else, etc.. My colleague just shook her head. I guess I'm kind of more of Sherlock Holmes of Social Work, that others. I want to know, it may helps someone. My colleague didn't have an answer for me on that issue. I guess it like I don't have an answer, or even a suggestion as to what to do about the complete mess that is the mental health and addictions system. What I do know is that changes need to be made. It is a broken system and it is harming people, not helping them. What do you guys think would be a way of fixing these kind of things?

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