Shootings at Fort Hood No Surprise

Sat, 7 Nov 2009 12:11:27 -0500

I was at work on Thursday when some office mates told me that there had been a mass shooting at an army base. They were convinced it was a terrorist incident. I replied that I thought it was a disaffected veteran who was being redeployed. We were both wrong.

It's common to think that we are not affected by all of the stories we hear of heinous cruelty. A military psychiatrist hears tales of soldiers sent back to Iraq or Afghanistan when they are not recovered from their wounds. Even more, he or she hears stories of young men and women reduced to a red mist, mangled, maimed, and afflicted with head injuries that are only poorly understood and most often untreated. How could this, day after day, not lead to some dark shift in this helper?

I am not for a moment defending what Hasan did. I've never heard of a mental health professional doing something like this.I mourn for all of the dead, and pray for their families.

Vicarious trauma, or the impact on the helper of working with the traumatized, is real. It impacts caregivers across the spectrum of being--mental, physical, spiritual. It can lead to Post Traumatic Stress Disorder and physical illness. We need to examine why we keep sending physically and mentally disabled soldiers back to fight. And we need to acknowledge that those who help them suffer too.

Take A Deep Breath

Mon, 12 Oct 2009 12:10:57 -0400

I read two things in my local newspaper recently that struck me forcibly. One was that my state has the dubious distinction of being 50th out of 50 in the number of psychiatric beds it has available. The other was that social work was the most poorly paid out of any of the majors one could choose.

It made me sad. Sad for all of the mentally ill people I see wandering the streets. Sad for the families who have fewer and fewer community resources to help with their troubled siblings and children. And very sad for the young, idealistic people who acquire massive college debt and then feed themselves into the maws of social services and community mental health, only to find that they will be paying off that debt until they retire.

The institutions they work for can be very dark places. Many community mental health centers do the best they can, but with such heavy case loads (anywhere between 50-170 cases per clinician or case manager) it is difficult to feel that one makes a difference. The work is exhausting and most frequently cannot be done in a 40 hour week.

The second point, that of a dearth of psychiatric beds, says several things. One is that insurance companies frequently exclude mental health issues from coverage, and so families cannot afford to pay for decent mental health care: hence no beds. Stigma about mental illness still prevails, despite increasing scientific evidence that mental illness is as biologically based and "real" as physical illness. And those abusively underpaid social workers and therapists will be the ones managing very ill cases outpatient, because there is nowhere for the patients to go.

At every level of the mental health system, acuity of illness is rising. That is because we are trying to care for people who should properly be accomodated at the next level: some outpatients should properly be cared for in day treatment; some day treatment people need residential care; and some people in residential really need to be hospitalized.

The bad news doesn't end there. Pay tends to flatten out as one works in community settings: that is, a social worker with 20 years of experience will not get paid all that much more than one with ten.

Assuredly, money is not the only reward of working with the disenfranchised and dispossessed. There is a sense of altruism, of making a difference. The social services and community mental health system rely on this to keep themselves going. They bring in newly graduated human services people, work them hard, and show little compassion for the impact on them of the waves of poverty, cruelty, waste, and grief that is the fate of most mentally ill people in our country. The lack of appreciation the system displays for its workers is a commonplace. When one is trying to support a family on the wages and consideration that this system provides, altruism can seem like very thin gruel.

estrelladalva's Open Salon Blog

Shootings at Fort Hood No Surprise

Take A Deep Breath