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I was going to title this post “The extermination of advocacy:  How Community Mental Health Clinics (CMHCs) are being eradicated with the insidious help of the very providers in the system”, but, the title in itself turns out to be a post, so I went with the above.

Hmm, so anyway, where to start, well, let’s look at the definition of “disenfranchised”:


There are several ones I looked at, but the theme was always about politics first, so in this one, I like what it says just after the start: “The rules work against you, your rights are constantly violated, and you have little power to change your life for the better.”

That seems to sum it up for me fairly well.  I know I have been railing about those who ARE NOT seeking honest and appropriate mental health care of late, but, I have also met plenty of people who complain they are interested in the standard of care for their problems and needs, and aren’t given it by professionals who claim to be credible and responsible providers.  And, in my travels especially in the past 10 years, I know the complaints are legitimate!

You know what should be listed as terms in ITPs (Individual Treatment Plans, you know, those hideous bureaucratic monstrosities managed care entities forced on the mental health profession) these days:  enabling, indifference, and abandonment of patient behaviors and symptoms to just maintain the status quo.  Especially for those either without insurance coverage or those on MA (or in this state, PAC, which to me is a greater obscenity than being uninsured because PAC gives the illusion of coverage but then cruelly denies any specialized or acute care needs).

In my last 3 experiences working in CMHCs, they have been, well, too many undesirable examples of poor care interventions (and a few is too many in my opinion), not a global indictment of all the people at these sites, but, there were enough people who just either went through the motions of providing what they deemed care, or, some didn’t even have the courtesy of even trying to show an interest in their job description, but instead more like a “job depiction” which was quick to lead to hostility and false bravado to what they claimed to be providing when challenged by people like me.

What is really sad, and frightening as well, is the pervasiveness of poor boundaries, false diagnostic interpretations as much as efforts to engage the patient, and the sheer dearth of boundaries or sense of honest caring in “treating” people as patients.  Oh, and it gets lovely when a provider like me has to deal with the projection and deflection of such poor care efforts by providers called on the mat for not doing their job.  I mean, really, “if you (Dr H) would have given the patient the right medication, we wouldn’t have to worry about psychotherapy” or “the patient is Bipolar/ADD/Schizophrenic/personality disordered (really, the Axis 2 dx has been said more than a few times) and needs to be on meds, there are no psychotherapeutic interventions to offer”, what can you say of substance and impact to such a lame defense?

And the initial title I wanted to use at the top, it is not an exaggeration, there really has been sizeable displays of enabling, indifference, and sheer abandonment of care by providers who not only gain further employment after abrupt leaving or been fired from prior mental health care organizations, but at times administration defends and justifies such behaviors.  Incredible, one might say in reading this?  No, outrageous and indefensible are the appropriate replies.

So, my point, when I should be in the midst of a summer daydream and just writing about various CME articles to be reading to maintain my educational pursuits to be an up to date psychiatrist?  Psychiatry is doomed as it stands, no surprise or revelation to any who read at sites like this, but to have to broaden the doomsday attitude to the entire mental health care field, that is sad, and profoundly cynical and pessimistic, no argument to that appraisal from readers.

But, I write this post to both educate and empower those who are seeking care and not only want, but expect and deserve the standards of care needed for the mental health problems one is struggling with and in need of intervention.  This dismissal of therapy that is growing, in my opinion, logarithmically and just engulfing care efforts by honest and invested providers who have to unfortunately depend on collateral supports is just ugly and pathetic to watch and endure.

So, what will be the mental health care image by 2016, when PPACA is in full force and just further minimizing and discarding the care needs of the mentally ill who have to depend on CMHCs at the very least?


Yeah, a harsh image, but, is it really outlandish, when you see what is going on in current care environments I think are systemic across the country?

Well, I’ll be doing Locum care for the next year or so again, and be sure I’ll update the opinion, hopefully more optimistic, but more realistically equally pessimistic as offered tonight.

Well, at least for you addicts, you can read this below link and be glad you aren’t living in these countries, where not only wouldn’t you get any care, but might have to genuinely fear for life, kinda makes one rethink active addiction?:


Ain’t a nice read, take my word for it.