Minggu, 29 September 2013


I met a new client this week. She didn't come to me through the usual route by scheduling an appointment, having her insurance verified, or through referral from the managed care company. She came to see me because someone had told her I would help her find housing. When she came into the clinic asking to see me last week, our clinic administrator was confused--this wasn't the way new clients came in. I spoke to the woman briefly, and asked her to come back to see me at an appointed time, as my schedule was full that day. I wondered if she would come back.

She did come back. We talked on Tuesday. My usual first appointment with a new client is a comprehensive clinical assessment. I have a list of questions, including everything possible about your life, the bad things that have happened, the good, and every possible vice you may have and when you first partook of it. It is the entry point for someone to receive services in the public mental health system.

This woman was too scared to tell me anything. She responded to most of my questions with silence, so I didn't ask many. She told me she didn't have a home. That she lost her apartment in January. And that she has disability benefits. No Medicaid, but she has Medicare (Medicaid is the "golden ticket" for mental health services; Medicare pays very little and many providers simply do not take Medicare patients anymore--too hard to make it work in the business model of behavioral healthcare. Often, someone with Medicare and disability benefits from Social Security had a good work history before becoming disabled, and their disability benefit is too high to qualify for Medicaid.)

The feelings I got from her were of deep sadness and fear. When I asked if she had had mental health treatment, she said she had been in the hospital and was given a diagnosis of schizophrenia and that she used to have a counselor at OPC Mental Health Center (the old community mental health clinic). She had a hospital bracelet on her wrist, and said she had been to the ER for stomach problems recently, but she couldn't remember exactly when. I could read her name and birthdate on the bracelet, but the date of the ER visit had worn off.

I told her it must be difficult not to have a home, and her eyes welled up with tears. I asked her where she was staying now, and she wouldn't tell me. I told her that I didn't have a home for her today, but if she would come and meet with me, I would help her find a home. I told her that being in our clinic usually meant seeing a doctor. She said she would be willing to do that, but indicated she was afraid of medications.

We made our first connection. Will she come back to see me? Will she tell me her story?

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