MANDATED TREATMENT AND RED TAPE by Melinda Nichols Balliett

I spent the day with a client who has schizophrenia and is medicated only because it was mandated he be medicated when he was in prison. We're jumping through hoops to keep him on his meds after his release from prison. 

In our initial phone call with Medicare, we were on hold for an hour. I wanted to inquire why my client cannot pick up the medication that is waiting for him at the pharmacy? I was told my client must first go to the Social Security office to complete his reinstatement of Medicare. Really? A client with paranoid schizophrenia must go wait in a government building with tons of strangers?

As his therapist, I took him to the Social Security office and waited for 3 hours to be told he needs to have a stack of papers filled out and his legal guardian needs to sign something (you know those attorneys that see their client maybe once every two years).  Meanwhile, my client was becoming more symptomatic. With his eyes darting around the room, he became increasingly restless in his chair.

I've established trust with this client, so I am usually able to de-escalate situations for him. But I am furious that finally, when he understands that he needs meds, he has to go through so much red tape to get them. After being released from prison and determined to be disabled, Medicare and Medicaid services should be ready for clients, not barriers for clients.

People with diagnoses of serious mental illness (SMI) should not have barriers to medications. Any gap in medications can lead them to self-medicate on substances like crack, meth, alcohol or heroin. I have clients on all of these substances, and crimes are often committed with the combination of SMI and substance abuse more often then not.

I am a therapist. I can't force my clients to medicate and I can't always make the medications available to them — although I've found myself to be a pretty good beggar for things like United Way funds to pay for meds.  Meanwhile, our community mental health agency is underfunded. We have a whopping 13 beds on our crisis unit and the wait time for new patients to see the doctor is two months out.

As an assertive community treatment (ACT) therapist, my goal is to be part of a team that offers wrap around services to keep clients out of prison. Sometimes I find these clients during outreach (driving around the community). At this point, however, we still need the police and court involvement (thank goodness for mental health court which is my Thursday job) to bring them back into treatment.

If someone knows how we can mandate medication, without the process being abused, before a crime is committed, please speak up.  I believe, once a crime has been committed and clients have been diagnosed with SMI, they should be mandated to take meds. And, for god sakes, the meds should be paid for —  happily — by our government.

 

 Melinda

Melinda