Friday, October 22, 2021

Comments by Bricew

Showing 4 of 4 comments.

  • I can definitely relate. Now that I’m a few years removed from the field, I recognize that I was sicker in my ‘recovery’ than I ever was in my addiction or mental illness. The culture in mental health is so dysfunctional and now that I am free, I can practice what I preached and set healthy boundaries. I now get paid enough to care for my family, have a work-life balance that actually allows me to engage in self-care, get entirely employer sponsored insurance, and I get fantastic benefits like gym memberships and reimbursements for anything that helps me stay fit. My employer doesn’t petition the government to keep the minimum wage low, demand that I read books like Man’s Search For Meaning on my unpaid time off, require overtime or work on holidays like the residential programs I worked at, encourage Medicaid billing fraud, or force me to lie to patients and say that drug testing holds you accountable, or addiction is a disease or that antipsychotics work. I no longer work for a company that pays below a living wage or gives just the legally mandated amount of vacation. I got 12 weeks of paid parental leave at the start of the COVID lockdowns to transition my son to the online schooling. I get to set my schedule and can work from wherever I want. I no longer work for a company that won’t adopt an EHR but won’t pay for printer ink and I don’t feel obligated to buy candy or cupcakes with my $18/hr salary for a patients graduation because the company won’t do anything to celebrate the achievement. I no longer stay late to write notes or write them for free because they’re not ‘billable hours’. I’m able to take my vacation because I don’t feel bad about my patients going weeks without anything cause the company won’t do anything when I’m gone or they’ll overload another counselor with an already ballooning caseload. I don’t have to dearth with insurance agencies that would rather patients die than pay out or probation officers that don’t care. My name is Brice, and I’m in recovery from addictions counseling, not addictions to substances.

  • The data quality issue is largely of the medical field’s own making. Format and contents of clinical documentation are determined by insurers, governmental regulatory officials, and other funding sources. Data is generally only collected for the purpose of billing and not for future clinical use or research/training ML algorithms. I’m not sure what they mean by ‘black box’ either. Just because YOU don’t understand the math, doesn’t mean I can’t. Backprop is fundamental to how neural networks learn from data so you should always be able to follow backwards through the model from the decision in the output to the data in the input. The real problem is the lack of collaboration between the two fields. I don’t see the example above as a failed intervention. AI was able to cheaply address the low risk population, leaving the experts more time to focus on the ‘problem children’. That’s a failure of the treatment program to utilize the treatment in the best way possible. Remember, AI based cancer diagnosis only beats human based diagnoses slightly. The real improvement comes from augmenting the human. Human’s armed with Ai diagnostic data perform better than any ML algorithm ever will.

  • I can respect that. I don’t really like the term recovery either, since I’m not in recovery from the ‘disease’ of addiction, I’ve really just ‘developed’ the tools to cope with life without a chemical chaperone. Many of the terminology we use is routed in the archaic and barbaric past of the psychiatric sciences. I certainly have no problem moving away from that. Just, not at the expense of framing these issues in a way that downplays the reality or further suppressing and excluding those we are supposedly trying to help. I’ve lived longer without my mother than I did with her, and her suicide is far from complete. And I’m not saying we shouldn’t try to help others or that I’m glad my mom is dead or that I wish I had been allowed to kill myself. I’m only trying to say that the reality is that if her suicidal ideation even was treatable, she likely wouldn’t have been able to access the treatment. I don’t think the system failed to stop her, I think it failed to reduce the harm her actions caused. It failed to give her autonomy. It failed to identify my brother and I as high risk and make any effort to address that. Until it was far too late. I watched my aunts and uncles argue over whether to dress my mother in a turtleneck or a scarf, to hide the markings on her neck from the leash. Nobody in my ASIST training thought about that. If we demonize suicide and somehow convince this person not to do it, at least for today, and we do the “warm handoff”… But he later does it anyways, what then? His family can’t have an open casket because he took a shotgun to the face. His family can’t say goodbye, because some self righteous 50 year old white dude told me to at all costs use MI to convince people not to kill themselves. I understand it’s not all black and white and sometimes you have to accept whatever small victories you can get but I can’t live with myself imposing such beliefs on the community. All of this to protect myself from a $500k fine? No thanks, I’m a millennial. Maybe then I’ll be able to file bankruptcy so I can get rid of the 6 figure student loan debt doctoral training in social sciences awards you with. And what about my license? Eh, I can get paid more cashiering at Whole Foods. At least with my morals intact, I can look myself in the mirror. I can tell my son what daddy does for a living and not be ashamed.

  • I’ll never forget my ASIST training. It was required by my employer, who also conveniently was the only provider of the training in the city. The training was conducted by the clinical director and his wife. I had just been hired as an Administrator of a residential program. One of the first things the trainers said was “Nobody ‘commits’ suicide, they ‘complete’ it. We’ve talked to a lot of survivors and this is how they feel about it.” My first thought was “F- You!” I’m a ‘survivor’ by any definition of the word. My mother committed suicide when I was 12 and my step mother did 9 months later. I spent my adolescent years in and out of psychiatric facilities for suicide attempts that included everything from overdoses to cutting myself. I never once heard of or thought of suicide in such a way. And I never will. I have a set of grand parents that won’t talk to me because I remind them of my dead mother and the pain is too much for them. I don’t know that my mother’s suicide will ever have been completed. Needless to say, the trainers were just as respectful and professional for the rest of the ASIST program. The facilitator later had the audacity to complain to my direct supervisor that I didn’t participate much, after being instantly stifled and all but shut down. They preached the notion that all suicide is bad and nobody truly wants it. That we must always try to stop suicide. They claimed to be person centered when harm reduction would teach otherwise. My mother hung herself with a dog leash after finding out my father had an affair. This wasn’t her first attempt either. Advocates of euthanasia say mental health is ‘treatable’ and so, should be excluded, but whatever treatment she had access to was never going to solve the problem. She didn’t want to be here. In my early 20’s, I thought this was a failing of the public mental health system and took it upon myself to become an agent of social change, but these days I can recognize there is more to it. I will no longer fear licensing issues or litigation. It is not moral or ethical of me to impose my own desires or beliefs on another, so I will not use motivational interviewing, only simple interviewing. If only someone had the strength to give my mom the okay to do it, maybe I could have been there. Maybe I could have said ‘goodbye’. Maybe, she wouldn’t have died alone in a cold garage in northern Idaho.