Learnings Learnings

Thank God for my profession. In it I have the opportunity to look at my shortcommings and "hopefully" make improvements for the better.

Yesterday we had an incident on the unit in which a client escallated to the point of taking an overdose of medication. As a result, today we as a staff have sat down, made adjustments in our procedures, all in the hopes of preventing a similar or worse situation.

I enjoy meeting with other clinicians. So often I get swept into the feelings of clients who are placed on 5150 holds. When you are forced into a psychiatric hospital against your will, it may feel like the worst possible situation. To many clinicians they view this as something positive! Especially those who work in hospital settings where people on holds are sent.

This may sound bizarre. How on earth can a hospitalization be viewed as a positive? Well if voices are telling you to harm yourself and you feel driven to take your own life, in hospitals, medication is adjusted, people talk with you, give you a plan of action, become supportive, and praise your positive actions. Regardless of your social/economic situation, your gender, your race, or your age. There are programs set up in the City of Los Angeles where this service is for free!

Life can be a hellish experience to people who experience acute mental and/or emotional illness. Unfortunately this type of person fights even harder to keep the needed assistance away! Then you are plopped in front of me and by law I have to take reasonable action steps to keep you and others that surround you safe. Yes at times I am the first line of defense - or offense in the case of hospitalizing somebody.

So with the new protocols being established, I pray that the situation from the day before becomes a distant memory and a spring board to swifter and safer action.

Peace!

HOLY COW!

Well as Tom Slick says, "You knew the job was dangerous when you took it!" Today was a doozie! Fasten your seat belts, this happens maybe a few times a year - thank God.

A client came in today who had voices telling them to kill themself. As a licensed clinician I have to take this very seriously. I interviewed the person, the Psychiatrist interviewed the person, and our nurse interviewed the person, the verdict - they needed hospitalization. The next step is explaining this to the client however, there are a few people that "Can not handle the truth." This was our client's sentiments. Needless to say when the ambulance drivers, rolled the gurney into the room the client reacted. Not a little bit - A LOT!!

As a clinician, I try to bond with people, give them so tools to use and try to look out for their best interests. When the sh.. hit the fan, all the therapuetic mumbo jumbo from an hour earlier is not only tossed on the floor, but stomped on as well. What a shame. This person went through a torturous life and needed to address the inconceivable events they suffered through. I have full faith in my particular brand of psychotherapy but after the reaction - which got even worse, it was now out of my hands and into somebody else's who I hope has comperable training - but I'm not too sure of it.

As the dance continued - the dance of "how on earth are we getting this person to sit on the gurney and get straped in dance", the client reached into a bag they brought and took a fist full of pills. Yep for the third or forth time, a client tried suiciding themselves in front of me. Oh, this dance is just warming up.

When the partner began verbally assaulting me for my wrong doing, and the client began attacking nearby staff we had to call in reinforcements - enter the paramedics and a handful of police. Great. I entered this field to help people, how in the world is this bringing more peace into the world?

After multiple interviews by the county's finest, after the client was transported to the nearest trauma center to get their stomach pumped I stood in an empty room wonder what in the hell had just taken place? All the training in the world didn't prepare me for this fiasco. I plan to learn a multitude from this fubar. However at the forefront in my mind is compassion for the client. Yes they now had a few suicidal gestures in less than a week, yes they need tender care to work through not only this recent trauma, but the back log of traumatic experiences in their life.

God bless this person. God bless the 911 system in working quickly to perfection. And God bless my supervisor for having to deal with the aftermath of this.

May the world have a mentally healthy night.

Too Bad I Am Paid So Bad

Hello everybody it is great to be back at work after vacationing for a week. The sessions today were awesome and the only drawback is my poor salary. To have professionals who know their craft in a crisis situation is desperately needed. Too bad this fair city doesn't have the budget to pay us at the scale that is needed. Unfortunately in the long run this can drive me away to a private practice, away from the people who desperately need crisis stabilization.

This doesn't minimize private ongoing clients, when they hit a dormat issue, it may and often times will feel like they are in a real crisis. I am referring to the masses in this city who have never sought treatment, feel psychology is for quacks and then they get plopped in front of me, spilling their guts, talking about things they would never tell a soul about, and leave feeling that the weight of the world has been lifted from their shoulders.

It is good to be back. A very long day. This is all the time I have allotted until the next time we blog. Thanks to all that are supportive.

Trust me, the best is yet to come.

Good Friday

Yes I know it isn't the real "Good Friday", however at the Crisis Center it has been today. Why? Why is everybody in a good mood?

Every once in a while the star all align, or something like it when the clients are wonderful, the staff is laughing and even a pharmacuetical rep came by and brought us all ice cream!

Physically I had been under the weather for months and tried something different. Instead of the antibiotics that drain me I tried an alternative suppliment called Olive Leaf. THis is an antioxidant in higher doses takes on a natural antibiotic effect.

Disclaimer: I am not a licensed nurse or dietician so the advise from this blog is only from my individual experience.

With that stated, I had an absess on my tooth, used Olive Leaf and in two days I've seen the lump almost disappear! Wouldn't that put you in a good mood too?

I am a firm believer that we as individuals set the tone for others to shift to. Test this out. Try to hold onto a good mood - no matter what is going on around you. Trust me, happiness can be a choice regardless the circumstance. Today the staff seemed to respond favorably to my jovial mood.

What can you do to bring more health, happiness and wellbeing into your life? How often do we put these tools on the back burner because of our fast paced living? Only in a crisis are we motivated to take proper action steps. I see this in my clients, I especially see it in myself.

It is also a Good Friday because I go on vacation after my shift is over. Being an avid Dodgers fan I just have to check them out in spring training - a life long aspiration! Win or lose I know my friend Mike and I will be winners. Two thirds of the old comedy group will be reunited from a memorable road trip once again.

Comedy? Is this true? Absolutely! I was in a comedy group for two years called: "We Love Us, and We Have Every Right To!" Three best friends simply took our zaniness onto the stages around Los Angeles. The Comedy Store, the Improv, Geos, Bullwinkles, The Great Wall all saw us make fools out of ourselves and may be still talking about our antics!

Is there room for comedy in mental health? I believe without comedy depression in this world would reign. Though comedy is not the "one size fits all" approach. When people are in crisis comedy is not recommended - compassion is. If comedy is elicited from the client, mental health can flow.

So good Friday, Saturday, Sunday, etc. to everybody. Stay safe.

MANIA!

Mania. An interesting word. When you are manic it isn't very fun - to say the least. Many patients come into the Crisis Center with mania. They can't sit still, hate being who they are, feel uncomfortable in their own skin, and talk a million miles an hour for sometimes an hour! Could you imagine going through this on a constant basis? It is a living hell!

Being manic means your brain is working in hyper speed. Calculating this, seeing all the angles with that, at some point a crash is inevitable! What is the crash? Either huge depression to the point of being suicidal or severe panic!!!

How is this treated? Psychiatric medication is the key, though to many individuals they have convinced themselves through all the research they have taken that the psychiatric medication is harmful. Thanks Tom Cruise. Mania stems from problems with the Hypothalimus - the part of the brain that regulates cycles. When impaired through drug use, head injury, or heredity, it needs to be stablized. The only method we know that is effective is with psychiatric medication.

Many people feel if they eat a well balanced diet, take vitamin and herbal suppliments, get the proper exercise, and think good thoughts the mania will all go away. Well to be honest this can help greatly. But seriously how many of us are able to do so? And still the brain is impaired.

The biggest challenge for me as a therapist is convincing people medication will be benificial and it is okay to take it to stablize. For Diabetics they have to have medication or they will die. If psychiatric medication is seen as benificial a lot of untreated mental illness in this country will go away.

Please research the benefits versus the detriments on your own. There are plenty of web sites devoted to the pros and cons of psychiatric medication. All I can tell you is, if you are at your wits end and want to feel better I've seen miracles with psychiatric medicine.

Special Job

I realized today that I have a very special job. I get to interact with people that basically keep to themselves. Many have no family, no friends, and spend their entire day with themselves. Do they like themselves? Most don't. How unfortunate is that? Why did they turn out this way? Mostly from lack of connection with others. Their parents were into drugs and partying. They were abused. They were raised in group homes. Ect. Ect. As a result, since nobody cared about them, they misperceived they were flawed or a mistake that should have never been born.

When our Gods (mom and dad) could care less about us, it's like a dagger going into the depth of our soul. Fast forward to being an adult drugs, jail, failed relationships, mental illness follows. Then somehow they get plopped in front of me.

"Hi. I'm Doctor Scott, what brings you to the Urgent Care?"
Many of these people just start crying from the get go.

A client came in today who from 12 years old lived on the streets as a gang banger. His single parent abused him. He never met his other parent, but the gangs welcomed him with open arms. I wondered how uncomfortable he must have felt talking to whitey white man, having to talk about sensitive issues and about the voices in his head.

"These questions must really bother you. If I was in your seat I may not want to answer them." Was all I said. For the next five minutes he cried like a baby. Somebody finally noticed him. Somebody finally knew his torment.

I have a great job - but the pay sure ain't. I guess there isn't any profit in helping out individuals in a crisis. There sure should be. These people if treated right can rejoin the working class, they could parent their kids and get them out of the foster system. There would be less psychosis and anger on the street. Illegal drug use could be lessened. Who would need street drugs when you could work through issues instead of avoiding them? The drug cartels would collect less money. And more funds could be circulated around to the people in our cities who need it the most.

Mental health can be the key to getting us all back on the right track. Therefore a yes vote on Scott's raise --- just kidding -- this blog was sounding like a political advertisment.

We all have it in us to heal, no matter what the ailment. The clients that have had horrible things done to them, or have done horrible things to others can heal. In paying attention to them, it empowers them to speak more to others and feel better about who they truly are.

Anger

If you want to learn about anger, hang out in an urgent care setting. We get more of our fair share of angry clients on a weekly basis. What causes anger? Why is it wired in to every person? Is there positives in anger?

Anger is a signaling device for sure. If anger presents it's ugly head, something underneath needs to be addressed - NOW!

When on overwhelm, the mind shuts down and can not process information the same way. Our first defense is putting up a shield - anger is one of the best. This keeps people away and gets our needs met in the most primitive way.

Usually anger goes hand in hand with regressive behaviors. A regressive behavior is similiar to a roller coaster ride back to an earlier version of ourselves. Suddenly the thinking rational part is gone and what is left is a suffering younger aspect of us that is trying to survive to the best of it's ability.

We had a person come in to the urgent care that was extremely angry and looking for a fight. As a therapist I have to deal with these people. How do I survive their onslaughts? Remain calm, ask them what they need, fulfill these needs to the best of my ability as quickly as possible, and move them to the front of the line for the psychiatrist to see. Often these irate people are given medications to calm them down, with their prior authorization of course. Then the waiting game begins - when is the medication going to kick in?

Underneath our anger is hurt feelings from our past. If we aren't in a stable place to work through our past "undoings" eventually they will undo us, and others if they are in the way. Well, this client was making sure she was safe by terrorizing the patiently waiting clients.

When there is a threatening situation, the priority is to protect who? The staff? The clients in the waiting room? Well actually the number one priority is protecting the patient who is unstable. Of course we also care for the other patients, often removing them from the room or into vacant offices if gets violent.

Until the client calms down and returns to their right mind, then is the time to explore what was going on under the surface. What triggered this? Did something remind them of difficulties from their past? Is this a repeatitive cycle that needs working on in therapy? To the latter question the answer is a resounding YES!

When love is applied to our hurt healing takes place. For those who are chronically angry they need to risk feeling their hurt and being tender with it. It takes an adult to face our underlying hurt. A person needs to have the mental make up to do so. If not, then medication management is the only option and strict adherence to the medication regime is essential.

To Hospitalize or not to Hospitalize

That is the question. Everyday my main priority is determining to commit somebody or not. Today a person came in who stated, "I have a switch and when it goes off I want to kill myself or others." Of course today the switch was off.

I can not place a 5150 on somebody because I suspect things. The holds have to be based on current level of functioning. Even if somebody for years and years was dangerous, then presented functional to me I can not detain them.

Many healthcare professionals won't ask the big question, "Do you feel like hurting yourself or others", because if so they would risk holding them, possibly risking injury if they got violent. It is not a question of asking the question that is key, it is "How" you ask the question.

For this particular client, I made it a priority to ally with them from the onset. In doing so, it creates a relationship. In working together with clients, we find solutions together. The beauty of being a therapist is asking somebody anything. Though within reason. Abusing the power of our position is a crime. Many therapists have abuse their power causing clients to be in even worse shape. Tragic, but true.

Many want hospitalizations, many don't but will accept it if you handwalk them through it.

Our client today didn't need this and had been able to avoid hospitalization since september. In giving the client medication, we hopefully will delay this even more.

Peace.

"The Present"

What to write about? This day was bound to happen. Pretty slow day, much of the same. Did some continuing education courses to keep my license up to date. Positive Psychology was the subject in which it was important to keep a positive attitude while facing life's difficulties. Seligman believed we cemented into our brains the way we looked at life. If we were gloomy, our gut reaction was to look at life in a gloomy way. He believed we can train ourselves to view the world in a positive light. Every problem this way can be seen as an opportunity.

This reminds me of Assioli, a student of Sigmund Freud's. He was the first student that broke away from the pleasure principle / penis envy shit and believed differently. According to Assiloi man was motivated by spiritual reasons - a longing to be whole. Psychosynthesis then resulted. This approach is still practiced today. They believe that man, being created in God's image, has a perfect blueprint of wholeness and wellbeing within. For optimum mental health, people need to connect to this inner blueprint. What pulls people out of this centered place is past or future thinking. How often are you thinking about what you have to do, or the stupid things you did in the past?

"The past is history, the future a mystery, but now is a gift and that's why it is called the present."

In order for us to be happy, we need to be centered in our loving hearts in the here and now. However this is more difficult than it sounds. What pulls us away from the here and now is unfinished business - according to the Gestalt Therapy folks. If we've experienced a shock to our system in the past, there is a part of us still hiding way back there. It is imperative for us to scoop this part up, interact with it in a caring and considerate way, and in the process complete what is unfinished. This is an artform and well worth the effort! In "working through" our issues, it is easier to stay in the present.

Something created over a hundred years ago still rings true to this day. There are things created thousands of years ago that also do the trick. What might you say is that? We according to Spiritual Psychology - God does all the healing. Then if God is the ultimate healer, wouldn't it follow to create more of an intimate relationship with Our Creator? How is this done? The Bible maintains pray is the main avenue. I think everything we do can strengthen a relationship with God. Drawing, dancing, singing, music, letter writing, you name it. If the intention is for us to create more intimacy with God, we are then centered in our blueprint.

LPS Designate

I am licensed in the County of Los Angeles to place people into Psychiatric facilities for 72 hours if they are a danger to themselves, a danger to others, or gravely disabled. I don't take this responsibility lightly. If I was to go into a facility and be held there against my will, it would probably be the most traumatic experience I could think of.

In assessing people for dangerousness, I try to be sensitive and get them involved in the process. Ninety percent of the people who need to go into the hospital, want to go into the hospital. It is the other ten percent that can be a little unruly.

Once a man who weighed twice my weight didn't think it was such a good idea and immediately marched out of my office to the front entry. Unfortunately for him the front doors are locked day and night. He was causing quite a scene. The people up front scattered, staff members from around the hospital were called to the front and ultimately a solitary policeman showed up that was a third of his size. Wouldn't you know it, without any weapons the policeman calmed him down and transported the client himself to the hospital. HE WAS A HERO!

When somebody who weighs well over four hundred pounds is upset like that, I feared not for the people, but for the building!

Being sensitive to people that need hospitalization is paramount! Medication is helpful but often it kicks in in six weeks! That is a lot of suffering before relief.

Today I placed another person on what is called a 5150 hold. By law we can place an individual in a hospital for 72 hours and it is up to that hospital to reinterview the person in case they still need to be there. Three days can turn into a week, a month, and years under the right circumstances. Trust me, the people in mental health facilities are so overworked they don't want people in hospitals. We all are extremely sensitive to client's needs.

Like the old saying: An ounce of prevention is better than a pound of cure. If you are feeling unstable - depressed, angry, moody, psychotic - take care of these symptoms as soon as possible. When the symptoms get out of hand, you will probably be sent to me. I will do everything in my power to keep you out of the hospital if need be.

Happy to be Back!

Illness. It got pretty bad. Only a few days of work this week and each session was rich and moving. This obviously keeps me coming back to the crisis center. The entire staff is sick and keeping everybody sick. THe whole staff is complaining and I put a stop to this in my own way.

Refusing to engage with the staff complaining about the same people, the same things, and carrying on the same conversations I've heard for the past five years, I found a Beatle station on the internet and let the music speak for me. Instead of the cranky people we occasionally broke into singing and laughing about it. Of course by most the comments were negative (try figuring). But, since the staff doesn't feel that well I'll give them a break today.

So happy feelings to all of you. A blessing to our staff, we all need a great weekend to heal ourselves to face the next batch of mentally ill patients.

I Learned Somthing.

It's good to be back! On Friday, Monday, and Tuesday I missed my blogs. Friday work was too busy and I ran out for my own sanity. I went straight to our desert property to fix the place up, battled with some moldy ceiling tiles and they won. I've been down and out since then, but forced myself back to L.A. today.

Working sick is never fun, especially when you have no voice. My first client was very manic, had to repeat stories over and over again, then would go onto new tangents and talk about them over and over again. In the end I cut her short, replying, "Try the same tool, it should work for you." In the next ten minutes she lecturned me about how everybody cuts her off and she never feels understood.

I made sure to tell my next client I was sick, shouldn't be there, but honor my commitments. He appreciated this and our session flowed.

Communication is the key I am reminded once again. If I told the first client about my condition, who knows? perhaps the struggle between us would have never happened.

In the end, I confided in the woman who seemed to appreciate my telling her this.

How often in my own life to I fail to communicate? It seems like I make it a giant thing as if somebody won't be able to handle the truth, or "they are going to get upset and leave", and create scenario after scenario, causing me to paralyze myself.

I learned something. A brief statement can smooth over difficult terrain. It is amazing how clients can become such great teachers.

Hopefully I will feel better tomorrow and have more to say.

Peace.