tag:blogger.com,1999:blog-26666124.post116856621840379786..comments2024-03-18T03:28:36.581-04:00Comments on Shrink Rap: My Big Fat Hissy-FitUnknownnoreply@blogger.comBlogger17125tag:blogger.com,1999:blog-26666124.post-1168751594577642602007-01-14T00:13:00.000-05:002007-01-14T00:13:00.000-05:00OMG!!! This is hilarious! You three know each ot...OMG!!! This is hilarious! You three know each other and see each other, but you decide to debate this issue on the blog. I can't help but get a chuckle out of that. Ha! This is such a podcast topic, I'm surprised you guys are still debating it rather than putting the topic on hold until you are all together and recording.<BR/><BR/>(person formally known as Jennifer) Ok...I'm still known as Jennifer. I just decided to finally come clean with one of my alter egos. ;-)sophizohttps://www.blogger.com/profile/00565728981524456790noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-1168746556733192172007-01-13T22:49:00.000-05:002007-01-13T22:49:00.000-05:00Oh no. Don't tell me you have that nasty flu that...Oh no. Don't tell me you have that nasty flu that's going around. I'm just over that (with a horrid lingering chest cough!!!).<BR/><BR/>I had a fever for 7 days, ugh.<BR/><BR/>I sure hope you don't have that!<BR/><BR/>a new kind of transference through the blog - flu viruses. hee hee! (to the tttb, not to the flu.Sarebearhttps://www.blogger.com/profile/09208596053319110470noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-1168739668757636192007-01-13T20:54:00.000-05:002007-01-13T20:54:00.000-05:00Bless you Sarebear.I may need that referral & heal...Bless you Sarebear.<BR/><BR/>I may need that referral & health insurance Dinah---running a 101.8 temp here.ClinkShrinkhttps://www.blogger.com/profile/13316134491751195651noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-1168735601194107152007-01-13T19:46:00.000-05:002007-01-13T19:46:00.000-05:00Clink! Don't feel like you can't talk on the podc...Clink! Don't feel like you can't talk on the podcasts! On any subject, but especially your expertise!<BR/><BR/>I like hearing all of you guys anyway.Sarebearhttps://www.blogger.com/profile/09208596053319110470noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-1168731802751037842007-01-13T18:43:00.000-05:002007-01-13T18:43:00.000-05:00You, however, have health insurance and can afford...You, however, have health insurance and can afford private care. Yell if you need a referral. Talking is good.Dinahhttps://www.blogger.com/profile/09227988351623862689noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-1168731635110504542007-01-13T18:40:00.000-05:002007-01-13T18:40:00.000-05:00This blog is really cutting into my Ravens time. C...This blog is really cutting into my Ravens time. Can't say the game is going well but I've loved the commercials.<BR/><BR/>I like the triage system you set up in your clinic Dinah.<BR/><BR/>I think the heart of the ex-offender ER visits is the problem getting scheduled aftercare in general. The thinking of the inmates appears to be (from what they tell me): "I don't have insurance. I'm not on disability and I can't afford a doctor. Why bother going out with medications that I know I won't be able to keep taking?" So they don't take their meds with them and eventually realize they need them. I've had guys refuse treatment right up front with the explanation: "I can't afford this when I get out, why start treatment now?" I have no answer to that.<BR/><BR/>We really need some type of forensic outpatient component. California has mental health parole but I'm not sure I like that idea because it involves coercion with patients who don't necessarily need to be coerced. There's also the privacy & dual agency issues for those providing care. But that's the closest model we have right now I think.<BR/><BR/>And thank both of you for bringing this up on the blog instead of on a podcast. It's such a hot topic that I really would need to talk.ClinkShrinkhttps://www.blogger.com/profile/13316134491751195651noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-1168730478047415222007-01-13T18:21:00.000-05:002007-01-13T18:21:00.000-05:00so all 3 of us are blogging during the football ga...so all 3 of us are blogging during the football game; warms my shrinky heart.<BR/><BR/>Actually, I'm against making appointments for anyone anywhere unless you're the person who's going to carry them to the appointment. Made appointments don't get kept and stretch the resouces of stretched staff at facilities. As a clinic medical director, I used to have a requirement that folks come in for an intake interview to screen out those who wouldn't show up. The intake times (anyone who called was given a list of the times, twice a week, first-come first serve, so no one waited more than 2 days) was staffed by a psychiatrist who just triaged. Quick screen and an appointment for a full-eval, but the shrink could choose to provide an emergency refill, to EP someone, or if only one person showed up, to simply do a full psych eval. I wish I could say it decreased our subsequent no-show rate, but I don't think it did.Dinahhttps://www.blogger.com/profile/09227988351623862689noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-1168730081913561742007-01-13T18:14:00.001-05:002007-01-13T18:14:00.001-05:00Oh, and my ideas are just random shrink theory, I ...Oh, and my ideas are just random shrink theory, I don't think you ever have to worry that I'll be in the clinker sending patients to Your ER.. Go see Dr. Roy, he fixes everyone!Dinahhttps://www.blogger.com/profile/09227988351623862689noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-1168730045190125792007-01-13T18:14:00.000-05:002007-01-13T18:14:00.000-05:00OK, so in an ER you do the same release planning t...OK, so in an ER you do the same release planning that I do with the exception that you don't release them with meds. <BR/><BR/>Medications are available from the facility at the time of release---they just have to pick them up or call me for a script if they run out. You also give a list of referral resources but don't make appointments for them. Correctional facilities are not hospitals and should not be held to the same standard. An ex-offender in free society has more resources for arranging aftercare than I do. In two of my three work sites I don't even have a telephone much less a social worker or discharge planner.<BR/><BR/>I don't see that your ER scenario for release planning is that much different from mine.<BR/><BR/>Remember too that these guys are responsible for (and do) many other required things in free society that aren't set up by the facility: report for court dates, report for urine screens, report for substance abuse treatment (if available) and report for parole hearings. It would be a bit odd to suggest that a clinic appointment should be any different than these other things that they are expected do on their own.ClinkShrinkhttps://www.blogger.com/profile/13316134491751195651noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-1168729983585278062007-01-13T18:13:00.000-05:002007-01-13T18:13:00.000-05:00The Ravens are losing at half-time. I may need to...The Ravens are losing at half-time. I may need to bring husband to ER.<BR/><BR/>At the ER in MajorHospitalCenter (a Fat Doctorism), there are emergency slots held in Outpatient CMHC for ER patients, so that ER can dispose of such patients. Possible that said patient could be given an appointment within a day or two at clinic. I don't know if this persists, lots of changes lately in what insurance clinic can take, if pts need to be in or out of catchment areas, or even if clinic continues to hold slots for ER pts, but given that we're talking about a life-or-death situation for these immediate ex-inmates, really, I think an emergent hospitalization and hook-in to care is a better outcome then death. I'm really against premature death, especially from preventable behavioral/psychiatric issues in young people, just so you know.<BR/><BR/>Another issue, people often lose their insurance/disability while they are in jail and then they Can't fill those scripts for the super expensive meds we give them.Dinahhttps://www.blogger.com/profile/09227988351623862689noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-1168729300412573592007-01-13T18:01:00.000-05:002007-01-13T18:01:00.000-05:00Clink, I have to agree with Dinah. I concluded th...Clink, I have to agree with Dinah. I concluded that the answer to my question ("do you guys routinely set up aftercare before release?") is no.<BR/><BR/>For pts in hospital, we attempt to arrange an appointment before discharge. We have both a social worker and discharge coordinator, whose function is to ensure aftercare is arranged. If we leave it solely to our pts, it usually won't get done.<BR/><BR/>Dinah, time for <B>my rant</B> (guys don't have hissy-fits, but might eat quiche). You correctly predicted that us ER-types would not appreciate your referral of these pts to the ED for refills. Unless pts have aftercare already arranged, and the provider can be contacted in the ED, we generally do NOT give scripts. Why? These pts need follow-up, and it is risky to give a one-week rx for Prozac without any plan for follow-up. We do give them a list of people to call, the same list they'd get calling a warmline.<BR/><BR/>Here's a more typical scenario of what happens:<BR/><BR/>Patient: <I>"Dr Dinah told me to come here for prescriptions. I just got out of jail, and I couldn't wait for Dr Clink to get my prescriptions. I ran out 3 days ago."</I><BR/><BR/>ER: <I>"You'll have to call your doctor. We don't do that here."</I><BR/><BR/>P (knowing how to get their attention): <I>"If you don't help me, I'll kill myself."</I><BR/><BR/>ER: <I>"This is Mr. Jones. He'll escort you to our psych area."</I><BR/><BR/>P: <I>"Never mind. Just let me leave!"</I><BR/><BR/>ER: <I>"You have to stay to be evaluated to see if you're safe."</I><BR/><BR/>P: [starts to storm off]<BR/><BR/>ER: [in walkie-talkie] <I>"Security to Triage. Stat!"</I><BR/><BR/>... and so on. ER's are for Emergencies. If you've ever tried to get something routine done in an ER, you'd know what I mean.Steve & Barbhttps://www.blogger.com/profile/16543746132388754693noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-1168716428207845082007-01-13T14:27:00.000-05:002007-01-13T14:27:00.000-05:00Dinah, they get that already. And I'm not sure how...Dinah, they get that already. And I'm not sure how you can take my two paragraphs explaining release mechanisms and summarize it into "so, they don't get any aftercare planning."<BR/><BR/>Yes, it's up to the inmate to make their own appointments. That's ALL they have to do.ClinkShrinkhttps://www.blogger.com/profile/13316134491751195651noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-1168712582069870132007-01-13T13:23:00.000-05:002007-01-13T13:23:00.000-05:00So, no.Somehow I can't imagine that any released p...So, no.<BR/>Somehow I can't imagine that any released prisoner, ever, has called their local health department to ask how to obtain ongoing mental health care. I'd be more shocked if the person at the other end of the line was able to help the former inmate negotiate such care, though I'm sure that's just a function of who you get on the line and what mood they're in; my cynacism of the moment ranting. "Go to the ER" might actually be better advice (I cringe at saying this, and Flea would die, and the ER psych folks would kill me, but from the ER one might actually get a few days of refills and even an appointment made for them-- which this impulsive crew may or may not keep.<BR/><BR/>Maybe you could make up a sheet to be given to every prisoner upon release: How to Get Mental Health Care, with a zip-code "If you live here, call this number". Maybe even a listing of These Are Your Medical Conditions and These are the Medications (with dosages) that you received. Amazing how many inmates get that little white pill.Dinahhttps://www.blogger.com/profile/09227988351623862689noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-1168710917890781382007-01-13T12:55:00.000-05:002007-01-13T12:55:00.000-05:00The medical provider typically isn't notified abou...The medical provider typically isn't notified about a release until the day of release. The mental health provider is never notified about release dates.<BR/><BR/>The way I handle these situations is find out from the inmate when he is getting out then time my appointments so that he will have a fresh medication order that will be filled just prior to release. Then all the inmate has to do is notify the pharmacy of his release date and they will package up his meds. (By law you can't release them with pill cards. Any release meds have to be packaged in bottles with proper labels.) The inmates can't carry the bottles with them during the release process, but if they wait at the door after release the med nurse can come down and hand off the bottles. If they get released from court then the inmate has to come back to the facility to pick up the meds. Meds are usually held for a couple days after release before being returned to the pharmacy. Most inmates don't want to wait or return. Thus, no meds. I've also occasionally given out my office number to call in prescriptions if needed, but only a handful of inmates have ever taken me up on that.<BR/><BR/>Regarding aftercare, I usually provide information about whatever treatment resources I know about---which is pretty much limited to Charm City. If it's a jurisdiction I don't know I usually tell them to call the local health department or the <A HREF="http://www.uwcm.org/FindHelp/fcfh/" REL="nofollow">First Call For Help</A> number. I don't make their appointments for them.ClinkShrinkhttps://www.blogger.com/profile/13316134491751195651noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-1168699813280908592007-01-13T09:50:00.000-05:002007-01-13T09:50:00.000-05:00What did we do before the blog? It's good the inma...What did we do before the blog? It's good the inmates have Clink to love them and keep them alive...Dinahhttps://www.blogger.com/profile/09227988351623862689noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-1168665873332680152007-01-13T00:24:00.000-05:002007-01-13T00:24:00.000-05:00What I hear from them after being released is that...What I hear from them after being released is that they were not set up with aftercare, ran out of meds, and decompensated (or relapsed, or both). Clink, do you guys routinely set up aftercare before release?Steve & Barbhttps://www.blogger.com/profile/16543746132388754693noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-1168580610760910652007-01-12T00:43:00.000-05:002007-01-12T00:43:00.000-05:00Thanks so much for saying this. I was getting read...Thanks so much for saying this. I was getting ready to write a rant of my own on this topic. I'm glad I read yours first. Better than the pathetic post I would have written. Well done!Dr. Ahttps://www.blogger.com/profile/05207266669522973903noreply@blogger.com