All in a Day's Work

I've been thinking a lot about my job lately. Mostly because I really and truly am getting much closer to walking away from it. After all, I technically retired almost four months ago. I've been working a couple of days a week on contract since August first to try to provide a bit of continuity until the county can find a replacement. But it is time to go. I feel it in my bones.

There's an old saying, "It's not what you know, but who you know." That's pretty important in county mental health with it's confusing welter of rules and regulations. There are a couple of attorneys I converse with from time to time. Their knowledge base is a godsend. And there are other mental health directors who've been friends for years. (More than twenty for some.) I appreciate knowing people I can call to discuss things with. Those linkages will leave when I do, unfortunately. And it will take a long time to build new ones for whomever comes next.

Those linkages are critical because there's always another agency trying to push mental health to do something about the crazy person cluttering up the streets or someone else's waiting room or the local market. The mentally ill tend to make people nervous. When something makes us nervous, we want it to go away. Since local mental health staff have the magic bullet that can get someone sent for a three-day involuntary stay at a psychiatric hospital, there's a lot of pressure. And many conversations that go something like this:
"Why can't you do something about that person?"
"Because they don't meet criteria?"
"Well, why don't they?"
"Because it's not against the law to be  crazy . . ."

Nope. It's not against the law to be weird, or psychotic or delusional. We can only hospitalize folk involuntarily if they are an imminent risk of danger to self or others because of a mental illness. Not because they're drunk or an addict or a public nuisance or haven't had a bath in awhile. There is one other category: grave disability. This means someone is incapable of meeting their basic needs for food, clothing or shelter because of a mental disorder. We don't really see a whole lot of that. What we do see is people who are too drunk or addicted to take care of themselves, but the code sections don't apply to them.

And so it goes. In the past two days, I've untangled a few thorny legal issues, continued to work on a perennial problem with transport for mental patients, attended a politically charged meeting, provided support and consultation for clinical staff, pulled together an agenda and attachments for next week's Quality Improvement (a Medicaid requirement) meeting, and finessed the final stages of getting opening windows in our office suite--something I've been working on for a couple of years.

There are things I will miss when I go. Years ago a friend of mine who ran the Health and Human Services Departments in first Shasta, then Placer counties, told me he loved being in the thick of things when bullets were flying. I know it's metaphorical, since no one shoots at you these days with anything but words and documents, but I like that, too. I will miss solving the day-to-day problems at my workplace, which is probably why I'm still there.

On the other hand, so long as I'm hanging onto one personna, it means I don't really have the time I'd like to let the writerly side of myself blossom fully. There's something the Dalai Lama once said about some doors having to close fully before other ones can open. Makes sense.

As Thanksgiving draws closer, I am grateful for my long friendships in the mental health field. And ever so humbly grateful to have been able to provide support for a disenfranchised population that has little in the way of a voice.

We are all human beings. Black, white, brown, rich, poor, straight, gay, mentally ill or sane. John Donne said: "Each man's death diminishes me, for I am involved in all mankind. Therefore never ask to know for whom the bell tolls. It tolls for thee."

It is never just about you, or about me. But about all of us. That's why I'm still at county mental health. Because it's a place where I can give something back. The challenge for me will be finding another way to do that after I leave.


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