Fly on the wall: personal reflections 2/29/2009

There is so much to say, I hardly know where or how to start. Over the course of my career I have worked in a variety of mental health settings (community, hospital, long term care, etc.) and I must say that my Somerset experience has left me disillusioned. Let me explain! I am by nature an optimist and entered this field (a number of years ago) to improve the quality of care and services provided to the chronic mentally ill. Without question working with the chronic mentally ill is challenging; however, this has been made infinitely more challenging and difficult because of the lack of public support and funding.  Throughout the years I have seen community based programs close, programs in development stop abruptly due to funding cuts, community support services reduced, partial hospital programs almost become non-existent, inpatient hospital stays drastically reduced (to the detriment of patient and community safety),  I could go on but I think you get the picture.

CMS (and let’s not forget this was driven by the state), in its infamous wisdom de-certified Somerset in effect forcing hundreds of residents to leave. Where will these people go? What will be different now? How did all of these community services and housing options miraculously appear?  Many of our residents unfortunately will be forced to experience this firsthand, since the state deemed many to be appropriate for independent living.  Did the “state” overlook the fact that these individuals were functioning and stable because they were receiving 24-hour care and support? These same individuals living in less structured settings decompensate rapidly.  Did we forget that a number of these residents came to Somerset from community group homes because they were consistently unsuccessful in that setting?

Let’s go back to the whole rescreening of Somerset residents for independent living. I find it interesting that all of a sudden there is this great interest in providing these residents with independent living arrangements.  Putting that aside, here are some things to think about. I’ve been informed that the individuals from agencies coming into Somerset to rescreen the residents have been given directions to score as many residents as possible “as appropriate for a less structured setting.”  These same individuals stated that there were not nearly enough resources available for these people in the community. On a side note, I can tell you that I was horrified after reviewing some of the candidates that the state deemed as appropriate for a less structured setting. Many of these recommendations are clearly are not appropriate.  According to the staff on the units, these various agencies are not asking for input about how the residents are functioning. There is no collaborative effort to ensure that a clinically accurate picture of the resident is formed so that the best placement option can be decided. Finally, I am really interested to find out the rescreening status of the identified offenders! Where will they go? I cannot imagine that a reasonable and informed mental health professional would agree that this current effort on the part of CMS, IDPH and others is in the best interest of our residents. As a professional I am saddened by these events. I believe that CMS and the state will continue to de-certify other facilities. There will be a major crisis in this state, soon, probably sooner than they imagine. I ask the community and other mental health professionals to GET informed and then let CMS, IDPH, HFS, DMH, your state representatives and others know how you feel about this important issue and direction that it appears these agencies are going.

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