How “The Why” of our work becomes important.

I recently had a case where I believe “the system” failed a youth that I am working with. I also have been reading other blogs exposing errors in both the medical and mental health professions. I wanted to provide some insight about when the “system fails” what that looks like from my perspective. It seems like system failure covers a wide range of actions from someone feeling they got bad advice to rare cases of death. As a licensed professional and member of an organization, if a formal complaint is filed then also a wide range of actions can happen.

Things get tricky when a formal complaint is not filed and someone feels as though they have been treated unfairly.  If it is not me being “unfair,” and if I agree then I will help a parent file a formal complaint. This is one of my favorite parts of my job: to hold other systems accountable for taking advantage of or not following due process with my clients.  If it is me I will talk with them individually, process it, and try to work it out. For instance, calling Child Protective Services on a family is often viewed as “unfair” but I educate the family about this process. It is not a guarantee, but the more information we give our clients the fewer “failures” we will have. Sometimes we just take for granted that not everyone knows about “why we are doing what we do.”  I am often guilty of this as well. I don’t always explain the why of my work to families but I will try to make an effort to do so. It is a critical step of informed consent, making individuals and their families aware of the treatment options and allowing them to make a choice.

Sometimes the “why” is based on law or policy and choice is taken out of peoples hands. When persons become a danger to themselves, others, and/or can’t care for themselves the waters get muddy and quick. Intense feelings happen and all logic goes out the window.  As in the case with calling child protective services, it is my opinion explaining the the why of our work becomes important. We don’t always do this with individuals and families in crisis.  We often take for granted that they know the rules for things such as “least restrictive environment”, medication over objection, restraint, or involuntary admission. As professionals we need to educate clients and families about these things.

My case currently is returning four siblings to their father after being in foster care for 6 years. My client has intense mental health needs. I understand the father has his rights but to my client his father appears to be a stranger. In his current foster care arrangement they have built stability, consistency, and healed from a lot of trauma . I feel that uprooting them from this is a failure to them. In the eyes of the law their father has still not done anything wrong. This is a hard pill to swallow but I will. I puzzled about the why, advocated against the why, but now I have to accept the why.  I am not thrilled about this but I will try to make it successful and continue to advocate for my client.

We don’t always have to like the why, but it sometimes needs to be explained.  I struggled to understand the legal mandate versus my client’s mental health needs. Families experience the same thing about their loved ones. Sometimes it requires repetition but we need to constantly educate and remind ourselves about the why.  Also let’s work more on explaining the why across different systems. For instance the addiction “why” is different than the mental health “why.” The special education system “why” is different then the mental health “why.”  In my estimation this might reduce some of the system failures. It is working together and respecting our clients, their families, and our colleagues. Let’s explain the why the best we can.

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