When I was in psychiatry residency, the training director, Dr. Rapaport, once asked me, “What can I do to best support you?” She must have seen something in me because my response to this led to the best gift of all -- Dr. Bernhardt.
Patients and clients bear witness to the dangers and adverse effects of K2. How can we capitalize on the principle of social currency and that of peership, to help our patients and clients, like Raj, who uses K2, a dangerous drug with significant adverse effects? After all, this is in line with the principle of harm reduction.
New strategies for substance use assessment will help us master the needed skills, so we can continue to do the best work possible for our patients and clients, helping with relapse prevention, promoting full recovery, paying attention to integrated care, lessening fragmented care, and feeling gratified, as we continue to do this challenging though noble work.
Contrary to popular belief, while personal efforts can contribute to one’s attendance to appointments, groups, and to one taking medications as prescribed, addiction or substance use disorders are caused by a combination of bio-psycho-social and cultural factors, and the treatment also requires the same multidimensional approach. As clinicians, it is our role and duty to follow this framework in our assessment, treatment, and approach with our patients and clients, and especially in how we communicate with them and talk about them and about addiction, as a whole.
Split treatment remains a challenge and has been shown to be detrimental to our patients and clients. This becomes more significant when it involves a patient population with several comorbidities. Patients with both mental health and substance use treatment needs are particularly vulnerable to split treatment, and integrating substance use treatment and mental health services is not only advised but also essential if we are to make meaningful changes.
The first five questions, described in the previous article, help with establishing rapport, with joining in, and with understanding and formulating a plan. Once you have reached this point, it is time to go to the next step that will prepare you to problem solve. This step involves having a clear picture of the magnitude of substance use, including the related consequences; assessing the stage of change for your patient and client; and discovering which barriers need to be overcome. Here are the five additional questions to ask when conducting a strategic substance use assessment, as part of this second phase.
To be able to identify our biases and think of ways to practice in a more integrated way, will enhance our advocacy skills while working with individual with substance use disorder. Also, to help lead our agency towards this effective way of thinking: enhancing communication, enhancing clinical outcomes, halting the cycle of fragmented care, and upholding educated expectations. Lastly, we will stop falling into the trap of unknowingly and unintentionally failing to provide the right care for our patients and clients.
You may be failing to provide the right care to your patients and clients with substance use disorder. You may also be using your counter transference and biases to their detriment, unknowingly and unintentionally. Learning the new strategies to working with individuals with substance use disorder will help you avoid falling into this trap. It will also help you promote and practice integrated substance use treatment and mental health care; improve your awareness and advocacy skills on behalf of your patients and clients with substance use disorders; and become a passionate educator to help decrease stigma against substance use disorders.
The system has its role to play. It needs to empower clinicians and advocates, patients and clients, if there are interests in decreasing staff turnover and restoring trust. If burnout is to be addressed and prevented and self-care promoted, we all have to work together. And, these efforts must be supported by the system, if we are to reach our goals and continue working effectively and with the passion with which we came into this field.
“It is rather strange to me that all of us in this room came into this field because we love people, we love to help, we want to make a difference in their lives, and yet, suddenly, we all feel defeated and left with a sense of helplessness and hopelessness and, sometimes, even worse than our own clients.” Paul uttered these words with frustration in his voice, as the rest of the group stared at him in disbelief and then at one another and at Rodis, the consultant and group facilitator.
After experiencing a phenomenon for so long, it becomes the new normal, the new culture, which is then very challenging to change or undo. It is going to be a slow process, which requires a collective effort from all of us—clinicians, advocates, agency leaders and decision makers—and from the system, as a whole. It will be a process, but it indeed starts with understanding “The Why” of preventing burnout and promoting self-care.
Cynicism, depression, and lethargy are some of the manifestations of burnout. Burnout is present in about 21-67% of mental health professionals. The ramifications can be devastating for our patients and clients, our clinicians and advocates, and for our agencies and the healthcare system, as a whole. Burnout can and must be prevented. Self-care can and must be promoted. Here are four reasons why.
A lack of purpose and direction in treatment has been one of the factors contributing to feeling drained when working with patients and clients suffering from Borderline Personality Disorder. This draining propensity is rather common; it adds to negative countertransference and leads to clinician resistance to working with these patients and clients.
Prior to learning the skills, exploring the reasons why of the skills helps put things into context and helps prepare the terrain for a successful implementation. Strong Countertransference, Draining Propensity, and Splitting Ability are the three reasons why it is crucial for us as clinicians to learn and master the skills for working with patients and clients suffering from Borderline Personality Disorder.
Kate looked at Roger and said: “I am feeling more and more empowered each day. Peter is opening up to me. However, he keeps talking about dying and about his non-stop cough. How do I best support him?”
Many of the same principles required for supporting someone going through pain and loss can also be applied to assisting someone who is battling a terminal illness.
Peter received home health care resident visits from multiple providers, including, nursing care, the care coordinator, and the diabetic educator, in addition to visits from Kate, the social worker. He began sharing medical concerns and complaints with Kate that he was not sharing with the rest of the staff. However Kate was limited in her understanding and ability to best support Peter.
“What are you laughing about; why are you laughing at me?” Castro asked these questions during his visit with Jack in the ER. He started to raise his voice, then he got up, made a fist, and as the situation escalated, he ended up in restraints.
“How dare you tell me I can’t leave; who do you think you are? How dare you?” Harry spoke these words loudly and in anger to Nate, a forensic social worker, who was meeting with him for the first time, for an evaluation.
Are you ready to make engagement part of daily practice? As stated in Part 1 of this article series, engagement is a process; it does not happen overnight, and it requires patience, flexibility, and a different mindset, a willingness to consider a strategic approach. As a result, to be successful, you need to desire it, and to decide to make it a priority.
Patient and client engagement is a challenge across all aspects of clinical care and more so in mental health, especially for those who feel forced into treatment. There is no single best definition for patient or client engagement, but I usually describe it as the active patient and client involvement in his or her care for best outcomes.