I have mentioned before that the economy in my city is not good and the majority of our patients are either uninsured or have Medicaid. The psychiatric benefits for Medicaid in this county were farmed out a few years ago to a private, and sadly, for profit company that has spent a great deal of effort trying to tell us how to do our jobs. Much of this is because if every little piece of busywork that they want completed is not done, they can deny payment for the service . This is the ultimate goal of any insurance company. Sometimes, however, I honestly believe that there are some poorly qualified individuals with a correspondence degree and a GED who think that they are improving care by coming up with suggestions to help our patients in the so called "recovery model".
The recovery model of treatment is a perfectly reasonable approach to treatment but needs to meet the patient where he/she is at. The idea is to help people to look beyond their diagnosis and strive towards recovering to a higher level of function. Hopefully the patient will be able to return to a work setting, or at least remain in the community, living independently and living a healthy lifestyle. This was opposed to the older model with tended to lock patients in psychiatric facilities for years or even life, a system which has been abandoned decades ago.
Our particular managed care company, I will call NBH (Nag,Bitch,Harass), not their real name, has decided they want an individualized safety plan to prevent suicide in every patient we discharge. They suggest we have them plan such activities as: walking, meditation, attending a church, joining a gym, getting a volunteer job, etc. Of course, not all of our patients are suicidal when they are admitted to begin with. Some become quite defensive when you ask them if they are suicidal and refuse to participate in such discussions. Some are homicidal, some psychotic, some are just trying to get their girlfriend to come back to them so they cut their wrists and claim to be suicidal. But they think that they have a great idea and if we are to get paid, we have to do this.
Some of us were sitting around trying to come up with some ideas that would fit their criteria but might be more appropriate for our patient population. When a patient claims to be suicidal because she got a second floor apartment and now has to climb a flight of stairs to get home is not going to get a volunteer job. In fact, she is too lazy to put her street clothes on when she is on the unit and we are just happy if she will shower and put her underwear on. Meditation? The closest thing to a meditative state our patients will ever see is drug induced are we are trying to discourage that. Join a gym? These guys will not pay a $1 copay for medication. Where are they going to get $50 a month to join a gym? So we tried to come up with ideas that would calm NBH's jets. They are not going to work, but they will fit the criteria. Then we came up with what our patients would be more likely to be receptive to. Not to sound cynical, but you have to be realistic sometimes.
| What NBH Expects | What They Will Do |
| Call a friend | Call a friend and tell her you took an OD |
| Join a club | Join a drug gang |
| Reconnect with family | Have sex with a family member |
| Read a self help book | Read a porno mag |
| Meet you neighbors | Get in a knife fight w/ the neighbors over a man |
| Go to AA | Go to AA for 13th stepping(picking up chicks) |
| Take a walk | Take a walk to the stop'n'rob to buy smokes |
| Start a garden | Grow marijuana in the closet |
| Start an exercise program | Get drunk and run naked through the streets of downtown |
| Get into art and paint a painting | Get a new tattoo |
| Get a volunteer job | Volunteer to be the lookout in a drug deal |
| Go to church | Join a Satanic Cult |
| Go to a public event | Go to a bar and get shit faced. |
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