So there I am working in a Partial Hospitalization Program the other day and one of the patients that I am case managing comes up to me and tells me that a transitional program will not take him because he has had suicidal thoughts within the past two years. Not suicide attempts, suicidal thoughts. My first reaction is, "Are you shitting me!" (thought, but not expressed out loud for the sake of professionalism).
So let me get this straight, because the guy felt suicidal several times when he was drunk, that is a reason to deny him admittance to a transitional holding program???
I know people that every day of their lives feel suicidal but they don't act on it.
So I call the director of this program and we end up playing telephone tag. One voice mail from her tells me, "yes, we do look at each case one by one."
Then to add insult to injury, the next voice mail informs me that they would not take the patient "anyway" due to his "psych" issues and the fact he is on medication and they do not have a nurse practitioner. Furthermore, they only treat addiction.
Lets see, the guy has depression in on an anti-depressant, Celexa. He has outpatient providers for his "Psych" issue and would be coming with a thirty day supply. In the case of a person being on a benzo or something like neurontin which is being used on the street to enhance the heroin high, well yea, one would definitely take it case by case. But Celexa, are you kidding me??
As far as they "only" treat addiction, that is really sad. For the fact is, the majority of people that keep returning to formal treatment have another issue(s) going on that are not being addressed. Maybe not Axis I but I would tend to think at least Axis II (but what do I know. I am only entering my 21st year in the field and have worked literally every modality of treatment; from shelter, to inpatient psych/addiction, to outpatient, hospital detoxes, open detoxes, etc).
I find it to be a sad state of affairs when people working in the field either have all addiction training and limited psych, or all psych training and limited addiction.
Being a teacher on substance abuse and co-occurring disorders with addiction students at a local university, I emphasize to them if your program does not have the trained staff to work with those that are dual-diagnosed, you should at least know of the resources available for this population.
Maybe it is about time that DMH (psych issues) and DPH (addiction issues) truly discusses merging together (such as they have done in New York state).
I understand that each is a 'fiefdom' that does not want to give up power to the other. But would this not really benefit that patient?
