Welcome to the #AtoZChallenge on mental health, letter C. Today, I have quite a few words to discuss with you.
When I first entered the world of care, I didn’t have a care plan. They were just starting this up at the blindness rehabilitation center and I was among the last who didn’t have one. I hated it, because I thought a care plan meant I’d actually get better care. That’s the idea. It doesn’t work that way in real care.
Care plans in mental health are part of treatment plans but not the same. They list the patient’s goals for a particular time period, the help a patient will get and the risks if the patient doesn’t get that help. Care plans are framed in a very rigid format. As such, they cannot accommodate all the varied problem areas a mental patient might experience. The care plan also needs to conform to one’s care package, which is the amount of funding allocated to a patient’s care. Then again, care plans are also used to justify funding. If this isn’t a circular argument, I don’t know what is.
A treatment or care provider’s caseload is the number of patients assigned to them. In intensive outpatinet care, one professional might have a caseload of ten patients. Usually, their caseload is much larger. Caseloads are related to how much care a person is allocated again. For instance, as a person in my care package category, I’m only allocated 50 minutes of “treatment” a week. This includes psychotherapy or counseling, social work, medication management, etc.
This is the co-existence of two or more mental illnesses in one person. Many people in long-term psychiatric care have more than one diagnosis. Interestingly, a “dual diagnosis” refers specifically to a mental illness and an addiction co-existing.
I once read a list of things typical to institution life, and at the end, the list went: control, control, control. Even though the philosophy of mental institutions has changed over the past several decades to “allow” patients more independence and to rehabilitate us, this has become its own framework of control. I have had many battles with nurses who said that, because this is a treatment unit, I should be able to do daily activities independently, despite the fact that I can’t do most of these.