A List of Wishes for Mental Health Service Providers in 2015

(written by the mother of a young adult son who is being treated for bipolar disorder)

1. Care. It really shows when you do. It really shows when you don’t.

2. Remember who you’re serving. Expecting a severely mentally ill patient to ask clear questions about your “menu of services” is completely unrealistic.

3. Speak in layman’s terms when providing information about what you can do for your patients. A fulltime “navigator” or “Journeys Program” or “wellness check” means little to someone having a psychotic breakdown. Common everyday words will resonate best for those whose thoughts are confused, depressed, or delusional: “people who can help you make the right connections for help” (for Navigator), a “program to help you map out your next steps” (for the Journeys Program), and a “physical performed by a doctor or nurse practitioner” (for a wellness checkup).

4. Don’t expect a person in the middle of a breakdown to give you full information. When you forget to ask new patients if they’ve recently been hospitalized, it can cost a patient a 3-4 week delay for an evaluation at a time when the risk of suicide is high and the need for stabilization is severe. Don’t expect the patient to realize how important full information is.

5. Accept a loving family member’s input until the patient can speak for him or herself. We understand HIPAA laws – we really do! But disallowing us to provide information on drug use or hospital stays or things we know our mentally ill loved one is misrepresenting merely prolongs their suffering and ultimately makes your job harder. Trust us to want what is good for our mentally ill family member – probably more than you do.

6. Provide appointment information in writing. Do you really think a psychotic patient is going to remember Tuesday the 14th at 2:45?

7. When prescribing new medications or making meds changes, book a follow-up appointment. Have a responsible system of checking the effectiveness or ineffectiveness of medications. Leaving a follow-up appointment to the patient may be reasonable for other medical patients, but not for those with severe mental illnesses.

8. Review all the services you can provide and let the patient express what he/she needs. Therapy may not be nearly as important as life skills or a physical.

9. Coordinate the patient’s care by communicating with each other. Why can’t the psychiatrist share with the therapist the medication change that was made? Why can’t the therapist share with the psychiatrist that the patient will be starting a new job and may need a different strategy to be alert early in the morning?

10. Don’t offer your most important life skills classes in the mornings and offer little in the afternoons! Many people with mental illness are notorious for not functioning at full alertness in the morning. Having seminars on Using Art to Help Depression are wonderful! – but not at 8 a.m.

11. If a mentally ill patient calls in the afternoon for an emergency appointment, don’t ask him to call back at 8 a.m. the following morning. Did you hear that he is having an emergency? Do you recall that many people with mental illness don’t function well in the morning?

12. Inform your first-line telephone representative about the programs you have. To call your main number and have the answerer say she doesn’t know of a program called “Journeys” is a poor reflection on you … and something that would completely throw off someone who is mentally ill.

13. Make your website understandable. See #3.

14. Publish your Patient Advocate’s name and phone number where patients can actually see it! How would they know they have an advocate if it’s not on your website and you don’t share this information when they arrive at your facility for assistance?

15. Don’t look at the computer when you’re asking sensitive questions of your patients. Remember that they have mental illnesses; they are often overly sensitive, overly suspicious, vulnerable, and at risk. They need to trust you in order to tell you if they’re considering suicide, if they feel like zombies on the current medication, or if they’re having delusions that are scaring them. When you look at the computer screen and spend much of your appointment typing in information about them, they feel – inhuman.

16. Include family members and friends in the care plan. Ask the patient who loves him/her, who will be supporting him/her, and whether those people could be part of the connected support system. We as parents are desperate to support what you’re doing as professionals, and we don’t want to interfere. We also see many sides of our loved one that you don’t. Operating as a team is the best way to achieve a truly comprehensive care plan for your patient.

17. Know that we as parents are heartbroken and sometimes feel hopeless about our child or adult son/daughter’s condition. If we sound distraught when we call, it’s because we are – and your recognition that our calls are to support a good plan (not criticize your work) will go a long way.

18. We know that any organizational system will have its shortcomings, so we’re realistic. What we mostly hope for in 2015 and beyond is … well … see #1.

– Anonymous in Boulder, Colorado

The opinions expressed in this blog are those of the submitter. They do not necessarily reflect the opinions of the board of directors or members of the Interfaith Network on Mental Illness