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A Personal Reflection

I would like to thank New River Valley Community Services for its support to Cindy Stewart and myself in attending the National Case Management Conference held in Los Angeles last month. It is with much pride I report Cindy’s presentation for the Case Management Supervisor of the Year and her acceptance was one of the highlights of our trip. Another highlight was having the opportunity to meet other professionals in the behavioral human services field. I always leave this conference with much to ponder, this year being no exception.

After attending the first session, I questioned if the current services offered to our clients with serious mental illnesses are not in fact enabling them to maintain at their present functioning levels. One day later I was convinced this is true. I see little focus on recovery from the illness and more on providing support in order to maintain in the community. For the case manager, the challenge to assist a person through the recovery process is complex.

When addressing issues of any disease or condition that disables persons, the cost of support becomes ongoing once treatment and rehabilitation has achieved best possible benefits. The less effective the treatment and rehabilitation of making persons independent, the greater the cost. When funding does not match the growth in caseload size, providing these supports eats into the funds needed for treatment and rehabilitation, which increases the cost of long term supports, and the effectiveness of the system is at risk.

When we provide excess supports to individuals based on program design rather than individual clinically justified needs, we rob the person of the opportunity to learn to be independent, and resign them to build lives dependent on mental health programs. Are we creating an institutionalization within the community?

Recovery is a MUST, and the opportunity is knocking on our back door. We have the good fortune to see dozens of new therapeutic drugs that go far beyond the dulling control of positive symptoms. Specific drugs for specific disorders offer relief from disabling symptoms without disabling side effects. Drugs that alleviate negative symptoms provide new opportunities for persons to launch personal rehabilitation plans focused on personal valued desires. Equally advanced psychotherapies like dialectical behavioral therapy, and cognitive behavioral therapy for schizophrenia and depression offer the case managers roles with clients that can be curable as well as nurturing and supportive.

In order to implement a more effective and efficient program, we must change the old. Current program rules hinder the individual’s independent growth. They are barriers. We need to become partners in treatment. We need to look at the level of support requested by our clients. Because many of our current services are designed to deliver large amounts of support services, we need to move away from “case management” to “community treatment and rehabilitation.”

And a final note, when opportunity is knocking on our back door, we need to open this door to allow those who have benefitted from the recovery process to live independently in our community.


--Miner Carter July 17, 2002

Editor's Note: This piece reflects the personal opinions of Miner, a New River Valley Community Services Board (Virginia) Case Manager

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