One size fits none
As someone with the lived experience of mental illness, I’d like to respond to the outstanding commentary published in The Bollard [“The Case Management Trap,” April 2016]. It was very revealing to hear from the viewpoint of a case manager who provided services to people with mental illness.
The writer made it clear that dependence on services may be a result not only of personal situations, but also the system. It seems there is a victimization of individuals who access services and who are supposed to sign off on their own progress notes and the continued stay review (CSR). I know there are many excellent case-management services in Maine, but not in all cases.
When I had a case manager, I signed off on all progress notes and other paperwork. This empowered me to check all paperwork filed on my behalf and allowed me to address any inaccuracies that may hinder my progress. I was also able to recommend corrections. This provided me with tremendous empowerment to shape my own course.
The commentary in The Bollard made me feel quite hopeless for the people who do not have this same opportunity. Community integration and MaineCare should be providing more flexibility to individuals. If the service were set up more like arranging an appointment at a doctor’s office, people could get help when they need help. MaineCare currently requires that individuals be seen every month, whether necessary or not. This is a one-size-fits-all approach for people with very different mental-health needs. Mental illness is a personal experience. MaineCare’s case-management service is based on system needs, not client needs.
I was a participant in a graduate program offered by a nonprofit, in which we met with community-integration workers only as needed, and also participated in recovery classes and group meetings. Unfortunately, the program was grant-funded and lasted only about a year. The program worked because it suited my needs and I could access services when I needed them, not when somebody told me I needed them.
Some individuals have stayed in the system for five, ten, fifteen or more years with no incentive to move on. Community-integration agencies have many benefits, but some create a service dependency and almost a trap. In fairness to the dedicated case managers in Maine, I know that many have billable face-to-face hour requirements they have to fill.
I am hoping this message reaches people like me who would like to have more power over their lives. Thank you for printing this commentary and bringing these important issues to light.
Karen A. Evans