For people with severe, chronic, and unpredictable symptoms stemming from a mental health condition, having a reliable, trustworthy, and rational point person is critical. A point person can be anyone on your treatment team. That is to say, a point person can be your therapist, friend, family member, psychiatrist, or case manager.
It doesn’t matter which role they are assigned to on your team. Good leaders aren’t dependent on them being clinical savvy or their ability to carry out complex case management. Instead, good leaders take on responsibility, own their mistakes, reap the benefits of reflecting on learning moments, and are passionate in their approach to the helping process.
My first clinical supervisor would remind me of these ethical and, without question, moral underpinnings of providing therapy or other services in mental health treatment settings. Indeed, these ethical and moral questions from my supervisor became even more frequent when I would allow other clinicians to take the lead in certain cases, instead of taking on the leadership role myself.
Many clinicians, friends, supports, and allies of people with a mental health diagnosis don’t want to be held responsible if their loved one’s or patient’s condition worsens.
Many times, these brave and compassionate clinicians absorb the blame of their colleagues and lose face or take damage to their reputation when perfectly plausible interventions fail or were ineffective in impacting or providing relief to a patient’s symptoms, which had become seemingly increasingly resistant to treatment.
That’s why so many people in the helping profession – psychologists, psychiatrists, friends, and family – sometimes take a step back and put distance between themselves and the person in crisis, who would benefit from that sort of attention in the provision of their own treatment.
When stepping down to a lower level of care or discharge from a programme or inpatient facility, people in these circumstances require extra help – this is always the case. Whether it’s because people are adjusting to fewer supports, or experience a reduction in the frequency and intensity of psychotherapy or pharmacological therapy, people in this position must find a way to compensate for the fall off, and titration down of their mental health treatment.
Also, since adjustments themselves can exacerbate symptoms, patients recovering from a mental health disorder are likely to be surprised, blindsided at times, and always in suspense of other new or similar problems ahead while transitioning to a new level of care and step down in support. In some cases, depending on how difficult or compromised their situation is, this can be enough to trigger anxiety, and cause other more serious symptoms to reactivate.
Leaders, and natural point people, must sometimes make ethical and value-based decisions for their loved one or patient. These are decisions that, at times, impact the care and provision of their loved one or patient’s treatment.
Patients need to believe in their therapists to help them make the right decision – there are undeniably times when people with certain mental health diagnoses experience symptoms that interfere with good decision-making, and in many cases, are appointed lawyers and health proxy, in advance of losing the capacity to make the right treatment decisions for their ongoing care.
A point person may need to step in with a case like this or take the lead in these emotionally difficult situations for loved ones. With this said, when the course of treatment takes a problematic direction, the point person becomes even more important. This happens in the tragic event that treatment ‘fails’ and a more restrictive treatment fit needs to be put in place for the safety of their patients or family member.
This applies also for mental health patients, in particular, who are likely to have wrap-around services and are living in treatment homes in the community, in a supervised living situation. Many patients with severe conditions are living out their lives in the community in these adult homes. Since these adult homes are little more than free-standing and self-sufficient wards scattered and dispersed in the community, we shouldn’t forget to include, when thinking about a patients clinical picture, a deep understanding of the patients living situation.
This should always incorporate the general housing arrangements already in place to get a complete picture and direct treatment moving forward. Thus, being a leader means not only knowing the immediate mental status of their patients, but also, in clear terms, how stable the patient is in the larger clinical picture to ensure the health of their patients continues to prevail over their symptoms.
Max E. Guttman, LCSW is a psychotherapist and owner of Recovery Now, a mental health private practice in New York City.
