At the end of a very long day I sat down to read the local newspaper online. I was disappointed to see a major provider of mental health services in the area is closing leaving 170 patients to find services. The agency had provided care in the form of case management for 27 years. A little longer than me being back in Portland. I am disappointed each week when I read of more and more agencies having to close their doors. I actually have as much work as I feel I can safely provide. This work is very strenuous at times so I know my limits. I do feel badly when a colleague will want me to see a patient and I just don’t have the time to take the patient on. Sometimes things will open up briefly in my practice, but those appointment times fill quickly. I also don’t want to take on a new referral if I could not give appropriate followup appointments in a timely manner. Could I add a day a week to my schedule, sure, but then my own self care would be compromised. In my opinion, no one would benefit from an over tired doctor/therapist. I am adding to my psychotherapy practice but that type of work is weekly for a 50 minute hour and I get to know my patients very well. Although it can be strenuous at times, it is entirely different from working in community mental health. Patient’s have to be much more independent and able to manage symptoms with little involvement from me outside of the office.
I would say that 90 percent of my practice is providing therapy. It is the work I truly love and why I went into Psychiatry in the first place. While there is a part of me that feels helpless when I see another agency close. I know that I am only one small piece of the puzzle. I never quite understand why the “bigger players” don’t step in.
I hope that reimbursement improves which seems to be the driving force behind the closures. That would mean that the State would have to allocate dollars toward caring for these patients and I know it has been an uphill battle the last eight years. I am hopeful things will improve over time. I just hope it’s not too little too late!