A day in the life of a community mental health worker
7:41- I’m going to be late catching my bus.
7:48- I literally make a flying leap onto the platform at the downtown transit center as my bus is pulling away from the curb. Grumbles ensue from the packed No. 5 as I dig through my backpack for a bus pass and plop breathlessly into the one empty seat.
8:02- The bus driver actually pulls the bus over and yells at the teenagers in the back, “Ladies! Watch your freakin’ language!”
8:08- I arrive at work to find that the rest of my team has started their early morning shift recap without me (it’s quite typical…I’m just the intern, and I’m always slightly late depending on the bus schedule–a fact which I suspect irks many of my colleagues, who all have that Michigan compulsion towards punctuality).
8:45- My supervisor engages me in a heated one-sided discussion about how the free market will not solve the Social Security crisis and repeatedly proclaims Sarah Palin to be a wingnut. He is so emphatic that I’m afraid he will splash coffee on me, and I just bought this shirt.
9:05- I have signed out the medications for all the people I’m visiting today and head out. One of my team members has given me the keys to the “nice” county vehicle, a Pontiac G6 which I will proceed to drive as if I own the road. The county logo emblazoned on the side of the vehicle grants me supposed immunity from speed limits and u-turns. I’m on a higher mission! I’m out to promote community mental health, and I can’t be bothered with your fascist road standards!
9:27- I see my first consumer of the day, whom I call Jorge. Jorge was recently caught cheeking his meds and as such was switched to a liquid form of Depakote, an antipsychotic that apparently tastes like “a cherry took a shit in my mouth” (his words) when you drink it. Since regularly taking his Depakote, Jorge has gained about twenty-five pounds and is none too happy about it. He is also aggrieved by what he claims are the sexual side effects of the meds, a.k.a. problems getting it up. “My girl’s freaking out about it,” he shrugs, as if to say, “Hey, it’s not my problem.” (Nice cover, Jorge.) As we chat it turns out that his problems in the sack are the greatest after he’s been drinking. “How much do you drink per day?” He hems and haws, then finally admits he’s been drinking approximately a pint and a half of hard liquor per week. I fear this is a conservative estimate and briefly wonder how to describe “whiskey dick” in clinical terms. He agrees to come back to a support group run by the center for people with substance use problems, and dismisses me, saying, “All right, I’m going back to bed now.”
10:02- I take a sharp curve and promptly spill coffee all over my lap and the side of the car door.
10:07- I pay a visit to “the projects” of Ann Arbor, a large, nondescript housing complex funded by federal subsidies through the city’s housing commission. I use quotation marks because the Ann Arbor projects, while admittedly not the swankiest apartments the town has to offer, are decent, clean, and relatively violent crime-free with amenities such as working elevators and running water that the New York City Housing Authority would probably deem too luxurious to bestow upon their poor.
10:17- One of my favorite consumers, a middle-aged woman I’ll call Diane, answers the door with watery eyes and an obvious sinus infection. She is currently very symptomatic (diagnosed with schizophrenia) and is experiencing a lot of delusions around cashing a weekly check she receives from her guardian to pay for necessities. She launches into a long story about a man being shot outside her apartment last night and having to scrub the blood off her door, then chirps, “You look lovely today, hon. You have the nicest earlobes.”
10:45- The classic rock station has proclaimed the month of September to be “Zeptember” in honor of Led Zeppelin’s 40th anniversary, a fact which tickles the hell out of the woman I’m driving to the Social Security Administration for an appointment. She was born in 1959 and knows every song on the radio. “Magic Bus by the Who! You know dear, I saw the Who on December 14 1976 when they played in Detroit it was their first time in Michigan.” Or, “Now this dear is ‘Night Moves’ by Bob Seger who I saw in concert August 29 1974.”
11:02- The Social Security Administration is the most hilarious place. I’m waiting for Helen’s (not her real name, of course) number to be called and watching people trickle in through the front doors. As soon as you walk in to this particular SSA, there is an enormous red-lettered sign that says “START HERE” with an arrow pointing to a screen and keypad, directly in front of the entrance. In fact, it’s so direct that you have to step around it just to get in the waiting room. Yet person after person bypasses the computer station (which gives you a number after you press a button on the keypad specifying what services you need today) and has to be rerouted by the security guard, who very patiently explains how to get a number. I nearly fall out of my chair when one elderly couple walks in, looks at the computer, turns and walks up to the security guard and practically shouts (I assume they’re both hard of hearing), “YOUNG MAN, WE’RE HERE BECAUSE THEY GOT HIS NAME WRONG! HOW DO WE GET THEM TO SPELL HIS NAME RIGHT?” The wife then hands the offending document to the security guard, who is not an actual employee of the government but of some contracting agency–a fact which, of course, is lost on the couple, who proceed to holler about getting the name right until the guard has to physically walk them back to the computer and help them press a button. Once they have gotten a number the wife continues to air her grievances quite loudly, stating several times, “GOODNESS, I DON’T KNOW WHY THEY CAN’T JUST FIX IT WITHOUT US HAVING TO GO THROUGH ALL THAT!”
11:34- Helen’s number is finally called, but once we get to the window she has trouble completing certain tasks that the worker needs–like handing over her state identification and reciting her Social Security number. “Why does she want all that?” Helen hisses at me. I try to explain but Helen keeps insisting that I’m talking too fast. After about five minutes of back-and-forth, I finally communicate to Helen by speaking a s s l o w l y a s I p o s s i b l y c a n that the government is not after her, she just needs to produce identification so the worker can get on with the day’s order of business (an official document listing all the benefits Helen currently receives). Helen then throws back her head and begins laughing wildly, her whole body shaking, as she digs out her wallet. “Here! Take it!” she giggles shrilly. The entire waiting room is now staring at us, and the worker (who, admittedly, is putting up with us rather well) is obviously irritated by how long this is taking. I’m struck once again by how socially acceptable it is to gawk and cluck at people who appear to have a mental illness. I want to tell everyone to suck it.
12:07- Back at the office, I wolf down my sandwich and face down another onslaught of Sarah Palin ire from my supervisor, who has come into my team’s room to heat up his free-range turkey chili and rant about politics. Apparently, it’s his way of showing that he likes me and thinks I’m smart; although he is a licensed social worker with many years of experience in the community mental health field, he is one of the most socially awkward people I’ve ever met and is constantly harassed by his staff, which makes me feel sorry for him.
12:17- Still finishing my lunch, I drift in and out of the conversation happening around me. Larry is out on a last-minute vacation (kayaking), which has apparently been a gigantic source of contention and nonstop grumbling in the ranks…even though, when Larry is available, his job duties do not include much more than the shit work of transporting clients here and there. After thoroughly bashing Larry, the topic moves to the county’s new insurance policy and ovulation. The two seemingly disparate topics are related because four out of the six social workers in the room are currently attempting to get pregnant; the other two already have children. They are calculating how to schedule conception around signing up for a beefier insurance package, since pregnancy is considered a pre-existing condition and would not be covered. Somehow the subject moves, quicksilver, to whether they’re going to have C-sections or all-natural childbirth. I chime in with my unsolicited two cents, recommending the documentary “The Business of Being Born” and the practice of midwifery in general. I am then stared at as though I have three heads. (It is a stare similar to the Vegan Stare, which is what I often get from older people in the Midwest who have never heard of such foolishness. I believe it generally means, “Oh, you poor idealistic idiot with your silly diet/lifestyle/politics. You’ll grow up someday and get over it.”) Then one of my colleagues says something both hilarious and hilariously stupid. [Adult content to follow.]
“I don’t think I’m going to breast-feed, either. Because, like, then I can’t drink. And also, I think it’d be weird to have a baby sucking on your tits. What if it’s a turn-on? I mean, what if it’s something you like your husband to do? I think it would just be weird. No, I’m definitely going to do the formula thing.”
P.S. This woman is 30 years old, not 13.
1:05- Since Larry is not here today, the shit jobs that nobody else wants to do are passed along to me. I don’t mind–I really like being out of the office, even if it means just driving someone home from an appointment or dropping something off at the Housing Authority’s main office. My task this afternoon is to round up three different clients who came in to have their blood levels checked during the center’s weekly Clozaril Clinic and take them home. (Clozaril can dangerously lower your white blood cell count, so weekly lab tests requiring a blood draw is mandatory during the first few months you are on it, gradually decreasing to a once-monthly basis.)
As I weave through the crowd of people in the reception area waiting for appointments or other business, I am swarmed by the clients who recognize me. “Annah! Annah! Annah!” shrieks one woman, who compulsively repeats everything she says between two and six times. “Guess what? Guess what? Guess what? Guess what? My brother’s giving me fifty dollars. My brother’s giving me fifty dollars. My brother’s giving me fifty dollars. My brother’s giving me fifty dollars. My brother’s giving me fifty dollars.” (Can anyone find the pattern?)
Another client, a lanky man who always wears a backpack and knee socks, quietly tells me he likes my tattoo. Somebody else asks if I have a lighter. A middle-aged woman who always dresses in flowing black velour dresses a la Stevie Nicks squawks, “You are really thin.” Then, to everyone else in the room, “I used to be thin like that.”
As I walk toward the door three people actually get out of their chairs to open it for me, one of whom an elderly man who needs a cane to walk. I find my three charges waiting patiently for me on the smoker’s bench and pile them into the car for the ride home. They are grateful that they don’t have to take the bus on a potentially rainy day and pass the time during the ride by watching out for bad drivers on the road and asking me about New York.
3:01- I have finished my progress notes for the day and our shift change begins, which takes place during the last hour of the regular workday and is meant to be a discussion of every client on our caseload and how they are doing. Today’s meeting is being interrupted frequently by the antics of one of my esteemed colleagues, who finds it extremely difficult to refrain from talking. All the time. She must be talking every second of the day, or else she is not happy. She talks more than anyone I have ever met, and if you know my mother you also know that I come from an impressive line of garrulous folk. When she isn’t talking, she is interrupting everything I say. I look forward to the days when she is out of the office. I miss Larry.
4:11- The day is done and everyone has cleared out of the office; I cross the highway to stand at the downtown-bound bus stop. Several clients are already standing around waiting. We chat a little while, then the bus pulls up. I notice that as soon as we board, they spread out, giving me my space rather than continuing the conversation. Perhaps they do not want to talk to me anymore, but it seems to me they are simply honoring the “boundaries” that exist between us, as worker and consumer of services, as a person in a position of authority and charges, as an able-bodied individual and disabled individuals. I’m always struck by the artificial dichotomy struck between “professional helper” and “person in need of help” in these agencies. I’d like to view my future work as more of a partnership than a helper-helpee relationship, which to me seems inauthentic at best and oppressive at worst. Granted, I think there are lines that shouldn’t be crossed–you shouldn’t trash your co-workers or have sex with clients, for obvious reasons. Yet I’m increasingly uncomfortable with and disillusioned by the rigidity of the professional boundaries social workers are supposed to set with their clients, even as methods of “cultural competency” and “joining” and “authenticity” are drilled into us at school. It feels shitty to me, an artifice that completely contradicts what I think of social work and who I am as a person. If working toward social justice is our mantra, this identity does not disappear as soon as we’re off the clock; yet that is the way it plays out, with a professional life devoted to good causes and a private life where you have nothing to do with anything remotely social work-y. On an individual level it’s even more ludicrous–almost all of my colleagues, save Larry, are completely icked out whenever they’re in public and they see a client. They go to great lengths to avoid certain bars or areas of town where clients may live or frequent, and whenever a client approaches them out in public they are always horrified. This strikes me as simply ludicrous. Why are you in this line of work, if you do not believe in the rights and ability of these people to live peacably in the community?* Why the fuck is it a problem when they see you at the grocery store and say hi, or take a seat next to you on the bus?
I believe it is this attitude which has been internalized by many of our clients, and perhaps one of the reasons they pretend not to know me as soon as we board the bus. I notice other passengers scoot away, move over, and gawk as these individuals find seats and settle in. All I do now is close my eyes and hope one day for a better world.
*I feel it’s necessary to note that, because I live in a neighborhood very close to the heart of Ann Arbor and utilize public transportation, I see a person I can identify as someone who receives services from my agency almost every day. Sometimes they recognize me, sometimes they do not. Not once has anyone bothered me in public; not once has anyone followed me home, asked me for money, or done anything more than simply acknowledge me and perhaps say hello in passing. So that’s part of the reason why it’s difficult for me to understand the ire seeing a client around town provokes in my colleagues, who seem to think it’s a novel event that requires a bunch of squawking about and strategies on how encounters can be avoided. Shameful.
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