The ‘Point’ Person: Care-Coordination

The ‘Point’ Person: Care-Coordination

For people with severe chronic and unpredictable symptoms stemming from a mental health condition having a reliable, trustworthy, and rational 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 carrying 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, my supervisor’s ethical and moral questions 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 either be responsible if their loved one’s or patients’ condition worsens.

These brave and compassionate clinicians often absorb the blame of their colleagues and lose face or damage to their reputation when perfectly plausible interventions fail or were ineffective in impacting or providing relief to a patient’s symptoms, 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 people need a lot of care, either from 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. Which, in some cases, depending on how difficult or compromised their situation is, can be enough to trigger, invoke anxiety, and 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, which, 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 treatment takes a problematic direction, the point person becomes even more important. This happens in the tragic event treatment ‘fails’, and a more restrictive treatment fit needs to be put in place for their patients or family member’s safety.

For mental health patients in particular, who are likely to have wrap-around services, live-in treatment homes in the community, and in a supervised living situation, many patients with severe conditions live out their lives in these adult homes.

Since these adult homes are little more than a freestanding and self-sufficient ward scattered and dispersed in the community, we shouldn’t forget when thinking about a patient’s clinical picture, including a deep understanding of the patients living situation.

This should always incorporate the general housing arrangements to get a complete picture and direct treatment moving forward. Thus, being a leader means knowing the immediate mental status of their patients and, 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.

J. Peters

J. Peters

Max Guttman '08, MSW '12, is the owner of Recovery Now, a private mental health practice. Through his work as a Licensed Clinical Social Worker, therapist and disability rights advocate, Max fights for those without a voice in various New York City care systems. He received a 2020 Bearcats of the Last Decade 10 Under 10 award from the Binghamton University Alumni Association. Guttman treats clients with anxiety and depression, but specializes in issues related to psychosis or schizoaffective spectrum disorders. He frequently writes on his lived experiences with schizophrenia. "I knew my illness was so complex that I’d need a professional understanding of its treatment to gain any real momentum in recovery," Guttman says. "After undergraduate school and the onset of my illness, I evaluated different graduate programs that could serve as a career and mechanism to guide and direct my self-care. After experiencing the helping hand of my social worker and therapist right after my 'break,' I chose social work education because of its robust skill set and foundation of knowledge I needed to heal and help others." "In a world of increasing tragedy, we should help people learn from our lived experiences. My experience brings humility, authenticity and candidness to my practice. People genuinely appreciate candidness when it comes to their health and recovery. Humility provides space for mistakes and appraisal of progress. I thank my lived experience for contributing to a more egalitarian therapeutic experience for my clients."

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