Thursday, May 22, 2008

Smells Suspicious

I am giving a presentation tomorrow about a narrow area of mental health law in NH. I am not an attorney, but the nature of my job means that I know this area as well as anyone. What I am going to say has been vetted by the one person who knows more about this than I do. It is going to be controversial, and resisted, but I know it is correct.

People heavily involved in the issue are very encouraging, telling me that this training and change in the way we do things is ten years overdue. I am going to tell people they have to change what they are doing, but I have no power of enforcement, only persuasion.

The people who have actual power of enforcement have stated they will back me up. But they don't know the law that well, and when challenged, are going to be emailing me emergency questions asking whether we really do have to do it this way.

Most (or all) of the powerful, important people who are telling me I'm right will back down on about 50% of what I'm saying when the challenge comes.

I have seen this before - I am about to be hung out to twist in the wind. I just figured that out today.

Not this time. Not again. I am not an astute political player at work - I still think that when people ask for my analysis they really want it - but this time I'll, I'll...

No, I'm cornered. I'm pretty much screwed.

4 comments:

bs king said...

David - it may be cold comfort, but when I ask for your analysis, I really want it.

Of course, that's probably why I don't ask overly often.

lelia said...

Well, now I'm left hanging. What are you going to say????? Please, I want to hear it.

Jonathan said...

So..... how did it go?

Assistant Village Idiot said...

The presentation went well enough. In the wrap-up the attorneys indirectly lent support to what I was saying - their comments took as a given the same things I had been explaining. That should knock down some of the criticism. The problem will mostly be the people who weren't there who will now have this apply to them. In general, they did not show up for the workshop because they didn't think they needed to, knowing it all already. They aren't the sort who will like to be told "No, it's not that way. Never was. If you'd been at the required training you would know that."

Lelia - New Hampshire has a Conditional Discharge statute that allows to release psychiatric patients on specific conditions, such as taking medications or keeping appointments. About half the other states have some limited version of this, but New Hampshire's is more comprehensive and complicated.

Over the years, treatment providers develop mission creep, and try to use the conditional discharge to write in whatever they think would be good for the patient, or would make the provider's life easier. These violate both the spirit and the letter of the law, but they grow like weeds. Like Cassandra, or like Churchill speaking to Parliament in the 1930's, I have been telling people for years what's what, but I am not usually believed outside the hospital I work in.

Today I pruned back some growths, telling people "you can't use this condition anymore - it's illegal. Conditions must be designed in the following way." We'll see how it plays out. I remain suspicious.