04 February 2008

Seeking Treatment

Ray has a 3:00 p.m. appointment with his psychiatrist in Walnut Hills. From downtown, where Ray has a room in a residential shelter, it's a twenty minute or so busride, depending on how many stops the driver has to make. It's been raining steadily since 1:00; usually this translates into people waiting at just about every busstop. A woman in a wheelchair has to board the 24 bus at Hoxworth Blood Center. She wears a plastic lawn and leaf bag for a raincoat, a hole torn for her head. She has some trouble with the wheelchair. It's not a state of the art set of wheels, but rather a used, reconditioned wheelchair from an agency that provides for people who have no insurance to pay for medical supplies. "Medical Supplies" is what pharmacies call most anything a patient needs that is not ingested. Compression stockings, orthotics, canes and crutches, that sort of thing. After the driver extends and lowers the bus's chair lift, the lawn and leaf bag lady tries backing her chair onto it. She has rain in her eyes, and lining up the wheels proves problematic. She abandons the rear-first approach and rotates her chair to face the bus. Onto the lift she rolls with no problem. The driver hits the switch and ---- there is a great creaking and groaning, and the wheelchair lift refuses to lift her. Close examination by the driver reveals that the lift is indeed jammed in the fully extended position. The bus cannot proceed. Ray and two dozen other passengers wait fifteen minutes for the next bus to arrive. Since it is not lift-equipped, the lawn-and-leaf-bag lady will have to wait even longer.

Ray arrives for his appointment 2o minutes late. After he checks in with the receptionist and takes a seat, four Cincinnati police officers and two security guards get off the elevator and stride into the doctor's office suites. The receptionist waves to Ray and suggests he reschedule. He won't be able to see the doctor this afternoon. He was rescheduled for the day after Christmas. Which was no problem. A week after that, however, he received a form letter from the office manager. Th letter informed him that if he "missed" another doctor's appointment, he would be demoted to the "clinic doctor." In other words, he would have to go to cattle call appointments where one doctor has an appointment with many patients, and how long you sit in the waiting area depends on how soon you sign in. Everybody is scheduled for the exact same time, but you want to arrive early so that when you sign in, your name is higher on the list. If you merely arrive on time for the cattle call, youmight end up 10th or 20th signing in ---- which results in a wait of 2 or 3 hours. Ray goes to the main library downtown later that evening and sends his case manager an email. He also sends a copy to the office manager. Ray feels that it's unfair to threaten him with demotion to the clinic doctor, because he was only late for his appointment. He missed it due to circumstances beyond his control. As yet nobody has answered his email. "On the other hand," he tells me, "Nobody has said I'm wrong either. A lot of times they will remedy a mistake they made without admitting it. I'm trying to decide whether to send a copy of that email to the county Mental Health Board. The client grievance process is almost worthless." Free email accounts --- with a digital trail to prove that they were received by the addressee --- have changd the way case managers and agency bureaucrats deal with the mentally ill homeless. If a client is higher-functioning enough to compose an email, it is not possible for him to be totally ignored. But clients who are profoundly impaired by mental illness or disability can still get neglected for months at a time, because they don't have the ability to use the internet to their advantage. It could be argued that the higher functioning mentally disabled have an unfair advantage. They can use email; their profoundly impaired brethren cannot. In this way, the internet is less democratic for the mentally ill, rather than more democratic as it tends to be for other populations.

1 comment:

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