Latest / The Brain Dump / Individual Accountability as Distraction: What the Mental Health System Gets Wrong About Tragedy | Episode 31

Transcript

Individual Accountability as Distraction: What the Mental Health System Gets Wrong About Tragedy | Episode 31 · The Brain Dump

• 0:00
  SPEAKER_00: Hi, I'm Sandy Boone, therapist, coach, and nervous system educator with 30 years in healthcare and mental health.
• 0:06
  SPEAKER_00: I built two practices, got diagnosed with ADHD at 50, and learned the hard way that healers need healing too.
• 0:13
  SPEAKER_00: Help female therapists and healers regulate their nervous systems, reclaim their lives, and stop being everyone's everything.
• 0:19
  SPEAKER_00: Welcome to the Braind with Sandy Boone.
• 0:26
  SPEAKER_00: There is a trial happening right now in Massachusetts that has the mental health field in an uproar.
• 0:31
  SPEAKER_00: If you have been anywhere near a therapist Facebook group in the last few weeks, you know exactly what I'm talking about.
• 0:37
  SPEAKER_00: I'm not going to name the case, and it's not because I'm pretending I don't know what everyone is watching, but because it's an active trial and I'm a licensed clinician and commenting specifically on a case that I don't have complete information about is a professional line I'm not willing to cross.
• 0:52
  SPEAKER_00: What I will say is that the public conversation around it, and especially the conversation happening inside therapist spaces, has been sitting really heavily with me.
• 1:00
  SPEAKER_00: This week I also made a CPS report.
• 1:04
  SPEAKER_00: In the process of making that report, I discovered that a previous report had been made by someone else and nothing really had happened.
• 1:11
  SPEAKER_00: Not because anyone was malicious or because people didn't care, it's because the ball sat somewhere between two agencies and nobody picked it up.
• 1:19
  SPEAKER_00: Those two things, a trial that has therapists in full panic mode and a drop ball in my own backyard are the same story.
• 1:26
  SPEAKER_00: They are a story about a system that is broken in ways we are not willing to look at honestly, because looking at it honestly would require us to do something about it, and that is much harder than pointing at a person.
• 1:38
  SPEAKER_00: I'd like to talk about what I'm seeing in therapist spaces right now because I think it's important and I think it's also a problem.
• 1:46
  SPEAKER_00: Therapists are rethinking their documentation, rethinking their risk assessments, and rethinking whether they're willing to take certain clients at all.
• 1:54
  SPEAKER_00: They're also rethinking how they present themselves in their marketing.
• 1:58
  SPEAKER_00: Should they present themselves as experts even when they really are?
• 2:02
  SPEAKER_00: And all of these things are worth assessing.
• 2:04
  SPEAKER_00: It's important to assess all the time, right?
• 2:08
  SPEAKER_00: That's that's what we need to do, that's the responsible thing.
• 2:11
  SPEAKER_00: The instinct to look inward when something horrific happens is not wrong.
• 2:15
  SPEAKER_00: What is wrong is the assumption that better individual clinical decisions would have prevented a systemic failure.
• 2:21
  SPEAKER_00: My friend Sarah Mildram talks about this often.
• 2:24
  SPEAKER_00: Systems fail, people get hurt.
• 2:26
  SPEAKER_00: Here's what most people out the side of the field don't understand, and what a lot of people inside it don't say loud enough.
• 2:34
  SPEAKER_00: A therapist cannot do much until someone has a plan, the means to carry it out, and the stated intent to do so.
• 2:42
  SPEAKER_00: That's the threshold.
• 2:43
  SPEAKER_00: That is what involuntary intervention requires.
• 2:47
  SPEAKER_00: Below that threshold, we're working with someone who has the right in this country to make their own decisions, including decisions that worry us and decisions that keep us up at night.
• 2:57
  SPEAKER_00: And even when that threshold is met, the system still has to work.
• 3:02
  SPEAKER_00: The hospital has to have a bed, the law enforcement response has to happen, and the follow-through has to be there.
• 3:08
  SPEAKER_00: None of those things are guaranteed, and none of them are controlled by the therapist sitting in that room.
• 3:14
  SPEAKER_00: When I see therapists spiraling in Facebook groups about what they would have done differently, what I want to say is the problem is not your documentation.
• 3:22
  SPEAKER_00: The problem is the structure you are documenting inside of.
• 4:31
  SPEAKER_00: Confidentiality laws mean you get almost nothing on the other end of that call.
• 4:36
  SPEAKER_00: You make your report, you document that you made it, and then you release it into a system you cannot see or control.
• 4:42
  SPEAKER_00: And that is a very hard thing to sit with, especially when you discover later that the thing you released into didn't catch it.
• 4:50
  SPEAKER_00: I keep coming back to this when I look at all of these situations.
• 4:54
  SPEAKER_00: In this country, we value freedom over safety.
• 4:58
  SPEAKER_00: I'm not saying that as a political statement.
• 5:00
  SPEAKER_00: It is a structural observation about the framework inside which every one of these systems operates.
• 5:06
  SPEAKER_00: We cannot force someone into mental health treatment if they don't meet an involuntary commitment threshold.
• 5:12
  SPEAKER_00: Because we have decided as a society that individual autonomy matters more than preventative intervention.
• 5:20
  SPEAKER_00: We cannot remove weapons from someone's home based on a therapist concern alone, because we have decided that the right to bear arms is protected even when the risk is apparent.
• 5:29
  SPEAKER_00: We cannot hold someone in a hospital against their will for more than a brief period of time without meeting a very high legal bar because we've decided that liberty matters more than containment.
• 5:41
  SPEAKER_00: None of those decisions are inherently wrong.
• 5:44
  SPEAKER_00: They reflect real values about freedom that are certainly worth protecting.
• 5:49
  SPEAKER_00: The problem is that we make those decisions and then we act surprised when things go sideways and when the gaps they create produce tragedies.
• 5:58
  SPEAKER_00: We act like the tragedy was the result of an individual failure, a therapist who should have known, a caseworker who should have followed up, a prescriber who should have adjusted the dosage, rather than the predictable outcome of a system designed to protect freedom, not safety.
• 6:14
  SPEAKER_00: So we point at people and individuals, the therapist, the psychiatrist, the caseworker, the agency.
• 6:21
  SPEAKER_00: We ask why they didn't do more, why they didn't catch it, and why they didn't stop it.
• 6:26
  SPEAKER_00: And while we are busy pointing, the system doesn't have to change.
• 6:30
  SPEAKER_00: Folks, that's not coincidence.
• 6:32
  SPEAKER_00: When we make it about one person's failure, the structure gets to stay exactly as it is.
• 6:38
  SPEAKER_00: Individual accountability becomes the distraction from the structural accountability.
• 6:43
  SPEAKER_00: The Facebook groups debate documentation practices, the trial dominates the news cycle, the agencies defend their protocols, the next gap quietly opens up somewhere nobody is looking.
• 6:55
  SPEAKER_00: The ball that dropped in my CPS situation this week was not dropped by a bad person.
• 7:00
  SPEAKER_00: It was dropped by a system that doesn't have clear enough ownership of the space between the agencies.
• 7:05
  SPEAKER_00: The police have their process, CPS has their process, the courts have their process, mental health providers have their process, schools have their process.
• 7:14
  SPEAKER_00: In the spaces between those processes, in the handoffs, in the communication gaps, in the moments where one agency assumes another has acted, that's where children and vulnerable adults fall through.
• 7:27
  SPEAKER_00: That's where people fall through.
• 7:29
  SPEAKER_00: Therapists, who are often the first people to see the full picture of someone's life, are operating inside a system that gives them relatively little power to act on what they see, and then it holds them responsible when the system around them fails to act either.
• 7:43
  SPEAKER_00: That is not a sustainable position to put clinicians in.
• 7:47
  SPEAKER_00: It is not an honest conversation if we're willing to talk about what the therapist in the room should have done differently.
• 7:53
  SPEAKER_00: I'm not going to pretend that I have a simple answer here because there isn't one.
• 7:57
  SPEAKER_00: And I think it also speaks to the importance of having conversations, not for blame, but to change the system.
• 8:05
  SPEAKER_00: What I do know is that the conversation cannot stay at the level of an individual clinical decision.
• 8:11
  SPEAKER_00: It has to move to the level of systemic design.
• 8:14
  SPEAKER_00: Who owns the gaps?
• 8:16
  SPEAKER_00: What does communication between agencies look like and who's accountable when it breaks down?
• 8:22
  SPEAKER_00: We also have to be honest about the values question.
• 8:24
  SPEAKER_00: If we want a system that prioritizes safety over freedom, we have to say that and build for it with all the complexity and civil liberty implications that come with it.
• 8:35
  SPEAKER_00: If we're going to keep prioritizing freedom, we have to acknowledge that the gaps we are seeing are a feature of that choice, not an accident.
• 8:43
  SPEAKER_00: You cannot have a system designed around individual liberty and then act shocked when it can't intervene to prevent tragedy.
• 8:51
  SPEAKER_00: Those two things are in direct tension.
• 8:54
  SPEAKER_00: Until we're willing to sit in that tension honestly, the conversation will keep defaulting to who we can blame, and we will blame because that's what we do.
• 9:04
  SPEAKER_00: The therapists in those Facebook groups rethinking their documentation are not wrong to want to do better.
• 9:11
  SPEAKER_00: They are wrong to think that doing better individually will fix something that is broken structurally.
• 9:17
  SPEAKER_00: That trial that is happening in Massachusetts that has the mental health field watching and waiting and reacting, and the ball on the floor in my backyard this week that nobody picked up, those are not separate stories.
• 9:30
  SPEAKER_00: They are the same story about what happens when we build systems that protect freedom more than they protect safety, and then ask the people working inside those systems to fill the gaps with individual effort and good documentation.
• 9:44
  SPEAKER_00: Talk about a road to burnout.
• 9:46
  SPEAKER_00: We can do better clinically without a doubt.
• 9:49
  SPEAKER_00: We also have to be willing to say that better clinical practice inside a broken structure will only take us so far.
• 9:57
  SPEAKER_00: The system needs to change.
• 9:59
  SPEAKER_00: That conversation is harder than pointing fingers, and it also is the only one worth having.
• 10:06
  SPEAKER_00: Thanks for being here.
• 10:07
  SPEAKER_00: If something today resonated, check the show notes.
• 10:10
  SPEAKER_00: You'll find information about booking your root cause roadmap with me at sandyboon.com.
• 10:15
  SPEAKER_00: Come find me on Instagram at the Sandy Boone, and if you're a healing professional looking for a community that actually feels good to be in, come join us in the Rooted Conf collective on Facebook.
• 10:25
  SPEAKER_00: It's a space built for support, nervous system tips, and building your best life as a healer without the drama.
• 10:31
  SPEAKER_00: Links for everything are in the show notes.
• 10:34
  SPEAKER_00: Thanks for being here.