However, I have not yet been asked by anyone if the amount of care a patient is obtaining is too fragmented and without any clear leadership. At times, courts will ask for a review and expectations from treatment of a defendant to assist in sentencing determinations. Sometimes, employers want to review a treatment plan to ensure the safety of their employees. Often, insurance companies want to review the continued need for treatment or whether any treatment is warranted at all. I am asked to comment on the appropriate nature of a given treatment. That’s several providers for the treatment of one patient.Īs a forensic psychiatrist, I am often asked to review treatment plans of other providers. A team can include a psychiatrist for psychopharmacology a neuropsychologist for psychological testing a social worker for psychotherapeutic strategies another social worker to assist in obtaining social assistance an addiction counselor for substance use disorder another psychiatrist who monitors the administration of a single medication, like ketamine and a pharmacist who approves the medication regimen. In many settings, a treatment team includes a series of providers who are sequentially involved in the life of a patient. In some ways, the sequential intercept model has similarities with modern mental health treatment teams. ![]() ![]() I worry that by creating a model encouraging all to participate, we have just absolved ones who make any effort, even if inadequate. In practice, what I have seen is a series of half-hearted recommendations: Emergency responders who consider their role finished after giving a patient the number of the suicide hotline, attorneys who are satisfied by giving their clients an outdated list of community mental health clinics, judges who interpret their recommendations for treatment as a fait accompli, and correctional facilities that release patients with an absurdly short supply of medications and the address of an emergency room. ![]() However, I am reminded of the complexity of large systems trying to change. I applaud the model for encouraging all participants to intervene in changing the course of our most challenging patients. The model rightfully encourages anyone in the continuum of care to take ownership of a situation and intervene. Sequentially, throughout the remaining stages, the patient can be diverted by an attorney, the court, a presentencing correctional facility, the sentencing judge, a postsentencing correctional facility, or probation. If that works, the patient may be diverted by first responders out of the legal system and back into treatment. In the first stage, a patient may be provided enough care in the community to never enter the criminal system. The model intends to divert individuals with mental illnesses at any one of five described stages in their journey through the legal system.
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