I kept my job, Deborah. One of 4 who did. After the carnage I asked for and received a demotion back to psychotherapist (kept my pay though.)

120 adult patients lost their doctor. I can probably find other doctors in the community for about 40 of them. 70 patients lost community support/case management services. 50 to sixty lost their psychotherapist. Some of the numbers above include patients who lost all three of their service providers. Approximately 30 of them also have children who were in services and the children also lost their community support workers, and 15 of those lost their psychotherapist. Some small number of these people will be referred to one of our clinics in another town. However, most of them won't have transportation to get there, or won't be able to buy gas at $3.00+ dollars a gallon to get there.

These are poor people. Many of them are very anxious, frightened people. Probably 60% of those who can work out transportation will still not go. The next town is a foreign country. Probably close to 25% of the clients I have worked with over the years suffer from panic attacks when they leave familiar areas, expecially if they are behind the wheel of a car.

For 38 years the clinic provided a full array of mental health services, including 36 hours of psychiatry per week, psychotherapy, case management, Adult Day Treatment (milieu treatment) and walk-in crisis services to the intire community, but especially to those on Medicaid, Medicare and the uninsured.    Until last Monday, we had an active case load of 465 children, families and adults. In less than 24 hours, we went from that to serving no children, providing no case management or community support, no adult day treatment, 8 hours of psychiatry, no crisis services, and to wait listing the uninsured. The other remaining therapist and myself are to encourage and market ourselves to middle class, high-functioning adults with good insurance.

The response of the Chairman of the County Commissioners was basically, gee, that's too bad.

The doctor who was let go was our best doctor and worked 20 hours at our clinic and another 12 at a sister clinic 40 miles away. She refused to compromise care, to crank patients in and out of her office in 10 to 15 minute intervals, insisted on spending non-billable time on the phone with clients as needed. She insisted that the poor arw as entitled to good psychiatric care and attention as anyone else. The remaining, 8 hour doc, cranks 'em in and cranks 'em out. When patients destabilize, he sends them to the hospital instead of working to stabilize them in the community. He has a psychoanalytic private practice, and is probably good at that. He is lousy and devaluing to indigent people, and doesn't even see it. He works one day a week to do 'good works' to feel good about himself. Don't get me wrong, he is a nice guy-I like him- but I hate the way he condenscends to his patients, and so do they. A good, insightful, worried-well patient with the means to pay comes along now and then, and gets whisked off to his private practice.

I had the awful job of going out and getting each person who was being let go and bringing them back to my office to meet with the muckymucks from the home office in Ohio. These wonderful, committed people conducted themselves with such grace and dignity. To a person, their first concern was for the people we serve. Several have come in on their own time since being laid off to work on proper termination with their clients, or took phone numbers with them to call patients from home to try to help with transitioning or to give the patient some time to grieve. I would be fired if the muckymucks knew I was allowing non-employees to do this. The muckymucks apparently think the former employees might sabotage equipment, or steal 'trade secrets.' These are people who have served this community for 15, 20, in one instance, 33 years.

The lay-offs happened on Monday. Friday night I had a party for everyone at my house, to give us a chance to grieve the death of the clinic and the of community mental health in our community, but also to honor and celebrate the dedication and service the clinic and the people who have worked there over the past 38 years have provided. We did a champagne toast. The toast ended with "May each of us find new ways to serve."



For myself, I am staying on the verge of tears, I am so full of grief at what has happened to my clinic, my colleagues and my community. I have 3 job interviews in the next week. I do not want to work for this company. But I am very conflicted about leaving before I am kicked out the door. If I leave on my own, I will be abandoning these same clients, at least as many of them as I can manage to continue to serve.

The voting public in North Carolina is ultimately responsible for this travesty. They are indifferent, and as long as they remain so, our elected officials can continue to ignore and refuse to fund public mental health at a level adequate to provide even the most basic services to those who need them. Except for fee-for-service dollars from Medicaid, public mental health is primarily the financial responsibility of the states. The federal block grant is, I think, about 500 million a year (divide that by 50 states.) The State demanded privitization, then structured and funded it in a way that makes it impossible for private companies to provide adequate services and stay in business.

but my company has pockets deep enough that they did not have to go about it in this manner, with this abruptness, without offering severance pay, without time to notify and terminate with clients, or help make any transitional arrangements for clients, without even the appearance of clinically sound practices or responsiblity to the communities in which the clinics reside. The other remaining therapist and myself are struggling with the same issues. We need to work, we need to take care of our families. If we are not making money for the company in a couple of months, we will also be let go, and the clinic will close entirely. If we don't jump to their unethical and greedy tune, we get kicked out the door. Both of us see our real masters as the indigent and uninsured population of our community. It is clear the company has no loyality to us, and we would be very foolish to to have any since of loyalty to the corporate entity. Hoever, if we act in our own self-interests, and leave the company,we will be acting against the mentally ill who need services, whther they can gert them or not. I am thrust into a place where my own values conflict with one another, but where values push up angainst survival. If we leave, there will no services abailable to the community. If we (the other therapist and myself) we are coopted and compromised, but we may still have jobs to provide for our families. If we leave of our own volition, the last vestiges of public service to the mentally ill in our community are gone by own acts of will.

And no matter what we do, because of the decisons by the haves, the poor are once again tossed on the trash pile.

Janie