I remember when I was first doing clinical training we had an advanced psychopathology course every Wednesday after rounds. When we started, we looked at the syllabus and there were a number of familiar texts: the DSM-IV-TR, and Adult Psychopathology and Diagnosis. But sprinkled throughout the texts were other readings: Nabokov, Dostoyevsky, Rilke. After we’d had a moment to look it over the teacher said, You will no doubt notice that there are a number of texts that you have not seen before. This is because I assume that your clinical training to be largely complete. Otherwise how would you get here? But now you have to learn what things actually look like. And, over the course of my career, I have found that anywhere a psychiatrist would go a great writer has been there before and has described it better.
This was, fortunately, the beginning of a long process of unlearning: unlearning the idea that just because I knew big words I knew best, unlearning the idea that my concept of health was the only way for a client to be healthy. This, allowed me to learn that sometimes the job isn’t to ‘fix’ people; it’s just to walk beside them at a time that they need help.
As part of my work for the Center for Social Innovation I have been lucky enough to work on a project funded through the Massachusetts Department of Public Health called Praxis, which allows me to continue the lessons that I was taught. Through this work I and the other members of our team train providers working with clients with substance use issues in four main topic areas:
- Harm Reduction,
- Opioid Overdose Prevention,
- HIV/AIDS Care Integration; and
- Viral Hepatitis Care Integration.
All this work is based on a strong understanding that care, and the systems that provide care, should be person-centered, trauma-informed, and recovery-oriented. I’ve learned that not every person’s walk with us will end in abstinence. It’s important, though, to understand that for many our interventions cannot create positive outcomes. This is also a function of our job—learning the difference between care and ownership. For some, I know that no matter what we do their walk with us will end. Incidentally, one of my clinical supervisors told me this when I was complaining about someone not adhering to a plan. I think you’ve misunderstood your job, he said. Your job is to keep people alive. Week to week. That’s it. You’ll know when you’ve failed. And even though we don’t have the power to keep people alive, we can always try to arm them with the skills they’ll need to keep themselves alive.
[pullquote]It’s about making sure that providers in the field feel equipped with the most recent information, the best tools, to be able to keep someone alive.[/pullquote]
The work that the Praxis team has been able to do in Massachusetts is not only about the dissemination of best practices—it’s about helping people save lives. It’s about making sure that providers in the field feel equipped with the most recent information, the best tools, to be able to keep someone alive. To keep them up and walking. And I’m grateful that the learning continues to be bidirectional. Every time I head into the field to work with a team of providers I come back with something new. I also reaffirm my gratitude to my original mentors for setting me on a long path of unlearning.
As Massachusetts and other states continue to suffer the lethal consequences of the opioid crisis I can only hope that The Comprehensive Addiction and Recovery Act (CARA) of 2015 and other legislation like it moves forward. In Massachusetts we are lucky enough to have leadership at the highest level that has prioritized funding programs like Praxis. Other states aren’t so lucky. Other walks end too soon.
Learn more about CARA, why it’s important to us, and how to help.