Case management is the GLUE !

I often recognize in our clients that have been provided the gift of case management and therapy, that they are often more compassionate and sometimes even more conscious of others feelings than most people that have never utilized these services. Many clients with whom we have the privilege of closely working have developed an understanding of the less than perfect side of human nature and the need for compassion and understanding regarding how people treat them, kindly or otherwise, which has been explored in their work with their therapist, Psychiatrist, and in case management.  We often use situations during which a person was treated rudely or poorly as a platform to teach ways to work around these situations and  understand that it is less about the individual than it is about the person that is yelling, unkind or treats them poorly. This also provides the opportunity to learn more humility and thoughtfulness toward others. Many could well learn and benefit from this perspective in general.

So, when you ponder if a case manager can help improve your loved one’s life, think of the words that I have heard from our clients when they confide that they felt “tortured “or wanting to dissolve into the floor or ground” to avoid another mean spirited person being abusive because they couldn’t manage a task quickly or not at all, all the while gripped in a panic or confusion.

Frequently a case manager/behavioral specialist is working with a person during a crisis. In this heightened situation it is obvious to everyone that this situation requires the case managers full focus, so without question family members and loved ones of the person seek help and want to know if we do crisis intervention.  We are told that one can see the benefit of a case manager when there is a crisis situation, however time and again, we hear “we don’t want to pay for a case manage to take him/her shopping, or to attend appointments with her.” So, I  must point out that each of us have many facets to our personality and life, so if one is to learn skills to translate into each area then we need to be able to look at the whole scenario and assess where we view the needs are the greatest and discuss options from this viewpoint. Some situations of crisis occur as a direct result of symptoms building from anxiety, fear and paranoia over daily activities and events that many people take for granted. Shopping for groceries, eating out with family or friends,  going to a movie, going to a meeting!   Therefore, it behooves us all to listen and hear when a person is telling you that they cannot do what you are insisting and believe is simple.

Finances will often dictate how much time that a person might be given for case management and for this we are very sad that it is not a covered area by insurance as there is no better opportunity than to help a person with a chronic mental illness by giving the time and support to learn how to manage and navigate their lives with the right tools. The average person often views some areas of the work as something that they could just do themselves to help or work in this area, but the reality is it is very complex and challenging and always is an ongoing arena of observation, assessment and learning.

The expertise of a seasoned and skilled case manager will be useful in monitoring and building a strong rapport so that the person permits the case manager into their world to better understand the level of complexities that the individual might endure and this is mostly assessed in the community and in our one on one “sessions”.  During the sessions a huge amount of good work is done by both the case manager and person as the goals and the plan unfold so that appointment planning, medication regime and general care of symptom management are all addressed along with a tailored specific focus for the person and their needs and goals.  These regular case management sessions along with socialization activities for many people that may have previously been repeatedly in and out of the hospital, show that hands down the reason that our clients stay out of the hospital and build more stable and fulfilling lives is that they are better able to manage their symptoms due to a good mental health support team, including case management.

It is in the areas of the socialization activities and shopping where we see people become incredibly empowered and gain confidence in their daily lives and so encourage our clients to utilize these same skills we taught to be used in their business, their place of work, and, or while in public places.  Yet time and again, I am asked or told by families looking to hire the services of a case manager that they believe that they or a friend can do this part…. They view these activities as menial tasks and “don’t want to pay someone for this type of assistance”, and frankly in several cases it can be true that it is not always needed to help someone learn a budget or learn to choose specific groceries over another type.  However having said that, even while assisting a client with shopping or a socialization activity the case manager is listening and observing symptoms, issues, and concerns of the person in the various real life situations in which they walk. To be with a person in their world of activity is invaluable to the case manager  to get to know what to teach in order that one can overcome or work around the obstacles that impedes someone having a full and more productive life.

Family is often not the best choice to assist a client since we all know that families have their own dynamics and there are often a set of sparks and tensions that negates the learning.  Therefore, if you can provide the gift of Case management then I highly recommend utilizing this resource as frequently the obstacles and ways to work around them are rarely as simple as they appear.  It can and often is a difficult and complex process of work to use strategies and find the right tools to employ.   Would the person still be isolating and still not doing those things for herself/himself if it were as easy as others around him or her believe it to be?

Case management is often the least important role considered or recognized by many families and friends as imperative to a loved one’s wellness. It goes without saying that I am an advocate of a good Psychiatrist (and medications if required) and a Therapist as equally important. We began the private case management practice as we saw that the services and resources available through established agencies were lean and too difficult for many to navigate alone and the county services, if one was eligible for case management,  were laden with too many cases.  If you were not eligible for county case management you were left to work solely with a Psychiatrist and therapist with no one to teach the skills in the community where you live and work or attend school. Now Willow Haven Resources, by M. Ludwig & Associates, serves both county clients and also people who are not eligible for any county case management as we are asked to augment some of the county services due to budget and time constraints. Over 26 years I have observed the differences for people living in programs or people struggling home alone, or living with family, compared with those who had the support of solid case management and were able to move on with the skills they developed. Some people require intensive case management, some require minimal, and some people have lost the trust in themselves and just need the support and encouragement of knowing that someone understands and is by their side as they build strength to do what is required to work through tough areas.

Case management is the GLUE that holds all of the parts together.  It encompasses all the moving parts of an individual’s personal network. In order to assist everyone around the person, their family members, other medical providers, along with all of the needs for a person 24/7 in their lives then this is the job of the Case manager who pulls it all together and asks all providers and people in the network to assist by collaborating and supporting the team so that the client does not fall through the cracks or miss any opportunity or appointment, and need I to say, case management provides the support, care and real world lessons that enable the person to be able to more fully engage and participate in their life.  Over the past several years we have collaborated with an excellent Private therapist. She also works per Diem in a large San Francisco crisis unit and is a strong advocate for her patients and as such she highly recommends and has frequently referred some of her private patients to us in order that we can assist in a client’s growth and to help them to stop cycling through the crisis unit or the hospital.   She states very clearly that her experience and observations of clients cycling through the crisis unit is why she can advocates so strongly for clients to have a case manager. With our practice, Willow Haven Resources, the case management team will augment the person’s therapy by providing real time case management in the community through which the person lives and moves daily.   We teach the necessary skills that will help keep people out of the hospital.    Although this article might appear long it is such a very brief and incomplete summary that I have attempted to share. It is in the hope that it might serve to provide you a small glimpse into what can be done with a good case manager and particularly when there is a team attached to collaborate and consolidate resources. Case management and life strategy skills that provide resources that pertain to a specific person are the most effective training and teaching that the person who struggles to manage their life will ever learn to gain the quality of life that most of us take for granted.  Don’t underestimate what Case management can provide.  It can be the most valuable gift of love that you offer to your loved one.

With Kind Regard,

Michèle Ludwig-Petersen

Case management is the GLUE !