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Dec 06, 2017

Fistful of Dollars

Last week I wrote about two significant challenges counselors face in Wyoming:  a culture that doesn't encourage people to ask for help, and what I call the (seeming) lack of resources to fund mental health services.

I also mentioned Wyoming is Indian Country.

Both state and federal dollars fund Medicaid, a service Native Americans access as enrolled tribal members.  Federal money also flows into tribal coffers, typically by way of the Bureau of Indian Affairs, funding a variety of services and programs.

This funding is unstable from year to year, however.  And with funding cuts comes a ripple effect reaching beyond the reservation's borders.

For example, last year federal funding cuts forced the IHS – the Indian Health Service – to cease handling any crisis work after normal business hours.  That additional responsibility fell to the agency I work for, which conducts suicide risk assessments and, if necessary, facilitates involuntary hospitalizations.

On-call clinicians (like myself) were already doing an unfortunately brisk business here.  Once local Native Americans lost access to crisis services at their own IHS clinics, the burden on the ER in town increased dramatically.

This spotlights another aspect of the resource challenge.  It's not only about dollars, but human capital.  We may have gotten more clients, but we didn't get more workers.  And with the increased workload we run a high risk of burnout.

When counselors are exhausted and unhappy, they do not stay.  In a part of the world to which it can be difficult to attract clinical talent to begin with.

The positive aspects of the resource challenge include learning to be more creative in your work.  You find new ways to accomplish your goals.  And that can serve to strengthen alliances between community providers – essential if we are to work as effective multi-disciplinary teams.

With regard to crisis resources specifically, the looming question is always, how do we reduce the number of individuals in crisis?  While often providing fertile ground for positive change, crises can be expensive.  Committing someone to a psych hospital costs the state thousands of dollars every time it happens (and here it happens several times a week; sometimes, several times a day).

It often happens to the same people, over and over again.

At the start of this post I called our lack of resources “seeming.”  Because if we have the funds it takes to detain a high-risk client to a psych hospital, we have the funds to put into prevention.  It's not really about a lack of resources.  It's about efficiently managing the resources we have.

This translates into another needed culture shift, doesn't it?  One that takes us from expensive band-aids to the careful work of cultivating healthier communities.

I'm beginning to think my undergraduate work in Anthropology and all that focus on culture is going to come in handy here, one day soon. 
Stormy Filson is an independently licensed counselor living and working in Wyoming, with special interests in treating trauma, community building, and empowering women.  She is also passionate about writing, photography and film.


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