My Issues Overwhelm Me

It is amazing to me how many of my patients present at the psychiatric prison where I work and say this, or something like this in so many words: "My issues overwhelm me."  So often their issues are free world issues over which they have no control, could not change or influence even if they were not in prison, and would not even be a consideration if they were in the free world and living the lifestyle they lived that got them into prison.

But in prison, these issues take on overwhelming importance  Perhaps for some, they have had an epiphany and understand what is really important to them in the free world, which does not include a life of crime. But for most, it is a stance, to use to manipulate the system, to get sympathy for their "pain," to get numbing medication, staff sympathy, and whatever attention they can garner. They know the magic words to say.

These same patients take up large amounts of time from the treatment staff, clog beds that need to be cleared for truly sick patients, are prescribed medications, at great cost, that they do not need, and in general, waste the resources of the system for which I work
But because they know the right vocabulary, they fall into the system, get the evaluations, and possibly the medications they so desperately seek.

I understand this.  And woe to me for ignoring a patient's comments that indicate suicide or homicide because I think he is being manipulative.  Although it happens that the manipulative comments and behaviors are more manipulative than psychotic, I report the patient comments and mood to the provider, so I will cover my responsibility, but more importantly, to protect the patients from themselves.  Because some of them are desperate enough that they will truly act out in a self-injurious way to prove their point.

This is sad.  But it is what it is, and it is a reality with which we struggle every day.  I understand that prison is a scary, depressing place. And vulnerable people are more vulnerable in prison.  I just hate that people who are "users" use the mental health system in prison to help the them negotiate the prison system so they are not exposed to the horrors of ill behavior, at the expense of truly mentally ill people who need our help and support.  And, the "users" expose the staff to their manipulative behaviors so much so that the really needy people are lumped in with the users and are often not treated with the dignity, respect and consideration that the truly mentally ill deserve.