nursingforsocialjustice

Is something always better than nothing? Is something ever better than nothing? And, how do we judge this in a meaningful way? I have been thinking about this more and more since I attended an education session about 6 months ago on traditional views of addiction treatment. The speaker discussed the effectiveness of AA, a well-known and cost effective addictions treatment option. He discussed how ineffective AA actually was, in terms of efficacy in helping people with addictions issues resolve those issues; he discussed the harms that occurred because of the rigid, individualistic, all-or-nothing nature of the group that berated people for slipping and relapsing, also the predatory actions of some people in the group. He argued that AA helped a small number of people, and actually harmed a larger number of people. Since hearing that talk I began to think, what else are we doing in the name of good, that is actually harming people because of the assumption that we are making that something, some service, some treatment, some action is better than none at all?

I fear that sometimes we (royal we) think that any service (even if it is poorly designed, implemented in a hurry in order to meet the deadline for the finite amount of available funding, questionable in terms of cost effectiveness and accessibility) is better than no service at all. I think that this is a mistake. First off, it is a waste of money. Secondly, when the program is an epic fail it leaves staff morally distressed and mentally burnt out, the people and families accessing the service bewildered and frustrated, and reinforces notions that the people being helped at lost causes. Logically, I think that we know this is wrong. We know that ICU unit without policies and procedures, with only half working technology, and untrained staff would be unethical and dangerous for any patient admitted there. We know that we would be misleading the  people being admitted and their friends and families, who would think that the care area was well developed and that the service was ethical and staff were competent and working in an area safe to deliver care. Is it right that the same rules do not seem to apply when we are talking about mental health and addictions services?

Too many times it feels like we are putting the metaphorical cart before the horse, fixing a problem without exploring what is actually going on. And sometimes, I think that we are so stuck in a box of stagnant ideas and maintaining the status quo that we cannot we out of the box to pragmatic solutions. I think that we are making some pretty big assumptions right now about a need for more inpatient mental health and addictions “beds”. What does this mean? And does evidence actually support this? Is lack of service beds the problem or is this a rhetorical Band-Aid that politicians say to try and win votes? Or is it something else? Is this downstream thinking or upstream thinking? Are we simply fishing the drowning children out of the river or are we looking further up stream to see why there are so many children who cannot swim being thrown in the river to begin with? I am not sure if the problem is a lack of inpatient beds (acute care or residential), but I do know that spending more at this level is the most expensive and also targeting people who are the most symptomatic and need the most help. Acute mental health beds are for people who require 24/7 care in a secure environment. The goal of the care is assessment and stabilization. A Nalaxone kit is not an upstream idea. Overdose prevention as a suite of interventions and education may be, but I am not sure that it is in the way that is currently being conceptualized and discussed in popular media.

Peace,

Michelle D.