This is a cross-posted comment to this article in THOUGHTS From the HEADoc.

I have witnessed first hand our Mental Health Centers insidiously disappear under the name of reform. The State Hospitals are next on the chopping block. Our citizens have been totally eliminated from knowledge of what is really happening with that situation. Also first hand, I watched the jail population become almost exclusively of those with mental illnesses and chemical dependence, effectively keeping those people from public site for the most part.

Most people don't appreciate the severity of the drug culture and how deeply it has penetrated our society at least until a family member becomes affected. It is no longer a ghetto problem only. Maybe my view of the situation is skewed because of the concentrations of populations I've worked with. The main difference I really have seen is that the blacks are treated in jail and most whites are treated outside of jail for the exact same problems. This situation seems to give the impression to the general public that all is well. Doctors are basically divided into two groups. The largest group are those who take no risk and treat no patient with history of high risk behaviors. The smaller group of physicians are those who haven't learned to join the larger group yet. I learned this difficult lesson over the past year. There is essentially no protection for a solo practitioner who will see higher risk patients. Like a sitting duck, that practitioner may be targeted by pharmacists and those sociopathic doctor shoppers I have written about many times before.

I have felt like Mudbone, many times, guarding the levy. The levy is weakening every day. The public in the valley are dry and unknowing. The politicians on the hill are dry and really don't give a damn. The levy is going to break and the people will feel the force of the metaphorical water. Many will drown. I must accept that it is not my purpose to address social issues because there are just too many and those in control at this time are indifferent, at best, to such issues.

I understand your discouragement. I've been there myself. After 30 years in this business, I find myself still shocked by the stories of deprivation, abuse and trauma I hear too regularly. I've come to accept that I have little influence on the big picture. I take my swings in the political sphere, but I have to retreat from there and focus on what I can do or I risk falling into a dark hole as deep as some of my clients'.

I figure I impact the world one person at a time. So I do the best I can with those who care to listen long enough to benefit. I celebrate and take credit for those that succeed. I quickly let go of those who are "falling elephants". With all those people out there who have benefited, I figure I have had more impact on the world than most people do. I'm grateful that my job is interesting, challenging and never boring. I learn something new everyday. And I meet some incredible people. And I learn who I don't want to know and how to protect myself from them.

I'm not sure I'd want to work as a solo practitioner in a high risk setting. That population demands a team approach. Solo practitioners really do have to limit their practice. There is no shame in that. It's good for the practitioner and the client.

I work as a team member in a partial hospital program in a large public hospital in the inner city (an endangered species, I know). It is probably the closest thing there is to an ideal setting for therapy with high risk individuals. The program model quickly weans out those who are not serious about changing their lives. We see them all, 2/3s don't make it by self-selection. A few are kicked out. Those that stick it out are forever changed. Many crack, meth, alcohol and heroin addicts actually make it. People who have suffered deep trauma often find peace. And I see my share of people with lots of potential and skills as well, many with their first time in treatment. I feel very fortunate to witness the beginning of their metamorphosis.

Keep the faith. The world needs more of you.