Another friend is moving on.  When commenting on his frustrations in working at our facility he specifically pointed to the secure units.  “It got to the point where I didn’t want to walk onto those units.”  We both readily admit we work with the toughest children in the region.  What was wearing on him was the high concentration of youth with incredible high-risk and anti-social behaviors.  He spoke of other kids being exposed to this level of acuity and learning their behaviors.  Just to be clear, the behaviors are purging, self harm and suicidal ideation.

He didn’t even want to share this with me, “I don’t want my bad attitude to affect you, you’re still here doing important work.”  But he quickly went on “We’re not doing any behavior modification.  These kids need that too.”

It was the type of conversation that wasn’t long but covered so much ground.  We bemoaned the fact that as a culture there is a collective pat on the back for closing psychiatric hospitals and shifting so much of mental health care to outpatient services.

Unacknowledged among the accolades of progress is the pressure to get kids stable and free up the bed.  Many of our clients need long term care.  Temporary stabilization isn’t going to do much for them if they return to the same environment without increased skills to manage they lives they were given.

This happens again and again when kids return to our care after failing to reintegrate at home or adapt to foster placements or group homes.  These kids aren’t going to improve without meaningful skill building.  And this leads back to behavior mod.  We simply aren’t doing it any longer.