Week 3

This week has been really exciting as I have been more involved with the patients. As the weeks progress, I will be even more instrumental in helping the patients cope with life at Carter Hospital

Activities -

• Treatment team meeting
• Rounds meeting
• Worked on learning plan
• Identified possible groups and activities
• Met with first patient
• Attended discharge meeting with patient and supervisor
• Researched mental disorders in hospital library
• Reviewed charts of possible patients to follow

Learning -

As the weeks progress, I am learning more about how the state policies affect the population of Carter Hospital. For example, because the state doesn't want to pay nurses their average rate, it hires a registry to provide nursing staff to all the state hospitals. Unfortunately, there is no consistency, as there are different nurses everyday. As a result, medical mistakes are often made and patients don't get the quality care they deserve. For example, on one shift alone, there were 40 medicine errors made. Patients didn't get their meds, patients got the wrong meds, and some got too much of a med. I believe that these are unacceptable errors that are a result of a state system neglecting its responsibility to its mentally ill citizens.


Something else I learned is that working with such a population, one has to be "thick skinned". One patient I worked with this week cursed a lot and used derogatory language. I had to face my own prejudices and assumptions to look past what he/she was saying. I realize how important it will be to understand that sometimes patients/clients will make me uncomfortable, and it is something I have to get used to.

Reflection -

policy/macro

House Joint Resolution No. 8, Definition of Marriage. Provides that marriage in Indiana consists only of the union of one man and one woman. Provides that Indiana law may not be construed to require that marital status or the legal incidents of marriage be conferred upon unmarried couples or groups (www.in.gov/legislative/bills/2008/RES/HJ0008.1.html).

This bill is important to me because I am a homosexual male and feel it would be a blow to my rights. I am strongly in favor of homosexual marriage and feel this bill, if passed, would further separate homosexuals from society. I believe the government should set the standard and feel it will add to the further structural discrimination of gays and lesbians.

Senate Bill No. 310, Death Penalty and Mental Illness. Establishes a procedure to determine whether a defendant charged with murder is an individual with a severe mental illness. Prohibits the imposition of the death penalty on a defendant found to be an individual with a severe mental illness (www.in.gov/legislative/bills/2008/IN/IN0310.1.html).

Personally, I am not an advocate for the death penalty. However, this bill would, at minimum, keep persons with mental illnesses from being placed to death for a crime they may have committed. This bill is interesting to me professionally because I want to work in the mental heath field and will be a strong advocate for mentally ill persons. This bill would protect mentally ill patients from being sentenced to death for a capital crime, and thus they would be able to be treated for their disease.

Both of these bills are significant on multiple levels. Resolution No. 8 is significant to me personally because I am homosexual and therefore feel strongly in favor of homosexual rights, and Bill No. 310 is significant to me because I am personally invested in helping the mentally ill. I believe what ever agency I work in, it would definitely be effected by these two bills. Any homosexual client would be effected (especially at the Damian Center) by Resolution No.8, and a state hospital like Carter would definitely be effected by Bill No. 310 if the mentally ill were to be exempt from the death penalty. It is obvious how clients would be effected by the bills. Homosexual clients would be further discriminated against and mentally ill clients could possibly become exempt from being put to death (if they have committed a capital crime and been found guilty).

Total Hours this Week: 16 hrs 20 mins

Total Hours to Date: 48 hrs 10 mins

Week 2

Well, I have two weeks under my belt and feel really good about how things are going. I still haven't had much direct contact with the patients (as the social workers at Carter don't do a lot of one on one) but am planning on following a couple of the patient cases.

Activities -

1) Filled out Medicare application
2) Participated in discharge planning meeting with client
3) Attended a meeting with behavioral/mental health providers for three of our deaf patients that will be moving into a home together.

Other than that, I continued to orient to the hospital and get accustomed to the policies/procedures. I enjoyed my week and hope I will get more "hands on" experience as the the weeks progress.

Learning -

I decided to add this section as I wish to reflect on what I have learned thus far. I find in amazing just how complex and complicated the state FSSA system is. There is such a large chain of command and the bureaucratic nonsense that employees have to deal with really takes away from patient care. I find that the more the state cuts funding and rearranges the way the FSSA is managed, the more hospitals, such as Carter, are shoved to the side and ignored.

I also learned that social workers have many different tasks, and depending on the setting, wear different "hats" at different times. Social workers at Carter mainly do case management and are less focused on direct work with patients. Even the social workers who have an LCSW do little if any psychotherapy. I realize, by my experience at Carter, that the type of social work I perform will be greatly influenced by the agency/setting that I work in.

These items stick out in my mind as the main lessons learned thus far. It is quite exciting to reflect on the lessons I am learning just by observing the daily happenings of the hospital. I can start to see the light at the end of the tunnel, and am closer to understanding the role I will play in the social work field :)

Reflection -

Research/micro

As I am interacting more with the patients, I realize that there is a lot to be learned about how to interact with persons with a large range of mental illnesses. No one method will work for each person, and I believe that doing a research project on how to effectively deliver social services to persons with mental disorders/handicaps would be beneficial. It isn't the same as working with someone who has an average intellect. Most of the patients at Carter don't process information in the same manner as most people do, and I would be better prepared to work with this population if I learn techniques and strategies on how to communicate and interact more efficiently. More effective and correct communication between the patients and I will lead to better social work.

Total Hours this Week (with 2 seminar hours): 16 hrs, 20 minutes
Total Hours to date: 31 hours, 50 minutes

Week 1

Enlightening -

Going into this practicum, I really didn't know what to expect. I knew Larue Carter would be a challenging and interesting experience (being a state psychiatric hospital) and I wanted that thrill and unique experience that I knew it would offer. However, I hadn't a clue as to what I would be doing or what a social worker's responsibility was at Carter. This week has enlightened me to just how important social workers are to the population at Carter. After my first week, I can say that I am excited and glad that I have the experience to spend the next four months at Carter.

Activities - 

This week, I didn't have much of an opportunity to work directly with the population. I mostly spent time exploring the physical areas of the hospital, discussing social work tasks with my field instructor, and generally orienting to the practicum. However, I did participate in my first patient treatment team meeting and also observed some of the challenges that social workers and staff members face at Carter.

It was interesting being part of a treatment team meeting. We interviewed five patients and discussed their progress thus far. Team members included a psychiatrist, psychologist, social worker, charge nurse, division director, med student, and myself. The goal of the meeting was to give the patient an opportunity to ask any questions related to his/her treatment plan. It was exciting to see first hand how the treatment of patients is handled.

I also got to witness, first hand, the challenges that staff members face in a psychiatric hospital. During our treatment meeting, a code green was issued because a patient was out of control and had to be detained. I witnessed staff members detain the gentleman, the nurse administer medication to calm him, and then waited with the rest of the staff while the patient calmed down. I realized that it can be challenging for social workers and staff members to deal rationally with persons who are severely mentally ill. One has to have a certain level of compassion and understanding when dealing with a population as such. It was eye opening and exciting at the same time.

I absolutely loved my first week at Carter. I am excited to continue with my experience and can't wait to see what else I learn from this wonderful and unique population.

Reflection - 

Policy/Macro

Being a state hospital, there are many policies that affect patients on a regular basis. I am just learning about the policies of the hospital and how they affect patients. One issue that I did note was the lack of funding that has a direct effect on the population. As the state budget is being cut, Carter hospital is operating at the bare minimum, often without adequate physical surroundings for patients. The building is old and is in need of repair. But because finances are limited, little is left over to improve the environment. I believe that if more was done to improve the environment that most of these patients spend 24 hours confined in, it could have a positive affect on the patients' mental state. There seems to be a sense that the state is trying to unload this hospital and I worry what will eventually happen to the patient's that require the security and services it provides them.

Total Hours this Week: 15.5

Total Hours to Date: 15.5