February 2007 – Tips & Topics – february-2007

TIPS & TOPICS
Volume 4, No.9
February 2007

In this issue
— SAVVY
— SKILLS
— SOUL
— Until Next Time

Thanks for joining us this month. Have you ever worked where there are disagreements and conflict? You might want to read on.

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Vol.12, No. 9

Welcome to the December edition of Tips and Topics (TNT). Happy Holidays to everyone – chilly and cold for our Northern Hemisphere readers and sunny and warm for our Aussie and New Zealand readers.

David Mee-Lee M.D.

SAVVY

There is always a well-known solution to every human problem–neat, plausible, and wrong.” H. L. Mencken, Prejudices: Second Series, 1920. US editor (1880 – 1956) http://www.quotationspage.com/quote/282.html

 

Or I like the paraphrased version: “For every complex problem there is a simple and clear answer; and it is wrong.” When it comes to the conversation – or more accurately – the war of words and deeds currently raging on in the USA about race and alleged police brutality, there is not a simple answer. So I am adding my words on the subject for this edition; or more accurately I am adding my comments on a couple of other people’s perspectives on this important issue.

 

TIP 1

How do you view race relations in the USA and what solutions resonate with you?

 

Matt McDonell, a high school librarian in San Francisco, wrote in a Perspective he titled “The Conversation on Race – You can’t have a conversation on race if both sides aren’t prepared to listen.”

 

If you want to hear Matt speak what he has written below, here’s the link:

http://www.kqed.org/a/perspectives/R201412090735

 

“In college, I attended a Christian Men’s rally where two speakers, one white, one black, addressed racial reconciliation. Longtime friends, they had spent years working through these issues together.

 

When the white speaker addressed the white men present specifically, he exhorted us to pursue relationships with people different from ourselves, to acknowledge the privilege we are born into and not to hoard that privilege but use it for the good of all.

 

Then the black speaker exhorted the black men to not use racial oppression as an excuse to avoid responsibility for the example they set for their community.

 

The white men sitting in front of us seemed defensive and dismissive of the white speaker, but cheered loudly when the black speaker addressed the black audience.

 

I’ve been thinking about that rally while reading the responses to my Facebook posts during our latest supposed national conversation about race. I’ve noted who has more to say about the loss of black lives and who has more to say about violent protests and it tells me we have a lot to overcome if this conversation is going anywhere.

 

Nobody wants to be the first to blink and admit that not only is my perspective incomplete, but I also have a real and important part in the change we need. Admitting the other guy has a point doesn’t let him off the hook, and taking responsibility isn’t accepting blame.

 

In my experience, the reluctance to do either is a human condition that affects us equally. I see no group — racial or otherwise — more inclined to defensiveness or humility, blaming or repenting, being open-minded or willfully ignorant.

 

I am just as guilty of this as the next person, but I want things to change. I don’t have any pat answers, so for now I’m just going to try to listen better. Not just listen for holes in others’ arguments and jumping in whenever there’s a pause. I’ve been doing that for a long time, and it hasn’t resulted in any productive change for anyone. I want to really listen, and let myself be humbled,and let myself be changed.

 

With a Perspective, I’m Matt McDonell.”

 

My Comments on Matt’s Comments:

While driving in the Bay area December 9, I heard Matt McDonell’s views on San Francisco radio station KQED. It made me think about these points:

  • It’s natural to tune into people who think the same way we do. With the plethora of opinionated radio commentators and cable TV pundits,it is even easier to listen only to stations that reinforce our beliefs.
  • Notice how the white men were dismissive of the message they didn’t like even though exhorted by a man of their own race. It is hard not to be defensive when I hear a message that requires a change in attitude or behavior.
  • It’s also difficult, as Matt says, to “admit that that not only is my perspective incomplete, but I also have a real and important part in the change we need.”
  • It takes a real step of humility and open-mindedness to admit “the other guy has a point”, and to take responsibility to change one’s attitudes or behavior.
  • But I’m glad Matt also made the point that it doesn’t mean I am all to blame. The “other guy” might have to make some changes too.
  • Like Matt, “I don’t have any pat answers” either. But I remember a family therapist years ago teaching me how to look at a dispute between a couple or family member. The advice: the person who thinks they are most right should be the first person to reach out to the other “wrong” partner or family member.
  • If we all took that advice, we might all “really listen”, and might all “be humbled”, and let ourselves “be changed.”

 

Lisa Hendrickson is a Substance “Recovery” Counselor, from Utah who wrote an email to me with the Subject line: “Drugs NOT Race!!”

 

Dr Mee-Lee,

Please bring attention to a critical factor in the recent shooting stories. I’m a substance recovery counselor, and I’m scared there’s a wave of chemistry destroying our youth that everybody’s missing. Michael Brown (MB) had THC levels in his blood and urine consistent with current and past use of marijuana. He was either intoxicated, i.e., cognitively impaired, OR more likely, he was CRAVING – hence the strong-arm robbery of the cigarillos which are typically used to make “blunts.” People behave in irrational ways when they are in midst of very real biological “urges.” (Everyone can relate to speeding when in need of a toilet.) MB didn’t want to go jail; he wanted to go get high, and no one was going to stop him. THAT explains his bizarre response to being detained by Officer Wilson. It’s called “dope” for a reason – it turns off the “thinking” part of the brain!

 

Right after MB’s death, Dillon Taylor (white), was shot and killed in Salt Lake City while intoxicated on alcohol more than twice the legal limit. He had hinted that he would rather die than go back to jail. He ignored the cops’ orders and acted like he had a weapon. The Salt Lake cop (mixed race) who shot him was cleared because he was wearing a body camera that showed the alarming behavior of the suspect. Just last week another young man, Gil Collar (white), was shot in Mobile, Alabama while under the influence of LSD and engaging the police officer (black) in an erratic manner. I’m sure if we analyzed data nationwide we’d see a CLEAR pattern: People do stupid stuff while intoxicated regardless of their race or that of the cops!!

 

Lisa Hendrickson

Substance “Recovery” Counselor, (SUDC in the state of Utah)

E-mail: lhendrickson@sbhcutah.org

 

My Comments on Lisa’s E-mail:

I haven’t researched the facts in these cases to be aware of what Lisa raises as a possible common theme in these recent tragic situations. It made me think about these points:

  • There has been much focus on what the police did in the split-second decisions they have to make all the time to protect the lives of all involved.
  • But you don’t hear as much about what the victims were thinking and doing that brought them to the attention of the police in the first place: What were their attitudes and behavior when confronted by the police? How provocative or ambiguous were their physical gestures? How did they respond to questions that could have been interpreted as resisting arrest or endangering the police officer?
  • Lisa raises good points about how alcohol and other drugs is a common and even determining theme in all three cases. “Drugs NOT Race!!” is what she declares.
  • Emergency rooms, acute mental health facilities and other general health personnel too often fail to screen for, assess and treat addiction. Here too, Lisa is saying the focus, in her opinion, has been misguided: concentrated just on race and not drugs. She may have an important point that explains the victims’ attitude and behavior other than race as the assumed common factor.

SKILLS

I caught the tail end of a radio panel interviewed about race relations and exploring solutions.I heard a brief snippet from one woman who apparently does a lot of training of families and children about race and the interface with law enforcement personnel. I missed discovering who the wise panelist was, as I arrived at my destination and had to turn off the radio. This is what she tells parents to teach their children about how to avoid tragedies with police officers.

 

TIP 1

Teach your children to avoid being a RAT

I was taken aback at first when I heard Rat and children in the same sentence. But it soon all made perfect sense:

 

R – Don’t run from a police officer

A – Don’t argue with the police officer

T – Don’t touch a police officer

 

I tried a Google search to find the panelist and what she teaches. I didn’t find her, however I did find a related article “Teach Your Child How to Survive Being Arrested at School”. You can read the whole content here:

http://www.dailykos.com/story/2012/01/30/1059937/-Teach-Your-Child-How-to-Survive-Being-Arrested-at-School#

 

Listed below are a few of the tips the article advised. Michael Brown may well be alive today had he been taught this:

  • Teach your child to say “I want a lawyer” as soon as they see handcuffs. Include the “zip tie” cuffs as well as the metal cuffs.
  • Teach your child to put their hands on their head when a police officer talks to them.
  • Don’t run from the police.
  • Don’t argue with the police.
  • Say, “I want a lawyer.”
  • Don’t touch the police officer at all.
  • Don’t gesture towards the police: no finger waving, no flipping the finger, no waving arms, no shaking hands, no speaking in American Sign Language (ASL), nothing they can and will interpret as a hostile move.
  • Don’t talk other than giving your name and saying “I want a lawyer”: “My name is __ and I want lawyer.”
  • Ask “Am I under arrest?”
  • Keep your hands where the police can see them.
  • Do not consent to a search.
  • Don’t resist the arrest, innocent or not.
  • Remember the police officer’s name, badge number, and patrol car number.

Reference:

Originally posted to Practical Survivalism and Sustainable Living on Monday, January 30, 2012. Also republished by Education Alternatives and Community Spotlight.

SOUL

It’s hard to watch the video of how Eric Garner died on July 17, 2014, on Staten Island, New York, after a police officer used a chokehold or headlock to arrest this 43-year-old father of six. It seems baffling to understand why such violence was necessary. Even though Garner had a lengthy criminal history and was well known to the police, you wonder why such force was applied.

 

Just the other day on December 20, 2014, two New York City (NYPD) police officers were ambushed and killed by a 28-year-old man, Ismaaiyl Brinsley, in retaliation for the Eric Garner and Michael Brown deaths. Again, it is shocking to consider such venomous violence against two police officers who daily risk their lives to preserve law and order. One officer was married with two children. His colleague just got married two months ago.

 

I am allergic to violence. It never seems to solve anything: people beat up police and loot innocent people’s stores protesting police violence; police beat people who may have just beaten up someone else.

 

I know, it is not all protesters and not all police. I’m not taking sides because Marshall Rosenberg, Ph.D. taught me there are commonalities about violence that join all protesters and police together – in fact, that join all of us together.

 

I referenced Dr. Rosenberg and his leadership with Nonviolent Communication (NVC) in the February 2007 edition of Tips and Topics. See more detail in SKILLS of that edition:

http://www.tipsntopics.com/2007/02/february-2007/#more-83

 

Rosenberg said: “Violence in any form is the tragic expression of our unmet needs” (P.78)

  • The tragedy of verbal or physical violence is that it usually induces a violent reaction in the other person.
  • That victim of the violence is now sadly even less likely to want to resolve disagreements, let alone reach out to help fulfill the unmet universal human needs of the attacking person.
  • Yet it is these needs which fuels the violence in the first place. If those needs could only be acknowledged, appreciated and addressed, the power of the conflict would dissipate.

What might be the unmet universal human needs of protesters, police and all of us which is fueling the violence?

  • The need for: justice, safety, security, respect, acknowledgement, recognition

Rosenberg again: “When we listen for their feelings and needs, we no longer see people as monsters.”

  • The universal human experience is that we all have feelings and needs. Even the most obnoxious behavior and aggressive language arise from feelings and needs we have all experienced.
  • The recognition of these feelings and the fulfilling of these needs is what all people crave.
  • Can you see the “monstrous” behavior as if it comes from a helpless child crying out for help to get their needs met?

There is no vaccine for the virus of violence that feels like it is going “viral”. But despite my abhorrence of violence, I try to remember: “Violence in any form is the tragic expression of our unmet needs

 

Reference:

Rosenberg, Marshall B (1999): “Nonviolent Communication – A Language of Compassion”   PuddleDancer Press, P.O. Box 1204, Del Mar, CA 92014.

Until next time

Thanks for joining us this month. Happy Holidays and may you get the best gifts of all – love and health.  See you next year – in late January.

David

Lessons from “American Sniper”; citizen of the world; trauma journals

Vol. #15, No. 5

Welcome to the August edition of Tips & Topics (TNT).  If you are in the Northern Hemisphere, I hope you are enjoying summer. If you are Down Under, may your winter be not too cold. 

David Mee-Lee M.D.

SAVVY

When President Trump declared the opioid crisis a national emergency earlier this month, I planned to write about that in this month’s Tips & Topics. However I am commencing this edition on a 13-hour plane ride back from Australia. That may sound like a long trip you wouldn’t want to make. Yet I’ve done it so many times- a couple of movies, a couple of meals, a few hours’ sleep and presto! You’ve arrived in San Francisco, non-stop from Sydney.
 
One inflight film I watched changed my whole plan for Tips & Topics. I am in awe of the impact a well-written, well-directed and acted movie can have to raise awareness, educate and catalyze empathy and understanding….in just over 2 hours. Not a brand new movie; just hadn’t yet gotten around to seeing it despite its excellent reviews.
 
TIP 1
Insights, information and inspiration I gained from the 2014 film “American Sniper”
 
Bradley Cooper’s portrayal of US Navy SEAL Chris Kyle in “American Sniper” is praised as one of his best performances. That is fitting since the life of Chris Kyle, if the movie accurately portrayed him, was also outstanding. Even if there were Holly wood inaccuracies, the messages and impact remain authentic for me.
 
Here, in no specific order, is a list of what touched me:
 
1. The total barbarity of war – the wars in the Middle East (and elsewhere) have been going on for so long, that news of another serviceperson’s death barely raises a flicker emotionally, I am sad to say.
 
2. “People are dying and we’re going to the mall” – It was words to that effect in the movie that reminded me how untouched most of us are by the wars. Fortunately now we treat the courage of all who serve in the military with great respect, unlike what happened in the Vietnam War; or as those in Vietnam call it “the American War”. But is it enough to let service people board the plane first ahead of even the most frequent flyers, honor them at the beginning of ballgames, and say “Thank-you for your service”? I know I am really am grateful for their service, but is that just because I’m glad it’s not me?
 
3. Posttraumatic Stress Syndrome  I thought I knew PTSD and what active duty and returning military personnel go through. But this movie ‘hit me in the gut’- what it’s really like for the person, spouse, partner, children plus friends and extended family:   
  • To be emotionally present: how incredibly hard is for the service person returning from a tour of duty, to try to live a regular life after the terror and trauma of war.
  • To simply hear ordinary sounds and experiences: These can so easily trigger rage, fear, and automatic aggressive reactions – e.g. the sound of the car mechanic’s drill triggering the memory of the terrorist’s drill torturing a child; a convoy of commercial trucks sounds like the beginning of a military operation; playful wrestling between the family dog with a child at a barbeque looks like the child is under attack.
  • The pain for loved ones to understand what is going on: It is so hard for the serviceperson to talk about what has happened to them and what is changing in their thoughts, feelings and behavior.
  • The partner’s pain: How painful it can be to love and be with the person who is not now the one you loved and married.
4. Trauma of the victims of war – Seeing what the citizens of the war-ravaged countries experience at the hands of both our military and the terrorists is heartbreaking. Both sides in the conflict believe they are doing “God’s work”. The civilians caught in the middle have no say, are at the mercy of their inability to flee and escape the unthinkable conditions I doubt I could survive.
 
5. Camaraderie and the mission – When there is a sense the mission is noble and worth dying for to protect home and country, the bonds formed in the military sustain the courage and grit needed to face the physical, mental and emotional demands of war. When the belief in any mission fades, only fear, tiredness and disillusionment is present.
 
6. Emergency services in the battle and healing support on return
The courage and sheer will it takes to be on the frontline is remarkable. In addition, there are so many others giving so much to save the lives of the wounded. For returning veterans, especially those with PTSD, they need easy access to all the services necessary to reintegrate back to “normal” life – housing, jobs, mental health services, physical health care and rehabilitation. Veterans Health and the Veterans Administration (VA) have such an important role.
 
7. Restoring hope – When Chris Kyle thought the only way to save more lives was to return to a fifth tour of duty in Iraq and kill the enemy, an astute clinician offered an alternative. He walked Chris through the halls of the VA to meet those who’d lost limbs, self-confidence, hope and health. There, he found a different, but equally effective, way to ‘save lives’ in service to returning vets. This not only restored hope for those he served, but also restored himself. His wife and family got back the one they loved.
 
8. War at home – I still believe there has to be a way for people to come together……come together not just in the big wars of the Middle East and North Korea and the many other hotspots of the world. But come together in the battles between:
  • White and black; white supremacists and multiculturalists
  • The different colors of race, religion and ideology
  • Climate change deniers and believers
  • Republicans and Democrats
  • Factions in Congress
  • The President and many of the citizens he serves
And the wars at home between:
  • Spouses and intimate partners in daily physical, mental and emotional battles
  • Siblings who don’t talk
  • Parents and estranged children
  • Grandparents separated from their grandchildren
  • The lonely, isolated and abandoned people at war with their depression and pain.

SKILLS

I am also in awe of the actors’ skills to make fact or fiction come alive on the Big Screen. They make us think, laugh, cry, horrify or inspire us. We work in the behavioral health field; here’s a few thoughts on our skills important to our mission and what we do.
 
TIP 1
Consider: what can you think, feel and do to help people thrive in the battles with addiction and mental illness?
 
Here, in no specific order, is a list of what comes to mind:
 
1. Nonviolent Communication
I have written before about understanding that behind violent words, behaviors and thoughts are universal feelings and needs to be recognized addressed and satisfied.
Tips & Topics, February 2007
Tips & Topics, March 2010
 
2. Keep an open mind to other methods, theories and practices
How aware are you of other treatment models and strategies different from your own training and experience? Do you fervently defend your approach out of ignorance, fear of feeling incompetent in other methods, or because this is what worked for you in recovery? In addiction and mental health, we have the battles between:
  • Medication in addiction treatment and abstinence-based treatment:
    “We don’t believe in medications here – it is just substituting one drug for the other.”
  • Harm reduction and abstinence-mandated services:
    “Harm reduction is a last resort for people who fail abstinence.” Do you think harm reduction is a good thing or bad?
  • 12 Step approaches and Moderation Management or behavioral therapy to teach controlled use.
  • A focus on psychotropic medication versus psychosocial and community-based interventions:
    Why is Pharma called “Big Pharma”?
  • Treatment and prevention:
    Where do the majority of funds go to: treatment or prevention? How much does lifestyle affect chronic disease development and healing?
3. Posttraumatic Stress Syndrome  Fortunately there is an increased awareness, education and skills in building trauma-informed services and systems. Films like “American Sniper” and talking with those suffering with PTSD and their families connect us to the full impact of the human experience.
 
4. Trauma of the victims of war
I have not personally worked with refugees of war-torn countries and immigrants settling into the United States. We have so much to learn from those who work in this arena. In the current political climate, it is disturbing to me how little empathy we have for these victims of war. What can our country, rich in resources and opportunities, do for so many people whose lives have been devastated by the guns, bullets and bombs of us and the terrorists?
 
5. Restore hope and a sense of mission  Many we serve have lost hope and any optimism they can recover. They doubt they can change and overcome their loss of control of substances, gambling, depression or mood swings. Having a sense of hope has more positive impact in treatment than even the evidence-based practice used. Guiding people to take even ‘baby steps’ of success can build hope for recovery.
 
Holding onto hope and retaining a sense of mission can be challenging for clinicians themselves faced with:
  • Increasing case-loads
  • Decreasing funding
  • A rapidly changing healthcare system with performance measures, electronic health records, strict managed care, productivity expectations and population management
  • Compassion fatigue and burnout
Who helps the helper? Who supports and nurtures the carer? What can you do to stay centered, empowered and hopeful? What are you doing to handle and resolve the battles and conflicts at home with your loved ones, estranged friends or family and at work with supervisors, colleagues and administration?
 
6. Holistic whole person care
Treatment isn’t just about abstinence, faithful support group attendance, medication adherence, psychosis stabilization and staying out of the hospital. Just as important is paying attention to the following:
  • Does your client have a safe place to live? – maybe a Housing First service takes priority over getting abstinent and sober first.
  • Do they have transportation, money to buy food, a drop-in center to feel a sense of community?
  • Can they access physical health care for their blood pressure which hasn’t been checked for years or for teeth unattended to in decades?
  • Will the person be bounced between addiction, mental and physical health systems when they need integrated co-occurring or complexity capable services?

SOUL

In many ways, I consider myself a citizen of the world. Growing up as an Australian-born Chinese kid in a then predominantly white Australia (they even had an explicit “White Australia” policy from 1901 which officially ended 1973), I had to learn my place in that world. I love foreign travel and the stimulation of experiencing different cultures and customs.
However I also have two countries I call “home” and two passports to prove it – an Australian passport for my country of birth; and a US passport for my adopted country where I have lived almost twice as many years as Australia. As I return now from Australia, I smile at the little things I always look forward to experience nostalgically when I return home:
  • Eating an Aussie meat pie – so much better than an American pot pie
  • Eating a lamington – even a lot of bakeries in Australia have stopped making them: sponge cake covered in cocoa or chocolate topped off with desiccated coconut, cut up into little rectangles or squares of about 3 by 4 inches. But the size varies, so that’s also part of the fun.
  • Aussie hamburgers – Of course McDonalds and Burger King’s equivalent called Hungry Jacks are everywhere. But a real old-time hamburger has handmade hamburger with lettuce, tomato, beetroot and a fried egg between a mouth-widening bun.
  • Vegemite in both my “home” countries – we always bring back some jars so we can have toast spread with Vegemite and avocado in both Australia and the USA.
Lorikeets
There’s more eating memories, but onto a few other animal experiences you could relate to as a tourist: the huge variety of birds from colorful lorikeets, flocks of white cockatoos, laughing kookaburras and many more birds; cuddly sleepy koalas on our hikes. You have to watch out for kangaroos at sundown just like avoiding deer on the highways.

 

  • Aussie beaches – wide, long expanses of sparsely trafficked, fine
    Brunswick Heads, New South Wales

    sandy beaches. No pebbly, rocky, narrow, coarse sand beaches for me!

  • Australian currency – besides an exchange rate with the US dollar favorable to the US visitor, the actual notes and coins are both attractive and practical. There’s a one and two dollar coin – no $1 or

$2 dollar notes. All the Aussie notes are brightly colorful, easy to distinguish. Somehow they’re manufactured with material that’s always so smooth, durable and new-looking. They don’t crinkle up as they get old; they stay flat and compact in your wallet. Take a look at your US dollars and see if they meet the same criteria.

Well that is surely enough of what I look forward to. Thanks for indulging my nostalgic experiences. They are certainly not enough for me to up and leave all the stimulating and gratifying experiences of my adopted home.

In this world of ours, so torn by conflicts and wars and pain and suffering, how could we all become citizens of the world? What would it take to be proud of our country while also shunning intolerance, isolationism, hate and bigotry? How might we embrace empathy, inclusion, community and the fulfillment of universal human feelings and needs?

I know I am naïve and idealistic.

SHARING SOLUTIONS

Here are some relevant Interactive Journals from The Change Companies:
 
Trauma In Life – (Women’s Specific version) Developed with the Federal Bureau of Prisons for their 16 hour workshop offered through their Resolve Programming. It is focused on risk and resiliency.
 
Traumatic Stress & Resilience – (Men’s Specific version)- Developed with the Federal Bureau of Prisons for their 16 hour workshop offered through their Resolve Programming. It is focused on risk and resiliency.
 
Coming Home Series – It is transition-focused but also explores PTSD and has some great self-management resources in it for those dealing with Trauma.
 
Self-Management Journals– although not ‘specific’ to trauma have great resources in there for individuals with Trauma
 

Until next time

Thanks for joining us this month. See you in late September. 
                                                                                                                                               
David

November 2017

Vol. #15, No. 8 November, 2017 Welcome to the November edition of Tips & Topics (TNT). To all of you in North America, I hope you had a great Happy Thanksgiving. Wikipedia says that Thanksgiving is also celebrated by some of the Caribbean islands, and Liberia....

April 2012 – Tips & Topics – april-2012-tips-topics

Tips and Topics
Vol. 10, No. 1April, 2012
This April edition of Tips and Topics (TNT) is the beginning of our tenth year. Welcome to all and the many new readers this month too.

Senior Vice President
of The Change Companies®

(more…)

March 2010 – Tips &Topics – march-2010-tips-topics

TIPS & TOPICS from David Mee-Lee, M.D.
Volume 7, No.11
March 2010

In this issue

— SAVVY   – Staff Morale and What’s Bugging You?
— SKILLS   – How to Express Powerful Appreciations
— SOUL – Singapore, China and AA
— SUCCESS STORIES  – Conflict: The Benefits of a Policy
— Until Next Time

(more…)

January 2009

Volume 6, No.9 | January 2009
In this issue


SAVVY | SKILLS | SOUL | SOCIAL COMMUNITY | Q & As

David Mee-Lee M.D.


 

Welcome to the New Year and a couple of significant events: a new President of the USA with all the accompanying hope and optimism (at least for the over 50% of voters); and equally earth-shattering, the launch of my new website www.davidmeelee.com More on that later.

SAVVY

Recently I was asked to present a workshop to help keep the behavioral health team healthy, especially in these tough economic times. I use a very illuminating exercise I heard about 8 years ago at the University of California, San Diego (UCSD) Summer Clinical Institute in Addiction Studies. It uses the familiar image of an iceberg to show that there is a visible culture and a much larger invisible culture hidden below the waterline. Problems you see on the surface are impacted by deeply held attitudes and beliefs- under water, out of view.

If you Google “culture iceberg” you’ll find many ways this metaphor has been used. I heard Dr. Schiff use a version which has become very useful for teams to discover what lies beneath common surface problems like high staff turnover rates, or treatment and service plans that are general and non-individualized.

In SAVVY, let’s look at high staff turnover rates; and in SKILLS, we’ll take a look at general and generic treatment plans.

  • Identify the hidden cultural norms, assumptions and beliefs of your treatment culture by looking below the surface of the Culture Iceberg.

Imagine 10% of the iceberg showing above the surface and the huge 90% below. You see the polices, procedures, symbols and rituals in your treatment culture but not the norms, assumptions and beliefs that profoundly influence and affect what really is happening.

On the surface, you have a policy and procedure to be welcoming to all clients and consumers. On the wall is the framed Mission Statement saying people are the agency’s most valuable resource. Then we have to lay staff off or give them unmanageable case loads. Clients call and get an answering machine with complicated prompts that even a sober, mentally-stable genius would struggle with. Then, if a caller does reach a person, they are placed on a waiting list as if their problems were no more important than a football fan waiting to get a ticket to the Super Bowl.

Take a look at a common organizational problem —> high staff turnover rates.

That is the visible, surface problem. Here’s how you get to the hidden cultural norms and assumptions fueling and perpetuating visible problems. You can get to hidden norms by completing the sentence: “It’s OK to…….”, and you can get to hidden assumptions and beliefs by following that with: “Because…..”

So, for example, beneath high staff turnover rates problem might lie: “It’s OK to have staff leave after a short period, because we pay low salaries and can only attract entry level candidates.” Here are some other possible hidden norms and assumptions and beliefs beneath this surface problem.
Hidden Norms and Assumptions

* It’s OK to not orient new staff well because they will leave soon anyway.

* It’s OK to bad-mouth management and each other, because we don’t have respect for each other.

* It’s OK to be overworked because we can’t turn clients away and they have to be seen.

* It’s OK to be discontent and complain because nobody in management cares anyway.

Feel free to add more if this is an organizational problem where you work. But you can see how getting below the surface can identify what might be fueling the visible issue. Sometimes what is beneath everything cannot be changed immediately and it helps to just know what is going on, so you can decrease expectations for a swift resolution.

For example:
If you cannot turn any client away and the demands for service are immense, staff can anticipate that they will be overworked until a solution can be found to have more manageable caseloads. Similarly, supervisors and clinicians will understand that they are in “crisis mode.” They may not be able to do as thorough clinical and documentation work as they would like. Naturally this will not make life easy. However these realizations can relieve some of the stress that comes from feeling bad about not doing your best work; and to understand that your supervisor is not a heartless slave-driver.

On the other hand, if the hidden norm is identified as a lack of respect for each other and no policy or procedure for conflict resolution exists, then this can be addressed immediately. With the commitment to develop and use a conflict resolution policy and procedure, the team can begin to turn around a culture of disrespect, gossip and back-stabbing.

(See TIPS and TOPICS, February 2007 for a sample Conflict Resolution Policy and Procedure – keep checking back for this to be on the website shortly)

References and Resources:

1. Steven Schiff, Ph.D. “Organizational Culture and Treatment Implications”. Presented at 30th University of California, San Diego (UCSD) Summer Clinical Institute in Addiction Studies, La Jolla, CA. August 1, 2001. The Culture Iceberg is work of Dr. Steven Simon, Culture Change Consultants, Inc. 2005 Palmer Ave., #105 Larchmont, NY 10538 www.culturechange.com

2. NIATx – Network for the Improvement of Addiction Treatment www.Niatx.net

 

SKILLS

Concern about general, generic and non-individualized treatment plans is almost a universal issue in accreditation surveys and quality audits as well as in documentation supervision and paperwork reviews. Clinicians also struggle to make treatment and service planning meaningful. This is one issue the whole team can look at; or if you are a private practice clinician, this is also an occupational hazard for you too.

  • General and generic treatment plans may have multiple causes. Expose the invisible culture beneath this problem.

Some of the causes may be: skills-deficits, feeling overwhelmed with caseloads, ignorance, laziness, lack of critical thinking, philosophical rebellion against documentation, fixed, program-driven perspectives or more.

Here are some ideas to get you started. Participants in past workshops have raised these.

Hidden Norms and Assumptions:

* It’s OK to write general treatment plans because we don’t really use them anyway.

* It’s OK to just get the paperwork done because our caseloads are too high.

* It’s OK to write the problems without the client because they aren’t thinking straight anyway.

* It’s OK to give everyone basically the same plan because the program is pre-scheduled with a set curriculum and manual.

* It’s OK to write the plan for the client because the client is in denial, mandated and doesn’t want treatment anyway.

* It’s OK for treatment plans to look much the same for all clients because everyone has the same basic problems.

* It’s OK to have the same plan because the client keeps relapsing and has been here five times with the same problems.

* It’s OK to write general plans because we’ve been doing it this way for years.

* It’s OK to not individualize treatment because that’s the only way I’m willing to get the paperwork done.

* It’s OK to put less effort into treatment planning because treatment plans don’t help clients recover anyway.

Maybe these aren’t your team’s top ten hidden assumptions. See what you come up with. Solutions will follow if the team can get to Preparation and Action.

SOUL

A few weeks ago, I watched an interview with the National Transportation Safety Board’s spokesperson on NBC’s Today Show (January 16). She was talking about the “Miracle on the Hudson River” where the US Airways flight “landed” safely with all 155 passengers and crew safe, sound and soggy. She said that “usually we are focusing on what went wrong. But in this case, there was so much that went right; and we want to learn from that too.”

That same day on National Public Radio’s Talk of the Nation, Science Friday program, the discussion was about how copper can decrease microbial counts and perhaps help in preventing hospital infections which kill more people than HIV and breast cancer combined!

In one experiment, patients’ beds, surfaces in their rooms, and other equipment are being changed to copper to gauge if this will improve infection rates. Apparently you have a 1 in 20 chance of contracting a hospital infection just by checking yourself in for inpatient treatment; and a 1 in 20 chance of dying.

All this got me thinking about what a risk patients and clients take to get treatment. It shouldn’t be that they get sick and die, even as they come for help. Obviously I want people to keep coming for help. I believe treatment heals many more than it harms.

We work in behavioral health, not physical health. We may not amputate the wrong leg, take out the wrong kidney or leave surgical forceps in a patient’s abdomen. But we all create a treatment culture: it can be a healing one or not. Does it inspire, attract and welcome people? Encourage them to embrace recovery?

Does it “infect” individuals, discourage them, dishearten them?

There is a lot of pressure on us to treat problems and pathology. As when a plane crashes, we do want to identify what went wrong. But, just like Flight No. 1549, we want to focus equal time and energy on learning from what went well in people’s lives. Doing more of what works is as instructive and effective as doing less of what hasn’t worked. And it is a lot more hopeful and attractive to engage people around what works than around what is wrong.

 

SOCIAL COMMUNITY

Thanks to everybody for your feedback on the website. More is welcome. Your comments and suggestions are appreciated. I’ve received many common questions which are answered in the next section.

If you haven’t already clicked on the new website, it’s still a Beta version and new things will be coming.
I hope you will take a look. It’s a good beginning of what I hope will eventually be a place for us to:

–> get information
–> share information
–> create open source assessment and treatment planning forms and software; policies and procedures; treatment supports and whatever else our social community sees useful
–> get consultation and learning opportunities
–> buy useful products and services
–> link with other resources and people; Take a look at a video interview about co-occurring disorders at www.AfflictedandAffected.com in Archived Shows.

It’s not Facebook, MySpace or Amazon.com. It’s davidmeelee.com. It will be evolving over time.

Simple Website Q & As

Q: With the new website now, do I need to re-subscribe to Tips N Topics?
A: No! Your email address is the same and still in our database as before.

Q: When will be all the Tips N Topics issues be up on the website?
A: Very soon! Keep checking back as we’re updating that section regularly.

Q: On the calendar, how can I tell if trainings are open to the public or not?
A: The perfect solution has not yet been finalized, but we intend to state “Open to Public” right in the date box. Details on the training will be available as well.

Q: I don’t see a “Home” tab on the website?
A: You can always click on the logos in the upper lefthand corner to get to the Home Page. There is also a link to “Home” at the bottom of every page.

Q: Will your email address change also?
A: Yes very soon- but emails to the ‘old’ address info@dmlmd.com will still get to us. We’ll let you know when the address changes.

Q: Are you going to add other things to your site?
A: Yes. Coming soon- products to buy, more free resources, links I recommend among other things.

 

Until Next Time

Thanks for reading. See you later in February.

David

January 2008

Volume 5, No.9 | January 2008
In this issue


SAVVY | SKILLS | SOUL

David Mee-Lee M.D.


 

Happy New Year and may 2008 be a successful and productive year for you and your team.

January’s edition takes a fresh look at the Mission, Vision & Values of both your agency and your personal work. Similarly I also am taking a fresh look at my Mission, Vision & Values and -my website, www.DMLMD.com.

I am evaluating the website – what works, what doesn’t, what’s relevant, outdated, helpful, useless, unfriendly, missing, time-saving, cumbersome, easy, difficult. You name it —- the good and the bad! I want my website to be really useful to all the people I serve, including you, the readers of TIPS & TOPICS.

Many of you have given me helpful feedback about TNT. Now I’d like to harness your feedback to help me revamp the website. I want it to serve you better, and build on the community of TNT readers. So I’d like to meet you where you’re at: I need your opinion.

Look for a second email where you can express your opinions. There just might be some prizes for three randomly selected responders. We all love free stuff!

 

SAVVY

It seems there are hardly any cities, counties, states and health care systems NOT thinking about, planning for, or actively working on integrating services for people with co-occurring substance use and mental health problems. Administrators may decide to re- define their mission to better serve people with multiple needs. That doesn’t mean every frontline worker is ready and willing to suddenly shift focus. I have consulted with systems on this, and here are a few steps I suggest:

Tip 1

  • Assemble team members to take a fresh look at the Mission, Vision and Values of the agency or system involved in the change process.

Addiction counselors may not be interested in working with those “crazy” psychiatric patients, and mental health clinicians in working with “those people – those out of control alcoholics and addicts”. In fact these sentiments partly explain why clinicians may have chosen their ‘specialty’ in the first place. Suddenly they are now expected to work with clients with both problems (not that they weren’t actually working with them already.) The juices for working with co-occurring disorders don’t just automatically flow simply because administration declares a new direction.

Where does a system start in the change process? Team members will be challenged on their attitudes, perspectives and comfort zone of work competence. Include all important stakeholders to fashion the Mission. This meeting sets the context, and establishes the process of collaboration with all involved parties. It gives each person the opportunity to take responsibility for re-committing to his/her job. It is a time (if they are honest in their heart) when some may decide/declare they are not interested in, or committed to the new Mission.

When you arrive at discussing Values, the team identifies principles before policies, procedures and personalities. This discussion usually provokes the inevitable disagreements over “what to do” in a variety of clinical situations. What do we do if a client shows up to treatment having used alcohol or some other drug on the way? What do we do when a client refuses to take medication? What do we do when a client wants to stop methamphetamine or heroin, but keep drinking alcohol or smoking marijuana? When we discuss and name Values before a concrete clinical situation arises, this creates an anchor, a solid reference point to guide what to do in the heat of the moment.

–> For example, suppose your team agreed on this Value:
“Any relapse -whether in addiction or mental health – will be addressed as a crisis in a client’s treatment. This requires evaluation of the crisis and a revision of the service plan. We will not suspend, discharge from treatment, or have zero tolerance for relapse with any client – whether a substance use or mental health crisis.”

–> When the Value is discussed as a group, all team members have the chance to air their various points of view.

Tip 2

  • Develop individualized agency development plans and individualized staff development plans that recognize all agencies, program sites and team members are likely to be at different levels of preparedness to integrate co- occurring services.

Most clinicians are familiar with Stages of Change, and understand that clients seek help at different “stages of readiness.” Agencies (or program sites within an agency) are no different, just a larger organism. Staff also may be at different “stages” on being ready to adopt more integrated services. However, all would be expected to develop a formal plan that begins where they are comfortable, but also requires that they progress toward better integrated services.

–> Change leaders, technical assistance (TA) staff or consultants guide each agency/service site in the development of an “individualized agency development plan” matched to the stage of change and readiness for integrated services of that unit or provider.

–> They then monitor the progress of the individualized plans inside each agency in their service network.

–> Similarly each team member fashions an “individualized staff development plan.” This is done in collaboration with their supervisor, Change leader or TA consultant. The plan should honor each team member’s stage of readiness. It provides for training to increase awareness of the need for integrated services, as well as the skills to engage and treat people with co-occurring disorders.

–> Change leaders are personnel who have embraced the mission for integrated services. They are committed to improving services to the co- occurring population. To give Change leaders time to meaningfully participate in this mission, administrators and supervisors may need to adjust caseloads, job descriptions or duties.

SKILLS

It is fairly easy to stage training workshops, write up elaborate strategic plans and sketch out impressive timelines for goals/tasks to integrate services. The more challenging task is actually making change happen, the type of change which ends up making a difference on a daily basis to the people we serve in the trenches.

Tip 1

  • Develop specific implications for each Value raised in discussions of the new Mission and Vision.

Nearly every agency and company has a Mission Statement which very few team members can recall, let alone articulate, or explain concrete implications of the Mission.

–> Test yourself. Can you recite right now your agency’s Mission Statement without looking it up?
–> Have you always thought of it as being so generically lofty, “motherhood and apple pie,” so broad as to be of little practical use in the dilemmas and pressures of daily life on the job?

A good next step is to comprehensively explore and list all the implications for each Value you created. Let’s work with the example Value above.

It states: “Any relapse -whether in addiction or mental health – will be addressed as a crisis in a client’s treatment. This requires evaluation of the crisis and a revision of the service plan. We will not suspend, discharge from treatment, or have zero tolerance for relapse with any client – whether a substance use or mental health crisis.”

What would be the implications of such a Value? The list could include:

–> If a crisis of substance use, suicidal, violent or self-mutilation behavior, psychosis, mood instability should occur, all clients will receive timely assessment to address any immediate needs. We will revise the treatment plan to improve the client’s progress and outcome.

–>If a client’s relapse triggers reactions in other clients, this provides the opportunity to assist both the relapsing client, as well as helping other clients learn from their reactions to the relapse and crisis.

–> No client will be excluded from treatment because symptoms recur. But if a client deliberately undermines treatment by enticing others to use substances or violates boundaries with violence or impulsive behavior, we will likely discharge a client who is not interested in accountable treatment.

When you actually put pen to paper and write out the implications, this generates open discussion of often disparate ideologies and attitudes. When implications are made explicit -before confronting a “live” relapse crisis- this minimizes the inevitable conflicts which arise amongst people of different disciplines, personalities and life experiences. Remember, conflict is normal. There are policies and procedures that can make resolution more likely. See the February 2007 edition of TIPS and TOPICS for one example.

Tip 2

  • Work with team members in the same way you would with a client: i.e. challenge/ support one another in adhering to each team member’s development plan.

When a client presents for services, what drives the treatment planning process should be an alliance around what the client wants, and why they chose to walk in the door.

Here is the parallel process on the agency level. When a new Mission is written, it requires team members to re-commit to work in that agency. So each team member can ponder the following steps. Supervisors and Change leaders can facilitate the team member’s personal exploration by ensuring a strong, supportive, safe work environment:
–> What do you want that makes you choose to work here, especially with the new Mission? For example: being honest, do you just want a paycheck especially if you are close to retirement? Or are you getting ready to go to graduate school and want to be on the cutting edge of new directions? Or are you wanting a paycheck and not wanting to change what you are doing- in which case, your plan may be to transition out of the system if you are taking responsibility for your personal sanity and self-care.

–> Where are you at as regards the new directions the Mission promotes? What is your attitude, stage of change, comfort level and competence level? For example, if you see no reason to change the Mission, your personal development plan will require attention to some consciousness-raising. What information do I need to convince me of the need for change, before I am ready to focus on actually expanding knowledge and skills? If you are eager to be on the cutting edge of new technologies and methods, your development plan might have you lead the team in a journal club; or plan the in-service training curriculum; or be the local change agent champion.

–> How best would you acquire new skills necessary to promote the new Mission? Do you learn best by observation, trial and error, didactic presentations, individual supervision, group peer supervision, discussion of case examples, viewing videos, on the job coaching etc.? Your personal plan would include whatever methods will quickly and efficiently expand your knowledge and skills.

SOUL

I have not gotten on the Harry Potter bandwagon of incredibly successful books and spin-off films and merchandise. It’s not because I approve or disapprove; I just haven’t read JK Rowling’s works. Her fans may gasp at this point. What I do admire about her is how she pressed ahead when hardly anyone believed in what she had to offer.

In an interview recorded in TIME Magazine’s December 31, 2007 – January 7, 2008 edition, she was asked about her beginning fame. “It happened very, very quickly. I had written a book that I was told repeatedly was uncommercial, overlong, wouldn’t sell. So when it happened, it really was a profound shock.” That prediction about her book is right up there with “Who would want a computer in every house?” What successful author, musician, artist, entrepreneur, politician or athlete has not faced repeated failure, before eventually finding themselves contributing in a way they had set their sights on? And it is not just those professions. This is true for just about anything worth achieving.

Most of us are involved in work, leisure and community activities which do not require the kind of commitment and energy that it takes to run for the Presidency of the United States or to compete in the Super Bowl with a perfect win record of 18 straight games. But when you show up for work everyday, have you chosen to be there? Or are you just going through the motions? How cynical, burnt-out, compassion-fatigued, frustrated are you? When a flight gets cancelled due to weather, and I have to drive seven hours in freezing rain and snow to make sure the workshop goes on the next morning, the experience of frustrated, burnt- out and fatigued come to mind. All that melts though, when participants leave having gained a lot to help them in their work—and appreciatively feed that back to me.

Here’s what JK Rowling also said: “I hope my work sends the message that self-worth is about finding out what you do best and working hard at it.”

This won’t necessarily translate into instant fame and fortune. Who wants the paparazzi anyway? But it is a great formula for a meaningful way of being and contributing; and a potent antidote if you find yourself cynical, burnt-out, compassion-fatigued, and frustrated.

Until Next Time

Thanks for joining us for this first edition of 2008. See you in late February.

David