I think Nevada, or at least Las Vegas, must be a different animal when it comes to mental health practice. Back in Ohio, one would know of unqualified or neurotic managers or department heads, more rarely an agency director who, rumor had it, “didn’t know how to run a mental health center.” Generally, the feeling of most places was viability, solidity. But Vegas – it seems to be the Bermuda Triangle of hiders and charlatans, fake smilers, crooks and the weirdly ambitious: people who left their crime in one state; new CEO’s with old rap sheets and complementarily, a litigious bent; psychiatrists one can google for scandalous court cases, baby-talking Prussian generals; owners who roll out the welcome mat to the new therapist but have no clients; the echoing whisper of “insurance fraud.” What is it about this area? I work with a population of low-functioning clients,* with résumés of misery and life blaming and slip-and-falling whenever a success approaches. But they don’t go and open mental health centers! It’s these other folks, a kind of plastic elite species who are pastors of storefront churches on the side, a plumber franchisee with Tony Robbins-type gusto, a beautician who probably liked therapy in her earlier life.
Honestly, I
have little idea. Is it easier to post a shingle here, akin to an on-line medical degree from Fiji? Burned a few times, I
began opening my eyes wider during searches. Gauche, perfumey agency names with “thrive,” “heart,” “infinite,” “angel,” “blessed,” “keep faith,” “tender loving
care,” “never give up,” “aloha,” popping up biweekly like those weeds that look
like flowers. Ugly, generic websites with Japanese-translation
verbiage; no staff listed, no reviews; no Internet presence after two years but an NPI number. Perversely, their Indeed.com ads would
often be four to six inches long: tedious, torturous details of job functions
as if a counselor must be led by hand and cattle prod through his day. And most
ads specifying “one year experience,” at the most two. I have twenty-plus years’
experience. Am I the leper?
My only guess
is linked to the fact that in Ohio, mental health treatment is either private practice or local government-based. In Columbus and vicinity there
are many state- and local-levy-funded centers and branches. The heads are operations experts
or individuals who rose through the ranks of social services – therapist,
department head, clinical or administrative director, CEO. They are employees with personal, clinical and professional association's ethics and governmental oversight standards under their belt. Nevada, as far as I understand, does not have this
system. There are some state-run or -supported facilities such as the state
psychiatric hospital, a domestic violence shelter, one or two outpatient
offices. Everything else – where you go for therapy for depression and anxiety
and trauma, personality disorder, a sense of meaning, marriage, loneliness and
self-esteem – is a twinkle in the eye of some individual with a
dream. A dream of what? Medicaid money, I’m guessing.
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* Year 2021 Update: Note that this well-meant insult doesn’t apply to my current client list: I have moved on.
As the old saying goes - "Whoever said the world was fair???" Inequality everywhere and not only financially speaking (although money bestows power, including personal power). I think capitalism appeals mainly to the dominant, non-feeling types. And I guess that's why you call yourself The Pessimistic Shrink! - because you know that for some people the odds are weighted against them, some of your clients for example. Once you have peered in to the abyss, the world is nothing like it seems, it's more like a movie.
ReplyDeleteI'm glad you asked, Paul. In fact, I do think that capitalism, as the principle of "free minds and free markets" (Reason Magazine), is right. Yet its freedoms can potentially unglue a society. Liberalism, on the other hand, embodies a Robin Hood mentality and behavior that I abhor. In Nevada, there seems to be a surfeit of the mean side of capitalism, and specifically where shysters open mental health centers in order to grab Medicaid money, and don't have the ethics or skills to do a good job. The "capitalistic" urge of a regular worker (blue collar or shrink) to make a "profit" for his family -- there's nothing bad about that.
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