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Dispatches from a Life-Long Government Employee and Conservative
One of the common themes on the right is that the government cannot do anything right, that government programs are wasteful and that they always provide poor services. There are many examples to point at, such as the VA, Public Schools, and the like. The general attitude is that government workers are lazy, have poor attitudes, and are generally no good.
I would like offer a counter to the conservative write off of all government workers and programs. This is not to say there are not many things that need to be trimmed. It is to say that blanket statements might not be accurate. Let me start with what my organization does.
I work for the government, in a taxed-based organization. I have been there my whole career of a quarter century. Six weeks out of college, I was working as a House Parent, helping men with significant developmental disabilities (mental retardation for the non-politically correct). That was my start. Now, I am the CEO.
Our Agency is one of 26 in the State of Georgia that provides safety net coverage for individuals with Behavioral Health challenges and Developmental Disabilities. We have a broad spectrum of services, ranging from outpatient therapy and psychiatric services, to 24 acute inpatient beds for mental health crisis and detox from substances. We have case managers who serve clients in the community, a supportive living program to help individuals live in the community, group homes, residential treatment programs, and we are the contractor for mental health services in the Cobb Adult Detention Center. That is “jail”, and by the way, we serve 600 people a month there, with our staff of 8, including an MD and Advanced Practice Nurse (APRN). That makes the Cobb Adult Detention Center the largest mental health facility in Cobb County, just like the jail in your community.
We are supported through State Funding, Medicaid, and a touch of Medicare. The population we serve, only around 15 percent of our population have Medicaid, 5 percent Medicare, and the remaining 80 percent are uninsured. Less than 1% have some other insurance. Of course, they cannot pay out of pocket, so the state lets us treat them on a sliding fee scale, that goes all the way up to 100 percent.
Despite what most people think about government salaries, we are underfunded. We do not have access to the State of Georgia’s pension program (and even if we did, 30 years for 30 percent of your top two years of salary is nothing to write home about; Georgia started reducing its pension plans in 1982). There is a national nursing shortage, and I cannot hire any nurses at the rates I can afford to pay, much less attract the top talent. $9/hour is not a lot of money to pay for a Client Support Worker to help care for someone with a developmental disability who cannot attend to their own Adult Daily Living Skills (this means they need help wiping their bottoms). I have seen my staff go years without COLA raises, while teachers, who work nine months of the year and get raises because they are more visible and popular.
Now, most of the staff who do work for me are dedicated, caring people, who have a mission in their hearts, God bless them. They are dedicated to making the lives of the least of the least, as good as they can be. This is hard work, and it can easily burn anyone out. If you stop caring it is time to go, but caring can be hard work some days.
So, when I see attacks on all government workers, I admit, I take it personally. These are attacks on the hard-working employees, some of whom make less than the people working at McDonalds, some of whom get hit by clients, some of whom go out into bug infested homes, or under bridges to serve our clients. These are attacks on the very people whom I am charged to serve. Our clients who nobody wants to help. Or clients who nobody wants living next to them. Without the meager laws on the books against bias, my residential clients would have no place to live.
I have seen a pastor for a church stand up and rail against land we bought from a previous mental health hospital to serve teenagers with drugs problems. I have seen our organization sued, because the city condemned that same land to block our use of it and the banks now wanted their money back. I have seen city inspectors have to be reminded that state and federal law allowed us to ignore zoning and place our clients into housing so they can live in the community. I have seen people in recovery, unable to rent an apartment because of a decade-old felony. I have heard otherwise compassionate people condemn the mentally ill, as lesser people. It is not unusual for me to hear fellow conservatives treat addiction as nothing more than an issue of willpower, or a failing of moral character.
Why do I mention all that? What my government agency does, the private sector has no will to provide. There is no money to be made on treating chronic conditions of individuals with no money, much less providing things like case management and supportive employment and supportive housing. Further, there is not enough private money applied to these areas. Mental illness and, to an even greater degree, substance addiction are still seen as moral failings (see above). Our culture in no way is ready to support the people we serve. With the utter destruction of the family, there is no one to support them. And this is not just single mom’s, but intact families who can no longer manger their loved one, who have been burned too often, or make it the problem of the State. our culture shuns these modern-day untouchables. They have no voice, no lobby, no money. They are the least of the least.
There are some things the government must do. Even if charity could, in theory, meet this need, the sad fact is that it shows no interest and likely wouldn’t until after several of our clients are in the morgue. Today, people are fine to donate for kids with cancer, but adult men who cannot control their drinking? Forget it. Remember, the pastor of a church did not want a treatment facility near their place of worship. If government organizations like mine do not exist, America will treat an increasing number in the justice system, which is an expensive way to treat them, money wise. It is even more expensive in the damage done to their lives.
Published in Politics
I’ll admit, I’ve known a few addicts and I agree that it’s ultimately a challenge of character, not an illness or some-such. Medications can help to block or supplement rewarding chemicals in the body. Psychological treatment can offer a more studied and organized framework than unprofessional caregivers typically provide. But regardless of how or from whom the help comes, most addicts remain or return to being addicts. Those who break and keep free of addiction do so not because the temptation is eliminated but because a habit of self-discipline is developed to overcome compelling impulses.
But I welcome arguments to the contrary. Since you deal with this professionally, I assume you have links to preferred studies or resources available.
Note that I’m not arguing that addicts should not be helped, but rather that they are served as well by private means. By government or by private care, the majority of addicts assisted revert to addiction. If that addiction leads to theft or violence, then yes, lock them up.
The personal challenges of some people are much greater than those of others. The deck can be stacked against a person by genetics or other inherited circumstances. Those circumstances do not ultimately negate free will.
There are several things to unpack here.
I don’t think government care is special or better, just that it exists. Being poor means treatment via charity or government. If you are rich, you can go to Betty Ford.
NIH has a primer on drugs and the Brain here:
https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/drugs-brain
https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/drug-abuse-addiction
The are basic, but get at the point that drug use effects the brain.
I have been in a number of trainings, but I cannot publish that material here.
I would say, however, the proof that addiction is not just a character disorder is weight. The same systems in the brain are used around food, drugs are just orders of magnitude more powerful. Now, you might be exactly the weight you want to be, and you eat healthy. 80% of Americans have issues with their relationship with food (me included).
I would consider you quazi goverment. Plus your locally run which is the proper place for almost all govermetal services that we need. My rants are more against federal Bureaucrats (DOD being the exception).
Hower you deal with men. I know on the addiction and prison side women really are drastically underseved compaired to men when it comes to programs. Due you see this same disparity on the mental health side?
I’ll give this a listen, too…Thank you, @latapada!
Considering that most women in prison are there because of drugs, you would think they would be the focus. Before the drug epidemic, women did not tend to go to prison.
We treat more women for SA because we have dedicated programs. Most of them have MH issues as well, because most women who are addicted (75+%) have some history of abuse. For MH issues only, we see more women, because it appears that more women suffer from mood disorders than men.
Without weighing in on what addiction is, managing chronic and clearly organic illness is also ultimately a matter of controlling or compensating for the resultant aberrant behavior and a challenge of character. I observed elsewhere,
Consider someone who’s, for example, coping poorly with Crohn’s disease. Figuring out which is the “real problem”, the “underlying disease” or the “poor coping skills”, may be beside the point. Trying to judge whether the person’s coping is poor in some absolute sense may also be beside the point. Even with what’s clearly organic disease, the whole point of symptomatic relief is to aim for the sweet spot of optimal coping. And even with organic disease, others can lose patience with a person’s difficulties in coping with it.
When do we lose patience with a person coping poorly? Coping poorly, even for reasons most people would sympathize with, is, after all, evidence that a person’s character hasn’t been up to the given challenge. I think we lose patience when we see it as evidence of a character “worse than average” or “worse than mine”, even if, unbeknownst to us, we ourselves or the “average person” would have just as much difficulty coping if we were in the shoes of the one we have lost patience for.
@bryangstephens thank you so much for this lovely and illuminating post. I haven’t work with this population in at least 15 years…and it is a measure of how hard I found it, that I eventually settled in terminal illness and palliative care….and thought it was easier.
You are correct about the push back in communities around having “these people” near them. It is heartbreaking to see, given the few options that exist for these adults, and those caring for them.
@iwalton I wanted to disagree (civilly : ) with your point below:
From my point of view, there are policies that could greatly help at all levels of government, including federal. I am not sure there is the will at many local levels (and this post also suggests that) to support the vast amount of resources that it takes to stabilize the lives of these adults. It is a great tragedy that our jails are the largest mental health system in our country. So, as a conservative I do want to streamline government to promote freedom and I don’t believe the government can fix every problem, but I do believe in a social safety net, and the clients and patients Bryan’s group serves, should land in it.
I would add another issue — substance abuse often is a way for addicts to alleviate mental health issues. Contrary to after-school specials, most addicts were not perfectly healthy and integrated into society when one hit destroyed their lives. Thus, even if you could snap your fingers to take away their addiction, it doesn’t solve either the underlying problems — mental or “just” sociological — that caused someone to find relief in substances or the additional destruction that the addiction caused.
I can’t get to it from my work computer, but look up cracked.com’s “Things I learned as a recovering heroin addict” article.
Again, my family experience shapes my perception. Close extended family networks are rare these days, but we were raised with a sense of obligation to cousins, aunts and uncles, grandparents, and even beyond to second cousins and other distant relations. Likewise, we take responsibility for friends and neighbors.
Within a large network of concern like that, not everyone has to be wealthy, strong, or talented. The few rich can serve the many poor. The few skillful (carpenters, plumbers, programmers, physicians, etc) can serve the many ignorant. The strong backs can serve the weak.
In essence, extended family or a neighbor/friend network is a society in miniature. It is the love-based manifestation of the philosophy of subsidiarity (issues being addressed at the most local, familiar, personal level possible). It is local government without the government.
And, in keeping with the writings of Thomas Sowell, this situation is not exclusive to any ethnic group or economic level. My family includes many economic levels, many races, and many geographic regions. Government is not the only method by which people can commit to each other and support each other financially. Formal donation-based programs are just the tip of the iceberg. Charity can thrive without such formalities.
Here’s the song I listen to when I need to remind my self that as someone who calls myself a Christian and follows the teaching of Jesus, I have a responsibility to minister (The song is from 1991, so yes, I am not young). Unto the Least of These – Bob Bennett
My favorite lyrics are the second verse:
Unto the least of these
In other words, mercy is a necessary element of care. Patience is necessary for both affliction and moral weakness. We try to be patient with the constant complaints and self-sabotage of others not for merit but as a gift of love.
But also, I think, out of humility: how often are we truly competent to judge what we perceive as another’s “self-sabotage”? Sure, moral taboos are immensely useful here. But especially when “self-sabotage” doesn’t involve obvious moral taboos…
A person who is “failing to thrive” (relative to what was expected of him) may hear a lot of well-meaning moral judgments, often mutually contradictory, explaining what he has done to “sabotage” himself.
“Too much of a whiner.” “Too stoic – your misbegotten attempts at stoicism are probably why you’re in this mess.” “Overmedicated.” “Not medicated enough.” “Worrying too much about what’s wrong with you.” “You don’t worry enough about what’s wrong with you, or you’d be doing more to fix it.” “Too hard on yourself.” “Too easy on yourself.”
Now, there are ways in which all these judgments can be true at once – people could be unreasonably whiny and anxious about some things while also being unreasonably stoic and indolent about others. But there’s no way for all these judgments to be categorically true at once. And yet we want them to be: we want “Don’t be so hard on yourself” or “Suck it up, buttercup!” to mean something.
That we may simply not know enough to render these judgments terribly meaningful is quite possibly a thought that horrifies normal people.
Most families can not support $600 a month in drug Rx, and supply housing, and pay for weekly case mgt. ($100), monthly psychiatric appointments ($170), and supportive employment($100). I could now, but I could not have before this job. While government is not the only method people can support one another, it is the only method that can provide a safety net.
Years ago, I helped care for a demented old man who could do nothing for himself. I wiped his backside, though even that is less than others did for him. When he was scared or in pain, I could do nothing because his mind was too broken to explain what ailed him. It once took over an hour to calm him when he was certain burglars were just outside his house ready to break in and kill us at any moment. Other times, he angrily tried to charge out of the hospitals keeping him.
I dreaded that job every day. It was not the humility required which made it difficult, but the wanting to help and not knowing how because of his advanced dementia. To my enduring shame, I eventually gave in to the temptation to leave his care to others. His family found someone else to fill my place until he died the next year.
The point is that I left but his family stuck with him until the end. They held to a moral bond which was not an inescapable legal bond. I’ve known other individuals who were abandoned by their families, which never fostered that sense of loving obligation.
When we say government is necessary as a safety net, it is to compensate for the failing love of families and local communities. But this is at best a Catch-22, because that same government erodes family values and local responsibility. Which influence is stronger?
Everyone thinks he or she is an expert in human behavior. I have arguments around my area of expertise as if my training and experience mean nothing. People would not have those arguments with a mechanic.
To be clear, I don’t categorically object to government programs devoted to care of people with various handicaps. But I do believe those programs should be funded and operated locally, not nationally.
It is necessary but not sufficient. I do not know anyone who is has made it in recovery from a severe mental illness without someone who can stand by them through everything, usually family. So I think we have a good deal of agreement here.
And yet there are skillful mechanics and incompetent mechanics, principled mechanics and scoundrels who over-charge or push unneeded services. The same is true of any profession, including psychology and physician services.
There’s no perfect solution, political or otherwise. I wonder to what extent many safety net programs exist because of unwillingness to accept that some will always fall through the cracks and mistakes will be made whatever we do.
Moral advice such as Midge described is undoubtedly often incorrect or unhelpful for other reasons. Yet as Christians we are called to admonish sinners and actively help our fellow human beings to better living. Silence and blind tolerance aren’t solutions either. Prudence is imperfect.
It is a fallen world. I would love it dearly, to live in a world where my organization was not needed. Where being a therapist was not needed.
I wonder, if autos could talk, would they have those arguments with mechanics? ;-P
Bryan, you are doing God’s work and deserve our admiration, especially since you have stuck with it. My son is in a similar business with addict felons, a private company that works off contracts with the county prison systems.
The public knows there are jobs that must be done and whether you are a father who misses his family because your ship is sitting off some hellhole, or a cop trying to decide if he needs to pull his weapon, or a person who comes in to work, knowing the challenges to be faced as patients struggle just to get by day after day, those folks deserve celebration.
We also know the DOJ lawyer who uses her power for personal vendetta, the corrupt EPA official who closes down a company at the behest of interest groups who will fund that official’s second career, the VA executive who rigs the incentive system tracking and lets people die.
It is hard not to let the first group blend in with the other unless you stay in touch with the good work and the bad work.
The problem is, most citizens just want it to work. They want government to be populated with heroes. They want a government that does it’s job well. (They may not want to pay for it, but we are talking emotion here).
I think you should ask a mechanic about this … people argue with experts in every field. :)
Well, people are fools. However, I do say once in a while to remind others “And that is my Expert Opinion”. I get some mileage out of it, but not like my Programming buddy or my Dad, who is a Doctor.
I’d like to see us as heroes.
Funny, though, the issue for me is now I am not in the hero mold. I am not the knight who goes out to slay the dragon, I am the King who sends out the Knights. I am still not used to it.
Seeing yourself as a hero is intrinsic to performing well. I have found that every job can have some meaning , where doing it right means something to somebody. Connecting your people to that is the essence of leadership. Good leaders define goals. Great leaders allow people to discover meaning in their work.
What’s local, Aaron? I can’t imagine my rural, largely-retired, singleton/widowed community finding/funding its own care…Especially as the Boomers more fully enter the system…Operating a program might be tough, too..
Aaron, don’t beat yourself up. You did your best.
No two situations are the same.
I’ll stand up and say that we are a family who abandoned our individual.
After over twenty-five years of absolute hell, of fear, both of him and for him, of his ‘friends,’ of his illnesses, his addictions, his manias, his terrifying threats, his theft, his lies, his self-destruction, his perversity, the ruination he caused to his, and everyone else’s, property that he came into contact with, his inability to care for himself, and his dangerous behavior towards both himself and others, we abandoned our individual.
After over twenty-five years of trying to work within the system, of trying to get doctors, hospitals, social workers, police, anybody, to help us to help him, and being shunned, shut out and ignored at every turn, we abandoned our individual.
After over twenty-five years of finding groups, joining groups, making contacts, trying to come to terms with the fact that we could try, and try, and try, and that it would make absolutely no difference, we abandoned our individual.
And on the day that we discovered, in a physical test of strength, that he was stronger than our aging bodies, even if our loving hearts still thought we could prevail and make things better, we abandoned our individual.
Yes, there were calm periods. False hopes all. And only leading to worse, the next time things went sideways.
So we abandoned our individual.
What did he do? He got himself arrested by the police for, among other things, drug and weapons charges. The day after he was arrested, a “forensic psychiatrist” from the jail called me. “Why isn’t he in a community-supervised program,” she asked me. “He obviously isn’t capable of caring for himself.”
I cried.
Because that’s what it took. And that’s “all” it took. He’s now in supervised care.
I wish we had abandoned our individual decades ago.
But our loving obligation wouldn’t let us.
A great post, Bryan. Maybe the best thing you’ve ever posted here, IMHO. We need to be reminded of these sides of life.
Yeah, helping people can’t be boiled down to any formula. So much is particular or circumstantial. So much is invisible to the helpers and even to the person in need. What person is even capable of fairly judging himself or herself?
Some people seem to respond to a hard kick out the door and harsh independence. Others wither in the streets. Some respond well to a strict routine and constant supervision for a time. Others never develop gratitude or self-direction.
In Christianity, we have the story of the prodigal son welcomed home with eager joy and forgiveness. But we also have Biblical advice from Jesus and His apostles to leave behind closed hearts not open to love or remedy. Many closed hearts open eventually. Others do not. We’re not called to help everybody… just as many as we can with willing cooperation.
Sadly, I’ve known more than a few individuals who simply don’t want to improve. If one can offer only gratitude, one’s helpers can find patience for everything else.
You’re right about that.
I probably should have made clear, in my previous comment (I’ve stated it elsewhere, but probably not well enough here), that we’re dealing with very serious and lifelong mental illness with this family member.
I don’t think volition has much to do with his situation. He really cannot help himself.