Entry #3: The Net

              We live in a society that professionalizes healers. By this I mean that we regulate the role and practice of healers. Most health care professionals and mental health providers are governed by a variety of boards in their respective states. The state I live in, Minnesota, alone has 14 boards: the Board of Behavioral Health and Therapy, the Board of Chiropractic Examiners, the Board of Dentistry, the Board of Medical Practice, the Board of Executives for Long Term Services and Support, the Board of Nursing, the Board of Occupational Therapy, the Board of Optometry, the Board of Pharmacy, the Board of Physical Therapy, the Board of Podiatric Medicine, the Board of Psychology, the Board of Social Work, and the Board of Veterinary Medicine. Each board’s mission is some variation of “promoting, preserving, and protecting the safety and welfare of the public” through “the effective control and regulation” of each area of healing practice. This almost always includes managing licensure and enforcement of state and national statutes and rules governing its licensees to ensure a standard of competent and ethical practice. In our society, in order to claim the title of a specific healer, say, a physician, nurse, or social worker, you have to show proof of appropriate training and education, pass at least one exam, and sometimes pass a background check. Then you have to show yearly or biyearly evidence of ongoing continuing education. Some religious organizations also regulate their healers, through things like ordination, licensure, or commission.

              But we also must understand that healers, even licensed healers, are also human, and like all humans are subject to the same problems, the same struggles, and the same diseases as anyone else. There is no amount of education or training that can make someone immune from developing mental health or substance use disorders. In my last post, I talked about the societal expectation that our healers be somehow unaffected by such things. I wonder if this is because a part of us wants to believe that a person can be immune from such things. By holding on to such a belief, two things result: we feel more trusting of our healers, but we also judge them as incompetent when they falter. But think of this: we wouldn’t be surprised if a doctor developed cancer, or if a therapist broke a leg. If we are truly going to consider depression, or anxiety, or substance use disorders diseases, as all medical science and research tells us they are, then we must accept that they affect everyone, regardless of role. To be sure, there are things we can all do to lessen our vulnerability to most diseases, but we are all susceptible.

              At the same time, we must also accept that when healers acquire such illnesses, their ability to engage in their healing arts may be compromised, and that this can sometimes endanger the people they are in charge of healing. In our modern world, this is where the Boards come in. All Boards have created regulations that dictate what should happen when a healer becomes compromised.

              At their best, the Boards protect the public by ensuring that the healers who are treating them are properly trained and practicing appropriately. They do this by providing support to healers so that they may operate at their best. They ensure that the healer is practicing their healing art within the bounds of the law, and if something is interfering with that, they provide a safety net to catch them early and return them to practice. There’s a good rationale for this. It is expensive to become a healer these days. For example, it is estimated that it costs $1.1 million to train a physician and takes 7 to 15 years. I couldn’t find any numbers for training nurses or mental health providers, but I imagine it’s several hundred thousand. My master’s degree and doctorate cost $120,000 in tuition and took 10 years, and required thousands of hours of supervision, which someone had to be paid for. So, in general, if something is interfering with the healer’s ability to practice, it is more cost effective to rehabilitate the healer and return them to practice, rather that training up a whole new healer.

              So what does the net look like? And how does it work? In this entry, we’ll talk about what the process is supposed to look like. In coming entries, we’ll talk about what it looks like in reality, and some issues with it.

              For most professions, it all starts with the code of ethics. All professional organizations have a list of rules that healers practicing with that official label should operate under. And they’re pretty explicit about what to do when a healer gets sick. For example, my code of ethics, published by the American Counseling Association, states that:

Counselors monitor themselves for signs of impairment from their own physical, mental, or emotional problems and refrain from offering or providing professional services when impaired. They seek assistance for problems that reach the level of professional impairment, and, if necessary, they limit, suspend, or terminate their professional responsibilities until it is determined that they may safely resume their work. Counselors assist colleagues or supervisors in recognizing their own professional impairment and provide consultation and assistance when warranted with colleagues or supervisors showing signs of impairment and intervene as appropriate to prevent imminent harm to clients.

So, in short, we are supposed to self-monitor, reach out for help when needed, and look out for our fellows when they need help. The spirit throughout the entire code is one of care and concern, over one that is shaming or punitive.

Many states provide extra support to healers who need help to be their best selves. Here in Minnesota, we have the Health Professionals Services Program. This organization, which is not a Board of their own, but often works closely with the Boards, “promotes early intervention, diagnosis and treatment for health professionals with illnesses, and provides monitoring services as an alternative to Board discipline.” Their services are confidential, and include the assignment of a case worker, and usually a prescribed program of counseling, psychiatric care, random urine tests, use of mutual self-help groups, and worksite monitoring. Most individuals are required to attend weekly psychotherapy appointments, meet with a psychiatrist regularly to manage any substance use disorder or mental health medications, show proof of attendance at weekly mutual self-help groups (usually Alcoholics Anonymous or Narcotics Anonymous), and have a worksite monitor who gives quarterly reports on the individual’s job performance. In addition, the healer has to participate in random urine tests, which usually involves being assigned a color or number and then submitting a urine sample on the days that color or number are called. These “bumpers” are meant to help the healer return to good health and maintain it.

              And when they work, they work well. Recovery rates for healers who get help are usually much higher than for those who don’t. Once recent meta analysis found that over three quarters of health care professionals in monitoring programs remained abstinent and working in their professions at 2-5 years post entry into monitoring programs.  Many states have monitoring programs, and this monitoring “net” becomes an important part of most healers’ recovery programs. As long as the individual is compliant with the monitoring contract, most Boards defer discipline, such as loss of license. Since the monitoring program is confidential, only compliance is reported to the Boards, thereby providing safety to the healer to be open with their providers.

              This is how the system is supposed to work. However, this net is not without problems. In our next blog post, we’ll explore what this net looks like, in real life, and some of the ways people fall through the net.