Family Meeting

I work in a state hospital for people with severe and chronic mental health issues. Once a week, the entire interdisciplinary team for my all female inpatient unit assembles to discuss the course of recovery for the 27 patients in our care. That team consists of myself, a psychiatrist, physician, social worker, head nurse, occupational therapist, recreation therapist, pharmacist, peer advocate, and the team leader. For anywhere from two to three hours we sit and discuss health care issues, patient progress, and then meet with patients and sometimes their families. Today was one of the more difficult and painful family meetings I have attended.

These family meetings are supposed to be about 15 minutes. Last time we met with this family, it went for an hour. This was our second meeting. It lasted 45 minutes. The patient, who is in her twenties, was asked to be present although she is still grossly psychotic; as the meeting progressed, it was clear she wanted to participate but often was so symptomatic that she could not contribute very well. Fortunately, she made it through the entire meeting and was able to visit with her family before they left -- but that was the only happy part of this story.

In this meeting, the family related how, over the last several years, they have struggled with the healthcare system. They have essentially had to watch as their daughter, their sister, got worse and worse with a variety of healthcare institutions and providers. They conveyed how they felt that too many doctors had ignored their observations and their input. Now, she was at the "last stop" in the system. Her mother almost broke into tears as she stated that she felt that she feared that we were going to be like everyone else and that this is where her daughter would remain. I nearly cried as well and dug my nails into my palm reflexively; their despair was so palpable and my fear that she was right peaked.

We listened. We talked. But, try as we did, the meeting ended, again, with us seemingly at odds instead of united. While truly this case is heartbreaking, they all are. We get the most difficult cases in Western New York. Often it seems that we are left to undo the damage prior healthcare providers have wrought before we can even get at the mental health issue itself. In the five years I have been assigned to this unit, I have been a part of a dramatic improvement in the quality of care on my unit. I was the first full-time psychologist assigned to that unit in over twenty years. My unit has the fastest discharge rate and the lowest readmission rate in the hospital. I have been personally involved in the discharge of five patients who had been declared a "lost cause" (and they are all still doing well in the community). But, in all those cases, I have never had such a meeting with a family -- so full of frustration, anger, and despair. I don't think my team has changed for the worse -- indeed, I think our team is not only the best in the facility, it is also the best it has ever been. It is just this patient? Just this family? Or is it something else... a sign of a growing disconnect between people and the healthcare system? Time will tell I trust. All I know right now is that I want to prove that mother wrong.