Sometimes you take a risk…
Working in mental health is challenging! Often it is hard to know exactly what the right path forward is, which medicine to prescribe, which patient has maintained sobriety, what might trigger or activate a particular patient or how a parent will react to their child’s diagnosis. A lot of what we do is uncertain. Of course decisions are made based on current research, a strong base of knowledge, education and best practices but there is rarely only one right answer, even then. Often we ask patients a question with an idea of what the answer is, but every now and then we take a risk with a question. And that is just where I found myself last week.
I sat in an appointment with a person in crisis and I knew it was time to try something different. The crisis cycle had been playing on repeat. Moods were up and down. There had been times without sleep and multiple relapses. Something needed to change and so in plain, direct language I explained we were at a fork in the road. I let my patient tell their story, express their emotions and feel like they were in a safe space. Then, without knowing what the response would be I got out of my chair, sat in front of them holding their hands. I told them there were two options, the one where they tried to live a sober, healthy life and the one where they continued as they have been, using substances, losing relationships, and getting in legal trouble. Sitting there on the floor in front of them I asked, “are you ready to choose?”
Now, let me be clear, I was terrified! In my head I was preparing for what the answer might be. I was considering how I could support them, even if the answer was not the one I was hoping for. Frankly, I don’t know who had more anxiety, me or the patient. I had to ask the question. I had to give my patient some agency. My patient needed to want to be well, me wanting it was not enough.
So, there we sat, together…I asked the question again, “Are you ready to choose?” Then, I held my breath and waited. My patient, looked up at me and said quietly, “yes, I choose being mentally well.” I could not have been more pleased and together we started making a treatment plan. Undoubtedly, there will be setbacks, challenges and relapses but we had a start.
So, why am writing about this? Its because in that moment I knew asking was a risk. They could have chosen something different and in all honesty, I was making decisions about what medicines I would have to stop, how to prevent overdose, how to keep them alive until they were ready to do something different even as I was sitting there. You see, its not up to us as providers to make choices for our patients. It is not up to us to make demands about how they live their lives. Its not up to us tell them if they are right or wrong. All we can do is educate, provide resources, care for them in the best way possible and implement whatever safety protocols we can to keep them alive. The patient has to choose because when we force the change, or treatment or level of care it usually isn’t sustainable, no matter how much we want it for our patients.
Here is the conclusion I have come too-its my job to take the risk. Even when I’m not sure what the answer will be. Even when I’m crossing my fingers and toes. Even when my voice shakes as I ask the question. It won’t always work out the way I hope. Sometimes the answer will be I’m not ready to change, to stop, to grow, to process, to do the work, but every now and then the choice will mean I get the privilage of watching someone begin their journey to change. And guess what-if the answer is they are not ready, I have planted a seed.
So, I will keep askimg, fully realizing I have to be prepared for whatever the answer is because part of my job is to let my patients choose for themselves