I hear that in other countries, people acknowledge the existence of medical rationing.  In the US, we like to pretend it doesn’t exist.

A jail is a microcosm of this: there is only one source of medical care, and the limited number of hours must be divided somehow among all the possible recipients. With 1600 prisoners (many of them with mental illness) and less than one full-time psychiatrist, there are never enough appointments for all the people who want them.

Where I work, the mental health clinicians are the gatekeepers for those appointments.  When one of our clients is in crisis, the mental health clinicians can make an argument to the rest of the team on why this person should see the doctor sooner.  A debate follows about symptoms, history of hurting self and others, risk factors, and whether medication is even likely to help.

During those debates, part of me always wants to say, “Yes, get him the damn appointment! I can’t stand to go back and tell him he’s not getting a med change for another five weeks!”

The other part thinks, “Who will get bumped if I move him up? Is it Angie, whose nightmares are waking her up screaming?  Khalil, who says the voices are getting louder?  Ernesto, who’s having panic attacks every time he leaves his cell?  Can I make them wait another week?”

These are the things that are happening every time we distribute resources, but they’re usually not as visible.



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