Well, it's finally happened. This morning I officially discontinued treatment on more inmates than I provided treatment for during my morning clinic. Policy dictates that if you don't show up to take your medicine for three days in a row, it gets stopped. If an inmate signs a refusal form, treatment gets stopped.
I'm still trying to figure this out. These guys come in from court complaining about how prison "isn't going to help me." They get screened for medical and mental disorders at the front door. They get enrolled in chronic care clinics for medical and mental disorders. They're provided treatment and all of this is done automatically, without having to ask for it, totally for free.
And then they drop out of treatment.
All they have to do is go to the pharmacy window to pick up their medicines. All they have to do is keep their appointments. All they have to do is show up. Treatment requires almost no responsibility on their part.
And they drop out of treatment.
I suppose I should be more sympathetic. I know that a decision to accept or reject treatment in a correctional facility is a complicated one. Accepting treatment means taking the risk that someone else may find out you're 'crazy'. It means potentially being turned down for institutional jobs or other programs because you take medication. It means having to admit that you really do have a disease that you'll have to deal with for the rest of your life. It means dealing with the frustration of coming down for Pill Line every day. And it's not like my patients are known for their good judgement.
But before I even start treatment I talk to these guys about all this. I ask them if they're willing to do it, and they promise me they are. Then they stop taking their medicines a week later. I wish I had some way of knowing who was being sincere or not because then I would be able to focus my resources on the ones who truly want help. If they said to my face that treatment was a waste of time and they didn't want it, I'd respect that decision. I'd remind them of the consequences of noncompliance and how to get back into treatment when the time comes, but I'd respect the decision.
So some of my patients lie to me about their compliance. Liars? In prison? Shocked! I'm shocked, I tell you.
I just wish it didn't require so much paperwork.