One problem limit – rationing emotional help

By David Joel Miller.

Can you have too many problems to get help?

Ever feel like you are standing in the wrong line? You go to a place and ask for help only to be told we can’t help you with that problem you need to go someplace else. If you have a few too many problems you might get discouraged and stop trying before you found the place that could help you. You might die while waiting for help.

Systems used to be designed as if people only had one problem. You go to the specialist who handles that one thing. That almost never works, people have multiple problems.

So the system would try to sort people out by their problems. All the people with substance abuse problems go over there. You people with a mental illness you need to stand in that line. We had a line for everything. Lots of places still do.

People with co-occurring disorders, combinations of a substance use disorder and a mental health issue got used to this. You go to a treatment place for substance abuse and they tell you to go see mental health. You go to mental health and they tell you they can’t see you till you stopped using drugs. I would like to do that if only the depression and the voices in my head would shut up. So around and around you go.

So we set up a system where the mentally ill stand in line 1 and the substance abusers you stand in that line over there. The homeless go to another building and the unemployed go somewhere else. If you have a physical illness we send you to this doctor but if it is your heart you see the heart doctor and so on.

Most of us would like to think we are not like those people. We are not homeless or criminals. Until that day when you lose your job and then can’t find a new one.  If you stay out of work too long you might run out of money and have to choose between making the house payment and paying the registration and insurance on your car. But if you get stopped while driving to that job interview with no insurance or registration you might suddenly find yourself as a criminal. That might make you depressed and you might have a drink or two, maybe too many.

See how quickly these problems begin to add up. Multiple problems can be overwhelming to the person with them. They can also be too much to handle for the person who is trying to help them. I would like to help you but the agency I work for has rules and if you don’t do what I say you will not get any help.

One woman told me she was sorry for missing her therapy appointment last week, could I still please see her. Seems she was told by her welfare worker that if she did not come in that day they would cut off her welfare. The same day she got a call from the principal at the school telling her that her son was in trouble at school and if she did not come for a conference this afternoon they would be expelling her son.

Can’t understand why a kid who was sleeping on the floor at a friend of his depressed mother would be grouchy and argue with his teacher or end up in the office after talking back to that principal.

Now I don’t want to sound all negative, though some days that is more likely than others.

Some systems are making strides towards being more helpful and less territorial about controlling the clients. Substance abuse providers are offering mental health treatment and physical health facilities are providing substance abuse and mental health treatment.

Still we have a long way to go before people who need help can get it wherever they go. As many of us have seen during this last economic downturn, anyone can be closer than they think to a whole list of problems.

SAMHSA talked for a while about the concept “No wrong door.” That no matter which place you went they should be able to help you and they should get you connected with the help you needed.

Then came this re-depression and we started locking doors.

Have you and yours been able to get the help you needed?

Care to share? What help have you needed? Has that help been easy to access or have you had to run from place to place and try to meet each programs differing requirement to get services?

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life.

You can recover. Your cruising along the road of life and then wham, something knocks you in the ditch. If you have gone through a divorce, break up, or lost a job your life may have gotten off track. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel that explores the world of a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

Other books are due out soon; please visit my Amazon Author Page – David Joel Miller

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For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page or my Facebook author’s page, David Joel Miller. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at


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