Friday, 19 July 2019

An Open Letter to Providers on Documentation

Dear Mental Health Providers,

We understand that you have a great number of demands on your time and priorities. You are under fairly constant pressure to keep up with licensing requirements, meet funder demands, minimize liability risks, and still do what most of you initially got in this work to do: Help fellow human beings who are struggling. In all that, we imagine that whether or not people working in peer roles are required to write service or other routine notes probably seems like small potatoes to you. But, it is not. Here are two major reasons why:

  • Having access to write notes in someone’s file is power: Peer roles are based on minimizing power imbalances as much as possible. It’s one of the most important, foundational elements of what it’s all about. And, it is also precisely what allows peer supporters to build trust where all trust has sometimes seemed lost, and to develop connections that might just be life saving. Meanwhile, there is simply no denying that having the ability to write notes on someone creates a power imbalance. Unless your organization has a system where employees also have files in which individuals receiving services can make an entry, then that power imbalance is vast. Even the United Nations Special Rapporteur on the right to health, Dainius Pūras, was recently quoted as saying “I call on States to shift their mental health investments from focusing on ‘chemical imbalances’ to tackling ‘power imbalances’ and inequalities.” When it comes to health and healing, power—and who holds it— is no small matter.
  • Notes have sometimes dramatically altered our lives: Many of us have been followed around for decades by the notes taken on us in various provider environments. That has led to harm in our lives. That harm has included justification for forced drugging, providers who react to us out of fear based on something sometimes many years in the past, increased restraints and other violence toward us that is driven by that fear, loss of job opportunities, and reluctance to support us in (or efforts to prevent us from) moving out of hospitals and/or into independent housing. Some of our friends and family aren’t around to tell us how they were affected by the notes in their files because they’ve died early as a result their legitimate health concerns not being taken seriously due to psychiatric notes following them around. Our reasons for not participating in documentation are far from frivolous. Asking us to write notes that will sit in someone’s permanent file for years to come is asking us to replicate harm done to us. It’s also asking us to ignore the very nature of our job which is to use our own experiences in the system to guide how we support someone in similar situations.

We understand that the absence of our notes can lead to some challenges for you. These challenges range from tracking employee productivity to being able to prove how often someone receiving services was seen to maximizing financial reimbursements. But we encourage you to at least ask yourself this as you contemplate this matter: Who are you trying to please and/or what needs are you trying to meet by having peer supporters take notes, and is that helping or hurting your original hopes and goals regarding why you got into this work?

In the end, people’s files are simply not an appropriate way to track employee activity. There are other, less permanent ways to track how often someone was seen. And, yes, there might be some financial loss in not  tracking every last contact, but more often than not, the loss is minimal or able to be overcome with other creative approaches. And, above all else, any loss or challenge you face as a result of prioritizing the integrity of peer roles will be far outweighed by the gains you will find in employee satisfaction and retention of your peer supporters, and the positive impact they are able to have on those your organization aims to help.

For additional input on peer roles and documentation, see this newly released ‘Documentation Guide’ produced by the Eastern Mass Peer Network. The guide is available by clicking HERE!



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