[MENTION=2578]K-gal[/MENTION]
Meant to answer you earlier. No, I don't work in mental health at the moment. When I did, it was at a locked sub-acute psych facility. Not really huge, and nothing quite as intimidating as a state hospital where many of the cases involve criminal insanity, but still intimidating in its own right. The environment these days is somewhat more welcoming to the resident due to the introduction of the recovery model as opposed to the goon squads and symptom-based treatments of the past. Still, there are plenty of occasions upon which I was attacked or involved in incidents requiring physical/chemical restraints, and though I was willing to burn the candle at both ends for a while, it did eventually catch up to me. These things didn't happen every day though, and things could be okay for a few weeks at a time between incidents.
Case management there was demanding but also rewarding. I was initially scared to death of running multiple daily groups, and I dragged my feet as much as I could, but eventually I had to pull my weight and do it, and after a while there was really nothing to it. It started off terribly because I thought that I would essentially have to lecture for the duration of each group, but it became way easier when I began to grasp the concept of facilitation and how to stimulate the group members into providing the majority of the dialogue while simply making sure that the general discussion is anchored into something both relevant and interesting for the group.
What really gave me the most happiness was whenever I was able to follow up on a promise or when I could successfully talk someone down from crisis. This wasn't always easy to do, and I failed plenty of times, but it really made the job redeeming to me. The residents were always in limbo due to the overall administrative process, and it was difficult to give them a clear picture of what was expected of them, and when they could expect to move on to a more independent situation, especially when having to deal with everyone from the judges to the county conservators, to the facility doctors, etc. One couldn't really blame most of them for being stressed out or depressed, but if I could follow through and get them some concrete information, take someone shopping who had been waiting for months, or get through to people during a group, it was the greatest feeling in the world.
We once had an older guy who was somewhat of a long-term resident. Whenever he would move on, he would always awol from his new placement and come back with drugs in his system. He exhibited all kinds of spiritually-oriented delusions and it was hard to hold coherent conversation with him beyond brief chit chat. Well, for the most part he was quiet and kept to himself and didn't really bother anyone save for the occasional verbal outburst and slamming of doors. At the facility there were weekly lab draws, and he had been in to see the phlebotomist who had not been successful as this guy's veins were extremely difficult to find. He had been stuck like a pin-cushion and eventually got fed up, got up and went back to his room. Initial prompts to come back to the medical room were met with verbal tirades. So eventually the boss said that we needed the lab draw, and we would have to prepare for a hands-on escort.
As the staff were banding together, I decided to give 1:1 a shot, so I asked them to hold off for a minute and went in to his room to talk to him. I did my best to convey to him the reason that the lab draw was necessary, but I knew that his issue wasn't really about that. He was just tired of the routine. Being woken up in the morning once or twice a week, every damn week, to get poked repeatedly with a needle to satisfy the whims of some doctor who rarely ever spoke to him and who worked for people who had restricted his freedom against his will. I knew he had a right to be pissed, even if it was in his best interest to be in a locked facility. So, after conveying to him the fact that I understood and I didn't know what to do either, I let out a deep sigh and ended up sitting down with him in silence for a while. I was kind of tired of it too and I didn't enjoy enforcing any more than he enjoyed resisting. I sat without staring at him or attempting to press the issue, and I think he understood that I wasn't his enemy in this case. After a while, he let out a brief chuckle, smirked, shrugged, stood up and followed me down to the medical room. It was a gamble, but I was glad that I had been able to reach somewhat of a silent understanding with him as opposed to the hostility, shouting and struggling that would have rapidly taken place otherwise.
I didn't mean to ramble, but you did provide some great insight as to things that you were able to do for clients, and I didn't want to leave off like mental health was all just physical altercations and so forth. I really do have a soft spot for psych patients in general because I feel that we all have detrimental/irrational thought processes here and there, and that the only difference between the psych patient and the free citizen lies in their ability to cope with those negative thought processes, or perhaps a lack of a formal diagnosis.