“Hi, this is Steve Bringe. I’d like to cancel my appointment for tomorrow, and per your policy I’m calling to let you know 24 hours in advance that I’m not going to be doing all that great managing my bipolar symptoms tomorrow.
“I feel just excellent right now and have had no indication for 15 months that bipolar symptoms will be a concern for tomorrow, the day of my appointment, but I am excellent at knowing 24 hours in advance – of an appointment I made six months ago – that I’ll be sick on that specific day, and it’s responsible for me to tell you that tomorrow when I wake up I’ll be shaving the neighbor’s cat with a chipped plastic picnic knife because the neighbor’s dog said it’d be funny to see the cat sunburn and the neighbor’s dog has never steered me wrong in the 1,552 dog years we’ve known each other. Regretfully, this will prevent me from attending my appointment.
“Of course, with this sort of 24 hour prescience, I’ll most likely be spending the remainder of this afternoon purchasing lottery tickets around the globe with the exact numbers to win every lottery on the planet that happens to be on the same day of the appointment I made with you six months ago. Making arrangements to purchase this grand number of lottery tickets from all over the world will take a good amount of time, so be thankful I’m taking these three minutes to call and cancel my appointment.
“Alas, my time would be better spent digging into my bag of tricks for coping mechanisms and wellness tools I know from years of experience will keep me out of crisis, especially knowing 24 hours in advance that I’ll be in the ravages of a full-blown mental health crisis that will necessitate a week’s relaxing stay at Kamp Kaseman. I hope there isn’t a 24 hour cancellation policy with lotteries so if I don’t claim my lottery win 24 hours in advance of winning I forfeit all of my prize money.
“Geez, I guess I’m not very responsible, so I’ll win a bunch of money rather than staying well and happy. What a waste of 24 hours of Nostradamus-caliber soothsaying just to prevent myself from becoming suicidal. And since I’ll probably be dealing with hypomanic spending sprees tomorrow, I’ll need every spare $1 million I can get my shaky fingers on.
“So, yes, I’ll be sick tomorrow, even though I feel great now and there are none of the obvious warning signs I’ve come to know so well that I’ll be sick tomorrow. I want to make sure to follow the 24 hour cancellation policy because it suits my recovery and wellness needs to reschedule for another six months down the road. And yes, I know it’s difficult to get in to see a provider in New Mexico, and I really should do my best not to wake up unexpectedly in a mental health crisis, but as I said, since I do expect the unexpected 24 hours in advance, it’s important I keep to the 24 hour advance notice policy and cancel my appointment. Reschedule my appointment for a date in six months? Sure. It’s okay. I can afford to go without seeing my provider for a full year.
“Come to think of it, I probably knew six months ago that the day I made the appointment I was already aware I’d be in mental health crisis tomorrow. How irresponsible of me! I totally get it. Even though I’ll be in crisis tomorrow, there’s no excuse for me forgetting to call in advance, regardless if I’m trying to suffocate myself by injecting three tubes of Crest Advance Protection up my nostrils.
“What do you mean, ‘Did you know we are a mental health provider?’ Of course I know you’re a mental health provider. Duh. I’m not coming to you every six months for a double-fisted routine colonoscopy. I’m coming to you to manage my psych medications and provide me with mental health therapy. So, yes, I am well aware you are a mental health provider.
“Because you are a mental health provider, I am confident you know a lot of stuff about things for helping those of us with mental health issues. You know what meds to prescribe, you know what additional services will be helpful, and you are 100% cognizant that a mental health peer can go to sleep feeling great and wake up shaving the neighbor’s cat while knocking back a few pints with the neighbor’s dog the next morning.
“Why are you questioning my ability to know 24 hours in advance that I’ll be in a mental health crisis and won’t be calling in to tell you I’m in mental health crisis because when I’m in a mental health crisis I’m primarily conjuring up ways not to kill myself and my focus is entirely upon self-advocating suicide prevention?
“Is there something in your professional schooling that instructs mental health providers that a peer in crisis might lack the capacity to call in 24 hours in advance to cancel an appointment made six months prior, that a cancellation policy based upon a person’s unpredictable frame of mind as a consequence of a malfunctioning organ (the brain, which you are tasked with treating in exchange for money) is ludicrous and unenforceable, and that providers really should know better that if a peer knows 24 hours in advance that they’ll be in crisis they would actually prevent the crisis from happening?
“Yes, it’s true, if I miss an appointment and don’t let you know 24 hours in advance that I won’t make it in, another peer won’t have the chance to take my cancelled appointment. With so few providers in New Mexico, it’s understandable why you have the 24 hour cancellation policy. I’m at fault and must be reprimanded. Rightfully so, you should nick off a “three strikes you’re out” demerit, scold me soundly, and fine me $50 for my lack of vision.
“Whoa! That sounds totally Palpatine! ‘Now, you will pay the price for your lack of vision!’ Um, do I pay you or Vader here? Because he’s so looking like he’s about to do that ‘Force Strangle’ thing on my nethers, you know what I’m saying? Right. Do you take Discover? No? Just Visa or MC? Um, can you take a personal check? Wow, this is really strict, trying to get this 50 bucks to you. Can I call my best gal to bring me the money? She’s only about 15 minutes away.
“The Romans came up with ‘mea culpa’ for exactly this purpose, to ensure mental health peers had a phrase to take responsibility for the audacity of having a disease, a way for peers to say ‘I’m sorry’ for the hubris of having symptoms managed through medications (your domain), therapy (your domain), a WRAP (my domain), and Jerky Treats (my neighbor’s dog’s domain). Mea culpa, baby baby. Mea freaking culpa. My bad.
“So, thanks for listening, thanks for understanding, and thanks for telling me I’m a ‘very good boy, yes you are, yes you are.’ And I’ll sum it up by saying it is entirely reasonable to expect peers to call in 24 hours early that they are in a crisis (a crisis they’re not in yet) to keep an appointment scheduled six months ago. That makes complete sense and there is no way to poke even a micro-dent in the stone-clad logic of the 24 hour advance notice cancellation policy. I totally get it.
“No, hold up. There might be another reasonable argument to make. I am a person living with a mental health diagnosis, I manage my symptoms well and take the personal responsibility to keep up on my recovery and wellness, and I might just wake up in such a bad place that I’ll either forget or just won’t care about calling when in crisis… 24 hours ahead or even the morning of the appointment… because I have a mental illness, and it affects the way I think, and it affects the way I behave, and it affects the choices I make. When I’m in crisis, making it to an appointment is not a priority or even a consideration. I’m thinking of whether or not I’m going to Kamp Kaseman, and not killing myself has my full attention.
“I am a mental health peer, I get sick at times, I might not follow through with appointments because I’ve gotten sick, and as a mental health provider you should know better than to threaten peer clients with expulsion and monetary punishment for falling victim to the exact diseases you are being paid to treat.
1.) Many providers have a policy that if a peer misses too many appointments they can be refused treatment and be excused from the provider’s services.
2.) In order to prevent being excused from treatment, many providers require peers to give a 24 hour advance cancellation of a scheduled appointment.
3.) As a peer, there is no way for me to know if I’ll be in crisis the next day.
4.) If I knew I was going to be in crisis, I would take every measure to prevent being in crisis.
5.) If I can prevent this crisis, there is no reason to give 24 hours advance notice that I’ll be missing my appointment.
6.) Therefore, applying the 24 hour cancellation policy to peers who miss their scheduled appointment because they end up in a 100% imposssible-to-predict crisis is a ludicrous (and unfair) policy.
This is a real thing. Peers are refused further treatment based upon violating the 24 hour advance notice policy. Providers do this regularly. Don’t try to argue this one with me. It’s happened to me. It’s happened to my friends. This is a real thing. It happens. Too often.
It’s a weird Catch 22 sharp-dull oxymoron policy, particularly because of the inherent conflict of interest, the peer can’t obtain a doctor’s note (from the provider whose 24 hour policy was violated) saying ‘Please excuse Steve from his missed appointment, he was shaving the neighbor’s cat on Wednesday’.
“Actually, I’m just messing with you. I don’t have an appointment tomorrow. It’s in six months. And come to think about it, you’re not even my provider. And you’re a OBGYN, and I don’t have lady parts. And I found your ad under ‘pizza’ in the Yellow Pages, and you deliver in 30 minutes or less. And you are not so much a OBGYN as Papa John’s on Central and Coors. And I have a BOGO free coupon that expired six months ago, can you still accept the coupon? What do you mean I should have called in 24 hours in advance that the coupon expired six months ago? Wait. Huh? Never mind. I’ll call Domino’s.
“I won’t be making it to my appointment tomorrow. Thanks for understanding!”