Thoughts about Numbers

28 Apr

I have been working on a project for one of my classes, in my project I have been interviewing Hispanic immigrants in North Carolina and while I was transcribing the interview I connected with something my informant told me. He spoke about the value of numbers- particularly the numbers assigned to a person via social security. Growing up those 9 numbers dictated his life, he was ruled by the power of that 9 number sequence- It got me thinking about the numbers we assign people in any system we belong to, take for example the mental health system. In mental health before a client is seen we request their social security number, date of birth, age, insurance number, we call up the management entity to gather information about their record number. Before anyone even talks to this person they become a mathematical code.

The equation continues to complicate as the individual returns their paperwork to the receptionist and the individual waits for their appointment time. The clinician steps out of their office after being informed that their 9:00am appointment as arrived. The clinician starts to build the relationship and starts the assessment process, typically with a standardized form to assess for an array of typical symptoms, many of the symptoms searching for frequency and duration.

More numbers.

The assessment concludes and the clinician sits with the information that was gathered in the assessment; notes about the duration and frequency of the symptoms,  notes about stressors and what brought them to the office for the assessment, Notes about their hopes and dreams for a future without this stressor. Upon reviewing these notes it is time for the clinician to think about the final numbers this person will receive in order to see this person, and bill insurance for the service.

The problem has been calculated down- now it is time for the clinician to justify the final numbers the client will receive, will it be 309.0 Adjustment with Depressed mood, or is it in fact 311 Depressive Disorder not otherwise specified, should the clinician rule out another number and later give them their GAF, or Global Assessment of Functioning number that is in the 50s range or the 60s.

Axis 1 + Axis II – Axis III + Axis IV + Axis V = Service Delivery and Treatment Plan

It is my fear that after a while, with soaring caseloads and the current state of mental health in the nation. It is easy to see where a person would stop existing as a person and is instead the person becomes that number, that diagnosis, that social security number.  It is my hope that people will stop being numbers and get back to being a more human and compassionate world. There seems to be no time to spend that time anymore, but that time is what fosters growth and allows for personal introspection.


4 Responses to “Thoughts about Numbers”

  1. Jessica Spence April 28, 2013 at 9:09 pm #

    Nice post! Definitely touches on the “revolving door”, “in and out”, high case load culture I’ve seen. I think that, in general, we really collect too much numerical data on clients. Does a counselor REALLY need your social security number? I don’t think so and I don’t ask people for it in my practice.

    There have been times when I have felt guilty for diagnosing someone as a number, not a person. I understand the system in place for billing, etc. etc., but it does make someone a 314.01 or 313.81 or 296.23, not a person.

    The bigger picture is that we are working within a system that forces us to see clients as numbers to be racked up- if we want to get paid or if our employers want to make a profit off our work.

    The sad part is that this hits those living in poverty the most. The poor are seen as numbers and are dehumanized. Medicaid reimburses at very low rates, so they get low rate counselors. The poor get newly licensed counselors, working in unethical agencies, who are forced to see back-to-back clients in 30 minute increments with case loads in the 100’s because it’s the only job they can get.

  2. Tom April 29, 2013 at 12:08 am #

    have you ever heard of narrative therapy? (good example here – )

    Statistical approaches to social problems is all part of the attempt to treat social problems like the problems of natural science, which must solved through statistical analysis of experiments. Unfortunately, this approach doesn’t work, but I guess most organizations and university psychology departments insist on learning this the hard way! Absolutely, you’re right that we cannot ignore humanity of people and expect to have positive impacts on their lives.

  3. Pamela Spiro Wagner June 10, 2013 at 4:28 pm #

    If you are not a number, you are the MI diagnosis you are given, without being asked what you think about it. And that MI Dx carries a stigma that you may never escape. Once diagnosed, the MSW or LCSW and all mental health personnel or professionals in general may start to see you only as the MI label, and cease to think of you as anything but Other…the Stranger. It has happened countless times. And people do not even think they need to examine their attitudes about this issue. It is knee jerk, born of fear and ignorance, and they believe it is proper…But we get dehumanized and run the risk of being so disregarded that we can be treated as less than human.

    • amandajaynemsw June 16, 2013 at 4:56 am #

      I completely agree, people in the mental health world, and people in general forget the basic, “People are people, treat everyone as you would like to be treated” mantra and look for ways to label and separate

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