A Matter of Responsibility

"Only thing is, it's dangerous to believe too much in good fairies and guardian angels... you get to lean on them too much. You get in the habit of sitting back and expecting them to do all the work for you. You've got to help yourself, you know."

- the Godmother to Cinderella in the CBS 1957 version of Rodgers and Hammerstein’s musical, Cinderella

Perhaps one of the most meaningless of all terms that gets tossed around when a person becomes homeless is case management. As if it were a panacea that will resolve all the homeless person’s problems, case management is touted as the medium through which the consumer – the accepted term used for the person receiving the case manager’s services – will ultimately be able to make a recovery and return to mainstream society. The only problem with this equation is that in the real world, it often does not result that way. Quite often, the consumer ends up in a hopeless muddle, wishing and hoping much like Cinderella for a miracle to happen, only that no fairy godmother appears to do any magic.

Case management, in and of itself, is a term devoid of any intrinsic meaning. Case managers are licensed social workers who have varying degrees of credentials and motivation for their jobs before they are given their case loads, which can often be staggering. Give even the most qualified and most highly motivated case manager a walloping case load of complicated cases that defy solution with the marginal salaries that they are paid and burnout is inevitable. Add to that picture the realities of present-day America in which social welfare programs are being cut back and resources are drying up, and there it is: a scenario in which case management is asked to do the impossible. It is useless to look for someone to blame when the blame is so obviously shared by so many factors along the way. Those persons who will still talk as if case management is the magic that will make all the ills go away are hopelessly delusional and, hopefully, will never be in need of the services that they think are out there for the homeless public, because they would be in for a rude awakening if they were.

The above analysis assumes that all the persons are working according to totally altruistic motives. In the real world, quite often the persons in case management positions have their own agendas that they follow far more than those of their consumers. The consumer who detects such errant behavior has little choice than to break free of the case manager and to request a transfer or else to accept the dictates of a case manager who may not be acting in the consumer’s best interests. It is then that the words of the Godmother start to ring true: the consumer has to look out for the consumer, not to expect the case manager to do the work. Then the question arises: why is the case manager receiving a salary, however meager it may be, when the consumer must do the work? That is a question that I have been asking for quite some time, and I think an answer should be given, as when things have gone wrong, the personnel in the Department of Mental Health and the core service agencies have not hesitated to rush forward, wagging accusing fingers at the consumers for not having taken personal responsibility when the case managers were the ones who did not behave responsibly! If the issue is one of expecting a consumer to take more personal responsibility, should it not follow that the consumer be paid the salary? Is this not just another attempt to cut corners on the budget?

I think I know the answer I will get to this question. It’s not a rhetorical question at all; it’s a very real question. Seeing as how I have grievances to file against more than one case manager because of this very sort of behavior, I know that I’ll see a lot of people doing a little sidestep now. It will be interesting to watch, not to mention very revealing.

Copyright © 2005