Articles: Minnesota Oversight Process Lacking &

Prolonged Grief Disorder {Below}

Minnesota Board of Psychology.png

By Angela Nelson, Psy.D., LP 

Signe L. Nestingen, Psy.D., LP, LMFT 

Rose M. Stark-Rose, PhD., LP

Minnesota Oversight Process Lacking

    Every state is required to have a program to evaluate and monitor health care providers, including psychologists, who may be impaired due to a substance abuse problem. All practicing psychologists need to make a point of being familiar with their state’s program, as they are required to make reports when necessary.
       In Minnesota, the Health Professionals Services Program (HPSP) 
provides this oversight and coordinates with other health service provider boards, including the Minnesota Board of Psychology. Minnesota’s program is unique in that it monitors providers who may struggle with mental health concerns and medical issues, in addition to substance abuse issues, that prohibit good patient care.

    Five states monitor both mental health and substance abuse issues. Most only monitor substance abuse concerns. Examples of areas monitored by Minnesota’s HPSP include substance abuse, depression, schizophrenia, medical conditions, chronic pain, etc.

    In 2016, the Minnesota legislature passed a law requiring health care providers to report a colleague they suspect may be practicing while impaired. The HPSP can open an investigation if a psychologist self-reports, if a colleague or employer reports, if a “cold call” is received  or if a colleague files an anonymous report. 

    When a report has been filed, HPSP conducts a thorough evaluation of the psychologist’s vocational, social, medical, psychiatric and substance use history. Typically, this takes 60 days. But, an evaluation could take as long as six months.

    HPSP has the authority to request that a psychologist under evaluation step away from their work for the duration of the investigation. This unexpected, and possibly unpaid, leave from work can result in economic hardship as well as disruption of patient care. 

    Depending on the outcome of the evaluation, a period of monitoring can last as long as

two years. Usually, individuals with a bachelor’s or master’s degree serve as case managers

for HPSP, conducting evaluations, establishing contracts and monitoring psychologists. 

A psychologist may be required to complete random urine screenings, attend therapy, provide

a record of any over the counter substance use, limit the scope and/or number of patients in

a practice or hire a work monitor to provide quarterly reports to the HPSP case managers.

    Typically, this system works well to protect the public and to support a psychologist who needs help. Recently, a psychologist brought a concern to the Minnesota Psychological Association (MPA) Ethics Committee about the investigative and monitoring process HPSP utilizes when a report about a psychologist has been submitted. 

    This concern led to an investigation of the HPSP process by members of the MPA Ethics Committee. As a result of the investigation, a critical question emerged. What recourse did a psychologist have if the psychologist found the evaluative and monitoring process of the HPSP to be labor intensive, and/or harmful to their economic well-being, their work as a psychologist, and/or in some manner contribute to disrupted patient services? 

    We started by asking HPSP directly. Their group suggested that a complaint goes to the Minnesota Attorney General’s office. However, when asked,the Attorney General’s office denied any control in this area and suggested that a complaint be filed with the Minnesota Board of Psychology (if the individual were a psychologist).             However, the Board cannot accept a complaint about HPSP as the required monitoring program for the Board of Psychology is the HPSP. The Minnesota Department of Health also did not know where a complaint would go.  In this circular system there is no way for an individual to file a complaint about the process or the outcome of an evaluative/monitoring process by the HPSP. Who is providing oversight to the oversight committee?

    The HPSP is an organization meant to protect the public by providing vital assistance when a psychologist’s work is compromised due to struggles with health, substance use or mental health issues. Currently, when the HPSP process fails, there is no recourse.

unnamed_edited.jpg

Angela Nelson, Psy.D., LP, has worked as a clinical psychologist, school psychologist, consultant and career counselor and has had multiple teaching posts. She serves on the Ethics Committee within the Minnesota Psychological Association. She can be reached by email at anelsonpsyd@gmail.com.

Signe L. Nestingen, Psy.D., LP, LMFT, is a core faculty member and Director of Clinical Training for the Doctor of Psychology in Counseling Psychology at Saint Mary’s University of Minnesota. She is a licensed psychologist and MFT and has a small private practice.

Rose M. Stark-Rose, Ph.D., LP, is on the faculty of the departments of psychology and community psychology, counseling and family Therapy at St. Cloud State University. She currently chairs the Minnesota Psychological Association Ethics Committee.

Prolonged grief disorder

added to DSM 5-TR

By Robert A. Neimeyer, Ph.D.

 

  The official announcement of the inclusion of prolonged grief disorder (PGD) in the DSM 5-TR has revived the simmering controversy over whether any form of grief should be considered a “mental disorder,” alongside life-limiting forms of anxiety, 
Psychology Session
depression, eating disorder, substance abuse and the many other conditions given attention and definition as diagnoses within this psychiatric compendium of human distress. Grief itself is an entirely normal response to the loss of someone (and in a broader definition, something) to whom (or which) we are greatly attach-ed. In the context of bereavement, grief has been described as the price we pay for love and is nearly as universal as death itself. Moreover, the ability to mourn one’s losses can promote adaptation to a world crucially and irreversibly changed by the death of another. We are left to navigate shifting emotions, realign our attachment to the deceased without relinquishing it and subtly or substantially revise our own sense of purpose and identity as we make meaning of the loss, and our own lives in its wake. Nothing in this is inherently disordered. Even if it is disorderly; it is simply the normative and variegated way we reconstruct our worlds in the aftermath of bereavement.

    Except when we don’t. A large and scientifically impressive body of research across cultures documents that, for a small subset of the bereaved (perhaps 5-10 percent) very little reconstruction ensues in the months, and sometimes years, following the death of a loved one. Instead, the bereaved may find themselves adrift in a seemingly endless sea of despair, preoccupied with the circumstances of a traumatic death or corrosive and unresolved relationship issues with the deceased. They may report feelings of drowning in anguish, being lost in unfulfilled yearning, or consumed by guilt, anger or hopelessness – little of which attenuates as months meld into years.

    The real effects of this suffering are obvious enough to those close to a mourner, as they find themselves struggling interminably to show up for their partners, parent their children, maintain friendships or perform adequately in the workplace – all to an extent and duration that greatly exceeds their community’s cultural norms. When these conditions persist largely unchanged a year or more following the loss – posing documented risk of suicide, substance abuse and serious illness –both the American Psychiatric Association and the World Health Organization concur that a diagnosis of PGD may be indicated. Genuine grief may persist long beyond one-year.

    Individuals may continue to experience periodic waves of significant sadness and missing, mingled with nostalgia and gratitude for their loved one’s ongoing contribution to their life for the rest of their days. However, the constructive integration of grief into life deepens, rather than cheapens, it and we may even live with greater purpose and intention, and greater compassion for ourself and others.

    Such a pattern of growing through grief does not deny its painfulness. Instead, it takes it

as a prompt to review and revise one’s values and choices, and affirm a life that remains

significant and is still beautiful. This image of a life changed by loss has a very different

trajectory than the one captured in the DSM 5-TR. But, crucially, PGD is only one formulation

of this painful and protracted form of distress. Like all diagnoses and all abstractions, we

use to orient to life and its challenges – for example, justice, human rights, crime, chance

and freedom, – prolonged grief disorder is a social construction, no more or less “real”

than any other. 

    Granted, there is ample evidence that the relatively few bereaved people it describes suffer grave consequences, but this condition could, in other contexts, be formulated in other terms, perhaps as a crisis of meaning, a dark night of the soul, a rupture in the network of social relations or a neurological event.

    Each such construction would carry its own implications for understanding and supporting the bereaved, and none could claim absolute “validity” in a sense that invalidated the others. Stated differently, diagnoses included are useful for some purposes and not others and should be judged on the grounds of their pragmatic viability, rather than their epistemological validity, per se.

    The relevant questions therefore include in what ways might a PGD diagnosis be helpful and harmful (as all social constructions will serve some purposes and not others) and who benefits and who suffers if this social construction is adopted? These are complex issues that merit serious attention, and they do not have simple answers.

    In the case of PGD, a diagnosis could have pragmatic benefits in opening the door to relevant, professional care in many cultural and economic contexts, without requiring the rationalization of misdiagnoses – generic depression or anxiety states, for example. Specifically, a PGD concept of a mourner’s distress could highlight some of what is distinctive in incapacitating grief, focusing attention usefully on the disruption of an attachment bond and a world of meaning unique to the precipitating loss.

    But it is likely to have a downside, including empowering professional healers (and especially physicians) at the possible expense of informal caregivers and supporters and perhaps contribute to a broader western trend to construe distress in merely pharmacological terms, rather than intrinsically existential ones.

    All of this suggests that responsible and critical analysis of the impact of such discourses for good as well as ill, is called for in the years to come. None of this resolves the suffering entailed by many forms of loss, or intense, life-limiting forms of suffering in which bereaved people occasionally become stuck, often for the rest of their lives.         With or without a diagnostic label, these extreme and intractable states of suffering call for humane and informed attention from all professionals or non-professionals, who respect both the legitimacy of grief and the human capacity for resilience in the wake of tragic loss.                                    

unnamed_edited.jpg

Robert A. Neimeyer, Ph.D., directs the Portland Institute for Loss and Transition. He is a trainer, consultant and coach, and has published over 600 articles and 35 books, most on the grieving process. His latest books are New Techniques of Grief Therapy and the Handbook of Grief Therapies. For more on the conceptualization and treatment of problematic grief see the Institute’s professional training modules at https://www.portlandinstitute.org

906801003.jpg
pdresources_ad.gif
246-2468032_picture-of-follow-us-on-twitter-stickers-sign.png

Did you know...?
That psychologists can earn 1 continuing education credit per issue for simply reading The National Psychologist? A great reason to 

Subscribe Today!

244523804_1307585243025992_6360315033234520779_n.jpg
new 2023 - Copy_edited.jpg
b521691f2255f04b4baa684467aa03a8.jpg
Advertisement
Advertisement
Advertisement
JL619-standing_720x.jpg
thumbnail (1).jpg
IMAgine a Career at IMA square  ad NEW.jpg
845001__35764.1647254006.jpg
National Psychologist web ad 2 300 (2).jpg
thumbnail.jpg
Advertisement