Catching Karens (CK) created a list of patient responsibilities per the modern mental health (MH) zeitgeist, as experienced first-hand on Twitter and over 20-years of in-person treatments.

These are items you’d expect clinician/providers to be accountable for inherent to basic services, but fail to do so in any effective standardized capacity.

This list ultimately represents an unfortunate reality of MH services: it’s haphazardly run at the sole risk of patients alone, never providers.

CK has four primary MH goals addressing many of the items below. However, the reality of achieving these goals is starkly naive and horribly unlikely… leaving these issues for patients to figure out completely alone. Or not at all.

  1. Clinician & Treatment Quality Control
    (Reducing Subjectivity & Ensuring Service Integrity)
  2. Clinician/Treatment Peer Review
    (Independent Fact Checking)
  3. Policing Mental Health Treatment
    (Enforcing Clinician Errors & Accountability)
  4. Constructive Mental Health Criticism
    (Reviews & Assessments)
  5. Improving Clinician Paychecks
    (Fixing Low Insurance Payouts)
  6. Assessing/Understanding Treatment Risk
    (Personally & Culturally)
  7. Confirming/Challenging MH Diagnosis
    (Precision/Accuracy)
  8. Managing Mental Health Expectations
    (Patients & Family)
  9. Obtaining Mental Health Services
    (Accepting Insurance)
  10. Performing Seamless MH Transitions
    (Moving & Switching Providers)
  11. Taking & Tracking Medications
    (Med Risks & Side Effects)
  12. Filing MH Complaints
    (Part of Policing, Accountability & Feedback)
  13. Concluding Treatment Failure
    (Avoiding Evasive Patient Referrals)
  14. Maintaining Long Term MH Records
    (Diagnosis, Medications, Notes)
  15. Negating Toxic Advice & Treatment
    (Includes Social Media)
  16. Maintaining Sanity
    (Mental Illness/Serious Mental IIlness)
  17. Handling Mental Health Emergencies
    (Emotionally & Logistically)
  18. Mitigating Diagnostic Amber Traps
    (Diagnostic Persistence)
  19. Diet & Exercise
    (Closing Physical/MH Chasms)
  20. Hormone Balance & Health Baselines
    (Testosterone, Estrogen, Vitamin D, etc)

No one is conducting industry-wide independent assessments of mental health service (inspecting/enforcing global standards).

A huge chasm divides MH from physical/medical health, with few standardized overlaps. Yet medications regimens will often treat patients without baseline data, even avoiding this data entirely. Examples include depression, mood, energy & focus.

While individual clinicians may address some of the patient responsibilities listed above, it’s rarely a standard experience enforced systematically.

In other words: Mental health persists as an unregulated wild-west experience problematically unique to every clinician/patient. Get lucky and it goes OK. Pick the wrong provider and no one knows the wiser. Almost no accountability mechanisms in place to incentivize avoiding harm. (see also: Hypocrites with Hippocratic Oaths)

CK’s primary mission was shifting these responsibilities away from patient back onto providers. But it’s just not feasible or practical among a vacuum-floating industry void of accountability. It’s ugly.

We have since shifted advocacy to simply: Patients beware; seek treatment at your own risk. Literally.

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