I don’t know how well the things I’ve been thinking about lately fit into this model, so I’m going to attempt to apply these to my own field (Youth Emergency Services for suicide/homicide/psychosis):
1) Bug is when a clinician gets a call about a crisis and fails to triage whether it’s an issue of sufficient severity. Mom calling because she took her kid’s phone away and now they’re yelling and won’t go to bed can probably be de-escalated over the phone, even if they said the magic words of “I’m going to kill myself,” as long as they don’t have a history of depression or suicidal ideation or self-harm. Simple fix is to train people to better triage and how to respond/deescalate remotely.
2) Dragon is kind of what the job was designed to deal with. Before mobile response teams existed for mental health workers, and in counties that don’t have them, people just call the police. The police will either sit the person down to give them a stern talking to, or arrest them, or take them to the nearest hospital’s psych ward, depending on what’s happening. Someone decided “Hey what if we sent therapists instead, who could de-escalate the problem instead and reserve the involuntary commitment for the cases that really warrant it?” Problem is it’s not really a “solvable” problem, which means...
3) Bullshit Mountain is sort of the job itself? There’s no Win Condition, it’s just an ongoing series of getting crisis calls and helping those involved as best we can, whether that’s teaching coping skills, creating safety plans, connecting them to services, or sometimes initiating a Baker Act (Florida protocol for involuntary 1-3 day stay at psych ward). Some people only call us once and everything’s fine in follow-up calls. Others call multiple times per month, sometimes even per week, and have been Baker Acted by us or police over a dozen times. But stats say the county is overall doing better for youth suicides/homicides and hospital psych wards have fewer kids being brought in, all this even with things like the Parkland shooting, so we keep plugging at it.
4) Cloud of Doom seems like it could be at least a couple things. The first that no one wants to be left holding the Liability Hot Potato for a suicide, let alone the next mass school shooter, so we have police departments and schools calling us if any kid says anything even remotely like “I want to kill my geometry teacher,” even if it was two weeks ago in a text message to their girlfriend, and then getting mad at us when we won’t Baker Act them.
Which leads to some Molochian bullshit, where organizations start to *set protocols* to call us for anything that seems remotely worrisome, and then *our protocols* say that we can’t be the ones to define a crisis for the caller, and so we get the occasional hilariously-frustrating call where a juvenile probation officer or school administrator calls us and says “They did/said X Y and Z, so do you need to make an assessment?” to which we have to reply “Well, if you say you want an assessment we’ll be right over,” to which they reply “Well they did X Y and Z,” to which we will reply “Yes, I understand, does that mean you want us to come assess?” to which they reply “Do you feel they need an assessment?” Either we decide what’s worth a crisis and liability falls on us, or the caller decides and liability falls on them.
You know where this is going: we’re getting a steadily increasing amount of calls, and our ability to triage them is being slowly but surely hemmed in by expectations from on-high.
The result being a second Cloud of Doom, where the YES team (and I imagine other mobile crisis teams in other counties) have tons of communal responsibility but no actual institutional power. Which is often demoralizing and makes it hard to retain staff. Which means we’re more often in situations where all our clinicians are busy out on calls, some of which we didn’t really need to go on, but more keep coming in and we have to tell them to either take their kids to the hospital themselves or call the police if they believe it’s an immediate crisis. Which was kind of what the job was originally designed to prevent from happening.
Does this seem to fit, or am I missing the essence of some of these?
I’d have guessed that the liability hot potato is a not a Cloud of Doom but in fact a Bullshit Mountain, as defined in the text. There’s a well-defined problem—avoidance of anything that could create liability leads to institutional paralysis—and a bunch of ways it happens.
Ah, maybe. I was under the impression that CoDs are the emergent properties of multiple Dragons or BSMs interacting, and their main feature seemed to me that they are the thing that “gums up the works” and makes it harder for people in a system that’s trying to solve problems to actually do so.
The liability hot potato itself is a Bullshit Mountain. Once the liability hot potato becomes a cause for multiple symptoms downstream of it, you’re in Cloud of Doom territory. So the ultimate problem is contextual—are you operating at a level of control where you can directly confront the LHP? If so, pick your causes and start shoveling. Or are you at a level of control where the downstream effects of the LHP are themselves the landscape you have to navigate? If so, welcome to your Cloud of Doom.
Why can’t you start shoveling those CoDs to pull off dragons from it? I’m not very familiar with therapy, but revision of business process (a what-to-do-in-which-case instruction) is usually a good way to handle power/responsibility problems. Finding occurancies when people have responsibility for something but have no power to change it and defining how to manage these cases should help reducing overall CoD. I’m a bit confused that article predicts that it only will make a CoD worse, I wonder why.
I don’t know how well the things I’ve been thinking about lately fit into this model, so I’m going to attempt to apply these to my own field (Youth Emergency Services for suicide/homicide/psychosis):
1) Bug is when a clinician gets a call about a crisis and fails to triage whether it’s an issue of sufficient severity. Mom calling because she took her kid’s phone away and now they’re yelling and won’t go to bed can probably be de-escalated over the phone, even if they said the magic words of “I’m going to kill myself,” as long as they don’t have a history of depression or suicidal ideation or self-harm. Simple fix is to train people to better triage and how to respond/deescalate remotely.
2) Dragon is kind of what the job was designed to deal with. Before mobile response teams existed for mental health workers, and in counties that don’t have them, people just call the police. The police will either sit the person down to give them a stern talking to, or arrest them, or take them to the nearest hospital’s psych ward, depending on what’s happening. Someone decided “Hey what if we sent therapists instead, who could de-escalate the problem instead and reserve the involuntary commitment for the cases that really warrant it?” Problem is it’s not really a “solvable” problem, which means...
3) Bullshit Mountain is sort of the job itself? There’s no Win Condition, it’s just an ongoing series of getting crisis calls and helping those involved as best we can, whether that’s teaching coping skills, creating safety plans, connecting them to services, or sometimes initiating a Baker Act (Florida protocol for involuntary 1-3 day stay at psych ward). Some people only call us once and everything’s fine in follow-up calls. Others call multiple times per month, sometimes even per week, and have been Baker Acted by us or police over a dozen times. But stats say the county is overall doing better for youth suicides/homicides and hospital psych wards have fewer kids being brought in, all this even with things like the Parkland shooting, so we keep plugging at it.
4) Cloud of Doom seems like it could be at least a couple things. The first that no one wants to be left holding the Liability Hot Potato for a suicide, let alone the next mass school shooter, so we have police departments and schools calling us if any kid says anything even remotely like “I want to kill my geometry teacher,” even if it was two weeks ago in a text message to their girlfriend, and then getting mad at us when we won’t Baker Act them.
Which leads to some Molochian bullshit, where organizations start to *set protocols* to call us for anything that seems remotely worrisome, and then *our protocols* say that we can’t be the ones to define a crisis for the caller, and so we get the occasional hilariously-frustrating call where a juvenile probation officer or school administrator calls us and says “They did/said X Y and Z, so do you need to make an assessment?” to which we have to reply “Well, if you say you want an assessment we’ll be right over,” to which they reply “Well they did X Y and Z,” to which we will reply “Yes, I understand, does that mean you want us to come assess?” to which they reply “Do you feel they need an assessment?” Either we decide what’s worth a crisis and liability falls on us, or the caller decides and liability falls on them.
You know where this is going: we’re getting a steadily increasing amount of calls, and our ability to triage them is being slowly but surely hemmed in by expectations from on-high.
The result being a second Cloud of Doom, where the YES team (and I imagine other mobile crisis teams in other counties) have tons of communal responsibility but no actual institutional power. Which is often demoralizing and makes it hard to retain staff. Which means we’re more often in situations where all our clinicians are busy out on calls, some of which we didn’t really need to go on, but more keep coming in and we have to tell them to either take their kids to the hospital themselves or call the police if they believe it’s an immediate crisis. Which was kind of what the job was originally designed to prevent from happening.
Does this seem to fit, or am I missing the essence of some of these?
I’d have guessed that the liability hot potato is a not a Cloud of Doom but in fact a Bullshit Mountain, as defined in the text. There’s a well-defined problem—avoidance of anything that could create liability leads to institutional paralysis—and a bunch of ways it happens.
Ah, maybe. I was under the impression that CoDs are the emergent properties of multiple Dragons or BSMs interacting, and their main feature seemed to me that they are the thing that “gums up the works” and makes it harder for people in a system that’s trying to solve problems to actually do so.
The liability hot potato itself is a Bullshit Mountain. Once the liability hot potato becomes a cause for multiple symptoms downstream of it, you’re in Cloud of Doom territory. So the ultimate problem is contextual—are you operating at a level of control where you can directly confront the LHP? If so, pick your causes and start shoveling. Or are you at a level of control where the downstream effects of the LHP are themselves the landscape you have to navigate? If so, welcome to your Cloud of Doom.
Why can’t you start shoveling those CoDs to pull off dragons from it? I’m not very familiar with therapy, but revision of business process (a what-to-do-in-which-case instruction) is usually a good way to handle power/responsibility problems. Finding occurancies when people have responsibility for something but have no power to change it and defining how to manage these cases should help reducing overall CoD. I’m a bit confused that article predicts that it only will make a CoD worse, I wonder why.