Phil Wilson: CSO has turned into a corporation

Last modified: Thursday, August 13, 2015

When I first took my baby steps toward becoming a mental health clinician, I interned at agencies that resembled small rabbinical schools.

In San Francisco, during the mid-80s, the directors of most of these tiny outposts were, first and foremost, fervent believers in this or that theory of psychology. Whether the director was a devotee of Heinz Kohut, James Masterson, or Don Jackson, one could be certain that much of the day would be spent splitting hairs with a handful of peers, and trying to capture the essential truth about self psychology, or object relations or family systems.

Such devotion to the deconstruction of doctrine carried certain risks. Clinicians were fired for careless ideological pronouncements. Still, while most of us had the sort of idealism that led us to careers providing therapy for people too poor to afford it, the pace was leisurely, with no demands for “productivity,” and the primary job stress involved withstanding the boss’s pedantic scrutiny.

These agencies were funded by United Way or other charities, and there were no insurance forms to numb a clinician’s focus on abstract thinking.

Fast forward 30 years and here I am working at Clinical & Support Options, a mental health agency modeled more aptly to resemble a sweat shop in Bangladesh than the basement of a Brooklyn shul. Here, my director, Karin Jeffers, does not skeptically observe my grasp and adherence to a chosen psychological theory. In fact, I have never even met Jeffers, although, I believe, I saw her silhouetted in a doorway at the end of the hallway at my Greenfield office six years ago. A coworker elbowed me gently in the ribs and asked, “do you know who that is?”

To be fair, Jeffers is not my “director” in the sense of those rather fundamentalist authorities in long ago California. Her title is CEO. This ominous designation, with its suggestion of corporate rather than religious affiliation has always struck me as conveying a discomforting irony. CSO is, one presumes, on a mission to alleviate the emotional damage afflicting victims of poverty. Donald Trump and Bill Gates are CEOs. I am not sure what title Mother Theresa wore in her time in Calcutta, but I am fairly convinced that she was not the CEO of anything.

As one might guess, at Clinical & Support Options there is almost never time to worry about psychological theory, and the most pressing challenges involve uncertainties about filling out insurance documents and avoiding getting into trouble for cutting corners while scratching out pages of redundant forms.

I can safely assert that more than half of the tasks done by CSO laborers are not compensated with even a single penny. One must fill out countless forms on ones’ unpaid free time, in addition to hours of unpaid travel time, phone calls, unpaid meetings and tasks that might be subsumed under the title of self-inflicted idealism, such as having a free therapy session with a client who has suddenly lost insurance coverage due to some sort of bureaucratic mishap.

While I am certain that the corporatization of community mental health is not in my interest as either a clinician or a human being, the phenomenon of megalithic mental health commands a certain fascination in the grotesque manner of a 10-car highway pile up.

I view, with resigned awe, the helplessness of a family of six, residing in a lead-infested Turners Falls apartment, facing eviction despite receiving $20,000 worth of CSO services annually. The housing problems plaguing this family might be solved by one person in a couple of intense weeks, but the billing protocol at CSO would not allow an individual to spend 10 hours a week peeling through layers of bureaucratic complexity.

CSO, unlike the little California storefront agencies of my origins, is a sprawling system with outposts (or franchises in the manner of Dunkin Donuts) dotting towns all over western Massachusetts — Pittsfield, Amherst, Greenfield, Athol, Springfield and Northampton — with an almost sure ambition to expand further, and increase their numbers of already hundreds of underpaid employees and unpaid interns (courtesy of area social work schools).

The trend toward growth, impersonal character, and the division of the agency into increasingly stratified layers of authority, necessitates a large pool of cheap labor to generate money for ambitious growth. Without surplus cash there can be no competition, no vision of Darwinian struggle for limited taxpayer funds with other equally rapacious “nonprofit” corporations like ServiceNet and CHD.

One should be encouraged to view CSO, ServiceNet and CHD as resembling McDonald’s, Burger King and Kentucky Fried Chicken in their war for dominance. A new CSO program might even be introduced with a glossy brochure as if it were a new Wendy’s fish sandwich.

These “new programs” are staffed by cadres of young college graduates who are paid at the median rate for high school dropouts, and who quit these “burn out” jobs at a rate faster than CSO can replace them. Perhaps, it might strike some as delightfully bizarre that CSO’s primary purpose is allegedly to help those disadvantaged souls who have been most wounded and abandoned by corporate values.

With little willingness to provide workers with adequate wages, CSO management has devised an almost surreal strategy of providing a sort of phantom benefit — paid time off without pay. Allow me to explain.

Fast food laborers are at least treated with the dignity of knowing that they have no future and can expect poor treatment for the duration of their employment. The spin masters at CSO have, however, attempted to trick their educated laborers into believing that they have sick time, vacation time and paid holidays.

It works like this: workers must labor an extra hour for every hour taken off. That is right. A CSO employee can get paid for Christmas if he or she works an extra eight hours at some other time. The same worker can even fracture a limb and collect a full week of sick time provided that this cornered employee finds a way to generate an additional 40 hours of labor to pay CSO back.

That is how CSO workers get paid time off, by paying for it themselves. This allows Jeffers to boast to the media, in her Kafkaesque vision, about CSO employees getting paid holidays, three weeks of paid vacation and five paid personal days.

Jeffers confusing utterances to the media comprise some of the most illuminating and amusing aspects of the CSO narrative. For example, she told a television station that she pays master’s level clinicians $36 an hour. This would mean that full-time clinicians would make $75,000 per year, but as one of CSO’s more successfully productive clinicians, I have never made more than $36,000 per year. Jeffers simply preyed on the interviewer’s naivete, calculatingly conflating “billable hours” (the face to face time with clients that insurance reimburses for) with overall rate of pay.

The boldness with which CSO management takes employee gullibility as a given has reached Orwellian levels with the latest contract offer for CSO workers to receive a 3 percent raise provided that they improve their “productivity” by 2.3 percent. In this instance, Jeffers has boasted to the media about a 3 percent pay increase which is, in reality, only a .7 of 1 percent raise.

Her media statement on this issue summoned the image of Marie Antoinette when she told reporters that union members are not going to be “paid more to do less.” Some 87 percent of voting SEIU union 509 members voted this offer down.

The recent strike at CSO is not merely about horrific low pay, deception and bad working conditions, it is about the heartless, unwieldy, self-destructive behemoth that CSO and other community mental health so called nonprofits have become.

Ultimately, one should fear that the CSO model of megalithic community mental health, taken to its conclusion, will produce burnt out, indifferent bureaucrats mirroring the problems that disadvantaged clients experience in Social Security and other government offices.

The workers at CSO, represented by union SEIU 509, have drawn a line in the sand. On the surface, the issues are the typical fare of union/management discord: low wages and oppressive work stress.

But, in conversation with my fellow strikers, there are clearly emerging deeper issues, reflecting an awareness of dehumanizing and deeply imbedded structures defining the current state of corporate, community mental health.

The three-day strike held at all CSO sites from July 22-24, has settled nothing as yet. There is still no contract. In the best scenario, this strike represents the opening salvo in a battle to determine the future values of community mental health.

Phil Wilson is a clinician at CSO.


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