I worked for a community mental health clinic in downtown Seattle for the first two years after graduate school. The clients at this location were considered the most severely traumatized and chemically dependent residents in the city. On my first day of work, my supervisor gave me a list of over eighty clients with a handful of names that were marked with an orange highlighter. We were talking about my caseload when he said, “It is a lot of clients, but the names in orange are the people you need to pay particularly close attention to. They are among the highest utilizers in King County.” I nodded my head as if I understood the implications of his words. Little did I know I would spend more time with these orange names than I would with my wife in the first year of our marriage.
A high utilizer is someone who has a special knack for ending up in emergency rooms or involving the police or fire department in their day-to-day affairs. Where some choose to rant or vent through a Facebook status update, high utilizers go for a more graphic, performance-art approach. Their theatrics have led me to tears of laughter and their violence has held me up against a wall at knifepoint. A memorable part of my job became the time I spent in our staff meetings comparing client stories. On one occasion, I shared about a client who plucked the tear ducts out of his eyes so that he could get a prescription of his favorite pain medication, which reminded a colleague about a client of his who ran in front of a metro bus in the hopes of being awarded a large enough financial settlement to move to Hawaii. Instead, all that client got was life without a spleen. Ostensibly, my job existed to help clients reach mental health goals, but I learned it had more to do with allocating tax dollars for mental health clinics so that we might prevent bodies from being splayed across a windshield on our morning commute.