The work

The young social worker calls what we do "slash and burn social work". It's not the practice you'd choose, but it's what the situation allows. We're spread too thin to do all that should be done. Scrambling to cover the bare essentials. The really good ones somehow manage not to let this show. 

You wake up at 2:30 AM wondering what the hell to do about the young man with psychosis and four fentanyl overdoses in a year. He hates psychiatric drugs and loves the illicit ones. He'll take anything and everything he can get accept the ones that reduce the power of his delusional thinking. His premature death seems a certainty. You can go through the motions and send him on to a substance use disorder treatment program. On paper, that plan is plausible enough. But you know sobriety is the last thing he wants; his psychosis will single him out among the others and make it nearly impossible to attend to what's happening in the groups; and he can walk out of there at will. It shifts the responsibility for him - the liability for what will become of him - elsewhere, but it's bullshit. He'll get out of the cab and never walk through those doors. You know it. 

He's your case. He's in your head. He's one of many. None are easy fixes. All are unique. Some have nothing to start with. You do what you can for them at a sprint. One leaves, another arrives.