Mental illness again
Mar 15, 2004 Shelter
I started working in the shelter at the end of ‘92, I think, and so my co-workers remembered when the mental health services shut down and people started showing up on the streets making their job providing shelter much more difficult. Portland does have walk-in mental health clinics but they are — of course — underfunded and understaffed. There is some subsidized housing for those with mental illness but to qualify for them, you need to be able to stay in treatment and follow a case plan, which simply isn’t possible for a lot of mentally ill people to do.
The rule for accessing shelter services is that clients with a diagnosis needed to be working with a counselor and taking their medication. Some clients came into shelter with the understanding that they would need to do an intake with one of the clinics within a week or lose their housing.
It’s a terrible thing to throw someone out of shelter for being too crazy. It was always a difficult decision to make but the thing is, we had only so many beds in shelter and there was always someone else needing that bed. So what can you do? House someone for a few weeks even though their presence is disruptive to the rest of the program? Knowing that they won’t be able to succeed at finding housing at the end of their stay? No, the answer is you have to kick them out so that someone else who may make better use of the bed can come in.
We revisited that rule a lot. It’s really really hard to ask someone to leave just because they’re insane. Sometimes we tried to let people stay depending on how their mental illness was manifesting. One of our case managers held a mediation between roommates, one of whom was schizophrenic and hadn’t gotten treatment. In a mediation, you repeat back what each person says to break down the disagreement and make sure that everyone is heard. She turned to one roommate and said, “Now do you hear what S. is asking? She’s asking that you stop shooting radio waves at her head.”
Frankly, someone who is concerned about getting radio waves shot at her head is not a great job search candidate. And getting social security is really, really hard. Many of our clients were great at masking their mental illness when required, which is how they got into shelter in the first place. By not admitting their mental illness — which many did not think they had — they were unable to get help and thus their homelessness was perpetuated.
There are many mentally ill clients who stay in my head.
We had one client with two children. She presented as flightly and friendly but perfectly sane. Then one day during our morning check-in, she told me that her 2-year old daughter’s head was growing at an astronomical rate, she said this in passing. The next day she told me that the doctors had said that she should put a belt around her daughter’s head every night and tighten it to stop the growth. She gave me detailed instructions as she remembered them being given to her and discussed the symptoms resulting from her daughter’s enormous head growth.
I called CPS after our meeting and asked them to come around and check things out and before they could arrive, the client left shelter. I think in part because she knew her story had raised our concerns since my reaction wasn’t exactly supportive.
I don’t know if she was following “doctor’s orders” for her daughter — a bright little sunshine-y girl with dandelion wispy hair. I do know that if she was putting a belt around her baby’s head every night it’s because she thought she was helping.
Getting services when your mentally ill is incredibly hard. You can’t get help unless you want it and many of our schizophrenic clients felt that there was nothing wrong with them.
I particularly remember one woman with long black hair who was solemn and dignified at intake. Later at her first case management meeting she disclosed that she had a mental health diagnosis and was told she needed to go to the clinic within a week to discuss a treatment plan with them. At this point, her psychosis surfaced entirely and she told her case manager that she would not go to the clinic since they were part of a government plot to brainwash her and steal her thoughts. I don’t know why it fell to me to ask her to leave — she wasn’t my client — but I do recall sitting across from her in my boss’s office telling her that she needed to comply with the case plan or go. She said, very calmly, that she recognized now that our shelter was part of the broader government system designed to take people in and control their minds. She said that she knew that we had Satanic ties — that I had Satanic ties — and that she would under no circumstances follow the case plan. I told her that first of all I felt she was very brave to sit there with me believing I was out to hurt her. Then I told her that I was worried for her safety. When I said this she drew a long, shuddering breath and blinked her eyes rapidly, giving me the only glimpse past her remarkable composure into her terror. She said she would be gone by 5pm that day and she was.
What I’m trying to explain here is that there are many layers that make it difficult to treat people who are deeply mentally ill. Without an understanding of how mental illness works, it can be easy to dismiss people as stupid or as liars. Some of our clients likely should have had other diagnoses, too — such as the mother wrapping the belt around her daughter’s head. I think she may have been mildly retarded, as well. What she was doing was abusive and so she is by definition an abuser but her intent really was to save her daughter’s head. When first talking to her, she just seemed — frankly — somewhat stupid. I can see that if she had gone to a hospital that was not prepared to see her mental illness or at a time when she was able to mask her mental illness, that she would have looked like someone simply not smart enough to know that what she was doing was wrong. Or even as someone too lazy to make good decisions. She herself felt perfectly sane, as did the woman who thought we were part of a Satanic plot.
See, if you count on people who have broken with reality to recognize that and get treatment, you’re counting on the wrong people.
I thought that A Beautiful Mind did such a terrific job of portraying this; that in the mind of someone who is psychotic, there is no logical way of seeing their own psychoses. That woman who refused the cesarean (and again, we cannot know for sure what happened) probably had very good reasons for refusing in her own mind. Andrea Yates, too, was operating with a logic that made perfect sense to her. To hold these women to our own standards is no more realistic than asking someone who speaks only English to tender all of her responses in French; it just can’t be done.
There’s a terrific book by a woman whose son had schizophrenia called, Tell Me I’m Here. Although her book focuses on the wreck of the mental health system in Australia, her frustrations and her son’s inability to get help are probably similar to the experiences of those living in the United States. I also highly recommend Kay Redfield Jamison’s excellent memoir An Unquiet Mind.
March 16th, 2004 at 11:23 am
Thank you so much for writing about mental illness with such compassion and empathy. One of my favorite books dealing with women, class and mental illness is Marge Piercy’ s Woman on the Edge of Time.