Today we continue talking about some history of mental health treatment. As long-term patients were released from mental health institutions, they needed community support. Theoretically, it was to be there. Practically speaking, the community was simply not prepared. Not that we didn’t try- we did. But much of the strategy of community support was based upon the efficacy of newer anti-psychotic medications, and the ability of community support systems to handle treatment. The newly funded community mental health centers had a combination of state and federal money to provide care closer to where patients now lived. Clients also were to benefit from being closer to friends and family. Case managers were to follow patients with home visits, and community psychiatry was to be able to prescribe and monitor those medications.
Of course, no system is perfect, and the above-mentioned model failed for numerous reasons. One, of course is that medication cannot be forced upon anyone (except in rare forensic situations). I well remember talking with a community client, recently released from the State Hospital, about the importance of taking his medication. We discussed side effects, which I seemed to minimize relative to the importance of the good benefits. I will never forget his response. He said, “To you they are side effects. To me, they are primary effects!” He had reinforced to me to see this whole thing from the client’s perspective. Medications helped mitigate his symptoms, but he paid a price for that.
One other little story for today.
When we were trying to establish a supervised group home in a small town, we stressed that there would be supervision in that home, and that mental health clients to be placed there did not pose a violent threat to the neighborhood. Indeed, the clients were statistically more likely to be victims of violence than perpetrators of it. Well, at a public hearing one evening, we were literally booed out of the council meeting. “Not in our neighborhood!”
Tough night!
The irony was, which we could not share with them, that for several years, we had been placing patients released from the state hospital in that very neighborhood, unsupervised, and the neighbors were not even aware of it. I am not blaming those neighbors. People have fear of the unknown.
Tomorrow, I talk about the misconceptions of mental illness and violence.
Reflections of a Counselor 