Most of the important things we learn in life come not from formal education but from personal experience, that “hard school” where even a fool can presumably learn something useful.
Nowhere is this more true than in the arena of mental illness, a topic on which researchers, consultants, judges, administrators and newspaper editors expound at great length, usually to lecture those in the “system” on some deficit or failure to provide competent care.
This is all well and good ñ and even necessary to a degree – but it’s one thing to give an accounting of the world, and quite another to experience it.
Based on my own experience as a family member of someone diagnosed with a serious mental illness almost twenty years ago, as a student of the public behavioral health system in Maricopa County and a supporter of many of its constituent groups, and as an occasional case manager of sorts for a friend diagnosed with severe and persistent schizophrenia, I have come to believe we overvalue the accounting side and undervalue the lessons from personal experience.
I thought about this recently in the context of an observation made by a counselor whose job is dealing with the emotional issues of children in the foster care system. “Some of these kids look around, and all they see are adults who are paid to take care of them,” she said. “They become cynical and hard at an early age. Who wouldn’t?”
Or this comment from my friend, who on his good days is a witty and engaging conversationalist, and on bad days leaves rambling, incoherent messages on my answering machine at 3 a.m.: “I worry about losing a basic sense of competency,” he confided. “They give you what the law requires, but they can’t really give you that.”
“They,” in this case, are the case managers, doctors, administrators and others who work in the public behavioral health system. Good intentions, good program design and adequate funding notwithstanding, there is no system in the world that can give my friend what he truly needs, which is a deep and abiding connection with at least one other human being.
Only I can do that. Only you. Only each of us in our everyday lives, stopping long enough from ranting about changing the world to actually change it with one simple act of connection.
I do not discount the real deficiencies in our system of care for persons with serious mental illnesses. We can and will do better. But I do discount the critics who trash the system and then drive by someone with a mental illness who is homeless and out on the street, and never give it a thought.
It’s like the people who walk into the restroom in my office building and notice paper towels strewn about the floor. “What a bunch of pigs,” they say. “Someone should clean this up.” Then they walk out without lifting a finger themselves.
This is more than hiring case managers and putting them out on the streets with checklists and hand held computers to “pick up the towels” as it were. Better salaries would help, but the turnover and burnout rate will remain high because of the intensity of the emotional connections with SMI “clients” and the intractability of issues that defy orderly classification and run the gamut across physical and emotional health, housing, education, jobs, transportation and sociality.
As a friend of mine who paints houses for a living puts it, “You can’t mess around with it without getting some of it on you.” How true. Get enough of it on you, and you look for another line of work.
The idea that there is any one system of care that can attend to all the needs of this ìcarve-outî population is absurd on the face of it. High expectations are one thing, unrealistic expectations are another.
We might begin by acknowledging that reality and look for imaginative ways to connect the formal system of care with the informal networks of sociality and support that constitute the true strength and resilience of communities.
Think carve-in, not carve-out. Support more informal gathering places, lunch groups, recreational leagues, partnerships with churches and civic clubs, book clubs, outings, celebrations. These things go on all the time, but they donít always show up on the “accounts.”
I take my friend to a nice restaurant for lunch. He tells me it’s one of the high points of his day, and I believe him. It’s good for him, it’s good for me. I don’t get paid, and he doesn’t either. It’s not work, it’s just part of trying to fashion a life worth living for both of us.
Only connect. That’s all there is, all there ever was, and all that ever will be.
Feedback? Send it my way: Roger.Hughes@slhi.org.
*The Drift reflects the views of the author, and does not represent the official view of SLHI’s Board of Trustees and staff.