Can we please stop all the crazy talk about mental health?

Can we please stop all the crazy talk about mental health?

I know mental illness.  I have had people tell me about the Queen of England's flying midgets, the Japanese Jerry Springer, and received complaints about one of my clients farting in Chinese.  I have heard folks complain that the car radio was talking directly to them—sometimes even announcing their name and threatening them with violence. People have told me characters on television speak to them directly and often in mean tones with demeaning messages.

“Blackie, one time Aunt Bee yelled at me  that she hated my guts and said I was dumber than Barney.” 

In short, I know about momentary—key word— off- angle episodes, odd talk, and peculiar thinking.  I also know the fear, the gentle nature, the awkward love, and the lonely existences that too many mentally ill people live. My blood boils each time one of our sacrificial mass shootings takes place and the scattergun like demonizing of those dealing with mental health challenges begins. I proudly stand up for my former client friends and beg for understanding. Could we please stop all the crazy, phony talk about mental health? 

Are you always certain of your own clear or unclear thinking? Have all of your decisions been thoughtful?  No impulsive errors? No self-made quandaries? No moments that cause you to blush and ask, “What was I thinking?” If you have lived a dilemma-free life without thinking errors then please reveal your secrets to the rest of us mere mortals.

Sinister acting by politicians who feign concern and their spurious calls for expanding mental health services after the latest mass murder episode is transparently demonic. Their normal actions have always displayed ignorance, neglect, and a stunning lack of compassion and concern toward those dealing with mental health challenges. It's all  part of the sick cycle of gun deaths and serves the purpose of diverting the real issue which we all know is our society's addiction to the availability of weapons of war.

“It has nothing to do with guns.  It was a solo crazy man.”

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This diversion helps us all too as it reassures us that only a crazed person would do such a horrid thing.  It could never be one of us, the sane ones, who accept 34 gun deaths per day and over 500,000 of those with mental challenges being locked away in our prisons as the price for a free society.  At this time, jails are this country's primary mental health institutions.  Hide those with mental challenges away from all of us  'normal' ones. Only mention them when they are needed to provide cover for the gun runners.  Some quick background. 

What could have been

What could have been

A month before he headed to Dallas in late

November of 1963 never to return, President John F. Kennedy, in what was to become his last public bill signing, signed into law an incredible piece of legislation that could have had a profound effect on all of society.  This three-billion dollar (1963!) bill had the blueprint for creating small, community-based mental health group homes and treatment centers all over the country.  JFK was sensitive to the issue as his sister had been lobotomized.

Tragically, the bullets fired at JFK not only ended the life of a young, vibrant president but also killed this bill as a mourning country became overwhelmed and distracted by grief and turmoil. No money was ever allocated for this remarkably wise and progressive plan that could have changed the world.  Hence, the program died like a still-born infant before it had the opportunity to take a single breath. 

Would that bill's design and principles have worked? To me, that is no longer an academic question.  The answer is a resounding series of shouts: “Yes! Yes! Yes!”  I have some proof. 

Please, hop in my old Subaru legacy—sorry about the noise, need a new muffler—and let's head over to the group home.  I want to introduce you to my guys.  You should probably roll down the window.

 I was lucky enough to work at a group home in a college town for over a full decade. This house was located in the middle of a modest, typical neighborhood.  It had no sign and looked like every other home nearby. It was the center for six full-time residents and four of them were on my weekly client list.  They had all qualified for my services as I had somehow became the region's main traveling, independent contractor dealing with their diagnosis— paranoid schizophrenia. 

Here we are. Let's flip back time, head in, and meet my guys.   There's big Tom, high IQ, mumbling George, college student Rickie, and Oscar, once a Seattle professional musician.   I visited and worked with these guys for thousands of hours from 2003-2015.   My services were cost effective as well as active, hopefully compassionate, and paid for by Medicaid.  The idea—a good one—is that mental challenges getting out of control and ending with a client being placed in a mental institution or sentenced to jail time after an episode of some sort, can be prevented.

It was a win-win-win situation as workers like myself used to get compensated for mostly pleasant, rewarding work, the third-world state of Idaho saved tons of money by paying someone like me rather than having to shell out the staggering costs of hospitalization or jail, the clients got to live and thrive in an unrestricted, cooperative environment, and their family members could rest assured that their sons or brothers were in a safe situation.  It worked.

I was basically a second set of eyes, a regular, predictable presence, a cognitive therapist, a teacher of life skills, and a friend.  I reminded them of medical appointments and transported the men to them,   helped them plan and shop for meals, monitored their sleep patterns, pointed out thinking errors, and took them out into the community as isolation was their default position and a serious danger.  The scorecard?  Two brief three-day stays—both caused by medication changes—in a mental health ward in over a decade total and no jail time for these four individuals. Such success had little to do with me as there are  thousands of people ready, willing, and capable of providing the little help these men in a safe group home setting needed to live an independent life. 

The basic problem is that prevention is hard to prove. Political conservatives constantly harp on government spending yet grow silent when presented with facts like these.  A six-month stay in a crowded mental institution could fund a traveling mental health worker for six years!  Mentally ill people are more likely to be a victim of crime than to be a perpetrator of a crime.  There is a big difference between sociopathic behavior and mental illness.  People presented with the challenges of mental illness often times can recover and learn to manage their disorder, especially if the disorder is identified early in the patient's life.

Here is a story that illustrates points about these wonderful brothers.  It is my attempt at moving from the abstract to the concrete for better understanding.

I had won a Texas High Hold 'Em poker tournament and decided to take my guys out to a local restaurant to share part of my bounty.   We ordered food, played pool, and listened to music on the new, fancy electronic juke box before heading back to the home.  As we pulled up so did a police car.  My first thought was one of minor paranoia. 

“Are they here for me?  Did I not pay a ticket or something?” I reviewed and dismissed the quick protection thoughts as invalid.  Instead, I walked toward the porch as my guys scattered from the car to the safety of the home.  I greeted the young cop. 

“Hey, officer.  I'm the case manager for most of the residents here.  Can I help?”

“Hi, sir.  I don't really know.  I got the strangest call.” The door flew up and there stood the only female resident Christie who spoke. 

“Come in officer.  I'm the one who called,” she said. 

The officer took off his cap and followed her in.  She flopped down at the kitchen table and began.

“It all started back in 1979 when . . .” 

 I smiled knowing this young cop was going to get an education and moved to the living room where my four guys were in various stages of beginning panic.

“Why the hell did you call the cops, Blackie?” George demanded.

“Oh, shit.  I knew I shouldn't have charged on that new credit card,” said big Tom as he slumped onto the couch. 

“I snuck a beer upstairs last night,” added Oscar who popped a smoke into his mouth.

“I always wondered if you were working with the cops,” said a suddenly suspicious Rickie. 

“No, no.  Everybody sit down for a second.  I didn't call the cops, Christie did.  He isn't here for any of you.

Be cool.”

“That's what you say,” said George and he disappeared into his bedroom.  I caught him sneaking toward the back door a few winks later.  He was holding something under his shirt. 

“George, what are you doing?”

“Ssh. . . he responded as he opened the door, raced down the steps, and into the garage.  I followed and flicked up his shirt to reveal his hidden collection of nudie magazines.

Now, don't misinterpret my amusement as mocking my guys.  I would never do that but I snickered at the things they would say and do as the workings of their minds simply fascinated me.  I had the same quick thought of paranoia but was able to let the thoughts vanish without getting concerned.  These guys took the same thinking and exaggerated it.  They sensed danger and imagined all kinds of possible, negative plots.  And their terror was as real as falling snow. 

This story is an example of the difference of a 'normal' response when everything that happens is quickly evaluated in micro-seconds for possible danger.  Their particular fear centers in their brains are more elevated and when activated, harder to switch off.  This exaggeration tendency is not limited to fear.  Imagine the time when you felt really lonely.  Now, expand it by ten times the intensity.  Ever felt disrespected?  Ever been falsely accused or misunderstood?  Troubling feelings are multiplied.  Understanding and acknowledging this magnification is a good step to building empathy and compassion.

The vast majority of time, these four guys lived their modest lives with little drama.  They took turns cooking, went shopping, took walks, and did their chores like cleaning the house and doing the yard work. A housemother came over a few times a week to check on them.  They were fully integrated into the community.  Here are the descriptions I used when trying to help keep the group home open.

Big Tom,48, walks the four miles to work at Taco Bell three times a week.  He has been at the home for 12 successful years after multiple stays in alcohol treatment centers, mental wards, and was once jailed for shoplifting food years ago.

Rickie,27, got his first B after three years of straight A's his senior year at the college, records electronic music, is active in political causes, and makes films.  He has been at the home for three years following a long, court-ordered stay in a mental hospital as he learned to accept and then deal with his signs and symptoms of schizophrenia.

Oscar,52, plays his music downstairs.  He was once a gifted guitar player and singer good enough to draw crowds in the Seattle area until one rainy night.  After a gig, he crashed his Harley and woke up severely injured to be informed that his wife—riding on the back— had been killed in the accident.  He immediately tried to take his own life and was involuntarily committed to a mental institution where he stayed for years.  He coped by learning the lyrics to thousands of songs and playing his music. He rarely speaks and communicates with only a select few.  Health problems caused him to move into town from his remote cabin.  He is a gentle, loving, private guy.     George likes to read the Smithsonian magazine while chain smoking and gulping cold coffee.  He loves to joke and go out in the community.  Prior to the  group home, he had lived in an Oregon mental institution for five straight years.  He was released, hitchhiked to Seattle in search of his mother and was  discovered by police confused, eating leaves, and mumbling incoherently after going off his psychotropic meds cold turkey.  His mother rescued him and brought him to this college town with her.  When I met him he was almost totally non-verbal and appeared to be a man with a low IQ.  Wrong!  Played chess with him and he used a classic Sicilian defense, he can repeat entire dialogue scenes from movies, and was always in gifted programs before the befuddling disorder took over in his late teens.

My four friends are viewed as throw-away people by society.  In fact, they were locked and hidden away at one point, all of them. They are no threat to anyone.  Yes, this is anecdotal evidence but to me, it shows that small group homes supervised by a community board and properly funded can be miracle centers.

If anyone is serious about expanding mental health services then I have a way to save us all a bunch of work.  Simply, get out the 1963 bill, pass it, and fund it. Mental health is not a single thing.  It is an umbrella phrase that covers numerous serious social issues.  If one is earnest about caring for those with mental health challenges then buckle up.  We need to deal with domestic violence, with traumatized young children, with families who have a long legacy of dysfunction, with addiction, homelessness, suicide prevention, and with the criminal justice system.  But there is also a worldview or philosophy that inhibits any real mental health care reform. 

Too many religious folks do not believe that mental illness is even real.  They suggest that the problems are simply a lack of faith.

I fought for years against Republicans who were opposed to granting mental health parity in our health care to those with mental health challenges. The most notable of these anti-mental health voices was none other than one John McCain.  He was one of the biggest advocates for the insurance companies' efforts to fight against mental health parity starting in with his 1996 vote against the first bill on this issue passed in Congress.  Even Bush ended up supporting parity and set up a commission to take on the issue in 2002 while McCain kept up his fight to defeat all efforts at changing this discriminatory practice and carried the water for the insurance companies.  I heard these type of things from those who shared McCain's view:

  • “seems like everyone is bi-polar, depressed, or schizophrenic nowadays.”
  • “How can a supposed mental illness be on par witha broken leg?”
  • “It is mostly a matter of personal discipline or lack of discipline.”

It took President Barack Obama to finally make mental health parity a reality when the ACA was passed.

We have our national strategy in place. We throw the mentally ill into prisons where they are not treated but tortured. (Imagine the magnification in that environment.)  They are out of immediate sight which accomplishes the goal.  There is no chance with Republicans in control that anything as radical and needed like mental health care expansion or reform will be suggested let alone seriously debated.

Those who advocate for the mentally ill are a small and lonely bunch.  Ever heard of a bake sale or walk-athon for schizophrenia?  From the National Alliance on Mental Illness (NAMI) site:

“For perspective, consider that for every one American with muscular dystrophy, there are sixty with schizophrenia.  For every person with diabetes, there are six with schizophrenia.  For every one with MS, there are five with schizophrenia.  For every one with Alzheimer's there are two schizophrenics feeling very, very, left out of the medical research funding aspect of things.  For an HIV perspective, consider that there are 800,000 living with this disease in America, earning a total of 1.792 billion in annual research funding.  Yet there are more than three times as many with schizophrenia ( 2.6 million in the United States) getting a scant 196 million in medical research annually.” 

Hence, vomiting out disingenuous calls for expanding mental health care services is crazy talk which fits the definition of not being reality based.  We know what to do but refuse to do it.  Want reform?  Let's start with this ending list:

  • Quit locking up the mentally ill instead of treating them
  • Increase research funding
  • Set up the Kennedy-era proposed network of small community-based group homes and treatment centers
  • Hire thousands of traveling mental health workers to assist people and keep them living independently or with a bit of caring, active community support.
  • Provide adequate respite care for those families who attempt to keep those family members with mental health challenges in the home
  • Take on self-medication
  • Educate the public so the cruel stigma of feeling inferior or different because of a mental health challenge can be forever extinguished.

I so loved these guys.  When I lost my Brenda to a quick battle with brain cancer several years ago, I took a few days off.  When I returned to my schedule, Oscar got out his guitar and sang a Don Henley tune to me.

I'm learning to live without you now
But I miss you sometimes
The more I know, the less I understand
All the things I thought I knew, I'm learning again
I've been trying to get down to the Heart of the Matter
But my will gets weak
And my thoughts seem to scatter

He finished and looked up.  “That was for your Brenda.” 

The last time I saw him was after the Sandy Hook murders.  For months he had saved up  money to get a small TV to use in his room.  I went up one day and noticed the TV unplugged and put on a shelf. 

“What happened to the TV, Oscar?”

“I can't watch it.  They keep talking about mental illness. I would never hurt a child!  Blackie, I've never even thought about killing anyone, other than myself.” He moved back to his remote mountain cabin a few weeks after the announcement that the group home was closing.  He died last year.

George has developed a serious kidney disease and needs 24-hour care.  He is in a nursing home in the Seattle area now, the last I heard.

Tom seems to be doing okay in the motel that rents out a couple of rooms by the month in town.  I bought him breakfast in December.  He thinks he is the reason the group home closed.

Richie got out of prison the other day.  I saw him wandering the streets and he told me he had gotten messed up with meth and is going to daily meetings to try and stay straight.  We had lunch in February.  The state has cut the program that funded the services I once provided to the bare bones. The house sits vacant and the once neat lawn is now a patch of weeds.  There are no available beds in the entire region now.  There have been proposals debated in the state legislature about turning the entire mental health program and services over to faith-based organizations.  Yeah, pray those auditory and visual hallucinations away!

I earned a good living providing services which means I was a bit of a mercenary not some hero. These four were my last clients before I retired.  I know this was a long article.  Hope it wasn't too tedious.  I could have written thousands more words on this important subject but I must go clean my guns to prepare for the inevitable waves of government troops in black helicopters that will be landing in my neighborhood.

If you are interested in learning more here is a list of references.

National Alliance on Mental Illness


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