These “Featured Article” pages will feature articles that have come across my desk. This will be like an internet magazine of articles that interest me (and may or may not interest you).
This article is by a person with a mental health diagnoses that has been a patient and care giver in the Mental Health System
In recent years, Milwaukee County has changed the title of its mental health facility from the Milwaukee County Mental Health Complex to the Behavioral Health Division (BHD). The facility has been under fire for many years due to its inadequate level of care, and documented assaults and deaths of patients on the premises. Yet it is the only facility available for the indigent; those in trouble with the law; and patients who are a danger to themselves or others yet refusing care. Today in addition, our county jail houses more mentally ill persons than the BHD and all other hospitals combined.
I would like to discuss in this writing the vulnerability of our mental health patients and the importance of radical changes to our system of mental health care today by giving examples of failed approaches in the behavioral model used by County BHD. Behavioral medicine is a byword these days for the treatment of mental health issues. This approach can have benefits with new techniques of cognitive therapies and a focus in some circles on proactive and preventative care. However when behavioral health is interpreted narrowly as simply changing the behavior of an individual, it becomes a misnomer which can lead to grave abuses of the human person. “Treatments” that use reward and punishment may well change the behavior of a patient with mental illness but in no way benefit that individual or society at large. I will give three examples. These are mostly not new methods but two of them are used extensively to this day.
Patients at the Mental Health Complex in the 1980’s for example were issued cigarettes “from the desk” on an hourly basis for “good behavior”. These cigarettes were purchased, not by the patients, but supplied by the facility. I had the experience while being housed there at the age of 20 of a nurse placing a lit cigarette between my fingers though I had never smoked in my life. The temporary ‘gain’ of calmer patients has huge ramifications on their physical, mental and social health. This is a simple example of ‘reward and punishment’ but I think the negative consequences are obvious.
The second technique used at the MCMHC and BHD that is still often used at the facility is that of physical restraints. Theoretically, if a patient is ‘out of control’, a “Code One” is called. A large group of staff then gathers around the individual and proceeds to ‘walk him/her in’, or forcibly bring them into the ‘Quiet Room’. From the beginning the situation for the patient is very coonfrontational and it only gets uglier. In the quiet room the patient is forced to lie down on a mattress while the staff quickly restrains each wrist and ankle with large thick leather straps to each corner of the mat. If the patient is forced to lie on their stomach a larger strap is secured across the back as well. Matter of fact then one or more medications is administered to the restrained person by way of injections in the buttocks or legs. Most often there is no explanation to the patient as to what drugs are administered. The staff exits and closed the heavy door of the near sound proof room. Staff will occasionally peer through the small window in the door to chick on the patient’s condition. The patient is left in a barren room on a matt with no ability to move and no human contact: near total sensory deprivation. Sometime the administered drugs can cause a creeping sensation in the body which can be agonizing. I had the experience of being restrained for 2–3 days during one hospitalization. When I was released I could not walk without assistance. This practice is not reserved for patients acting violently- mostly I have seen it used on patients who are raising voices or acting erratically but harmlessly. I would attest that this practice doe’s extreme harm to the individual it is enacted upon and that it is nothing short of torture. I recently heard of the death of a person being held in restraints and overmedicated at the BHD. Conditions in our county jail are even worse. For a person compromised by neurological issues, intimidation isolation and restraints are the antithesis of care. I will readily admit that the environment and behaviors in mental hospitals can become chaotic but this type of cruel and tortuous response does not bode well for the individual or the broader community. It may change the behavior of the patient but in no way promotes well being or healing. The individual returns to the community with more fear, less trust, and a tendency to try to deal with their illness retroactively on their own rather than proactively seeking the help of others. Loners and people who isolate or are improperly violent or reactive have often been prior victims of such forms of treatment.
Would we treat a cancer patient thus? Or someone in the throes of a heart attack? This consists of untoward violence being directed at a vulnerable, medically challenged population. It reflects a disregard for the sanctity of the human person and needs to be abolished as immediately as possible, I once heard the quote that a society is only as civilized a s the manner in which it treats its’ most vulnerable members. The practice of restraining mental patients is barbaric and feeds the violence and fear in our larger society. From the first call for help, a person in the throes of mental illness is treated as a hostile element. First responders are usually police officers. The person, most often having caused no harm learns to fear police, mental health and social workers, doctors and even neighbors who may all be involved in an onslaught of physical mental and emotional violence toward their person. This all is being directed at a person suffering a medical condition. It sometimes end in the ‘quiet room’ but is only the beginning of lifelong suffering for the individual. We accept violence internationally and in our communities far too easily. Nonviolent approaches could be implemented but are ignored and we slide on a slippery slope: an environment of fear mistrust and hidden abuse.
The third issue with regard to mental health I’d like to discuss in this brief essay is the fairly recent and often used method of ‘medical restraint’. Given that stays are now shorter in hospital and patients are often not given the time to fully recover, medical restraints are applied to keep behavior under control while the patient is out in the community and trying to reassemble their lives. Medical restraints are often high doses of multiple medications which the patient is prescribed or court ordered to consume. It is not uncommon for two or three antipsychotics to be prescribed along with many other drugs in combination. As a catholic worker who has tried to assist those with mental health diagnoses, I see medical restraining as a poor answer to meeting the needs of these individuals. Being overmedicated is dangerous to the physical body and can lead to victimization in the broader community. Furthermore, I see persons being unnecessarily diagnosed, for example while incarcerated, and having to cope with many debilitating drugs-and who is profiting from this?
Techniques of self-care, stress relief and helpful personal interaction are healing methods for the long haul, but are not emphasized in the mental health field today. Such methods provide true healing as opposed to treatments which look for a change in behavior in the most cruel and unethical ways. With the current mental health system behavior may change but many lives are and will be lost.
Lastly I would like to appeal to the churches in this matter. So many times we recount in church of how Jesus approached and healed those sick and suffering from mental distress. The wish of many of these persons was to be ‘made clean’, not only in their personal health but in being reunited and accepted in their communities. I have to ask churches and communities: where are the programs and ministries that reflect this basic tenant of Jesus’ life work and example? I am not aware of a ministry in our immediate community that addresses specific concerns of those living with mental health diagnoses. These are persons who are not only marginalized but outcasts with regard to the basic relationships most of us benefit from. None of the major religions in our county promotes radical change in mental health care though all of them embrace the ‘golden rule’ of loving one’s neighbor. I could expound many writings on the sufferings of those caught in the mental health system, maybe words and dialogue could spark more action. But still I wonder, as an individual with a mental health diagnosis, where is the compassion and the faith that we are humans too?