Observations on Mental Health Services
An
email chain discussion...
Hi All,
I wanted to share this with you. My son is in a IMD (institute for mental
disease) called Creekside. I know some of you have heard of it. They say it is
one of the better in Northern California. He has been there 18 months and in
that time he had one roommate, Tom. Tom is older, my guess is 40s but one of the
most friendly, easy going people I have met there, my guess is that he has
schizophrenia, sometimes he seemed quite psychotic and uable to have a
conversation.
While my son has been at Creekside I have been paying for a therapist to come in
and work with my son (my insurance pays for some of it), she is a speech and
communications pathologist who works with autism. She has made all the
difference for my son. Anyways, she is not familiar with the mentally ill or the
system but these last few months she has been telling me some interesting
insights from her therapy viewpoint. This is one email she recently sent me. Tom
was very happy to leave Creekside and go to a group home, that had 8 other
residents 1 month ago. He is back at Creekside. This therapist and I have been
talking about this idea of rehab, which is what Creekside (7th Ave. too) is
supposed to be. She is very baffled as to what is the rehab part of it, coming
from a therapist point of view. This is what my son's therapist had to say.
Remember she works the autistic children and working with my son was a very new
thing for her, in a IMD with an adult!
"It was funny I overheard the person who brought Tom back say that "Tom sure
loves Creekside" - you know if people go from Creekside - which is very
sheltered (for lack of a better word) to almost no support - and a lot of
freedom in a group home that seems to me like a very big step - of course people
are going to end up right back where they started - I guess that is where the
rehab element is missing - other than managing through meds what else is
happening? I have a behavior background - I tend to look at the "why" for
behaviors - why do these people end up here in the first place - if they only
bandaide the problem the bandaide is going to fall off. Just like the buddy pass
thing - they think he should go on them but has any one stopped to figure out
why he doesn't - and then approach it from that end. I know there aren't answers
to why for some of these things but I bet there are enough that could be
answered and addressed to make independence more successful for some of these
folks."
- D
Hi D,
I think that the focus on therapy is lost when the programs are designed and
staffed by psychiatrists whose training and focus has been that all of this is
JUST a biological disorder and can be treated with meds. Of course, there may be
a biological element, but these are mental disorders, and it seems that the
importance of psychology, therapy, coaching and rehab have been drowned out by
the hope that all can be fixed with a pill. Your son's therapist is right, lets
hope that more get her insight.
- Doug
There are many interesting issues in what the speech therapist and you all
are saying. Where a client wants to live and where he/she feels safe should be
directed by the client. I remember one year when our county had a campaign to
get long term residents out of Front St. Board and Care. Front St was their
home. Sure enough, like Tom in your example, the residents had a big time crisis
unnecessarily until they got put back where they wanted to be in the first
place.
Some consumers want to live in an independent apartment. I went to a client's
Open House party which was a disaster. She had new furniture and had bought
lots, too much, food at Costco. But she had not bought sponges for the kitchen,
or paper towels for spills on her floor, and did not put any towels out in the
bathroom. Now how was she supposed to know to do these things? She had gone in
her early days from home to institution. She had never been through that period
of having your first apartment and botching it royally and doing it over and
over until you get it right. The whole term Re-Habilitate is unfortunately
chosen. It's fine for stroke victims or someone injured on the job. Even if we
were going to use that model as it is used in general health care, a rehab
specialist would ask the patient what he/she needed to be able to do to live
independently again. The answers might be get to the bathroom, keep house
straight, keep meds straight, get food, operate an answering machine, have
emergency numbers to call, have a good radio to block out voices. Real concrete
things that could be tackled one by one. Symptom management and swallowing pills
is not all there is to life. Dr. Adams hired occupational therapists to help
with some of these issues, but the county didn't let them do the work they were
trained to do.
I am convinced that in the case of schizophrenia, that speech patterns,
recognizing figure from ground in sound patterns, being aware of social
linguistic practices is a vital key to functioning better. The rules that most
of society take for granted are missing. Such as telling someone when you have
finished a task, are leaving the room or the house. How to make small talk.
Social rules for interfacing with genders. What is appropriate to say to a
neighbor and what is not. And the big one: how to keep mental associations to
words in your mind and out of your speech practices so others can understand
what you are trying to communicate.
There is some saying: If you only have a hammer, then everything looks like a
nail.
Bonnie
