[at-l] Mental Illness, Homelessness, and Hiking

[Bror8588 at aol.com (Bror8588@aol.com)]

In a message dated 9/11/04 16:17:50 Eastern Daylight Time, 
stephensadams@hotmail.com writes:


> Let?s not forget, "The Great Communicator" reduced taxes by changing the 

> standards for access to mental health providers.  Former beneficiaries, and 
> people who would qualify under the former standards, are on the street now.  
> Many are unable to cope effectively within our society.  That's why they 
> received treatment.
> 

In a message dated 9/11/04 16:17:50 Eastern Daylight Time, 
stephensadams@hotmail.com writes:



> Let?s not forget, "The Great Communicator" reduced taxes by changing the 

> standards for access to mental health providers.  Former beneficiaries, and 
> people who would qualify under the former standards, are on the street now.  
> Many are unable to cope effectively within our society.  That's why they 
> received treatment.
> 



You may or may not know that then modern medication made it possible for 
patients to reside in their communities after spending 10-30 or more years within 
the walls of an institution that there was a universal move to release people 
back into their communities.  The Federal government directed that funds were 
to be used to reacclimatize the institutionalized to a deinstitutional way of 
life.  

Some states such as Connecticut set up an elaborate system to prepare and 
then support patients from State Hospitals to live normal lives.  Many patients 
were afraid to return to life on the "outside" and required a lot of careful 
management.  Visits over the course of a year or two from the hospitals to their 
home communities introduced them to what we take for granted.  Stores, Mall, 
Prices of items and necessities, modern clothing and modes of dress, and so 
much more, were learned.  Groups were formed in the hospitals to discuss 
discharge fears, as well as opportunities for living were addressed.  But the major 
factor in the success of the deinstitutionalization program was the assigning 
of Case Managers to each patient.  

The Case Manager assisted the patient in finding housing, financial benefits 
(Medicare and Medicaid, SSI or SSD, and Veteran's benefits), vocational 
training, day programs, psychiatric medication as well as physical health care, and 
anything else that they needed including socialization opportunities.  Many 
organizations were formed (attracted by the money that was allocated by the 
State and also by the opportunity to offer care to a needy population) to provide 
housing (group homes) and club services.  The case manager was the ombudsman 
and facilitator who offered various choices to the patient (now called 
consumer).  As the consumer of services offered by the State the formerly 
institutionalized grew into person capable of making choices.  Some grew capable quickly 
and others were slower.  No matter the pace the case manager remained on the 
job and eventually as a patient became stable there was a release to the private 
system.  In addition to the Case Management system there was a Crisis Service 
for those who were suicidal or in some cases homicidal.  

The Crisis Team evaluated those who were on public assistance, in hospitals 
as well as in their homes when called by family or neighbors.  At times the 
result of a home referral resulted in hospitalization to restore a medication 
regime or if needed a longer hospitalization to provide a time for new 
medications to be substituted for medication that was uncomfortable or just not working. 
 The Case Manager was called when their patients (consumers) were involved.  
Often the CM had information that was helpful in making an assessment.  The 
Crisis Team usually consisted of a Mental Health worker, a Registered Nurse, a 
Psychologist, and a Psychiatrist.  Usually two of the team would make the visit 
and then if medication or hospitalization was deemed necessary the 
psychiatrist would write or authorize the order to provide the care necessary.

Other States (such as NY) just dumped the patients into their communities and 
allocated the funds from the Federal government to the local communities, 
which in many cases merely used the funds to aid their police departments or 
municipal hospitals.  This did not work and caused many, who did not follow 
through with their medication needs, to deteriorate and lose any gains they may have 
made.  Many became homeless when their families became unable to care for 
them, or in the case of those who did not have immediate family, to become 
homeless.  They received their SSI money (somewhere in the neighborhood of $700 per 
month) and resorted to begging on the streets.  Some took menial jobs where 
they subsisted on minimal (off the books) jobs.  Often consumers or patients 
fell victim to predators (there are always some who will victimize the weak).  
Fortunately NY State has changed (brought on my public pressure) and now 
provides case management services.  The Homeless Services addresses Mental Health as 
well as other needs of those who utilize the Shelter services.  

Even the best managed services has individuals who "drop out" and become 
homeless and fall into the Correctional institutions (read: jails and prisons).  
My job was to advocate for those who were mentally ill and attempt to catch 
them before they were sent to jail (for misdemeanors) and refer them to a care 
institution.  If the mentally ill person committed a felony then there is a 
whole system within the correctional system which provides psychiatric services 
and then upon release (in Connecticut anyway) the person is referred to the 
Department of Mental Health and Addiction Services.  Again, prior to release, the 
patient is visited and services are offered in a series of visits and then 
upon release the patient is met and introductions are made.  Often the first 
place the releasee is housed is in a shelter and then applications (always begun 
when in prison) are processed for stable housing arrangements.  

Some patients (very small percentage) go hiking.  They can live in the woods 
cheaply and have their monthly income, available through direct deposit, as a 
resource for food, shelter, and other needs.  I remember one consumer who used 
to walk to NYC from Stamford, CT on a regular basis.  Now, I consider that 
"Long Distance Hiking."  I can't remember if he ever took his walking therapy 
out to the wilderness areas.  Some prefer roads and towns.  

Most of those who are mentally ill can function quite well with modern 
medications.  The asylums for the insane are a thing of the past.  Of course, there 
are those who do not respond to medication and there is a need for hospitals 
that treat mental illness to exist.  Many who have mental illness are subject 
to pressures of society.  Work situations often exacerbate problems that others 
can deal with in a positive way or ignore and go on with their lives.  
Parental pressure can trigger the buttons that when pressed throw the mentally ill 
into dangerous zones.  Weather, stories of heroes being killed, the sadness of 
war, breakup with a boyfriend or girlfriend, poor nutrition, the sight of 
police, newspaper stories regarding automobile accidents, and all of those things 
that everyone reacts to in the news, can trigger an episode that can result in 
a need for additional medication, or a stay in a hospital, until issues can 
be discussed, and medication adjusted.  This is why in day programs (which 
provide a type of structure) there is usually a current events group that allows 
issues to surface in the presence of others who can mitigate the severity of 
news that disturbs.  Often patients and consumers help each other better than 
the professionals involvement.  When asked what aspect of the day program was 
most beneficial one patient replied, "I like the coffee breaks."  When asked why 
he replied that the conversations with others experiencing similar influences 
allowed him to realize that his feelings were OK and not out of line.  I 
think this is analogous to the Shelter gatherings on the AT -- the hike is long 
and difficult but the shelters (or camping with friends between shelters) -- 
allow some venting and assurance that the pain and the experiences are "normal" 
and no one is alone in their pain or exultation.
In society, Bars or Coffee Shops offer the same opportunity to talk.  It is a 
universal remedy to the stresses of daily life.

Anyway, people are people, and we are all in the same predicament: Life!  
Some have chemical imbalances and others have emotional imbalances.  Medication 
can help some and not others.  Alcohol or other substances helps some and not 
others.  And, human contact can help some (most) but sometimes it is good to be 
alone.  Each has to figure what works for themselves.

Skylander