I spent a year working in a residential treatment facility for people with chronic mental health problems. I’ve been wanting to write about my experiences there for some time but feel at a loss for what to say. I cared very deeply for our residents and never felt like there was enough that I could do for them. I didn’t have any real training for how to care for their illnesses- my position though advertised as social work mostly involved keeping the toilets clean and the washer and dryer running, and cleaning up after meals. We did have group therapy sessions that the aides would lead, but they were repetitive and weren’t therapy so much as a way to kill time. Working there taught me so many important lessons, though. It taught me about our society in a way that working at the homeless shelter didn’t and couldn’t, because at the shelter you could expect the guests to get on with their lives. You could assign them the responsibility to grow and change. The residents at the mental health facility, though, were helpless to control their own future. Some of them were helpless to control when they slept and woke or even their own bladders.
We had many residents who were schizophrenic. Some had severe personality and mood disorders. Some had “undifferentiated symptoms” that regardless of a firm diagnosis were sufficient to get them sent to a treatment facility. Some of them were judged a danger to themselves or others, so the state paid for them to live with us. All of them had routine meetings with their supervising doctor every few months for medication monitoring. The aides, like me, were in charge of taking down routine group notes and individual notes to monitor how the residents were doing, and reporting any suspicions about adverse reactions to medications or symptoms not responding to medications to the nurse who worked 9-5 or to the doctor, who was in the facility once every 4 weeks.
It’s important to understand that these people were heavily medicated, some taking as many as 25 pills a day, and they saw their doctor once a month for 15-20 minutes. We had residents who were hospitalized because of severe adverse reactions. We had one resident who had a medication discontinued because it lowered his white blood cell count to the point that it could kill him, he went nearly catatonic and had to be moved out of our facility. We had residents who had narcotic medications that they could request at will who would daily take as many as they were allowed. When the staff reported that there was a concern about addiction it was met with the equivalent of a shrug. “This person is mentally ill, at least they are more or less stable, what do you want?”
I don’t really even know what I’m trying to say. I admire all of my ex co-workers, I admire the company that I worked for and the job that they did. The working budget was constantly being cut. We never were fully staffed, and everyone worked overtime constantly. I worked 12-16 hour shifts every weekend and went to school all week, and constantly felt guilty that I couldn’t work more. We only had two aides on in the evenings and nights to care for 28 residents, and did the best that we could.
A lot of the residents were people who had lived in poverty for most of their lives. Most of them didn’t get into the mental health system until their symptoms were so severe that their lives were unsustainable. A few had accidents that left them with brain damage, so living with us was their only option. One has to wonder what their lives might have been like if there had been earlier interventions. For those with mood disorders that statistically respond well to talking therapy, there’s this question in the back of my mind of who they might have been if they’d been able to get that therapy. Was it inevitable that they would slowly implode to the point that their rights would be revoked, and they’d have to take pills every six hours for the rest of their lives just to stay stable enough to live in a facility where they would routinely act out just to get attention, and have the staff respond by upping their meds?
Meds which could kill them.
I want to say something really deep and powerful about the mental health field, about dependence on mind-altering medications, about poverty and mental health and the sick cycle it creates. I want to say something powerful about how ignored the mentally ill are. How reviled they sometimes are. How helpless they are.
All I can say is that the budgets keep getting cut, and the patients have nowhere to go.
28 patients taken care of by two overworked aides with insufficient training being paid only slightly above minimum wage, and a doctor with a case load that rivals Atlas’s. We like to call this fair country the land of opportunity. With hard work and dedication, anyone can get ahead.
And the budgets keep getting cut.