I’ve been sitting on this for several days trying to think of what to say. Ultimately, what comes across in the beautifully written article is how completely, tragically unresolved it all is. Personally for Deeds. By extension for everyone else that has felt the isolation and suffering of loving someone with mental illness.
A few months before I began nursing school I was working for a non-profit doing case management for young adults. My co-worker and I split up the less desirable community functions, so that week he took the career fair at the local high school and I took the meeting with the director of the locality’s CSB (community service board) at the social services office.
Virgnia’s CSBs are tasked with providing a locality (usually a few counties) all legally mandated mental health, intellectual disability, and drug and alcohol recovery resources. They evolved in response to the deinstitutionalization movement that took place between the late 1950s and the 1980s (that is a doctoral thesis in itself, but check pg 1 of this report for a quick overview). Among many other functions, CSBs are the people that you must go through to have an person evaluated for commitment to a pysch facility against their will. They are legally responsible for providing a wide array of services to a vast and growing population, and they are so so desperately underfunded. At Rockbridge Area Community Services psych staff includes an RN, LPN, case manager, 2 psychiatrists, and 2 “telepsychiatrists.” Although not listed on their site, in my experience the professional staff are often part-time and more or less donating their services in addition to maintaining practices of their own. This skeleton crew is required to cover heartbreakingly vulnerable people 24/7. What about private providers? I’m a rural county, and so is Bath. Here at home we have zero mental health providers. In our neighboring country there are 2. There is no financial incentive to practice here.
Back to my story. On time for once, I sat in a small conference room with 10 or so social workers, free clinic volunteers, non-profit people, a few teachers. The standard frumpy, knitted brow people that give their lives to others for peanuts and are a little peeved about it. The CSB directer started his PowerPoint. People. Kept. Coming. More chairs were pulled in and the corners filled up with awkward standers. The PowerPoint went off the rails. It was 150 degrees in there. Voices were raised. “The wait list is 6 months long! I can’t let my erratic off-her-meds client be the caregiver to small children. What am I supposed to do!” His advice: go to the ER with a credible suicide threat and we can bump her to the top of the list. She’ll get seen in a week. The sheriff added, “Several times a week all my deputies are stuck in the ER for hours with a person who has threatened themselves or someone else. You come to the hospital and give us the order to detain them (Emergency Custody Order) and we spend hours driving the person to the closest in-patient psych unit if a bed can be found at all. I can’t afford that!” The “ECO” is time limited. For Gus Deeds time ran out before a facility could be located.
The meeting was an hour over time. The CSB director was pulling out his few remaining hairs. When all was said and done every single person in that room had a story about themselves or a loved one failing to get access to mental health services. I went home and ate a refrigerator of feelings.
How can we all have such intimate experience with the burden of mental illness and feel so ashamed to bring it up publicly? Schizoaffective disorder affects 1 in 100 people in the US. Bipolar is more than twice that. Let’s run some 5ks for goodness sake.