Institutions Don’t Help The Mentally Ill
There is no fundamental problem with hospitals and institutions, but instead a complicated and interrelated web of failings.
I was in the Petco wrapping up my purchase of cat supplies with my mother who had come to visit from out of town. We were heading over to the machine to inscribe the name “JELLO” and a phone number on the tag when I got the call. Jello, the little tortoiseshell cat that I’d been approved to adopt and take home the next day, who had spent seven years in a hoarder’s home and now could finally come home with me, was “very sick” and might well die. My world, already chaotic from a sudden move from the Atlanta area to Washington, D.C., a new job, and rats in my ancient apartment building, shattered.
A few days later, my mother went home to Georgia.
I fell into a major depression, as I had many times before in my life — I have a history of such episodes — but this time was the worst yet. I was already frayed by the move, the rats, and adjusting to a full-time job. I began thinking about all the knives in the kitchen — frequently — and burst into tears every time I looked at the corner with all the stuff that was supposed to be Jello’s.
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I biked to the cat shelter to visit her, but I wasn’t allowed to because they didn’t know what she had. On the way home, I almost biked into traffic. I had a complete breakdown at work the next week, sobbing into the phone to a friend that nothing was working and there was no one to help me be safe — my friends thought I might die.
My workplace helped me hail a cab to take me to a hospital.
The cab took me to George Washington University Hospital’s ER, where I waited for some time to be admitted to the ER. Finally, upon being processed, they handed me a new outfit. The gown was too big and paper thin. Even amid mental agony, I worried about it slipping down my shoulders. The emergency room was too bright and blurry through my tears. I was asked to tell my story over and over again — I muttered my misery to two psychiatrists, two nurses, a host of medical students at the university hospital, and finally, a social worker. None of them seemed to coordinate with each other. The nurses drew blood and did other tests. I was crying off and on; I didn’t have my headphones. It was loud and confusing. I wanted to die even more now that I was here and couldn’t go back. The social worker complimented me on the butterflies I had drawn on myself using my highlighter and ballpoint pen instead of stabbing myself with the pen.
Police officers and EMTs bustled about, occasionally bringing someone in. One of them appeared to be a homeless man. The police went through his belongings and pulled out discharge papers from his recent visit to the same hospital; they sneered and laughed. I grew paranoid that my story was making people laugh.
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I wrote down people’s phone numbers on the sheet of paper they gave me, and clung to it like a lifeline before they took my phone.
They whisked me in a wheelchair up to the sixth floor after hours of waiting. The ward doors read “FLIGHT RISK — KEEP DOORS LOCKED.” The nurse deposited me on the ward, where another nurse with a computer asked, “Is this your first time in the system?”
I cried. They handed me a cup of water, my usual medication, and two additional ones — an anti-anxiety medication and a sleep aid, both to make me stop bawling. I felt I was part of a machine that processed patients and spit them back out; some experienced resultant trauma from the stay, while others bore shattered self-esteem and dignity. Very few “recovered.”
I slept most of the next day.
One of the therapists really wanted me to go to groups, where patients participated in staff-led activities. I found them boring and unhelpful. Most patients seemed to go only to pass the time. My psychiatrist saw me for a total of 30 minutes in three days and four nights.
I watched as another patient laid down on the floor — they picked him up, medicated him, and made awful noises of pity. “Poor thing,” I heard them say, “we just found him lying there in the day room.” I met with a therapist sometimes — who liked to talk about my caffeine intake and my trouble sleeping.
My roommate had kids. She liked watching the sun set in the sky out the window, over a bustling city as busy and bright as the emergency room, a city that we watched from the inside.
My psychiatrist saw me for a total of 30 minutes in three days and four nights.
Breakfast was at a scheduled time. So was lunch. So was dinner. They took the phones away during group sessions, presumably to encourage us to go to groups. There were only two phones. I spent most of my time calling friends. I am not sure others were so lucky. Doors to your room got opened by nurses every 10 or 15 minutes.
It was very clear who was and was not a person, and who had control. We were flight risks in skid-proof socks and scrubs; not people, but DSM labels.
They called me “vibrant and passionate” when I got frustrated at one of their mental health resource recommendations — the group in question supported a rights-restricting bill, H.R. 2646, the “Helping Families in Mental Health Crisis Act.” This bill has recently passed out of committee and is on the House floor, poised to cut funding for the Substance Abuse and Mental Health Services Administration (SAMSHA) housing programs.
It would also increase institutionalization and forced treatment through court systems, with states given a financial incentive to do so. Disability rights groups and LGBTQ+ groups alike have condemned the bill. The psychiatrist told me later that he at least agreed the bill needed significant revision.
Eventually they discharged me with referrals. I had simply waited until I felt less like wanting to die to push for leaving. Nothing they had done had helped with that.
I still have echoes of being an unperson.
There is an urge to repeat the not-so-distant past that is in living memory, a perfect storm aimed at people with mental illness: the resurgence of state mental institutions. This damaging momentum comes in all kinds of forms, from University of Pennsylvania ethicists to psychiatrists in the New York Times. The Times even recently published a “A Room for Debate” debating whether we needed “asylums” again for the mentally ill — without having a single person with mental illness write for it.
There is no fundamental problem with hospitals and institutions, but instead a complicated and interrelated web of failings. They’re not comfortable enough, the staff do not treat patients as people; these entities exercise total control and ultimately become custodial, often trapping people in a cycle of neglect or mismanagement for their entire lives. They are a dumping ground for America’s unwanted; the abuse within hospital and institution walls was and is rampant. (Read “Behind Locked Doors — Institutional Sexual Abuse” by Maureen Crossmaker for more chilling insights into this phenomenon.)
Is there a set of serious problems facing American people with mental illness? Yes. But the solution is not more beds in psych wards. The solution is not more “asylums.” The solution is not H.R. 2646, which would limit what little community funding there is and strip protections and rights for the purpose of easily forcing treatment and institutionalization.
The solution is to fight to deliver the funding for community living promised in the Kennedy administration that never came — particularly in the wake of President Kennedy’s assassination. The solution is funding peer-respite centers, 24-hour drop-in centers, and community-based programs such as Substance Abuse and Mental Health Services Administration (SAMSHA) housing programs (and restructure those to provide more immediate assistance), and to provide support of our choosing if needed.
Funding is an ongoing concern — and tangible hurdle — but according to research by Disability Rights Washington, funding would stem from freed resources from the closure of state institutions; legislation could be fought for to allocate this funding toward peer resources and SAMSHA.
Ultimately, the solution is both simple and humane: Treat the mentally ill as people with agency, allowing us to direct our services, even if we need supports to do that. The solution is not to rip us away from everything we know when things go badly, but to surround us with community and the people we care for most.
All illustrations: Flickr/Josep Novellas