Publication Date: Wednesday, April 27, 2005
Guest Opinion: Seeking other options for those of us with mental illness
Guest Opinion: Seeking other options for those of us with mental illness
(April 27, 2005) by Barbara Yates Sonner
I read the recent Palo Alto Weekly column (Weekly, March 2) about losing a son to substance abuse and mental illness, and perhaps ultimately to the prison system, and was deeply moved.
I am a psychiatrist who does home visits to elderly patients for San Mateo County -- although the following represents my personal ideas and is not meant to represent those of the county.
Between that article and two recent events in my professional life I have found myself dwelling on the question, "How much should we intervene?" -- as a caregiver, as a family member or as a society -- to try to treat, support and protect those with mental illnesses and other impairments.
Earlier this month, for the first time in my almost 10 years of making home visits, I found an elderly patient of mine dead. I had been caring for her for a few months and did not know her very well. She was physically impaired but was managing to live independently in her own apartment.
She was off conservatorship and felt she did not have any mental illness, despite having spent much of the past few years in and out of the hospital and other institutions. The apartment manager also showed me pictures of how completely trashed her apartment would become prior to these hospitalizations.
In the patient's eyes, however, the problem was that the police would break into her apartment from time to time and hospitalize her against her will. When I found her that day, there were no signs of any trauma or struggle. It was determined she died of natural causes, but the first question to go through my mind was, "Could we have done anything different?"
If she had been in a more supervised setting, would earlier intervention have had any effect? When I spoke with past caregivers who had known her well, they expressed mixed sentiments, but also a strong sense of gratitude that she had been able to spend the last few months of her life living independently, as she had always wished.
Recently I attended two task force meetings for San Mateo County looking at how they can improve the mental health system with funds from the state Proposition 63 Mental Health Initiative funds, approved by voters last November. Several clients and family members told stories of their encounters with the mental health system.
I was especially impressed that some outpatient programs could find clients when they were in jail and perhaps be able to engage them effectively in recovery at that point. The Weekly column also mentioned the struggle of how much to intervene, from the point of view of a family member. The author spoke of the struggle of deciding NOT to be there for his son, realizing there were problems with always bailing someone out when they get into trouble due to their own poor choices.
He stated that "I wanted him in my life, not some zombie self. I grieved his choice." When I was at the task force meeting, clients shared one of their slogans about recovery, which was "A Life Worth Living." My patient who died was clearly seeking this option by choosing to live independently, and the author of the Weekly article was also clearly looking for this for his son.
I hope the March 2 story in the Weeklywill raise the awareness of others in the community. I hope the discussion of treatment for people with mental illness and substance abuse continues.
I belong to several organizations that are trying to decrease the stigma associated with mental illness. They print flyers and posters from time to time, but nothing can compare to the telling of a personal story or a personal connection.
I don't believe there is a definite answer to the question of how much a family member, health care provider or system of care should intervene to help an individual with mental illness.
But I do think there is value in all of us, as individuals, a community and a society, asking these questions, grappling with these issues and sharing our personal stories. I do not think jail and prison are the answer, and am troubled by the studies showing how many of our mentally ill patients end up being housed there.
I hope other options will be found and pursued as we work to transform the mental-health-care system in the coming years, a process that has started thanks to the passage of Proposition 63 and the promise of additional funding.
Barbara Yates Sonner is resides in Palo Alto resident with her husband and two young children and a psychiatrist who works for a San Mateo County mental-health outreach program which involves making house calls to elderly patients. She is a graduate of Stanford University and Harvard Medical School and did her psychiatric residency at Stanford. She can be e-mailed at bl.yates@sbcglobal.net.
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