We got the call back in the counseling center from "up front" where social workers and other staff served homeless people walking in off the street. They wanted an intern to deal with a "situation" that they couldn't handle. I was the one intern without a scheduled client, so I treked to the front of the facility, a homeless shelter, medical clinic, counseling center & food service center that helped 300-500 homeless people a day. It was a big facility and winding my way through passageways and corridors, I arrived up front about 5 minutes later.
A social worker showed me my task. A disheveled man*, partially unclothed and damp was requesting a shower. He was not taking no for an answer and kept entering the shower room partially clothed. The staff was frantic because he was becoming agitated and disrupting the facility.
I was introduced to this gentleman who explained that he was an Army Ranger and he needed to "hit the showers" prior to being sent to his "next assignment." This made it immediately clear that he was delusional.
So, I introduced myself as the Commander of the facility, or some such high ranking military official. I can't remember exactly what but I do remember that I made sure to outrank him. I have exactly zero military training but my step-dad is a former Marine, so I had enough to get by. I told the pilot "Permission denied" to his request to take a shower. I then told him to "stand down." He went into the "parade rest" posture. At this point, I had maxed out my military jargon and asked him his name, rank and family information. We used this information to contact his wife.
His wife told us that he had been in the military but was discharged for mental health reasons. He had just been released from psychiatric hospitalization, which had done little to improve his psychotic episode. She couldn't allow him back home because his illness was so severe. She requested that we attempt to get him re-admitted to the hospital.
At the time, despite my training, I was a little surprised that his wife was not willing to do more. Now I totally get it. Having completed my training and worked in private practice for 11 years I get it. I get it even more now that I have family members with severe mental illness.
We assume that when someone is psychotic or severely depressed or otherwise severely mentally ill that they enter a psychiatric hospital, receive treatment and discharged when their symptoms abate. This is not the case.
Getting into a psychiatric facility is a crapshoot at best. First, it is dependant on the availability of beds. If everything is full, it doesn't matter how ill you are, you won't be admitted. You may be shipped to another facility with space available hours from home. Once you get there, if that facility doesn't think you meet the criteria for hospitalization, they will not admit you, leaving you stranded in a strange place with a severe mental illness. Furthermore, even if a bed is available, you have to meet stringent criteria.
The criteria are as follows: you have to be in imminent danger of harming yourself, harming others or gravely disabled. If I have a client who tells me they plan to kill themselves immediately after their appointment, I am obligated to intervene. My job is to get them to the hospital. Once they are at the hospital if they then state that they are no longer suicidal they are released. Same goes for homicidal individuals. You'd think that being psychotic would make someone a shoe in for hospitalization, but it doesn't. If a person with psychosis is eating and basically minding their own business they won't meet the criteria for hospitalization.
Once you are admitted, the length of your stay is often determined by insurance benefits, regardless of your symptoms. If you have "good" insurance that will pay for you to stay as long as the hospital recommends, the hospital still has to discharge you once you no longer meet the criteria for treatment. This may or may not involve actual improvement. I've seen cases where the individual was discharged from a psychiatric hospitalization with negligible improvement.
All that is to say that it is very hard to get adequate treatment for the mentally ill. This is why an actively delusional man was discharged from the hospital and sent to the homeless shelter.
This leaves family members with very little resources and few options to help their loved ones. Depending on the type and severity of the illness, family members may not be able to meaningfully intervene, such as the case with the former military man.
Having a mental illness can be like drowning. The symptoms are overwhelming and debilitating. People with untreated severe mental illnesses can't maintain activities of daily living, meaningful relationships or employment. Likewise, the toll of caring for someone with a severe mental illness is akin to drowning. Some symptoms, such as suicidality or hallucinations are terrifying, sometimes even to trained professionals. Other symptoms such as tangential and confused speech that can accompany manic episodes or Schizophrenia are exhausting. It is overwhelming and very common to feel completely helpless. It is common to have no options available help your loved one.
It may seem cruel but as with drowning, you can't go down with the victim. You do all you can to help get the victim to shore so long as you are not in danger of drowning as well. If you are strong swimmer, you can attempt to tow them to shore. If not, then you throw a life preserver or stretch your hand out from solid ground or find some other option that does not also endanger yourself.
The lines are less clear cut when we are attempting to save someone from "drowning" in a mental illness. Sometimes they don't even know that they are in need of rescue. At what point in attempting to provide care do you determine that you are "drowning" as well? I think that answer is different for each person. It depends on each person's resources, psychological functioning and daily stresses. However, if you are not able to provide your own self-care or you are working harder than the individual with a mental illness chances are good that you are going under. Checking with a therapist or another trained professional can help you determine what when you are not swimming well. Therapy can also help you learn how to set boundaries, learn new coping strategies and handle stressful situations better.
Because when you are drowning you cannot rescue another drowning person no matter how much you want to or how much you love them.
*As always, I do not disclose identifying information or any information that could reasonably lead to identification of any individual. Any examples of specific individuals are fictional compilations.
I have also chosen the color of this new flooring based on our dirt. This is more of a dark brown shade due to tracking dried pine needles and bits of mud. I've already replaced the flooring in two bathrooms with this color scheme. Let me just say that this does an excellent job of disguising debris. Even the St. Bernard hair. Her white hair is kind of translucent, so until there is so much on the floor that it starts to clump, it works excellently!
