The Great Divide: What do we need to keep in mind when faced with a mental health situation?
Seeking solutions for those suffering from mental illness and their families can, often, be a divisive choice
By Janice F. Booth
Imagine: You get a call in the middle of the night from your sister, a successful engineer living on the west coast. She’s practically incoherent, but you gather that she’s suffering from anxiety disorder and has been under the care of a psychiatric team. Now, in the middle of the night, thousands of miles away, she is having a complete breakdown. You must fly out and bring her home with you, leaving behind her career, her apartment, her life as an independent woman. What comes next for her—and for you? Hobson’s choice—help her, or don’t. “Take it or leave it; that’s the choice.” (This phrase is said to have originated with Thomas Hobson, 1544–1631, a livery stable owner in Cambridge, England, who offered customers the choice of either taking the horse in his stall nearest the door or taking none at all.)
Or, imagine this: Your neighbor and friend has recently retired. Together, you’re planning a cruise, as well as taking a long-postponed pottery course. Your plans collapse when your neighbor confides in you that his severely depressed grandson is being released from a substance abuse recovery program and will be living with him for a while. That neighbor faces Hobson’s choice too. He can turn away his grandson, or try to help him. “How do I get help for my grandson now? I can’t see him living on the street.” What do you say to your friend? What help is available?
These are just two possible scenarios faced by families dealing with mental illness. Once beyond the services of the public education system, those suffering with mental illness and their families face a barren and frightening mental-health care landscape, bereft of reliable guides or clear paths.
Almost everyone reading this article knows someone who is affected by mental illness—their own or that of a friend or family member. What do we need to know if we are going to be supportive? What are the resources available in our community and region for treating mental illness? Can these mental illness crises be more than Hobson’s choices, with only one course of action, one lifeline?
Like a physical illness or disability, mental illness takes many forms, attacks unexpectedly, and presents in painful and sometimes embarrassing ways. But, too often mental illness receives little compassion from the public. If we see someone struggling with a physical disability, we’ll probably respond with a helping hand. But if we see a disheveled, mumbling woman shuffling down the sidewalk, we’ll probably turn away.
According to the 2015 Anne Arundel County Community Health Assessment, from 2013 to 2014 the use of mental health services increased by 11 percent in Anne Arundel County; more than 11,000 County residents needed help with mental health issues in 2014. The report states, “Residential mental health beds are almost nonexistent in the county.”
But change is coming, slowly. In the spring of 2016, AAMC filed a Certificate of Need to establish a 16-bed in-patient hospital on the Pathways campus in Annapolis. In addition, in July 2016, an outpatient mental health treatment center opened at AAMC capable of serving 12 adults and 12 adolescents. Yes, that’s 36 beds within the county for 11,000-plus residents in need of mental health services.
So, what do we need to keep in mind when faced with a mental health situation? How can we change a Hobson’s choice into an enlightened selection?
Become informed:Anne Arundel County National Alliance on Mental Illness (NAMI) Executive Director Fred Delp points out that we get help only if we speak up and speak out. Faced with your mental illness or a loved one’s, NAMI is a place to start. The Anne Arundel chapter of this national organization provides free advocacy, training, and support classes. NAMI members are dealing with situations not unlike your own. They can provide phone numbers and names of organizations in our community specifically dedicated to helping those suffering with mental illness. NAMI will help you familiarize with the laws, such as Health Insurance Portability and Accountability Act (HIPAA,) and newly enacted Achieving a Better Life Experience accounts (ABLE). NAMI has up-to-date lists of County service providers who may be able to help, beginning with Arundel Lodge and the Anne Arundel County Crisis Response service.
NAMI statistics reflect a delay of 8–10 years between the onset of symptoms of mental illness and interventions, such as outpatient treatment facilities and hospitalization. So, in the meantime, Delp suggests, “Build a support system of family and friends. Ask for help.”
Use what is available:Anne Arundel County’s Arundel Lodge offers services, both outpatient and residential care, for County residents suffering from mental illness and developmental disabilities. They hold walk-in clinics two days a week, when anyone can talk with knowledgeable professionals about a situation he or she faces. Mike Drummond, executive director of Arundel Lodge, acknowledges the lack of sufficient funds for the work done by Arundel Lodge, Pathways, and similar facilities; training and salaries are hardly competitive, contributing to a general shortage of personnel—social workers, psychiatric personnel, counselors, doctors, and other support staff. Drummond points out that Arundel Lodge serves approximately 2,500 clients per year. The Lodge works with other programs and facilities to provide diagnoses, treatment plans, medications, and housing, to name just some of the services. Arundel Lodge provides help for those with co-occurring conditions; that is addiction and some form of mental illness. The 2015 County Assessment estimates that 80 percent of those being treated for addiction are also struggling with mental illness.
Speak up & speak out:“We’ve got to get over the stigma attached to developmental or mental disabilities…Families and friends must be as vocal as possible to leverage the support they need and their loved one needs,” says Catherine Purple Cherry. Purple Cherry or “Cathy” as she urges everyone to call her, is an eloquent and energetic advocate for those living with mental and developmental disabilities, including her own son. She is a Certified Autism Specialist and serves on multiple boards, including Autism Society and Hospice of the Chesapeake. Among her recommendations: (1) Keep all school, hospital, police, and other pertinent records. (2) Look forward, at least ten years into the future when planning for someone living with developmental or mental disabilities. (3) Don’t withhold pertinent and anecdotal information from professionals who decide what services are available to the person living with mental illness. Often, only those intimately involved with the person can describe the symptoms of the illness and be compelling advocates for them.
As one mother put it, those who face the mental illness of a family member or friend must “… treat mental health situations as I would treat any other physical health problem, such as an auto accident or infectious disease. I figured what resources we could tap into, tried to learn the jargon so I could ask questions of the people treating my son, and became his advocate, trying to keep track of what was and is going on for him.”
Become informed:How will someone who is ill get the type and level of care he or she needs? “Hobson’s Choice,” again—to help protect the rights of an adult suffering a schizophrenic episode or severe depression, friends and family may be forced to decide whether to take legal guardianship and accept financial responsibility for the patient/client or to remain an advocate for the loved one with no legal rights to decide or, even, participate in treatment decisions.
Mental health care, like mental illness itself, is unfamiliar territory to the public. But the curtain is being drawn back, and mental health care is receiving more concern and attention, though funding remains sorely inadequate. “When the [Arundel] Lodge opened in 2008, 20 percent of the adults we saw with serious mental illness had never had an outpatient service,” says Mike Drummond. “It’s 2017, and there are now only about 10 percent of our new adult clients who are receiving first-time services.” Surveying the needs facing mental health service providers, Drummond notes, “There is a big need for permanent, supportive-maintenance housing for our clients. Only three or four agencies have received authorization for any additional beds since 1999.”
Dale Meyer, director of Maryland’s People Encouraging People (PEP) program, echoes Drummond’s lament. “There is a dearth of hospital facilities and affordable housing for our clients…The cost of housing in the region is 15–20 percent higher than our clients’ incomes from Social Security. Unfortunately, there is only bifurcated thinking on housing, residential treatment, or shelters.” This is often why families are left to provide housing for the person living with mental illness; and that arrangement can prove disruptive to the entire family.
The sad irony is that agencies have been established, laws have been passed, and programs have been instituted. But, funding for these programs often is overlooked. Meyer’s PEP organization provides Assertive Community Treatment (ACT) services. ACT offers a comprehensive outpatient treatment and rehabilitation system for clients whose mental illness does not respond significantly to standard treatments. Studies published in the Journal of Psychiatry and Neuroscience have shown that the expenses of ACT services are fully recovered in savings in hospitalization and associated care. The program pays for itself—yes, but the money to hire the staff and provide the services must first be provided. And, that is where governmental funding fails.
Advocate for change:Follow the money. This familiar quote out of the Watergate era applies to the mental health care dilemma. Our government and our community reveal what they value by where they invest tax dollars and private charitable donations.
If we demand better and more services for our citizens living with mental illness, we may make some progress. Advocating with our legislators, holding events to raise money, simply offering a helping hand to a family living with mental illness—there are always ways both large and small to make a difference.
In the next issue of What’s Up? Annapolis, we explore issues and local initiatives in place to combat and treat alcohol and drug addiction, as well as short- and long-term recovery options.
Mental Health Resources in Anne Arundel CountyCompiled by NAMI Anne Arundel County // Annearundel.md.networkofcare.org
NAMI: National Info-Helpline
NAMI: MD Warmline
Crisis Services (for emergencies, call 911)AA County Crisis Response
Eastern Shore Crisis Hotline
MD Youth Crisis Hotline
Suicide Prevention Lifeline
SAMHSA Disaster Distress Helpline
Veterans Crisis Line
800-273-8255 (press 1)
AA County Public Schools Student Safety Hotline
Substance Abuse Treatment Referral Line (Mon.–Fri., 8 a.m.–5 p.m.)
AA County Bureau of Behavioral Health, Dept. of HealthArundel Lodge, Edgewater
Omni House, Glen Burnie
People Encouraging People, Glen Burnie
Psychiatric Hospital ServicesSheppard Pratt Hospital Crisis Center
Johns Hopkins Psychiatric Emergency Hotline
Baltimore Washington Medical Center, Glen Burnie
Anne Arundel Medical Center, Annapolis
Legal ServicesMaryland Legal Aid, AA County
410-972-2700 / 800-666-8330
Maryland Disability Law Center
410-727-6352 / 800-233-7201
Annapolis VET Center
Hispanic-Latino Community Resources
YWCA of AA County
On Our Own of AA County
AA County Mental Health Agency
SOAR, AA County