Years ago, I volunteered in the mental health clinic at Healthcare for the Homeless. At that time, the clinic was located in a crumbling, barely habitable house near downtown Albuquerque. The place was uncomfortably warm year-round, which magnified the smell of the place by a factor of ten, at least.
The odor of that place was one of forgotten humanity – unwashed people in their unwashed clothes with their unwashed belongings in tow. The reek of cigarette smoke drifted from the folds of their clothing. I learned, by a system of surreptitious glance-and-sniff, to know if a client was addicted to alcohol, heroin, meth, crack, a combination, or nothing at all (approximately 15% of the clients were, simply, severely mentally ill, with no co-morbid addiction).
They came to the clinic with an astonishing array of medical issues beyond mental illnesses and addictions. Chronic illnesses like diabetes are virtually impossible to manage on the streets. A minor infection can become gangrenous in a short time when people live with limited access to basic sanitary facilities. A simple case of the flu is likely to become pneumonia when a person is living rough.
Underfunded and understaffed, the people at the clinic did everything they could for their clients. It was mostly a hopeless task. A receptionist, a nurse, four counselors, and a handful of volunteers can’t do a whole hell of a lot in the face of the vast needs among the many people who need help. A few people got stabilized on their medicines and tried to get clean, but more often they continued to decline, living on the streets and cycling in and out of jail, detox centers, and psychiatric hospitals.
I should have hated it. I mean, my God, writing about it now, it sounds so depressing. In fact, though, I looked forward to my time there. I spent most of my time with the clients, going out to lunch and driving them to their appointments. The counselors would give me Wal-Mart gift cards and send me off with 2 or 3 clients to buy socks, underwear, and toiletries.
We had fun. I got to know them, the people they were, underneath the illnesses that ravaged their bodies and their lives. I grieved for them when they died, which wasn’t uncommon. Cause of death was usually overdose or suicide, but there were a few murders (people living with mental illness, out on the streets, and addicted to drugs to boot, are easy targets for violence) and several deaths due to illness or infection. Sometimes, I made sad phone calls to a family member, phone calls that were never a surprise.
One client, I’ll call him Hector, died of a heroin overdose. The staff at the clinic knew he was struggling with delusions and hallucinations, knew that he was using more and more heroin to cope with his rapidly disintegrating hold on reality, but they were helpless to do anything for him. So, in a skeevy hotel room, Hector injected himself one too many times and died there, alone.
At least once a day, one or more of the clients’ family members called to check on someone they loved – a son or daughter, parent, spouse, or sibling. I was in the office a few hours after we heard the news about Hector when the phone rang. The brand new receptionist answered the phone. It was Hector’s mother, calling to find out how he was doing.
“Oh, Hector?” the receptionist said into the phone, “Yeah, hang on a second. I’m pretty sure he’s dead.”
Just that. With those words, a woman found out that her boy was gone. I sat with her the next day and she reminisced about her son; how joyful his birth had been, how she baked his birthday cakes and helped him with his homework. She described how unbearably painful life became when schizophrenia entered their lives when Hector was a young adult, and how shocked she was to discover how little help there was for him. She told me about the years of anguished resignation she and her family had endured, knowing that Hector was existing in the most precarious of ways, but lacking the resources to do anything for him.
To that new receptionist, Hector wasn’t a person with a mother. He was an anonymous, smelly, scary man who talked to people she couldn’t see and had a habit of rubbing at the left side of his jaw until it was raw. (Soon thereafter, she found herself jobless.)
Culturally speaking, the receptionist’s attitude was typical. If that was not so, Jared Lee Loughner might not have had the chance to shoot 20 people, 6 of whom died, in Arizona last week.
I’ve heard, in some dozen or more news reports, that Jared Lee Loughner “fell through the cracks” of our nation’s mental health care system. I laughed aloud, but bitterly, the first time I heard it. Cracks?
You’ve got to be fucking kidding me.
There are no cracks in our mental health care system, because we barely have a system at all. Brian and I have every advantage in navigating the mental health care system. We are college educated; have no cultural or language barriers; live in a moderately large city; own reliable transportation; have the best health insurance; and we are, relatively speaking, mentally healthy. And still, even with all of that, we struggle mightily to get appropriate care for Carter. In some cases, the care he needs doesn’t exist at all.
In the shrill conversation that’s ensued since Jared Lee Loughner opened fire, we’ve heard again and again, “How could this happen?” How do we, who are living at the whims of the mental health care system, get the point across that this is typical. People who need care, especially the most desperate, don’t get it. The difference here is that Jared Lee Loughner didn’t just hurt himself and his family; he hurt strangers, “normal” people, “innocent” people.
I’m having a hard time with the fact that the death of “normal” people is what it took to get this issue onto the public agenda.
Jared Lee Loughner is our nightmare, lurking as one of several terrible possibilities on our horizon. The fact is that Carter’s illness is difficult to manage, and when he’s an adult (and even before; in NM, a 16 year old can refuse medications without parental consent), I can’t compel him to get treatment. His future is up for grabs.
Dear God, save me from the anguish that Jared Lee Loughner’s parents are feeling now.
I hate that people were hurt. I hate that people were killed. They are very far from the first casualties of our cultural ambiguity about people with mental illness, though. Far from it. People die of mental illness everyday. The bottom line seems to be, we don’t want to deal with “those” people, the ones who are weird and unpredictable and seem so unlike the rest of us. For generations, we locked them up in appalling, shameful institutions. Then, in that uniquely US American way, we threw the baby out with the bathwater and shut almost all of those institutions down and replaced them with…
Not a damn thing.
There were promises of community healthcare, but they have never been fulfilled, especially for the very sickest of people, the people suffering from schizophrenia, bipolar disorder, schizoaffective disorder, and severe depression. And, of course, people with fewer resources have less access to care.
Millions of people with mental illness could live satisfying, productive lives with appropriate support, and those who are too ill for such lives could at least be safe and comfortable in appropriate institutional care that protects their human dignity.
Instead, they are left to live or die in jails and prisons or on the streets. People with mental illness are rarely violent; I feel comfortable calling Jared Lee Loughner a tragic one-off, but that doesn’t mean the wholesale abandonment of our neediest citizens is OK. To say that this issue only matters because of the 20 people who were shot is to say that people who suffer from mental illness don’t matter. If you believe that, I suggest you not say it in my presence.
As you’ve heard me say before, there are no disposable people.
Or, if you prefer, from a person much wiser then me, “do unto other as you would have them do unto you.”