A different way to help people with mental illnesses

[Innisfree]

We’ve talked about the problems caused by police without training for deescalation responding to mental health crises, and about the difficulties of finding proper housing and treatment for the people who need it. I found the town described in this article a breath of fresh air, and thought others might enjoy it. Not sure if we could ever replicate the culture which has grown over centuries there— certainly not in general, right now— but it offers a different view of the possibilities. The article is gifted, so there shouldn’t be a paywall.

Quote

A painful loop has defined Iosif’s 53 years on earth: trauma, mental breakdown, psychiatric institutionalization.

From his native Romania to a failed asylum bid in Belgium and later divorce and financial distress, Iosif’s condition has punctuated crises in his life that often spiraled out of control.

But as he sat at the dining table overlooking the woods through wide glass doors, he seemed at peace.

He spoke about his daily chores (feeding the donkey, doing the dishes), favorite pastimes (reading the Bible, shopping), worries (forgetting to take his pills, overspending).

In the living room, the sounds of cartoons filled the air. Etty, 71, and Luc Hayen, 75, were transfixed watching a children’s show involving a mouse on an outlandish adventure. The house cat was curled up on a cream sofa.

All of them live with Ann Peetermans, a 47-year-old beautician, and her teenage son in a long-term arrangement where people with mental illnesses move in with local families.

It is an approach to psychiatric care that has gone on in Geel (pronounced “hail”) since as early as the 13th century, archives show. 

https://www.nytimes.com/2023/04/21/world/europe/belgium-geel-psychiatric-care.html?unlocked_article_code=hyNFutzenwkeY43NSXtm_yFzXR_85kvu1UkKsoVEmRFRNOHf2hUcUaZ3I6pl4b-qNwqlRoyv9tX-1Z7I5iB_MoXsTxFDYyrm-B76WxVQ9wJBIMWaXuPPfhjBjvCrUo4XNIOE8uCsTiMinwT_bPnfUD2W8Y1DfQ1r7MbrNMdYtDI1vLDjxgd387p4UaxAkJ4Y-bdP8iaC1UZLe-lX7-WxJcsd7w9VTt-0ROY507gzpNZoB0-XKUik_11a59bXn-U6MJKOc-bw938Te2qEcLbuJd_-M8XHTUuA9eEJjG2SEP_I6j5PpIOQ_dgUDnIjiIHl80jga7Pz_ACvyBBK9e0vP7pREDUvGQvo8C-ddhk&giftCopy=2_Explore&smid=url-share

[Jean in Newcastle]

These people are all receiving psychiatric care (whether that’s voluntary or not is not said) and are on meds. What isn’t said is whether these people have access to recreational drugs or alcohol, which is usually incompatible with psychiatric treatment and certainly incompatible with most psych meds. In the US, the vast majority of people with mental illness who are in crisis are unmedicated, not receiving treatment and are self medicating with recreational drugs and alcohol. 

[Innisfree]

5 minutes ago, Jean in Newcastle said:

These people are all receiving psychiatric care (whether that’s voluntary or not is not said) and are on meds. What isn’t said is whether these people have access to recreational drugs or alcohol, which is usually incompatible with psychiatric treatment and certainly incompatible with most psych meds. In the US, the vast majority of people with mental illness who are in crisis are unmedicated, not receiving treatment and are self medicating with recreational drugs and alcohol. 

Certainly all correct. I don’t know if the model could be transplanted to towns over here, but you’re right, it requires that support services are available.

 I don’t think they consider every patient a candidate for this program, either. The article says people must be stable on treatment. I do suspect that some portion of our homeless population, with appropriate support, could manage in a setting like this. It would be good for a large group of people who were moved out of residential treatment when the goal changed to community-based support, which of course never materialized.

So, yes, the prerequisite is support which is hard to find here. That part needs to be fixed, however people are housed. Whether the political will ever permits sufficient support to be provided is another question.

[Jean in Newcastle]

19 minutes ago, Innisfree said:

Certainly all correct. I don’t know if the model could be transplanted to towns over here, but you’re right, it requires that support services are available.

 I don’t think they consider every patient a candidate for this program, either. The article says people must be stable on treatment. I do suspect that some portion of our homeless population, with appropriate support, could manage in a setting like this. It would be good for a large group of people who were moved out of residential treatment when the goal changed to community-based support, which of course never materialized.

So, yes, the prerequisite is support which is hard to find here. That part needs to be fixed, however people are housed. Whether the political will ever permits sufficient support to be provided is another question.

There are community based psychiatric halfway houses here in this country.  They operate on a similar model of treatment and meds and supportive environment with routines, chores etc. 

The article leaves a lot of things out - like who screens these people for the houses?  Who pays for the psychiatric care and meds?  What happens to those people who don't want to be there or don't want to comply with the rules?  (Many of the people who self medicate instead of staying in treatment or on meds do so because they hate how psych meds make them feel.  The side effects of pysch meds aren't going to go away just because of who funds the program or how friendly it is.) 

[Jean in Newcastle]

BTW - it might look like I'm raining on the parade here but I'm not.  It looks like a really good system that works well for them.  It's just that you need to be aware of what's behind it before seeing it it could be replicated elsewhere.  And comparing that system to unmedicated, untreated people ends up being an apples to oranges kind of thing. 

[PeterPan]

1 hour ago, Innisfree said:

I found the town described in this article a breath of fresh air, and thought others might enjoy it.

Thank you, the article was beautiful and hit so many good points. 

 

1 hour ago, Innisfree said:

Not sure if we could ever replicate the culture which has grown over centuries there

What they're doing in that town goes beyond the fostering. People are visiting people in the hospitals too. You can actually do that now. https://www.volunteerguardian.com/  You can actually be assigned to someone who needs another person and advocate for their medical care and well being, visiting them, making a difference in their lives. When I got into it, I didn't realize the degree to which mental health challenges were a reason people end up in these situations. Now I love the idea of communities and it's something we talk a lot about in the autism community as well. So there's this progression of settings. (independent living with assistance, congregate care, etc.) 

One of the bizarre things to me is that our system does not fund humane assistive living that would prevent the progression to needing more expensive care, sigh. Some counties do, some don't. I'm not sure all people with these challenges would *want* to live in a foster setting honestly. The reimbursement of the foster families is interesting. We have a "waiver" program in our state and I'm not sure whether other states do. One of the stated goals is to help the person say in a home setting instead of institutional. So in a way, we have this funding that can follow the person if they get qualified and have a host. I don't know if someone like my son would qualify for that eventually and I don't know how long it continues. 

Just thinking out loud. Anyways, if you want something you can do *now* it's the Volunteer Guardian Program. 

[PeterPan]

44 minutes ago, Innisfree said:

the prerequisite is support which is hard to find here. That part needs to be fixed, however people are housed. Whether the political will ever permits sufficient support to be provided is another question.

You have the in-between issue that people have rights, freedoms, including freedom to refuse care. 

 

[maize]

1 hour ago, Jean in Newcastle said:

 In the US, the vast majority of people with mental illness who are in crisis are unmedicated, not receiving treatment and are self medicating with recreational drugs and alcohol. 

While I know that self medicating with drugs and alcohol is common, mental health crises also happen without any drug or alcohol involvement. Since I belong to a religious community that eschews drugs and alcohol, many of the people I know who have been in crisis with mental health problems were not using either.

Serious crises still happen. 

Edited April 21, 2023 by maize

[PeterPan]

5 minutes ago, Jean in Newcastle said:

It's just that you need to be aware of what's behind it before seeing it it could be replicated elsewhere. 

Exactly, like how in the world are they quietly shuffling so many people with mental health challenges (and visible autism) to this one town? That's sort of institutionalizing in it's own right as it's not in the community they were from. There may be different laws on medical freedoms, etc.

Think about where we are as parents. Anyone dealing with a dc with disabilities is thinking through that turning 18 and rights thing very carefully. It takes paperwork and legal hurdles to help someone over that line. And they're going to have the *freedom* to burn a lot of bridges, relationships, destroy their health, etc. before they get SO BAD that they get placed. Even then they may still be considered competent legally to make their own placement, meaning they're there of their own free will even though they're vulnerable.

It's not an issue I fully understand yet, but we DO have things in place. We don't have enough volunteers to look out for the people who need guardians and it's something anyone here could decide to get trained on and do.

[Jean in Newcastle]

24 minutes ago, maize said:

While I know that self medicating with drugs and alcohol is common, mental health crises also happen without any drug or alcohol involvement. Since I belong to a religious community that eschews drugs and alcohol, many of the people I know who have been in crisis with mental health problems were not using either.

Serious crises still happen. 

Absolutely. I just have been working with the homeless or homeless adjacent community for years so I tend to see substance abuse much more often. 
 

ps- my understanding is that many of those religious communities also look down on psychiatric treatment and meds as well. 

Edited April 21, 2023 by Jean in Newcastle

[maize]

1 minute ago, Jean in Newcastle said:

Absolutely. I just have been working with the homeless or homeless adjacent community for years so I tend to see substance abuse much more often. 
 

ps- my understanding is that many of those religious communities also look down on psychiatric treatment and meds as well. 

The LDS church strongly encourages professional psychiatric treatment.

I know what you mean about the homeless community though, I have a friend who works at a homeless shelter and the intersection of serious mental illness and substance abuse is the biggest contributer to chronic homelessness. We can't generally force people into treatment so there are few tools available to address underlying issues.

[Mrs Tiggywinkle Again]

A city near me actually tried something similar.  Not quite a halfway house after release from the state psychiatric facility but more like foster families.  There were a few successes but the majority of these homes failed.  It was primarily due to lack of compliance with medication and therapy, as well as relapsing into substance abuse. 
Eventually, I think we will have to determine if people who are mentally ill can refuse treatment, or only those deemed competent, and what those lines are.  It may need to be something more than just harm to others/suicidal ideation.

[KSera]

42 minutes ago, Mrs Tiggywinkle Again said:

Eventually, I think we will have to determine if people who are mentally ill can refuse treatment, or only those deemed competent, and what those lines are.  It may need to be something more than just harm to others/suicidal ideation.

I wish I could remember where I read it, but in the past year I read an in depth piece following someone working in a state or county funded facility for people at that intersection of mental illness and homelessness. I thought it really illustrated that gray area well. This woman’s job was in part to go around and give clients their medication.  Often it would be a long acting anti-psychotic. The problem was that for people whose previous dose had worn off, their mental illness prevented them from accepting the medication because of their paranoia that the nurse was trying to hurt/kill them. These people were terrified, and living such a difficult existence when not medicated. So how do decisions get made for/by people whose very condition causes them to refuse treatment that makes them clearly feel better once they have treatment on board?

[maize]

@KSera that's the real challenge isn't it? A malfunctioning brain is not a reliable decision-making apparatus. 

I wonder if some kind of advance directive could be used for people who cycle between medicated/rational and unmedicated/irrational. In their rational state they could direct what should happen next time they are in a position of complete irrationality?

[Terabith]

Well, and antipsychotics are truly nasty meds.  I mean, they're life saving (but often seriously life shortening) and essential, but they come with a whole host of absolutely horrendous side effects that can literally cripple people.  Choosing to not take them is usually a bad idea, but nobody who hangs out around the mental health world thinks that people are necessarily crazy or incompetent for choosing not to take them.  

Edited April 21, 2023 by Terabith

[KSera]

32 minutes ago, Terabith said:

Well, and antipsychotics are truly nasty meds.  I mean, they're life saving (but often seriously life shortening) and essential, but they come with a whole host of absolutely horrendous side effects that can literally cripple people.  Choosing to not take them is usually a bad idea, but nobody who hangs out around the mental health world thinks that people are necessarily crazy or incompetent for choosing not to take them.  

Well this is true, though not to the same degree with the atypical antipsychotics often used now, especially when used at lower doses to mitigate side effects. Not saying they're great--no one should be taking them if not needed--but there are lots of people living very normal lives on these medications. In the piece I was reading, the people refusing were doing so not due to side effects but because they were actively psychotic with paranoia.