Serious mental illness affects us all in some way. What can we do, as professional nurses to help make a difference in our families, in our work place, in our community and in our nation?
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Ed called me to ask if we could have coffee and talk. As his long-term friend and a Faith Community Nurse, I was happy to oblige and we set up a time. When we got together he told me the difficult story of his brother whose wife has serious mental health issues. This was the fifth time she had made a serious attempt to kill him-each time the process escalated and her attempts were more serious. Near tears, Ed went on to tell me the sad story of how he was unable to help his brother despite his best attempts. His brother would go through the complicated steps necessary to get her committed, she would stay in a facility for a total of maybe two weeks, be released, have nowhere to go, plead to come home and the process would begin again-he ever hopeful that "this time would be different" and she appearing to adjust her paranoid, schizophrenic ideation/bipolar behavior for short bursts of time before falling back into the physical, emotional and spiritual abuse. Additionally, Ed's brother found himself unable to prosecute her criminally, simply lacking the emotional strength to send her to jail.
The cyclical nature of the pattern left everyone exhausted and also mentally distressed-the wife who lives in the grip of severe mental illness, the husband who is a victim and displays all the classic signs of victimization, their teenage daughter who simply wants her mother to "go away," and the extended family who vacillates between despair and hope with every cycle of violence and reconciliation.
What are the statistics on the prevalence of serious mental health problems? Of course, it is hard to know exactly as 1 in 5 of us has some type of mental health crisis at some point in our lives. But the more serious, destructive types of mental health illnesses are smaller in number:
However, these serious mental health problems have a disproportionately large effect on those around them. Mary Nicholas, MSW, Professor of Social Work at Mississippi
College states, "Mental illness destabilizes the workforce, the family, society in general, the educational system, even churches." The societal impact that one person with severe untreated mental illness can have is difficult to quantitate.
Ed went on to express his frustration with the emergency room as the access point for mental health evaluation and crisis. He detailed occasions where his sister-in-law was evaluated and sent home for unknown reasons. As professional nurses, we all know how hard it is to find a placement for someone in crisis. The options are few and often the chronically mentally ill have run through their money, run out of support systems, and have very few options. Additionally, the family system is so ill that their own issues become part of the problem.
How can nurses be part of turning this situation around?
Nicholas says, "I see a lack of funding. I don't think it's a lack of interest but I think we need to educate our people in authority regarding what mental health issues are and the devastation they can cause in our society when these diseases go untreated."
She goes on to point out some possible avenues forward:
Vote. One of the most important things we can do is participate in the election process and even go further than that by keeping our legislators informed and talking with them about mental health concerns.
Longer inpatient stays. I'm not advocating for institutionalization, but I am advocating for longer term treatments. The current standard of 13 days is simply not adequate. It's not enough. There has to be a place between being institutionalized for life and doing the "express treatment" mentality. Mental health issues are not a quick fix. They are not a single layer issue either. It's not just getting them stabilized, it is also dealing with all the devastation they have done while they have been unstable.
Acknowledge and address shame. If a person suffering from mental illness can be stabilized and get on medication, there is often a sense of shame in dealing with the past. This can be exacerbated by the culture of secrecy surrounding mental health and mental health treatment. As a society, we have to be more open about mental health, de-stigmatize it and give people tools to deal with the shame, including paths toward self-forgiveness and reparations.
Holistic care necessary. The approaches have to be holistic, long-term and team-oriented. Identifying the problem and finding medication is only a first step and maybe the easiest part of the process. The individual, family and societal support system necessary to move toward solutions is complex.
I listened carefully to Ed as he unburdened himself of more details of his family's terrible ordeal. He said, "Being mentally ill does not mean you are not smart. In this case and others like it, the person in question knows her rights. She knows how to use them to defend herself and in some ways, to perpetuate the problem. She is functional-just in very harmful, hurtful ways."
The National Association for the Mentally Ill (NAMI) helps to advocate for both the mentally ill and for their families. They provide support groups and connection to other resources and work with the mentally ill, their families members and professionals. I referred my friend to NAMI and he was able to attend group and get more connected.
What is your experience with the seriously mentally ill in the community? What do you see that is helpful? How can professional nurses move beyond identifying problems and become part of addressing solutions long term? What is going on in your community that is successful?
