The entire mental health system is not only broken, but it has fractured into tiny shards of ineffective state and local level outpatient programs, underfunded outpatient psychotherapy clinics, and psychiatric in-patient hospitals with limited beds and shortened length of stays.
This is the case for so many people in the public mental health system who cannot afford other treatments.
I still remember starting off my journey in the “system of care” after being discharged from a six-month inpatient stay in a state hospital facility operated by my state’s Office of Mental Health (OMH). I was still dysregulated at the time of my discharge, albeit eager to return home. The state hospital system simply doesn’t have enough open beds for the sheer volume of patients requiring this level of care.
Eleven years ago, my psychiatrist in the state hospital discharged me. I was clinically stable for discharge but still slightly symptomatic. While I could maintain my own safety (and not pose a risk to the safety of others) in the community, I needed 24-hour assistance and support from my parents if I was ever to survive in the world. The plan from the hospital was partial hospitalization until I could benefit from outpatient treatment.
I can still hear my friend Minerva prattle on the phone in our partial program about her career as a big-time writer.
“I’m on Lexington and Fifth, darling” Minerva repeated, loudly. “Darling! I’m with my literary agent! We just got out of a meeting in the boardroom, and it seems I am being published again!”
“Again! Yes, well, when you’ve been published this many times it’s a real bore!” lamented Minerva, taking off her sunglasses to look to check her makeup and fix her eyelash makeup through the tinted glass reflection. “A bore, can’t you hear me?!” she screamed into the phone.
“Minerva, is that you screaming? You know, there is a noise policy in this program!” A distant voice echoed.
“Minerva! I said, please stop screaming!” The voice was moving closer in proximity.
“Yes, Nurse Gottlieb! What is it now?” Minerva was almost smug with her tone, but more so with her eye-rolling.
“Minerva, you missed your afternoon meds! Wipe that smirk off your face! This is serious, you can’t just skip your meds, and make noisy calls outside the hallway when the group is in session. There are rules in this program, Minerva, and you will follow them!” Nurse Gottlieb exclaimed, starring Minerva in the eye, who was almost in shock by the directness and the tone of the nurse at the Ongoing Day Program (Partial Hospital) for the Mentally Ill.
“Get me out of here! I can’t stand this program!” Minerva said as she turned to me and kicked my leg in the treatment room.
“We’re going to the beach house this weekend, and you have an invite, Minerva. Everyone will be there. Just make sure you’re packed and ready,” I told Minerva to calm her down so she wouldn’t kick my leg anymore and we wouldn’t get in trouble with the staff in the program.
~
“How did you two meet?” My therapist inquired.
“In partial hospital…”
I elaborated at length.
I met Minerva in the Partial Hospital program after my discharge in 2008. I’ve known her for over 11 years, just about a third of my age now, 33. When I met Minerva, she had recently been in the hospital for a long time and was still hypomanic. Back then, Minerva was younger, hopeful, and supposedly ready to recover after a decade of ups, downs, manic extremes, and depressive lows. If it was an altered mental health state, Minerva had experienced it. In fact, she was passing through over the better half of the last two decades of experiencing severe bipolar disorder.
We bonded over mental health stories, mostly our own, and would meet for coffee during our stint in partial hospital.
When I attended graduate school for social work a few years into my recovery, we lost touch for a bit. After all, I was three hours away in a rigorous graduate program trying to stay afloat given the extreme nature of my illness and being new to recovery and healing from my own mental health diagnosis.
After returning home with my Master’s in Social Work (MSW), and becoming a licensed master (then clinical) social worker, I entered the system of care in my community on the other side as a clinician with my own psychotherapy practice. Given I was ramping up again, this time with employment and working, I didn’t have as much time for weekly coffee visits with anyone, Minerva included.
Venturing out into my own community where I had been hospitalized several times in the past and even had therapists of my own, I would run into people who treated my illness during the earlier days of my recovery. I also stumbled upon old faces, people like Minerva, and others, who I knew from treatment from when I was discharged from years ago. Now on the other side, it was rather awkward, especially in the case of Minerva.
I say this because when I reengaged with Minerva she was in the same spot as she was 11 years ago. Maybe even worse off. I am judging this by her level of care. Also, by the sheer amount of time that elapsed with little or no gains made in terms of insight into her illness or judgment when it came to repeated relapses without gaining additional perspective on her condition. Minerva was now in a Continuing Day program called PROs, which was on the campus we met at 11 years ago, just in a different building.
I couldn’t fathom going to the same small mental health campus for over a decade, and not benefiting from it whatsoever. During the last 11 years, Minerva had crashed another two cars during additional manic episodes and gone off her meds two more times without doctor supervision. When I found Minerva this last time, she was washing her laundry at the local halfway house, which was connected to the agency that subsidizes her supported housing program.
Eleven years and no progress, I thought to myself. This can’t be the case. I mean, it must take real work to stay in a holding pattern in life for so long without budging. Either that or she must be very sick or symptomatic most of the time. I would later find out that cases like Minerva exist everywhere, and she is no more unique than her biography is to other people with a mental health disorder who share their story.
“We meet for coffee every so often at the diner…” I said to my therapist, finalizing my thought.
Author Info:
Max E. Guttman
Max E. Guttman is the owner of Mindful Living LCSW, PLLC, a private mental health practice in Yonkers, New York.
