This I Believe

James - Rocky River, Ohio
Entered on January 14, 2008
Age Group: 65+
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Persons with mental illness remain among America’s least valued citizens. Their medical and psychiatric treatment ranks second class at best. Yes a small percentage exists whose super rich kin can pay for needed care out of pocket. Or these families own a platinum health insurance. Simply stated the mere presence of mental illness too often confiscates personal access to medical insurance. Many of our old friends, relatives and historically impoverished citizens simply cascade into a shadow world of non-care… our street people… many military veterans. And the most severely effected are persons who through no fault of their own won the whole kielbasa: they suffer from both mental illness and mental retardation.

A pediatrician and psychiatrist, I continue to wage a minimally successful campaign to assist these folks, the journey now extending over a third of a century, In 1975 the deinstitutionalization movement, driven by then new state and national legislation, began helping many with the dual diagnoses of mental illness and mental retardation. Assuming the medical director’s job in a state institution I discovered scores of profoundly and severely retarded, organically impaired persons who cavorted, either naked or minimally clad, from sunrise to sunset under the sometimes watchful eyes of quasi care givers in waders carrying hoses. Their jobs were simple: reduce the smell of human waste for another eight hours, or whatever! Nearly three dozen of the over 1600 persons institutionalized there had died during the previous 12 months. My objective was simple also: no one was going to die under my watch!

New Superintendent Bob Carl shared fully this objective and he knew how to change the culture. Staff was retrained; many did not agree with changes and were fired. A half-dozen physicians employed for years departed, frequently on unfriendly terms. People began wearing clothes. Psychotropics and antiseizure medications, monitored closely, increased and decreased based only upon that person’s behavior. Paint graced walls never previously visited. Human respect itself revisited the institution. Simultaneously most persons, requiring quite different services than those offered within the institution’s walls, departed for developing community care. Only seven persons died in the first year; in the second year over nine months passed without a single death.

What I believe is that we did nothing great. These persons deserved nothing less. Before those years these persons had no rights. They experienced no joys. They had no one who cared for them. Families dropped them at the door of our state’s large human depositories. They would never again join their families at the breakfast or dining tables. Gone and forgotten…

What I believe also is that these persons require society’s oversight and love. These persons now live in group homes, in supervised apartments, down the street from us. Many times we don’t know they have invaded our neighborhood. They simply blend in. The organicity of their symptoms compromises some. They may require intermittent visits to psychiatric hospitals. They see docs like me in outpatient care. Their caregivers for the most part perform fabulously. Family involvement usually continues with the person’s admission into community care. Instead of entering college, they enter group homes, often later than the usual college age. Or they stay with mom and dad or brother and sister until the latter can no longer provide necessary care.

We’re all a little weird in some ways. I believe that persons who are retarded and mentally ill, replete with their special weirdness, belong among us.