Years ago I was director of a county mental health center in an Eastern state. Shortly after taking the position, I became concerned that clients were being involuntarily committed too readily and without exploration of other options. I issued an instruction that all such activity had to be approved by a middle manager before it could proceed. This measure aroused enormous resistance from the front-line staff.
There was one client – let’s call him Charlie – who was committed to the State Hospital every year, usually in July. Every July, he would become “agitated,” would scream profanities at his elderly mother, and break things around the house. He carried a “diagnosis” of schizophrenia.
Mother would call the intake worker at the mental health center; the intake worker would visit the home, fill out the papers, get a judge to sign them, and take them to the sheriff. Ten minutes later a squad car would pull up at the house; Charlie would walk out – generally calm – get in the car; and be driven to the State Hospital, where he would be kept for about three weeks. Mother would breathe a sigh of relief, clean up the house, and take a well-earned rest from the burden of caring for her adult son.
Under the new system, the intake worker had to involve the middle manager. He visited the house and found that Charlie was “freaking out” and mother was nervous and apprehensive. So he suggested that mother come with him to the domestic violence shelter. She was hesitant, but agreed. There he explained the situation to the shelter staff, who welcomed mother with open arms.
The intake worker was furious. It wasn’t fair, she said. Charlie was the one who was being difficult – why should mother have to be “thrown out” of her own home.
The reality was quite different. Mother was thrilled to find a safe haven and staff who listened to her and offered support and encouragement. Charlie had no one to scream at and was having to take care of himself (a new experience). The manager visited him twice a day to confirm that he was OK.
When mother had been at the shelter for four days, Charlie sent her a message asking her to please come home, that he missed her, and that he would not be aggressive or violent. With encouragement from the shelter staff, mother sent back a message to the effect that she was very comfortable at the shelter, and that she planned to stay at least a week – maybe two.
In fact, she returned home after nine days – to a situation the dynamics of which had been altered in fundamental ways.
The moral of the story is that the knee-jerk mental health response of shipping clients to the State Hospital at the first sign of trouble is not always necessary, and usually provides only a temporary fix. The dynamics underlying and driving the problem behavior remain unchanged, and the problem behavior tends to recur.