I worked with youth from the time I was 18 until shortly after I turned 38. During that time, I was blessed to work with a large number of special population children in a wilderness therapy and outdoor education program. Special population is the nice, friendly, technical term for kids with some sort of psychological or psychiatric diagnosis. For the most part, I worked with kids that were Learning Disabled and/or Attention Deficit Hyperactivity Disorder (those in the business refer to this population as LD/ADHD for short). Although there were certainly a lot of challenging times and students, I can honestly say that these were some of the sweetest, smartest, and most tenacious kids who were on their way to being amazing adults.
I would be lying, however, if I didn’t admit that there were some times that I was genuinely scared of some of my students. There is this thing called comorbidity, which means that a person has one or more diagnoses or illnesses. Sometimes we would have kids that were admitted to the program whose parents had not been honest and either neglected to mention or drastically understated the seriousness of their child’s mental illness. These were kids that weren’t just LD/ADHD; they were diagnosed Bipolar or Oppositional Defiant Disorder or any of a number of serious mental illnesses or behavioral disorders. I can even remember one student that we had to drive into town once a month to get a Lupron shot. Lupron can be used as a form of “hormonal castration” to keep kids from being sexually predatory towards other children. Think about that for a while and see if you don’t lose some sleep tonight.
To provide some context, I am just over six feet tall and during the time that I was working with these kids, I never weighed less than two hundred pounds. My staff partners ran the gamut in both gender, size, and disposition. The only times that I felt like I wasn’t the last resort on behavioral outbursts in the field was when I worked with my friend Brendon, who dwarfs me in both size and strength. If you think it is disturbing to see a kid have a mental illness-related behavioral incident in public or in someone’s home, you should try being in the wilderness, thirteen miles from the nearest trailhead, and an hour and a half drive from the nearest working phone. Live through that a couple of times and then talk to me about what you know about adolescent mental illness.
Please don’t think I’m down on kids with serious mental issues, either. I once had a kid in my group that my staff partner had committed to a psych ward because he made her uncomfortable while I was on vacation for two weeks. When I came back, he returned to the group and finished the semester…she did not. Sometimes kids just need a caring advocate, but other times kids need serious intervention and their parents need help. The problem is that for kids with dangerous mental illnesses and their parents, there is no real help.
I read this article that my wife found online: http://www.huffingtonpost.com/2012/12/16/i-am-adam-lanzas-mother-mental-illness-conversation_n_2311009.html I have known parents like this. I’ve seen them grasp at straws because they knew that if something happened to them that no one would be around to protect/guide/manage their child. I’ve seen the pain on their faces when they have lost hope. I weep for these sorts of parents.
I have also seen the other parents: the ones in denial, still trying to “mainstream” a child with serious behavioral and emotional problems. These parents endanger the other families in their communities because they try to keep their children in a public school system that simply does not have the resources to adequately assess and meet the needs of their children. These parents often find false hope and encouragement from mental health professionals in a post-deinstitutionalization system.
These mental health workers are constantly trying to keep these sorts of children and eventually adults in an out-patient care scenario because that is what is “humane” and that is what our mental healthcare industry has been doing since the 1970’s. Since then, and increasingly so in recent years, it has been almost impossible to have people with mental illness committed to a long-term care facility. We used to call these places asylums, but I’ll give you a $100 if you can find one psychologist or psychiatrist in this nation that will use that term today. Mentally ill individuals that are in the midst of crisis or having serious behavioral problems are funneled into one of two places: Hospital Emergency Rooms or Police Stations. If you don’t believe me, ask a police officer or an ER nurse. In either event, the mentally ill person either ends up in a short-term psych ward until their release or in a jail cell. Neither of these is an acceptable answer for people with long-term illnesses.
The tragedy in Connecticut has sparked much debate, mostly about gun control. There are not words that can express how awful this tragedy is for the parents of those kids or anyone else in that community. Everyone grieves for those lost. My question is this: What is it going to take for us to finally talk about developing a tiered system of long-term institutionalization for the mentally ill in this country.
We need a system that can provide long-term supervision, accountability, protection and residential care for the mentally ill. We need a system where those who need help with minor mental illness can check in and out and still have somewhere to sleep at night so they don’t end up homeless because they can’t cope. We need a place where people with profound mental illness can get appropriate care and 24-hour-a-day supervision. We need system that keeps both patients and staff safe. And finally, although no one else seems to want to say it, we need a place where we lock the violently disturbed away in such a way that respects their rights and provides the care they need while protecting the general public.
I want people to wrap their heads around this set of facts and really think about them without any media spin. The shooter in Connecticut has a brother that hadn’t spoken to him in two years. He shot and killed his own mother and then gunned down a bunch of small, innocent children. I’m willing to bet that somebody, somewhere knew that he was unstable. James Holmes, the Aurora Colorado theater shooter had a history of mental illness. It seems that lots of people were concerned about him and their own safety but that he was being shuffled around by the system. We have seen a large number of murder-suicides in our country in the last several years and the trend appears to be increasing. We simply can not escape the fact that we have mentally ill people that need serious long-term help and who need to be removed from the general populace for their own safety and the safety of others.
It is past time for us to have this conversation as a nation. Let’s not let another group of innocents die before we take the time to figure out what we should do with our “emotionally disturbed students.” our “serious behavioral problems,” and our “criminally insane.” Let’s talk about institutionalization. Clearly, the out patient care isn’t getting the job done.