My sister Chris is on the left and our mother and keeper of black walnuts is on the right
My sister lives with chronic pain from various medical conditions which to becoming disabled. She just told me about a doctor who is being investigated for over prescribing pain medication at his clinic. When she was healthy my sister was a pharmaceutical representative. So she knew a little something about medication. Then she had to learn a lot more once she became a patient. She also has a college degree and paid attention to the number and type of pills that the doctor was prescribing.
Chris found that she could not tolerate the medication and described the doctor’s waiting room as a kind of casting call for potential addicted people. You will not see stories about people like my sister in the flood of media coverage about opiod abuse largely because of the color of her skin. Today’s newspaper has an article about white millennials as the face of the crisis. But long before it was a white problem, there were African-Americans in pain clinics who were being given way too many pills. Chris escaped because she recognized what was going on and changed doctors.
My overseas readers have deserted me. Meanwhile I was reminded of the power of in , person friendship. I attended a workshop today on the problems created by adverse childhood experiences. I had experienced several including racism, alcoholism, metal illness, domestic abuse and being exposed to smoking. But education, resilience, friendship and having a goals and hope helped me overcome my ACES. I saw myself as young gifted and black, not poor me.
A few years ago the Republican controlled state legislature passed a law taking decision-making authority for mental health away from the elected county supervisors and replaced them with a group of volunteers from the community. The board includes mental health consumers, attorneys, advocates and mental health professionals. There are a lot of big decisions to be made regarding Milwaukee County mental health. The county is moving away from the model of maintaining a large mental health facility which they have been downsizing over the years by closing wards and shifting the people who lived there to community based facilities. Case management, which helps people live in the community, has already been contracted out to various agencies. These agencies help engage with consumers and connect them to services with the aim of reducing their dependence on in patient treatment, which is expensive and often very traumatic.
However, there are no guarantees in this system. We all know people in community programs who died but we can try to reduce the number of preventable deaths. We can ensure that case management provides necessary services. We can increase the number of affordable housing units. We can offer physical and mental health in a coordinated fashion and make certain that people are getting regular check ups. We can have clinics where we would want to be treated. These are very easy steps we can take in our own agencies
But what we do to guide the process of system wide reform? One way is by joining the mental health board. Imagine my surprise when a former co-worker asked me to apply to join the board, which is appointed by the county executive. I will be tossing my hat into the ring tonight to see if I can add my experience to this group. I am excited, interested and curious all at the same time. I will post some more as the process goes along.
I just listened to a story on This American Life about Alan Pean, a young African-American man who experienced a severe psychiatric breakdown while living in Houston, Texas. Alan was a college student who had previously survived a couple of episodes of manic depressive disorder. Alan came from a high achieving family with doctors including his father.
Alan found that his mind was overpowered by a delusion that caused him to jump off the balcony of his third story apartment, make his way to his car and crash through the gates. He drove toward St. Joseph Hospital, a major medical facility in downtown Houston. He crashed and totaled his car into the hospital and somehow told the emergency room staff he was having a manic episode. But he was never treated for his mental disorder. His father who is of Haitian descent arrived a few hours later and also told the staff that his son was having mental problems and yet Alan was still not evaluated by a psychiatrist.
His father left to try to arrange getting Alan help for his mental illness and shortly afterwards the staff had trouble with Alan and called for security. This turned out to be Houston police with guns who were not trained in dealing with psychiatric patients. Alan was tasered, then shot and almost killed and later charged with assault. Although the charges were later dropped there is a disturbing pattern of mental patients being shot or tasered by police who have little or no training in dealing with them.
There is a New York Times article about the incident involving Alan Pean. People need to be aware of these kinds of incidents and understand that psychiatric patients need help, not bullets. They need people trained to deescalate and force is the last thing you would ever want to use to help someone recover his or her mind.
This story raises other questions, such as what if Alan and his father had been white? Would the outcome be different? Would the hospital staff you turn to for help be able to recognize that when a white person says he needs mental help, they would hear the person and attempt to provide help? What prevents them from hearing the same statements from people of color? What information is available about the hospital you use and their policy about the use of force? How equipped are they to handle people with a mental illness? Is the person the staff calls for help going to be an armed police officer? And finally, what safe alternatives are there to hospitals for people with mental illness and how widely known are these alternatives?
In the Sunday Milwaukee Journal Sentinel the front page story asks, are health systems failing a moral test? My question is simpler, who will care for the poor? I have worked in several levels of mental health including apartment programs, the crisis resource center, the mental hospital and case management, for more than 10 years. And much has changed during that time. The most dramatic is the downsizing of the mental hospital which now sites half empty. At the same time resources have been shifted towards improving people’s access to resources in the community. There are more organizations dedicated to ensuring that people don’t need the things that inpatient care provides.
When I worked at the hospital, nursing staff morale was low because they saw where it was going. I saw former nurses at a recent listening session held by the Milwaukee Mental Health Board. It was hard not to feel some sympathy for them as they talked about the end of their careers while in their 50s and early 60s.
There are multiple sides to this story. There are tragic stories of people who died at the mental health complex. There are people who did not need to be housed in the long term care units who were assisted in transitioning into the community. There are some acutely ill people being turned away from the mental hospital because there are not enough beds and not enough staff to care for them.
The Milwaukee County Mental Health Complex has always served as the safety net for the sickest and poorest of our residents. The Milwaukee Journal Sentinel asks which of the profitable existing private hospitals will take it over and serve their patients. People who had no insurance always knew the the county was there for them. But those days are rapidly coming to a close. They asked the advocates what they hoped for but I don’t recall anyone asking the people who sometimes become too ill in the community what they would like to see. If I was a poor person looking at these choices, I would be afraid. And the nights are still cold.
Today was a day away from our mental health consumers as the Milwaukee county mental health and substance abuse contracted agencies attended a session designed to educate us about white privilege. The presenter was a very dark skinned man named Dr. Eddie Moore. The presentation is part of a year long series by the change agents program designed to help improve outcomes by making us more familiar with the concerns of living in an increasing more diverse society. Dr. Moore had grown up in a black neighborhood , became addicted to drugs and remained involved with them until his first job after completing his bachelor’s degree. He didn’t clean up his act until he was forced to do so by his employers with Big Brothers Big Sisters.
Dr. Moore is in an interracial relationship and lives with his wife and children in Green Bay, Wisconsin. He is an experienced presenter and he and his wife own their own businesses.I was active on social media throughout the session, first complaining about hunger, then being disappointed by the quality of the food. I was sitting at a table with the staff at our agency who work for one of our other programs so I only see them at our Monday staff meetings.
I would estimate that 30% of the attendees were people of color. This included agencies and staff of Milwaukee County. Ours is one of the few agencies owned and operated b African-Americans so it was a little tricky taking about the ways that our policies may have been influences by the concept of white supremacy. There is also the problem of introversion versus extroversion. I was sitting next to a small quiet young woman waiting to break into the conversation at our table which was dominated by the more talkative people.
The program included an action plan which started with educating ourselves about the issue . I went to the library and checked out Color Blind Racism by Leslie C. Carr, My First White Friend by Patricia Raybon and Whiteness a Critical Reader.
I also admit that as an African American worker I have a certain amount of privilege regarding the consumers I assist. However, that is a topic for another discussion.
I am writing this in response to a training session sponsored by Milwaukee County in which Mark Sanders gave a very religious flavored presentation on recovery. The main focus was on developing cultural competence to work with African-Americans. He incorporated a lot of small group discussions and solicited a lot of feedback. I would even agree with some of what he said. There are consumers who are deeply spiritual or religious. I have several of them but as a secularist I don’t engage with them about something that I consider out of my realm of practice.
As for my agreements with Sanders, I have always focused on the strengths people present which may have been overlooked as they headed toward the cycle of diagnosis and disability. What do people do in their spare time for fun? I mention my hobbies or movies that I might have seen if the situation seems appropriate. I enjoy music which is one of my favorite protective factors. With music on my new computer I seek out you tube. On the way home I heard about an album by Thad Jones and Mel Lewis. I also seek out Cassandra Wilson, Aretha Franklin and Judy Collins. I can spend hours in the music room. Resilience, empathy and being able to identify with others help to keep me going. And although I joke about him, our cat helps to calm me down.
Overall I have learned to filter out a lot that I disagree with in these training sessions. It helped that I mentioned I did not like the presentation on my evaluation. One county worker asked me my opinion and I told her we need to find more secular oriented speakers to talk about African-American culture. Because not all of us are in the Amen corner.