Zachary offers deeper insight into mental health policy for vulnerable residents of Cleveland.
Mental health care has long been an underserved area of medicine in the United States. However, the issue has become too large to
ignore with recent statistics from the National Institute of Mental Health (2012) showing that mental illnesses afflict 43.7 million Americans over the age of 18. This does not include that number of people struggling with addiction, the children suffering from a mental illness, or the homeless mentally ill without an address. The numbers are staggering, but they do not show the lives of individual people struggling day in and day out. I witnessed this in my internship this summer was with Frontline Service in Cleveland, OH, which reaches out to those in crisis with mental illness homelessness. The greatest exposure I had to people in poverty with a mental health condition was from outreaches in the community or from shadowing mental health care professionals as people came for treatment. The internship showed me the debilitating effect of mental illness on people in poverty as well as how mental illnesses can exacerbate poverty. Additionally, I learned how the stigma associated with mental illness can enhance that effect. No case of poverty is the same, but mental illnesses prove to be a difficult barrier to surpass for those in poverty.
Enigmatically it is hard to determine whether the illness cause people to lose a hold on their situation or if the situation is so unbearable that the illness arises from the inability to survive. I saw evidence of both cases. One man had recently graduated high school and was on course for trade school when he had his first psychotic break. The psychotic break was so strong that he was convinced people were following him and wanting to hurt his family. The illness convinced him that if he could find out who the people were, he should attack them. His family was close to the poverty line already, and if he did not receive help with his condition, the family was on the verge of setting him on his own. Even if he receives treatment, it may be some time before he is stable enough to hold a job. He is at risk to falling into poverty due to his condition.
Another case showed how the mental illness symptoms stem from an impossible situation. One man we went to see at his home experienced suicidal thoughts and struggled with depression for the last several years. He lost his mother at an early age, and the first time he could remember seeing his father was at her funeral. His life was never particularly easy, and he had been injured due to faulty equipment. As a result he struggled to find a stable job, and when we met him, he had nothing. He lamented not being able to afford a safe apartment or to take care of his daughter. He told us of a recent robbery that had left his door broken, and we could see how the apartment was of questionable structural integrity. His depression made him want to give up and aggravated his feelings of hopelessness, leading to our visit for suicide prevention. His story is one of many persons I saw contemplating suicide or turning to drugs and alcohol. Whether the illness causes the decline into poverty or is a result of the decline, the effect nearly immobilizes persons seeking to move out of poverty.
One the most pervasive problems with poverty and mental illnesses is the lack of understanding that leads to a stigma. The stigma permeates people’s lives from families, co-workers, or government officials failing to understand the condition. Even harder than the external stigma is the struggle to accept one’s own illness. For those who were fortunate to come to terms with having a mental illness, many had no desire to seek help because of prior mistreatment. If a person was seeking help with hypertension and the doctor or staff did not effectively treat him or her, the person would find another place. This does is not the case for mental illness. One bad interaction with mental healthcare can be enough to prevent seeking aid again or even concluding that no help is possible. I frequently observed this phenomenon, and unfortunately, I saw evidence of maltreatment, even in a professional environment.
A girl who had voluntarily checked herself into the hospital due to suicidal thoughts was stripped down to her hospital gown, placed in a room away from all of the others with only a padded table, and worse yet, kept from using her phone to contact her parents. The room itself was dimly lit with a single light above the bed, and the door had a tiny window. Fortunately, the patient was allowed to keep the door open, though that was little consolation. I understand the desire to keep someone from committing suicide, but the situation was dehumanizing. The girl told us that she had trouble in the past receiving help for her depression. She felt like no one listened to her and health workers just shoved medication at her. Fortunately, the social worker convinced her to follow up at our agency, and the psychiatrist listened to her story. I sat in on that appointment, and the psychiatrist discovered a home situation in which the parents held unrealistic expectations coupled with low finances. All of this was made worse by the patient losing her sister to cancer a year previously. Her problems were not solved by the one appointment, but the psychiatrist provided a holistic plan for her. The tears she cried at the end of appointment were not those of despair but cleansing. The psychiatrist went beyond just treating the illness; he provided hope.
Agencies serving people with these conditions must work to fight the stigma associated with mental illness while ensuring the dignified care people need. Otherwise, those seeking a higher quality of life with a mental illness face nearly insurmountable barriers. All cases of poverty are unique, and this is an essential message for policy makers. From felons trying to reform but unable to get a foot in the door to children born into multiple generations of poverty, illiteracy, and teen pregnancy, poverty is not a simple matter of dollars but a web of positive and negative factors. No matter the story or the illness, people need to be treated as humans with the compassion and love that all deserve. This quality can be lost in a system strained by far more persons seeking aid than the system has resources to provide. This gap between resources and needs leads to rushed appointments and overbooking with the hope that some will not show. Mental illness is a dimension of poverty that can be addressed more effectively. We need resources to provide mental healthcare that is thorough and compassionate. However, for these resources to truly make a difference, the public needs to be educated about mental illnesses and how holistic care creates stable, if not thriving, conditions. With optimized care and public understanding, mental healthcare will not be an impossible challenge for those in poverty.
References
National Institue of Mental Health. (2012). Any Mental Illness (AMI) among Adults. Retrieved from National Institute of Mental Health: http://www.nimh.nih.gov/statistics/1ANYDIS_ADULT.shtml