A Second Arizona Tragedy

Hi, Mark,

I'm not sure the real tragedy is "the stereotyping of all people who live with mental illness as unstable and violent individuals." I think that tends to be a bit one-sided; it sounds a bit too much like advocacy, and doesn't take into account the difficult issues that families and churches face when mental illness turns ugly. I don't oberserve that kind of stereotyping nor do I know of any statistics about that.

What concerns me much more is the lack of resources available to those severely affected by mental illness, and the difficulty family members have when they are trying to get help for someone with, e.g. schizophrenia. As a pastor I've dealt with a few situations of this type, and it was near impossible to get help for these people, because their disease prevented them from seeing that they needed help. The medical system is also an obstacle rather than an asset much of the time. In one case of schizophrenia, we tried many times over the course of years to get a young person committed to a psychiatric hospital; but he was aware enough to manipulate his way out again. The police authorities said they were powerless to do anything, and even criticized me and the parents for trying to get him committed. Finally, when he managed to get hold of a hunting rifle, he did what he had been openly planning to do for many months; his parents found the body. The local member of the legislative assembly here in Alberta had the gall to blame the family and he defended the system, because the mentally ill have rights. But what do "rights" mean when you're not in your right mind?

A second situation involves a person who refuses to admit that he has mental problems, and projects his problems onto others, with a great deal of delusional verbal violence directed at specific individuals, interspersed with hyperspiritual preaching and grandiose reflections on his own virtuous and loving qualities. I am very concerned about the potential that the verbal violence could turn physical. What can be done about it? Next to nothing. This individual is receiving no treatment at all, and will not even submit to a psychological exam, and no one can force him to do so. The result is that his former spouse lives in fear for herself and her two children.

I think we need a more balanced view of mental illness. Far more people experience it than we like to admit, often in the form of depression, and I concur that there is a terrible stigma there that we have to overcome. But I think that in every pastor's career, perhaps in every congregation, it is likely that one will encounter a person who is mentally ill in a way that makes them a danger to themselves and/or to others. Moreover, I think we are likely to encounter a few individuals in our ministry who are sociopathic, to use the common term, who might be diagnosed with antisocial personality disorder; this kind of mental illness tends to leave a path of destruction in its wake. I suspect I have had a few parishioners who would fall into this category. This is also an area where pastors could use guidance and support. It can be very frustrating, leaving one with a feeling of powerlessness, when it comes to ministry in these difficult situations.

Ken, you missed my point completely, and misrepresented my comments as well. Are there statistics about people in general discriminating against the mentally ill? Not that I know of. Is it my experience as a pastor that people in congregations use the pejorative terms you list to describe the mentally ill? Not hardly. I made no claim that the mentally ill are responsible for any percentage of crime. My point is that the biggest problem I have faced in ministry in this regard, along with the stigma surrounding mental illness, is lack of recourse when a person does exhibit potentially harmful behavior.

No problem, Ken, I do that all the time. To answer one of your questions, if I were in a mental state that was psychotic, delusional, and dangerous (which is most likely to occur on a Saturday night before I have to preach), I would want my spouse to commit me to a mental hospital, so that I might have some hope of recovery and to prevent me from hurting anyone. I would presume that such a commitment would be involuntary, because I would not be in my right mind. I think people are very understanding, in my experience, when it comes to things like a schizophrenic member committing suicide; we talked about how it was the disease that killed him. But I also felt a good deal of impotent rage at a medical/legal system that ultimately ensured that this young man would eventually be successful in taking his own life. What I would like to see address by the office of disability concerns is how pastors can deal with this? What resources and strategies are available for this kind of ministry? How do you help someone who refuses help and believes you want to harm him/her?

Hello Ken and Randy: Thanks for the discussion. I was really moved by your initial message Randy. Our family lives with mental illness and I am deeply frustrated with exactly what you describe: the absurdity of allowing someone who is really sick to choose wellness, when they don't even know what that is. My daughter lived on the streets for several weeks last year and because she was 16 and "old enough", and despite her long history of mental illness, there was nothing I could do to stop it or get her help. Believe me, I tried. On the other hand, this event occured after 2 years of mental health care where she spent 6 months of each year in the children's psyche unit both in our local hospital and in a larger center. Where was the healing that was supposed to occur? You can read stories of people who do get "care" and invariably there are periods of time where they are over-medicated and time is lost. The whole system is so messed up, as a parent/advocate I hardly know where to put my 2 cents in to advocate for change.

I do think you are absolutely dead on when you say that people who care about the person who has mh issues need to be allowed to be in the picture and have their say. It is ridiculous that there is so little support or guidance available for those whose lives have been disrupted by a loved one with mental illness.

I was so excited about your post I passed it along to a mh worker we have seen over the last 4 years. Do you think that advocating for this with a letter to a mp would be something you could do? I know that it bears little fruit, but I don't know where else to begin. It is a justice issue, would it be appropriate to have someone like CPJ advocate in this matter? I am making wild guesses. What do you think?

Randy, Ken, and Nelly,

Thanks so much for your comments. In the U.S., we finally have a mental health parity law which requires insurance companies to provide the same treatment for people with mental illnesses as they do for people with other kinds of illnesses. This was passed a year or so before recent (and highly contorversial) health care legislation. We'll see how well this parity law actually plays out in how insurance companies put this into practice for people who need this coverage .

As for mental health and the church, I hear you, Randy. In fact, Disability Concerns organized a Mental Health Task Force a little over a year ago to address issues of ministry with people with mental illnesses. The Task Force began their work by going to a conference sponsored by Pathways to Promise, an organization dedicated to helping faith communities address mental illness. One of the founding denominations of Pathways is the CRC. Pathways' homepage has a link to a summary of the conference with many conference documents. I highly recommend a look. When you click on the link, it will look like a pdf of the conference brochure, but they added links to many other documents in that. It's rich with help.

Disability Concerns has also provided some simple resources for ministry on our website, but it's only a beginning. Last summer the Mental Health Task Force did an informal survey of pastors because we realized that ministering with people with mental illness, whether or not they are confrontational, is often one of the most difficult challenges that pastors and congregations face. We want to keep working at this and in fact are drawing in CRC Pastor Church Relations into the conversation starting next month. Randy, I forwarded your first post to the Task Force because it expresses so much of what we heard from other pastors as well. Thanks for writing.

Thanks, Mark, Living in Canada, I can tell you that changes in health coverage laws will not make one iota of difference in this matter. Canada has universal health care coverage, but the system has limited resources, particularly for the mentally ill, as advocates have pointed out to provincial and federal governments to little avail. Even with universal health care the severely mentally ill are still living on the streets and it's nigh unto impossible for a family to get someone with severe schizophrenia, for example, committed long enough to get a proper diagnosis and a treament plan from our overcrowded and under-resourced hospitals. The law is also a problem; it was a Canadian member of the legislative assembly in Alberta, the speaker of the assembly no less, who told our local ministerial that the mentally ill have rights (and of course we agree) and so it's up to them to get treatment or not (which is totally naive and unrealistic in the case of someone who is not competent to make those decisions). Moreover, getting help for someone in our rural Canadian town is extremely frustrating and almost seems designed to make people throw up their hands in surrender. It seems to me like an overwhelming systemic problem, not merely a matter of extending coverage. (And as a Yankee living in Canada, I have to say I have no clue what the new health care law is supposed to do; it seems like a bandaid on a head wound). I have no answers, only a frustrated lament, reflecting the pain of members of my congregation and our sense of powerlessness.

Mark, thanks for your words about the tragedy in Arizona. Last week, we had a similar event in Toronto. A police officer was killed by a man who had stolen a snowplow. The media is saying that the man has a mental illness. One of our  very popular hockey commentators,  Don Cherry, paid tribute to the fallen officer and did a good job of that until he called the man who killed the officer a 'whacko'. I'm afraid mental illness carries some awful stigma and will continue to do so until we educate everyone!

Here is the youtube link to Don's commentary. The tribute begins at about 6 min and 15 sec.

http://www.youtube.com/watch?v=QLFjuGsOJos 

For me personally, the "mental health parity" law has not done much.  In fact, in my situation, it is the opposite.  Faced with providing more mental health coverage, the employer cut back on coverage for physical health coverage to compensate for the new mental health coverage.  There is now equal coverage, but they decreased the "physical health coverage" to pay for what they now provide for mental health.  My husband's employer is also intending to increase deductibles, co-pays, and employee contribution.  Employees may have to provide "equal" coverage, but the employer can bring about parity simply by decreasing areas of the regular health insurance or requiring more employee contributions for the physical side of things.  Insurance companies and larger employers/corporations know how to work the system and get around any law that government passes with good intentions.  Some of the employers in our area are also cutting health costs by hiring only temporary employees.  One in particular, hires people in temporary positions -- 89 days.  They have to provide insurance at 90 days.  If the like the employee, they occasionally will hire them on a regular basis with continuing employment, however, in most cases, the company has them work 89 days, then they miss the 90th day (or 2-3 days).  Then they are called back and start all over a Day 1.  Many of these people are laid off or unemployed from their former jobs and can't find another one with or without benefits.  My niece was employed as a temporary person for about 9 months (less the 2-3 days off around what would have been the 90th day when benefits would start).  Her dad, my brother-in-law got laid off and finally after about 9 months found a new job, but this new job only provides health care to the employee and any children that the new health care legislation requires to be covered.  Their kids are grown.  His wife is the one with health issues, including Diabetes and heart issues.  His insurance covers HIM only as the employee.  He has no children, but his spouse still is not covered.  Companies cut back on all insurance benefits in these ways to offset the new requirements and cost of "parity."  In my case, since mental health parity became law, we are having to pay more for the physical aspects of our health insurance and more co-pays for mental health.  The sad part is that everyone ends up paying more for physical treatment at my husband's employer even though many of them other employees have no one in their family who gets mental health services.  In reality, THEY are being punished because of US (we who have mental health issues).  That makes me feel bad as well.

I think everyone also needs to remember that sometimes a person with mental health problems doesn't have support within their own household.  From what I’ve read, the shooter in the Arizona tragedy apparently did not have this support.  The college seems to have messed up as well, there was little follow-up by ANYONE.  I'm thankful that the above parents care about their daughter enough to try to get an involuntary admittance to a hospital or inpatient program to protect her (or others) and that they WANT to have active involvement in her treatment.  I have not been as fortunate with many family members.

I do need to share something regarding inpatient treatment (my personal experience) that not all people who have not actually been an inpatient realize.  I have PTSD/depression and a movement disorder.  I have been an inpatient -- and it was a very bad experience for me.  I also know of a teenager in our church who tried to commit suicide shortly AFTER being released from inpatient treatment.  I don't have the exact data in front of me, but I remember reading there is a higher incidence of suicide attempts for people when they are released from inpatient stays. The teenager I know attempted suicide within days of being discharged.  My first thought was "I wonder if he learned that from the other kids" and I mentioned that to a relative of his.   Inpatient stays are not always a good thing.  The patients talk with each other -- I learned about ways to hurt myself (self-injury) and some of what other patients felt or did in group therapy.  Group therapy sessions several times a day were required.  I couldn’t “get out of it” until several days had passed when I begged a nurse to ask the psychiatrist to let me stop attending.  None of the other patients' situations were similar to mine.  None were caused by childhood trauma like mine was (I'm an adult survivor who had repressed memories come back as an adult and the perpetrator admits everything).  I had a terrible time being with those people.  If anything, when some shared their thoughts, it made me think even worse things about myself or my situation -- things that I hadn't thought of before I was in the hospital.  I learned ways of doing "serious things" that I hadn't thought of before on my own.  I also was basically afraid of some of the other patients.  In my experience, the patients were and their levels of mental illness were very different.  There was an older woman who thought I was her mother.  I am not wacko or psychotic.  I may have some irrational/cognitive distortions.... but to have this woman follow me around asking me to give her a baby bottle about pushed me over the edge.  I am afraid of men I don’t know because of the type of childhood trauma I experienced.  We were required to eat together in one room and were told to “socialize”.  At mealtime, I sat at a table alone (being afraid of everyone else).  This one man always sat on the table next to me and he always wanted my food.  I heard over and over, “Are you going to eat that?” and he’d move toward me and practically touch my food.  I gave him whatever he wanted.  He and that older woman freaked me out.  Luckily, I had my own room (they weren’t filled up with patients when I was there).  It was at the very end of the hall and for some reason, the old woman and that man never followed me all the way down to my room.  In my situation at least, we were not “sorted” by gender, type of illness, our experiences, or in any other way.  Mine was a voluntary admittance, but you can't just say "I want to leave" and they unlock the doors and let you out.  After signing the admittance papers, THEN they told me that I could ASK to leave, but it was up to them to decide after a 24 hour evaluation.  They also waited to tell me all the "rules" and "requirements" until after I signed the forms.  I wanted OUT so bad.  As someone who experience what I was told can be typical for "general" inpatient stays, I can see why the girl above did not want to go back into the hospital. 

Inpatient care may NOT always best.  I was in a well known, large hospital and I still faced this situation.  I would fight “tooth and nail” before having to go back to that hospital, which does actually have a very good reputation.  My daughter-in-law's mother tried to commit suicide several times.  The time she came closest to succeeding happened when she was in an inpatient facility.  Even though the nurses checked inside her mouth to make sure her meds were gone, somehow she still was able to save enough to overdose during the night.  They checked on her at 2:00 a.m. and she was unresponsive.  She ended up in intensive care, unconscious for 5-6 days and they didn't know if she would survive. Hospital inpatient situations can do more harm than good sometimes (in my case).  Mental health issues are very difficult for everyone, but more for the person with the illness than family or anyone else affected by it. 

I do not receive much support at home (actually often the opposite happens out of my spouse's frustration that I am not the same person after the repressed memories came back, the stigma he still believes is true, and his unwillingness to learn more and have counseling himself to learn ways to provide support and cope).  I more than anyone realize I have made his life difficult and I am thankful he has stuck by me.  I am very fortunate to have a couple who are my very close friends and a pastor who helps me keep my faith alive.  Sometimes it is just a tiny flicker, but my pastor has provided scripture and counseling.  He has also worked to keep me involved in our church using some of my "employment skills" from my former employment.  I can no longer work outside the home, but doing volunteer work for church does sometimes make me feel needed and that I still am a valuable person in spite of my disabilities.  I try my best even though sometimes it is very difficult for me to even get out of bed in the morning, much less accomplish anything once I am up and moving.

Relationships are hard for me (and for those who care about me).  Some of my friends/relatives seemingly don’t care enough to keep in touch and they deserted me – I know it isn’t easy for our friends and family.  But, BEING mentally ill is awful -- I would change my health situation if I could, believe me.  Family relationships DO change.  I realize that and I feel responsible since I AM the one with the illness even though it wasn’t my fault.  Negative things occur for us outside our family and homes as well.  I was transferred to a less responsible (and much lower paying) job at my employer after developing my mental illness.  A change in management  took place a few years later, and the new boss basically fired me -- with a major labor attorney's advice working around the ADA laws (Americans with Disabilities Act).  I have had continual health problems, physical diagnoses and treatment difficulties for the mental illness.  I struggle in relationships -- often they are Christian people who have good intentions, but just don't understand or LISTEN.  Friends do desert you for various reasons and it is also at times hard for us to be with people.  We are often worn out physically and mentally.  Sometimes to the point it is impossible for us to cope.   I could make a list of 10 negative things in a flash that are the result of my childhood or the mental illness/movement disorder.  For me, it isn't just the "mental illness.”  The effects OF (after) being diagnosed and sharing that information with people, the mistreatment by people who don't understand or are afraid of me or who still believe the stigma, can hurt inside sometimes almost as much as the illness itself.  I think this is just another thing that healthy people will never understand "until they walk in our shoes."  I admit that I never understood until I became mentally ill.  I never looked down on mentally ill people and I tried to help them, but I had NO clue to the feelings inside that are a part of it all or the stigma and hurt that can come from people who just aren’t knowledgeable about our mental illness or just don’t listen or ASK us what would be most helpful.

I struggle with WHY God allowed so many bad and hurtful things to happen in my life -- and WHY he hasn't shown more positive results to various treatment plans.  It is hard to keep trusting God.  I know things will work out “for my good” because I do love the Lord, but I've basically come to the realization that "my good" will most likely happen when I leave this earth.  Even though my faith falters, I know God still holds me tight in his hand even when my faith is as small as a mustard seed.  Sometimes it is hard for me to think about waiting until God’s time for me to leave this earth because in my deepest pain, I wish that "my good" would happen NOW.  Treatment can help, but ultimately God is in control of my situation.  He is stronger than Satan.  (Deep down I believe that, but sometimes I say "He is SUPPOSED to be stronger than Satan" because often it sure doesn't feel that way and that is not delusional thinking – I have doubts because of the pain I feel inside).  

Also, I think it is important for everyone to remember that in most cases -- mine included -- we have done NOTHING to deserve our disability, mental or otherwise.  An adult (and a Christian) was responsible for the years of childhood trauma that eventually brought about my mental illness (and also my movement disorder).  He has admitted everything to my husband and siblings, but he has never apologized.  In my heart, I have forgiven him, but I still can't see or be near him because it causes setbacks for me.  I get no support from my siblings.  They acknowledge what he did and that it was awful, one sibling told my husband he asked the perpetrator, "Can't you at least say you're sorry?"  In spite of that, the person who hurt me so terribly as a child has never said one word in that direction to me or anyone else.

I do appreciate the opportunity to share my story and thoughts.  I read that there was a request for a "blog" for parents of children with disabilities.  Maybe there should be a "blog" for adults who HAVE disabilities, maybe separate for physical/mental.  While I have diagnoses in both areas, not everyone does.  Living with a mental illness is very difficult for the person with the illness (and everyone) -- the majority of us are not "crazy" -- and we can understand what is wrong with us and recognize that our thoughts are not necessarily "normal."  Sometimes we don't realize it until hours or days later.   I have found myself needing to apologize a day later when I realize I have been short-tempered or regret writing or saying something.  I recognize cognitive distortions and some other thoughts that are not rationale to everyone else, but it doesn't change how I feel inside – it doesn’t change how RIGHT my thoughts are to ME.  People can say, "You're being irrational or delusional" (two words I hate) -- but my thoughts make perfect sense to me and it is frustrating sometimes when people continually “harp” on me about what I think or feel.

To everyone who helps us, learns more about our illnesses, listens and tries to understand, and has to live with us (or counsel us as our pastors), THANK YOU -- but PLEASE be patient.  Most of us try our best not to be a burden or cause problems for others.  Living with mental illness (or any disabling condition) is a hard road with many ups and downs.  So many parts of our lives our out of our control.  We are helpless to change so many things about us or situations around us.  I feel terrible that others, especially people close to me who I love, have been put into a position of having to live with and/or deal with me because of my mental health problems.  To read some of the frustrations that are written within the disabilities concerns area by people WITHOUT mental illness does hurt sometimes and I believe not only me.  I am probably MORE FRUSTRATED that I can't fix my OWN brain (for myself and EVERYONE around me) than any of the pastors or family members who write in sharing THEIR frustrations or difficulties with US.  I recognize I make life more difficult for my family -- and even my pastor's life more difficult simply because of the time he has spent counseling or praying for me and others in our church like me.  We have a lot of hurting people in our congregation.  Mental illness is actually fairly common.  I get very discouraged because sometimes medical treatment and professional counseling doesn't seem to help.  Sometimes what my pastor says (and scripture says) doesn't stick in my brain.  Prayers don't seem to make a difference.  I get discouraged -- and I feel bad because I know others around me (including medical providers) get discouraged.  I even think my pastor gets discouraged because there are so many ups and downs and at times very little improvement.  Some situations, probably like the young girl above, are just very difficult situations and as hard as everyone tries, it will just take more time, new ideas, or .... like I believe in my case, it is a thorn in my side that I will have to live with forever while I'm here in this world.

Sorry to write so much – sometimes thoughts just pour out and are hard to stop.... 

Hi Brenda: I realize I am a month late in this discussion, but seeing as no one else has picked it up, I thought I would. I really resonated with your question about the usefulness of hospitalizations. People seem to assume that if someone asks for help, or is forced into it, that they will actually receive it and come out further ahead. That is so not the case. We have extensive experience with hospitalizations for our mentally ill daughter and most of the hospitalizations did little more than keep her physically safe while she was there. There was lots of bad things that happened, as well. However, I will say that when she was transferred to a larger center and then treated there we did finally start to see some improvement. I think the problem is that really, medication seems to be largely a guessing game, and therapy, especially in hospital settings, is very cut off from daily life, and therefore of little use. Now, I wouldn't say that she shouldn't have gone to those hospitalizations because one other benefit of them was that our family had a chance to pull together and recuperate from the damage done in our home. But I so long for more research and understanding into mental illness, and drugs, as well as further training with "professionals" who seems to really lack an understanding of the value of family in supporting a mentally ill family member. Those are my thoughts. Have a good day.

I am not 100% sure, but I do believe NAMI is strictly in the US and that we haven't really got a Canadian equivalent. Anyone else know?

Yes, although NAMI courses have sometimes been taught in Canada, NAMI is only in the U.S. This is the response I received from the head office:

NAMI does not have any official affiliates in Canada. Most of the support one would find from NAMI in the States is provided by the Canadian Mental Health Association.  You can find their website here: www.cmha.ca  The website offers affiliate information for the CMHA by province and then by local affiliate.

I have not checked this site myself.

NOTE: The NAMI Family-to-Family course is being offered in a couple of areas in BC this fall.

British Columbia

Program Director:  Eileen Callanan

[email protected] 

250-635-3620 

Terrace

Saturdays : starting 09/24/2011

10:00 AM to 12:30 PM

Contacts:

Eileen Callanan

250-635-3620

[email protected]

Noreen Spence

205-635-8206

[email protected]

West Vancouver

Tuesdays : starting 09/20/2011

7:00 PM to 9:30 PM

Location:

Family Support Centre, 1865 Marine Drive

West Vancouver, BC, V7V 1N2

Contact:

Family Support Centre

604-926-0856

[email protected]

You might check to see whether classes are being offered anywhere in Ontario this fall:

Ontario

Program Director: Madeleine Bertrand

[email protected] 

613-993-2711 

Fall NAMI Courses will soon be listed on this website:  http://www.namiontario.ca/