Is it really a natural outcome? Or can the future be different?

I have the belief that an early death is potentially one of the greatest risks of mental illness.  Whether the death occurs as a result of suicide, or is drug/alcohol related, or is simply due to the fact that people with mental illness tend to live a rough life.  And if you talk with any family member or individual dealing with mental illness, you are likely to hear about suicide attempts and other extraordinarily self-destructive behavior. In fact, the most profound and difficult situations that I ever dealt with as a case manager involved death.   So, I am going to tell you about one of them.  And maybe you will understand why I consider mental illness a huge risk factor in the possibility for early death.

One hot afternoon, one of the ‘consumers’ (a mentally ill client) of the agency I was working for sat outside in the Nashville sun for hours.  This person was not my client, so I am writing from what I remember from outside resources.  I gather that he had been waiting for an appointment with his case manager.  I believe that someone from the agency had attempted to get him to come in to get water and sit in a cool area.  But he refused. I think he was a street person, so his health was probably not the best.  And I don’t know what his diagnosis was.  But he was clearly chronically and severely mentally ill.  People weren’t served by this particular agency unless they were.  Case managers were housed in a room with low dividers between the desks.  There were well over 100 desks in the room.  It was designed to be open.  Consumers could find their case manager instantly, because we were all visible.  And conferences occurred out in the open, unless consumers asked for privacy.  At that particular time, I was sitting at my desk attempting to bully Nashville Electric Service into turning on the electricity for one of my clients.  (An attempt to tilt at windmills.)  All of the sudden I noticed that the room had become very silent.  Mine was the only voice that could be heard in my section.  Then someone tapped me on the shoulder to caution me to be quiet.  And they pointed to a row of desks about 10 to 15 rows ahead of mine.  To my shock and horror, this particular consumer had collapsed.  And as a room full of people watched, our medical personnel attempted to revive him.  The EMT’s came in and continued the effort.  But it didn’t work.  And a room full of people watched as this man died.

I remember how I thought and felt at the time, even if my mind is not clear about some of the details.  I thought about how incredibly lonely the experience of mental illness can be, and yet, this man suffered such a public death.  I thought that many of our clients probably experienced an early death because many of them were homeless.  Few were living a stable and healthy lifestyle. They were abusing drugs and alcohol.  Most of them smoked.  And of course other risk-taking behaviors were common.  Basically, the life of a mentally ill individual, even those in stable housing situations, is not easy.  My Mother died at 67 years old.  I believe she lasted that long primarily because she had housing and the care of family members.  But she did have some of the other issues that I saw in clients. For example, she had instability in her life and was incapable of even the most basic attention to self-care.  Luckily, she had medical care because my sister was a physician and made sure she was taken care of.  The clients at my agency had case managers to help them with health care, but a lot of time was spent trying to locate them in the homeless shelters and on the street instead of getting health needs taken care of.  Not that we didn’t try.  But the life of a chronically and severely mentally ill person may not be the safest.  Or the healthiest and most stable. And what we experienced that day at the agency was a natural consequence of those facts.

Even today, I can tap into the feeling of horror and helplessness as I watched this scene unfold.  There was nothing I could do.  Absolutely nothing. The whole thing seemed to happen quickly.  However, I really don’t know how long it actually took.  And that single experience solidified my understanding of the power of mental illness.  In a few profound moments.  I knew what mental illness does to individuals and families.  It destroys them.  Now, to make this clear: It doesn’t necessarily have to destroy them.  We have the tools to support and heal. As NAMI says, recovery is possible.  Medications are so much better than they used to be.  Ongoing support from sources such as NAMI and the agency I used to work for make a difference.  Support groups help consumers and family members cope with the daily struggle.   Of course, it is imperfect.  We need more money for these resources.  Medication is not available to all.  Many consumers don’t even cooperate with medication.  And we need to increase our understanding of how to appropriately treat mental illness.  Like with any other illness, the more we know, the more we can do.  And the more we educate, the more people feel relief.  I see the importance of each goal through the experience of watching a man die.  Which is exactly why I am talking to you.


http://www.nami.org/