I am deeply disturbed by the Philadelphia Inquirers' lead editorial of 1/24/09, advocating the wholesale move of the mentally ill (“developmentally disabled”) patients out of structured institutional settings into so-called “group homes or apartments”.

 

As a recent M.A. Art Therapy graduate of Drexel University and advocate for quality care within our mental health system I am saddened, shocked and outraged. It is heartbreaking to see patients in Philadelphia flourishing with proper mental health care, only to be abandoned by the system in the coldest part of winter. There was a patient on an adult psychiatric unit in our city who had been in-patient for six months. This person, I will call her “Jane,” entered the hospital in an acute state, appearing intrusive, paranoid, delusional, and unable to communicate appropriately with others. But over time in the unit, Jane became more organized, eventually contributing with set up and clean up for art therapy sessions. She responded very well to the structure and consistency the institutional environment provides. Granted, the atmosphere of an adult psychiatric unit is highly contained and limited. The key missing piece in our system is a lack of congruency. The departure of the structure and support of trusted therapists, psychiatrists, social workers, etc., causes a tragically unsafe situation for mentally ill Philadelphians.

 

 

Personally I witnessed this person—like many others with similar symptoms—flourish over time when attending art therapy. About four months after beginning treatment, Jane revealed moments of insight that could allow a quality of living that was absent prior to the institutional care. What "normal" people in our culture generally seem to lack is an understanding and appreciation for the difficulty that 1 in 10 individuals have in connecting with other people. This inability disables many from working and maintaining a functioning lifestyle independently.

 

 

One day at the end of a session, Jane asked me if I had a big enough house for her to come home with me to cook and clean, have no guests, and be able to take her medicine every day. For one moment Jane was able to communicate clearly what she seemed to want and need. I discussed with her the impossibility of that and explained that the discharge plan would allow her to live in a home and have a stable lifestyle.

 

 

Later, the patient was discharged to a residential facility in the greater community. One week after her discharge, and I am out after dark in Center City—which I might add is a rarity, as I myself tend to be a bit afraid of my own city after dark. I exit the Market East Station, and a cold wind sends a chill across my cheek before I am able to wrap my scarf. I see a person huddling in fetal position over a grate, and I walk around them, thinking, what can I do? I see another person leaning on a window ledge trying to sleep, and I’m saddened, but I keep moving. I cross paths with a third homeless-looking person, and suddenly I realize that this is the ex-patient walking in front of me, slouched over and dragging a blanket, looking cold and isolated. Jane recognizes me. Looking her in the eyes, I do my best not to cry.

 

 

Jane asks me for forgiveness, saying she doesn't recall my name. "What are you doing?" I ask, "Where is the house you are supposed to be staying at?" "I don't know." I proceed, "Where are you staying tonight?" She points north. I wonder where that means. "At a shelter?" I ask, "Which one?" Jane has no answer. "I'm so hungry and cold...your name, your name is Ms. Nicole." I begin crying softly, this is real. What ever prompted Jane to leave the residential service she had attended will never be known. I wiped my tear and said something like, "I'm sorry, I don't mean to cry." To which Jane responded, "Are you mad at me?" "No, I'm mad at our system. I'm mad that you are here on this cold street." I offered Jane the muffins from my backpack, but she humbly wanted to refuse. I insisted that she take them, and I wrote down a phone number for her to call us on the psychiatric unit. I walked away sick and disturbed. What more could I do? Calling emergency seemed useless. Multitudes of people were wandering the city streets cold and isolated. The following morning, I reported this to the team at the psychiatric unit. I found out that Jane had been reported missing several days prior. I requested the outreach number to call, should this ever occur again.

 

I'm not talking about drug addicts, or alcoholics, though they, too, are in need of greater support. I am talking about building sustainable permanent housing options that provide safety, structure, medical support, and food for the mentally ill population of Philadelphia. I am advocating for this population because their mental illness inhibits them from advocating for themselves. The brain is an organ, that just so happens to determine our communication abilities. Who, in a stable state of mind, would walk out of a housing option in the freezing cold without taking their money with them? We cannot let this be the way we care for our fellow Philadelphians. We must work for change.

 

 

Another week passed, and Jane was found dead underground in the city hall terminal after a freezing weekend—only three weeks out of the system after six months of structured safety, where she had just started establishing a better quality of life. I heard of this patient’s death on Inauguration Day, so here is my salute to change. This is how change will come: I will speak, educate, advocate, administrate and work directly with people implementing ideas with the support and vision of others. I understand that many people have a bigoted view of state hospitals, only a few years of experience working clinically in our city and six years of study and supervision with clinicians who have worked in this system for over thirty years has taught me that these facilities are an important answer to a huge problem. It seems kinder to turn the underground terminal into a long-term housing facility for the chronic mentally ill, than just to allow them to freeze to death.

 

Nicole Porter Willcox

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