Sue Lani Madsen: Thank you, mental health care ‘system’

He is now officially homeless. Thank you, mental health care “system,” you have done it again.

He was living in a filthy old house falling apart around him, paralyzed by depression, eating crackers and peanut butter slipped to him by a neighbor, ignoring his deteriorating health. Diabetes. Hypertension. Bipolar disorder.

A family advocate brought him back to the mental health “system” looking for help, a home. It was all about housing first, the news stories were reporting. The family believed the mental health “system” had changed. He needed stable, supportive housing.

But it was you, “system,” who told him he needed a referral before he could get housing. You who sent him to a health clinic purported to have wraparound services to get a referral. A clinic that re-diagnosed the hypertension and diabetes, but wasn’t ready to deal with the bipolar disorder. You who told him he needed to be on psychotropic meds before a counselor could make a referral.

And so a family advocate found his former private psychiatrist, the one who had last treated him and still had records, one who re-prescribed powerful meds. Who told him he needed to be living in supportive housing for medication management, but had no power to connect him.

It was like sending someone with cancer home with chemo cocktails and no medical management for the side effects, no monitoring for effectiveness.

It was you, mental health “system,” who told him to call Frontier Behavioral Health for counseling and a housing referral, an effort which took two days in a waiting room just to get an intake interview to start counseling the next week. It would have turned into three days in the waiting room if not for a family advocate at his side who went righteously indignant at the suggestion to come back and get in line a third day.

On his own, he would never have gone back.

It was you, mental health “system,” who told him to “call DSHS” for that elusive referral. More dead ends in more waiting rooms, more paperwork, more futility that would try the mental health of the most stable and grounded of patients as well as advocates.

Meanwhile, the family fed him healthy food. Got him moving again. Started him healing in body and soul. And the psychiatric meds kicked in without management.

Family can provide a couch for him to surf, but can’t be part of the treatment plan. Can’t be told what the meds are, or how they might go wrong. You, mental health “system,” can’t tell them anything. You keep letting the person with the head injury make the decisions.

But the family could tell you a few things.

After twenty years of vicariously living with mental illness, they could tell you how this cycle will end when the “system” fails him again. They could tell you how the unmanaged meds will kick in and the manic side will emerge, and the window of opportunity to meaningfully intervene with counseling will vanish.

They could tell you about the burst of creative productivity at the border between equilibrium and out of control. They could tell you how the anger will take hold, and why he will be homeless because it will no longer be safe for the family to keep him at home. They can tell you how they are resigned to seeing another confrontation end in jail. Like the last time.

The justice system got him the healthiest he’s ever been. They had a duty, he had to be well enough to face charges after a traffic stop gone badly, and sent him involuntarily to inpatient treatment.

He got better, sounded better than he had in years. The justice system did their part of the job. But then he was released for treatment, back to jail and out the door. The community-based mental health system dropped the handoff in spite of decent private health insurance. Having health insurance does not assure health care.

And so it was another long spiral back down into depths of depression, until the family intervened. Again. And tried to find mental health “care.” Again. And was disappointed. Again. And here they are. Again. And he’s homeless.

Love cannot conquer mental illness. It can only wring its hands and weep in frustration.