Mental Health System & Section 17

         In the last three months, I have started through Shalom House in York County. The particular program I work in is considered supported housing, in that tenants have 24 hour access to staff members (who are trained and licensed to administer medications); however they have full freedom to come and go as they please, and have as much contact with staff as they like (so long as they have visual contact 1x/day).  This is my first employment experience directly in the mental health field, and already, I have learned so much about the intricacies and challenges of providing care for those experiencing mental illness. Each resident has a number of different providers who they are required to see regularly in numerous locations. In addition to round the clock access to staff members, what holds each of these clients accountable for their self care (including employment obligations, appointments with providers and more) is the caseworker. In many cases, family members are unable to serve in this supportive role, and without the link to community that caseworkers provide, it is apparent that many of the clients in this residence would be unstable.

         Having this awareness of the essential work that caseworkers do, in conjunction with what is occurring with Section 17 in Maine, the Weil chapter on the history of the mental health system could not have come at a more appropriate time.  There are two sides to the “case management” argument– one in favor of the service, which accepts that 1.) the mental health system is fragmented and 2.) case management services assist those with mental illness or other serious diagnosis navigate the fragmented system. The opposition to case management services believes that 1.) continuing case management continues support of a fragmented system and 2.) (using language from government officials) case management “fosters dependence.”

         The ruling suggests that case management services be offered only to those diagnosed with schizo-affective disorder and schizophrenia – two illnesses deemed, in the public eye, to be the most ‘severe.’ When attempting to cut government costs, limiting this service to those individuals makes some kind of sense… that is unless you have seen case management in action. It’s easy to say that providing services fosters dependence. It is harder to provide empathy to high service utilizers with whom you have no connection – probably due to the fact that you have experienced an entire life’s worth of privilege. It’s easy to limit services to those diagnosed with schizo-affective disorder and schizophrenia – understanding that yes – those diagnosis by nature, are very severe. It is harder to attempt to live an organized life (attending doctor’s appointments, making phone calls, managing mail etc.) when experiencing the absolute chaos of homeless life.

         At least in the 1960s, at the start of the community mental health movement, when clinical, hospitalized services were diminished, something else was offered – even if it was short-sided and failed. The changes to Section 17 offer nothing but reducing services that are already flawed and fragmented.

         I don’t envy those in legislative positions in any way. However, fiscally motivated change with no first person knowledge of the impact on service recipients is inhumane. What is equally disturbing, is that despite heavy participation and action on this by providers, as Terrie Haggey put it in her write in to the Portland Press Herald, opposition to these changes are continuing to fall on “deaf ears.”

References:

Haggey, T. (2016). Maine voices: Did opposition to DHHS changes to section 17 fall on deaf ears?. Portland Press Herald.

Weil, M., Reisch, M., & Ohmer, M. (2013). The Handbook of Community Practice. 2^nd Edition. Sage.