Tag Archives: Assertive Community Treatment

Lost Minds: Serving people with mental illness

I have been planning to share a short journal I started months ago that describes my experience as a  mental health counselor.  I work at a P.A.C.T. (Programs of Assertive Community Treatment) which serves people with severe and persistent mental illness, such as schizophrenia and PTSD (Post Traumatic Stress Disorder).  The program staff  visits these individuals and provide psychiatric and rehab services to help them prevent hospitalization.  I have learned, in the three and a half years I have worked here, some aspects of these people’s lives.

Why am I sharing this with my readers?  Well, because serving this population fits perfectly (I think) with the Kingdom of Heaven.  People diagnosed with a mental illness, particularly schizophrenia, are usually marginalized and discriminated.  Only a selected few are willing to work closely with these people.   They are the “least of these” that Jesus talked about as well.  They are trapped in their own paranoid and delusional minds.   They are ignored, ridiculed, and avoided.  They are Lost Minds.

Here it goes:

October 2013    Yesterday, I visited David.  I saw him walking down the street ,claiming that he didn’t know where he was going but he complained of people calling him names. He was obviously having auditory hallucinations. He states he doesn’t have any friends and does not want to spend time with others .  David complains of pain on his neck and does not want to eat because he wants to lose weight.  His thoughts are concrete , just like a child.

Today I visited Mary for medicine observation.  We need to observe her take her daily medication to ensure she is compliant.   She opened the door to my surprise. She has a history of not answering the door or the phone when we call her. I could sense a strong body odor.  She sat down on the front porch while I talked to her. I reminded her about appointment with psychiatrist but she tried to avoid meeting with psychiatrist by saying that she had to submit a job application in the afternoon but then she said she would meet with the doctor. She tends to say she is busy or cleaning up as an excuse. She has been diagnosed with schizophrenia, paranoid type, and has auditory hallucinations on a daily basis. The “voices” started when she was in her late teens.
About a year ago Mary began to act more bizarre by not answering her door, acting more guarded, not letting staff come inside, and exhibiting poor hygiene.  She also lost significant weight, and we suspected that she was not taking her medication. We consulted among the PACT team members and decided to start observing Mary take her medication on a daily basis to ensure she was compliant. She reluctantly agreed. However , her sister called the PACT office and shared concern about Mary acting “weird”.  When the sister visited Mary one time, she saw a pile of trash in Mary’s kitchen. She reported that Mary was hoarding trash for unknown reasons.  Sister also said Mary did not have enough food and found hamburger wrapping paper with leftover food in it and the kitchen sink was clogged and filled with dirty water.  The sister said she offered to help do grocery shopping and cleaning up the trash, but Mary declined.  I visited Mary one time and assertively invited myself inside the apartment. I found exactly what the sister described.  I opened her refrigerator and it was almost empty. The pile of trash in the kitchen was about three feet high, and it included a microwave. When I asked Mary what was going on, she replied “I am cleaning up… ” which did not make sense.  I also offered to help her clean up and transport her to do grocery shopping, but she adamantly declined. I  warned her that if she does not clean the pile and buy some food, the PACT team will have to admit her in the hospital for an evaluation.  She managed to resolve the situation but her personal hygiene continued to be a problem.  She has also thrown away furniture because she has been “cleaning up.”  She still does not answer her door every time we visit her but she has been compliant most of the time.

March 2013   Ronald has a history of admissions to the state hospital and the jail.  He is diagnosed with paranoid Schizophrenia and cocaine dependence.  He has a history of accusing others, including the PACT team, of poisoning him , stealing his money, and breaking into his trailer. He threatens to kill some of his family members. He has talked about owning big companies , having surgeries where his organs have been removed , and having supernatural powers . He is one of the most severe cases of mental illness I have worked with. He was recently arrested and placed in jail for continuing to threat family members. He has been on conditional release which grants him the opportunity to live in the community if he complies with treatment . However , Ronald does not always remain calm and is often verbally belligerent and hostile towards staff and some family members.
I visited Ronald at the jail a few weeks later . He insisted that he was “poisoned ” and that his family “cut him up and shot him several times. ” I decided to confront and dispute his thoughts, but he became increasingly irritable and defensive.  He finally stood up and walked away.  The psychologist who evaluated Ronald submitted a letter indicating that given the recent history of threats and paranoia, Ronald is recommended to go to the state hospital.  And so the cycle continues.

May 2014   Today I visited Anthony who suffers from paranoid schizophrenia and cocaine dependence.  He admits to drug use but does not have the motivation to quit.  He lives in a dirty motel room.  He has roaches crawling everywhere and it has a lot of smoke from the cigarettes.  He talks about going to war, which did not happen, and being shot.  He only gets $10 a week from his payee, because if he gets anymore money he will use it for drugs.  I am supposed to transport him every week to cash his social security check.  But many times he uses the $10 to pay back one of his “friends.” So he often has very little food and goes out on the street to panhandle.

September 29th, 2014    Today I visited Robert.   He is currently struggling with the anniversary of his marriage with his deceased wife. He has cravings of drinking alcohol so that he can numb the pain that he feels for spending one more year without his wife.  He suffers from panic attacks and depression.   He tries to avoid large crowds.  His best friend is a little kitten that he owns, which gives him comfort during difficult days.

I also visited Will, who lives in an apartment that has numerous things around the living room and dining room which represents his mental status.   He suffers from disorganized thinking and substance abuse. He may also be suffering from dementia.  Having a counseling session with Will is almost impossible. He does not follow a logical conversation , since he jumps from one topic to another.  He also smokes marijuana.

December 11th, 2014     Today I visited Anthony again at the state hospital … He looks physically healthy, but exhibited some delusions. He wants to return to the community , and smoke cigarettes.  He said he will not smoke marijuana but I don’t believe so.  He does not have contact with his family .  He has no friends… He has no place to call home.  His mother died about 14 years ago… She appeared to have been his whole life.   Now he has nothing , except the hospital and the staff.  After this visit, he went back to eat lunch.   He was sitting by himself at a small table . What kind of life is this ? It is sad to see him like this.  What if he was my brother .. My friend… My cousin? Does his father ever think about him?

What am I going to think about this person’s life situation? He is doing fine? He is suffering? He has an addiction that is consuming him? He is just another worthless life?  Or is he a unique human being that needs help?  Lots of help….