Early in my career as a social worker, I couldn’t even see the phenomenon of mental health warehousing let alone know how address the issue in a relationship. My college texts had promoted the mainstream eugenic presumptions associated with mental illness. I didn’t know what was needed to recover from things like psychosis, personality disorders, or addictions and live a fulfilling life other than to tell the client to take their medication.
Now, in my twenty-three years of experience working in the system, I have seen many other workers not really learn about the effects of mental health warehousing. It’s as if those of us who work in the field slept during social psychology lessons of Stanley Milligram and the Stanford Prison Experiments. And many of us who do understand the dehumanization process associated with warehousing may abandon the work for private practice. It’d nice it they left a little space in their practice for warehoused individuals. Perhaps some do.
Believe me, I never imagined that mental health warehousing would happen to a conscientious person who excelled in the mental health professional like myself. I used to think I was empathetic towards clients because that’s what always impressed others about me. Now I think I was just sympathetic and encapsulated! Indeed, though it could happen to most us, we rarely think that way. When I did land in warehousing, it was a real education.
I went to work in a section eight housing project and alerted the press and challenged the police. A resident warned me to stop bucking the system, or the same thing could happen to me. He was right.
Now, seventeen years later, most of my clients live in warehoused conditions and need help adjusting to them. Many have lost family support and lived this way decades. Of course, I do what I can do to help them be free; but learning to do so has taken some time. For clinicians new to working with warehoused individuals, I have just five suggestions to make.
One, don’t presume it is easy to leave these very real experiences behind:
Once subjected to warehouse conditions, people may have a need to honor their experience and have a hard time leaving the neglect behind. Many tolerate and honor things that don’t make sense to the observer. In fact, many observers might have a hard time believing that what warehoused individuals report is real.
How could it be, for example, that in the land of the free, that the only job that a privileged white man with a master’s degree and a beef with organized crime and the police could find was at an Italian Deli with a four-hour daily bike/train commute? It was not for lack of job applications or resumes, I assure you.
During a two-year period, I had to learn not to snitch. I had to accept that people were breaking into my apartment and stealing my things, just as they had done when I was warehoused three-months in the dilapidated Montana State Hospital. Maybe you can’t believe it possible until it’s happened to you!
For people like me, it can take years of revolving door hospitalizations to get to the place where they accept warehouse living to start with. Then, to move on can be a lot for the ego to manage. It is hard to say all the warped things they learned from their experiences in incarceration were unnecessary. It is hard to abandon the post because, often, warehoused people know first-hand that things could be worse.
Two, don’t presume that you could get out of the very real holes they are in:
In working with warehoused people, it is important to temper the amount of advice you give them about how to be empowered in their situation. Just because you have power, doesn’t mean that they do. Thinking that they don’t know how to assert themselves is a good way to diminish the amount of trust that develops.
I have seen clinicians burn out because their advice is never heeded. Maybe they leave behind their duties physically or emotionally because they don’t believe the oppression is real. Many clients have seen this happen repeatedly. Here comes another staff person they are responsible for training. Now, they start from scratch, just so they can get their weekly check.
No matter how seasoned you are, it is always wise to be thankful when your client teaches you something that deepens your understanding of the layers of oppression they face.
Many workers may not realize that they couldn’t manage themselves what they are presuming their clients ought to.
Many clients, like the section eight resident who tried to warn me, know better than to try to fight the system politically. They will see advice or action towards that end as simply being naïve and insulting. Really, they usually know what’s up! Respecting the power structure but talking about how oppressive it is may help.
Three, find ways to address the fact that you are financially exploiting them in the context of the relationship:
Many would say it is cynical to look at the mental health industry and say that there is a lot of money reinforcing the suppression of its subjects into mental house warehousing. Seeing the mental health industry from this vantage point makes it seem like it is a plantation industry with finely educated suits with six figure salaries making decisions about how to keep the peasants maintained.
Clearly, not all the people I work with see managing the trauma and strife in their lives from so cynical a perspective. Still, I believe a therapist who works with people who have been warehoused needs to be prepared to work through these realities and feelings as they get unpeeled in the relationship. At times, I have found that it is important to argue the cynical perspective to help people become sensitive to how being warehoused has impacted them. It may be necessary to help people see and remember the value that they really have. This may help reinforce social rehabilitation.
Many warehoused people will appreciate it when you acknowledge your buzzard role in nickel and diming them and picking through their bones. At least talking about it will help them know you will do what you can not to get caught up in that trajectory.
Although I was only warehoused for a short time, the therapy I got at 125$ an hour while I was making 9$ an hour at a Deli seemed ridiculous. Talk about financial exploitation—for years it was. My parents mandated it and paid for it from a nest egg, but would not give me money for a car.
Four, know that therapy is still valuable and walk the line:
In retrospect, and knowing the business as I now do, I am just grateful that my therapist did not refer me back to the hospital so that I lost my job and my apartment. If I had seen an intern who wasn’t making top dollar, I likely would have overwhelmed them and their supervisor and been incarcerated back in the system where it would have taken me much longer to heal.
Having a therapist for warehoused individuals is important even if they don’t seem to like you. And good clinicians need to be tolerant, competent with what they are dealing with, and maintain unconditional positive regard.
Supporting your partners is ways that help them make well thought out slightly empowered improvements in their interpersonal situation is possible. In doing this, it is important not to act as if you know, but to collect a lot of information about the barriers in the situation with curiosity.
I think good therapy advances the mindset that it is possible to help warehoused individuals pursue healthy integrated activities that can mitigate the effects of warehousing. That is what I did maintaining a job. Many amazing people have taught me that a bed in a warehouse is just what it is. One can still do their hygiene up and go out and find healthy activities and connections. I now see and support people doing this every day.
And yet when I look at the workshops available to me as a licensed individual, there is little out there in my trade organization that encourages therapists to learn to work with these conditions and limitations.
I wish that more therapists would learn to specialize in helping warehoused individuals. For practitioners who care about social justice, there really is no better way to be of service in the community than to develop specialty practices that can reach out and include such individuals.
Currently we know this population growing exponentially in our local homeless encampments, our flooded shelters, our barrack-like board and care homes, our county jails and over-crowded prisons. Know people can recover and gain back their freedom! Help!