I was a skinny and reluctant social worker when I first started out. I was working through an eating disorder. Initially, I didn’t really believe that taking home a middle-class salary for nickel and diming those less fortunate was my idea of contributing to the world.

I guess, I’d gotten the idea that that was what the field was like during interviews I’d held with middle-class white women who worked down the street in government agencies during a social welfare class. I’d set up residence where I was finishing up my schooling, in Camden New Jersey. I needed money to stay independent from my parents.

Then, I took a computer test that suggested that I should become a cop in the career development office. I’d worked under-the-table at a local Korean deli for several years. Most of my neighborhood friends had pointed to the vice squad when they came in under cover and took coffee from us for free and told me they were the real bad guys. Sure enough when we were held up at gunpoint, the cops were scared to come around.

“Yeah, picture me as a Po-Po,” I said to my best friend, an English major who used to sell drugs and was going back to school.

“Well, actually, you always have had a cop mentality,” said my friend.

I shot him a look that said he was insulting my intelligence. I started looking at social work internships.

***

During my second job, I worked at a day program that was connected to a 30-day crisis house. Since I was only just entering a master’s program, I felt extremely privileged. As a result, I aligned myself with my supervisor and other more experienced workers. Without credentials, I was focused on working with people who would get my back.

One day, I received a client and was ready to get to work on housing issues, when I found out that she came attached with a more experienced case manager. Though not very talkative, she did tell me very clearly that she did not want to go to a particular boarding home, the largest such facility in the county. When I talked to the case manager, he was clear about the woman’s future. She had to go to the unwanted boarding home.

“Wow, that girl is really sick!” I heard a coworker who worked the graveyard shift at the crisis house say.

“I don’t get it,” I said, “I don’t see why she can’t live where she wants to. I help other people find housing, why can’t I help her.”

“That girl is very sick, I can just tell by the way her eyes roll to the side” said my co-worker

I deferred to experience. Sure, I had been hospitalized for six months myself, but I knew better than to make waves that would impact my work reputation. My therapist was teaching me that I could be a little paranoid and I wouldn’t let that affect my clinical judgment.

The woman was shipped away to the very place she most did not want to go. I can now see that she had been right not to trust any of us. For us, she was just protocol.

***

Once I graduated my master’s program and was promoted to a case management position, I visited the infamous boarding home which was buried in the New Jersey Pine Barrens in the far reaches of the county. Out in the pines, there were few stores, lots of sand and aged pine trees whose growth was stunted by fire. The pines were where most boarding homes in the county were located. I admired the scenery as I drove out.

The home’s one-story buildings were made of quarter inch plywood and styled in rows like chicken coops. There was no insulation from the elements in any of the buildings. Corridors were long and full of small rooms with cots and no furniture. At the end of each there was an open rec room where open vats of warm, iceless bug juice sat out under the dim lighting. There were no fans to drown out the buzz of the flies. These halls reeked of sickness. The chipping linoleum floors were being mopped with cheap chemical stink water that reinforced the sick feel. Almost all the clients were either gone to a day program or had walked the three miles to the store. I could not even begin to picture what the place looked like when it was full.

When I finished I followed the owner to the front office. The owner’s daughter had been in my sister’s class at our posh private school before male anorexia had drained my bank account and lowered my social standing. Back at the office, the owner had barraged me with gossip and information about the school.

Once freed to collect my thoughts, I recall betting to myself that they treated mentally ill better back in the Middle Ages.

***

A year later, I made enough money to fund a move to the west coast. Within six months of moving, I made a job transfer into setting up services in a section eight housing authority facility.

Here, I was reminded a lot of my inner-city days in Camden. I got to know a more urban style of warehousing. The project was scrutinized by the local media in the City of Seattle with its large homeless population. To get section 8, a homeless person had to spend time in this project.

I witnessed quite a bit in the six months I worked there: thugs tearing down doors and emptying apartments in broad day light; stabbings of impoverished addicts that were barely sanctioned; a suspicious death by heroin overdose; vulnerable individuals’ going to jail for being bullied into letting their rooms be used to deal drugs. And some of the things the residents said were even more eye-opening. I figured it was finally time I do something!

When I found out my supervisor had a significant drug habit I became suspicious of her intent. I stopped heeding her. Like a vigilante, I leaked info openly to a community activist and to newspapers and was starting to face unforeseen levels of threats.

One day, a resident with a job who had pointed out the local drug kingpin to me, told me, “It’s true we all love you here, even some of the shady people like you . . .”

“It’s just that we are afraid of losing our housing,” added his partner.

“You see,” continued the resident, “we all know this guy who came to work here and was just like you, fighting for all the residents. And he ended up having to come and live down here. I am just worried that that is going to happen to you . . .”

Shortly after this interaction, I received an unsuspected threat from my best friend from my inner-city college days who I called to consult. I found myself in a unique state of crisis. Was the threat real? He paid for college by working surveillance for a “bad” lieutenant in the Philadelphia Police. I matched up stories and began to see the world from a new nefarious perspective. . .

***

Three days later, I was picked up out of a ditch on a mountain pass outside of Butte Montana.  I had been harassed by police for the past two days since they had violently halted my escape to Canada and separated me from my car. Finally, I surrendered to them.

Two months in, I was transferred to the most chronic unit. The temperature inside was below freezing. There were icicles inside the window that sat above my head. It was almost as bad as the boarding home in South Jersey.

When I first entered those dank halls, I felt destined to behave with the subservient merriment of the thirty-year residents. I was given old, dirty clothing so that I could layer up among the crowded halls. My appearance and sense of self declined. Fungus off the bathroom tiles grew under my toenails and warts covered by hands.

I still remember waiting outside the ward in the freezing Montana winter, staring at the cash cattle in the field. I’d be waiting for the staff to return via bus, late from lavishing with their lunch.

There I was determined to stay hopeful, industrious, and independent as I weathered the biting chill and it only annoyed the staff to no end. They all rolled their eyes when they returned as if to say I was entitled.

“That’s what they all say about you,” said my psychiatrist who I finally got to meet with her two and a half months in. I had put requests to meet with her in writing, but it never worked.

The staff didn’t have any hope for me. They all knew I wanted to take down the mob for what they were doing to me. The Cowboy Security Squad even gave me a beat-down to discourage me. Maybe I was a little entitled because I kept mouthing off.

Meanwhile, other patients told me the mafia really was following me. Many said they were in the mafia. One even tried to lure me to join a local gang for protection.

***

All this I went through was just the beginning of some very hard times that would last for two years.

Discharged to the streets I moved to Fresno, California and the temporary work I landed to get an apartment to let me go when I ran out of my month’s supply of medication. I started to feel I was being harassed in the streets. I didn’t know what to do. Somehow, despite extensive efforts, the only other job I could find was at an Italian Delicatessen.

Working at the Italian Deli forced me to move from the Central Valley to the outskirts of the Bay Area. Only then, was my family who I believed was connected to the mafia was willing to do what they could to support me.  I had no supporter who seemed to believe that anything that I went through was real. They only treated me as though I needed tough love.

After ten months of employment, I finally learned to stop being bullied by drug-dealing, suburban kids who were half my age. I stopped letting my white shirt wrinkle during my rainy twenty-mile bike commute (and two-hour-long BART ride) to work; I accepted that I had to be polite to the Republican clientele that wanted to know all the ridiculous details about which farm their fine fucking olives came from. Finally, when I got insurance and could afford medication, I was able to get the anger and paranoia out of my eyes.

I believed people were entering my apartment during this time. Mail from job interviews would come to me already opened in spite of my complaints to the mail service.

***

Now, I am a Licensed Marriage and Family Therapist who works in an inner-city psychiatric day program, primarily with warehoused individuals. Boy, did I find it difficult to return to my career after being warehoused? It was a real uphill battle. I even lost a per diem job at one point and nearly landed back on the streets.

And the survivor’s guilt really keeps me up some nights.

Don’t worry! I have learned my lesson about being an advocate. Additionally, I know better than to try to educate the public about the evils of stigma and mental health warehousing. Research says that this will only make the problem worse.

Sure, I feel bad that twenty years ago a woman was committed to squalor and I did nothing.  But I learned advocating for the mental health of the vulnerable needs to be done carefully, one case at a time. Alerting the press and crossing the police is a good way to lose your housing and end up destitute yourself. I learned first-hand about how arrogant my actions were when I thought it couldn’t happen to me.

In these days of escalating disparities, I am grateful now to respectfully extend my therapy skills this forgotten about population which is growing exponentially in our local homeless encampments, our flooded shelters, board and care homes, our county jails and over-crowded prisons. When I think of all I went through and still go through because I was warehoused for one month, I am amazed to see people come back and do better and better. There is a lot to know and respect about them. It is important for social workers just starting out to learn from them. They know an awful lot about their situation.

I think in this era, losing housing could happen to many of us. Try attaching schizophrenia to your name and see how many people stick around to support you and listen to your woes. Some days I come home distressed that I cannot do more to help, but over the last sixteen years I have learned how to share my story and develop programs that do help people. I am extremely lucky!

The post Mental Health Warehousing And I appeared first on Redefining "Psychosis".

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.

Five, help!

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!

The post How to Work with Issues of Mental Health Warehousing as a Professional appeared first on Redefining "Psychosis".