Providers should be able to focus on healing, not social control

Globe Spotlight articles have highlighted the difficulties that the Department of Mental Health and its vendor agencies face when trying to help some people who have both severe mental illness and dangerous behaviors (“As patients leave state care, safety a concern,’’ Page A1, March 26). I am a psychologist who worked for 17 years in a DMH psychiatric hospital and for six years in a contracted vendor agency, and I experienced this challenging problem regularly.

It’s easy to argue that people with severe mental illness who commit crimes should be treated, not prosecuted, but this makes mental health service providers into agents of social control, like police, probation, and courts, and not clinicians trying to lessen human suffering.

These state-funded programs serve people with complex psychological profiles, which often combine mental illness, severe trauma, personality disorders, neurological problems, and substance use.

The message, conveyed by the Spotlight articles and many well-meaning observers, that people with mental illness are not responsible for their behaviors and therefore need to be supervised is counterproductive. This message can demotivate people from engaging in recovery efforts, and it puts mental health providers into supervisory, as opposed to therapeutic, roles.

In practice, especially outside of hospitals, it is very difficult to serve or supervise people who don’t want your services. Within DMH and its vendor agencies, senior staff are preoccupied with preventing the people they serve from hurting themselves or others. It can lead staff to become overly paternalistic, bossy, and insensitive to their clients’ privacy and autonomy concerns.

The best solutions to this dilemma involve mental health and legal authority partnerships, such as mental health courts or mandated treatment overseen by probation officers. We need to let our legal system do its job in managing criminal behaviors. Our mental health system works best, including at reducing dangerous behaviors, when the people we want to help freely choose these services because they are respectful, empowering, and high quality.

Neil Glickman

Natick

While violent acts draw attention, thousands struggle for basic care

Why does it take acts of violence making headline news for people to become concerned about the lack of mental health care for our most vulnerable citizens? Although the occurrence of assault and aggressive acts by mentally ill individuals is small, this seems to be people’s major concern.

What the article “As patients leave state care, safety a concern’’ does not clearly outline are the thousands of chronically mentally ill people who do not get adequate care for management of long-term illness. Many of these people are at much higher risk for self harm or suicide, and access to care is limited at best.

Community mental health clinics often have waiting lists weeks or months long. Psychiatrists are often limited to brief medication visits every two to three months, pressured by low reimbursement rates and large numbers of those needing services. The seriously ill are often detained in local emergency rooms for days while ER clinicians on rotating shifts search for an appropriate inpatient bed, and then they are released without adequate treatment.

Underfunded group homes and support services do their best to provide care in the community, but these are struggling nonprofit organizations often affected by sweeping cuts to Medicaid and other state funding. The statement about protecting a patient’s right to refuse treatment is accurate. The laws protect people to make poor choices and refuse services, but those rights are also fortified by the striking lack of resources for these people.

Elizabeth Hunt

Danvers

Highlight success stories — community-based system reaches many

The Globe Spotlight series on mental health services in Massachusetts seems to be reaching for some nostalgic vision when state hospital beds were more abundant and state case managers monitored care.

As a social worker with more than 30 years of experience, dedicated to working with people with mental illness, I don’t argue with the premise that the community-based system is in need of repair. But that’s no reason to look back.

Examples of innovative, effective services exist across the Commonwealth and the country. They include crisis intervention team training for police to assist with safe and compassionate responses to people in extreme distress; peer-run respite and Living Room-model services; and recovery response and respite centers that allow easy access and humane alternatives to hospitalization.

Perpetuating insidious myths equating mental illness with violence and despair reinforce common prejudices and take a toll on the well-being of people with mental illness. To what end?

I’ve known countless people who have left institutions in this state who have thrived and reclaimed lives of worth in the community. We have a responsibility to use 21st-century thinking, not 19th-century notions, to continue to find resources for solutions that work.

Elizabeth Whitney

Natick