Individual Rights or Professional Responsibility?

When you work in a homeless shelter for any length of time, you can’t help but meet some folks who have very serious mental illnesses.  The population of people we generally describe as “homeless” includes a significant few who have terribly painful and chronic conditions of schizophrenia.

It has been my experience that those people I have gotten to know just a little have had lives that were both tragic and courageous.  I got to know “Julia” a little, a woman in her 50’s who had been released (“de-institutionalized”) from a mental hospital on the West Coast in the late 1980’s and who had subsequently spent time in various homeless shelters as she traveled to the East Coast, eventually coming here to Main Street in Bangor. When comfortable to do so, she told me, in the manner of a friendly and patient teacher who has to explain something to a child, that the reason her life was in such disarray was that she was being pursued by a group of attractive, blond young women who were terribly focused on sabotaging her every attempt to lead a normal life.  “Jim” finally shared with me that the reason he would stand outside and scream into the air from the sidewalk while making karate-like moves was that he was being persecuted by the black tendrils.  “Warren” managed to live outside in Bangor for quite a while, always polite to anyone who stopped to say hello (hoping he was okay) and thanking anyone who gave him something to eat—but never eating that gift and later disposing of the food, as he believed the government had managed to insert a designer poison effective only against him into any and every item of food on a grocery shelf or from a restaurant.  The exception was a certain brand of peanut butter and a particular type of bread.

I don’t know where Julia might be.  The odds are that she is dead.  Jim is still alive and living a pretty low quality of life in Bangor.  Warren’s body turned up one spring in the waters off Bucksport.

As experience informed my vision, as I witnessed people suffering every day due to their illness, I would end up working with other shelter employees to try to get these individuals into treatment and a safe place.  The trick was, this would have to include the required evaluation to be performed by someone credentialed at an emergency room.  This wouldn’t be much of an issue if the individual needing care had the insight to know s/he had a significant illness.   So it would take some work to earn the trust to actually get the person to the emergency room, and that would be no guarantee of outcome.  A lot of these folks were not only very guarded but had fairly extensive experience, not of a positive kind in their eyes, with hospitals and mental health providers.  And so many could “clear”—act pretty darned normal, long enough for the evaluator to conclude they were not at enough risk to warrant inpatient treatment.  And then the person would return to the Shelter or, in more instances, decide we were no longer safe and leave town.

The current system may well be out of balance when it comes to individual rights.  We have a history in this country of first swaying in one direction and then sweeping back the other way when it comes to a number of policy issues. It is painfully clear that we have a history of criminalizing the mentally ill and then casting them out of our sight into filthy warehouses.  But it’s also been our view from Main Street that some sick people have not received the help they have needed ironically form a position of respecting their decision to decline, a decision not reached through a healthy mind. Talking with family members who have tried to get their children into residential care can be heartbreaking.

I wonder if we aren’t shirking some tough responsibility as we place the bar pretty high in terms of people needing to receive care against their wishes, wishes I sometimes think may be our projection of what others need rather than clear, informed decisions made by and for them.  And then there are the caring family members…  Let’s at least continue to have the difficult discussions these people are worth.

Dennis Marble

About Dennis Marble

Dennis has been the Executive Director of the Bangor Area Homeless Shelter since January of 1996. His previous career work includes non-traditional and adult education and management and sales and sales management. He’s a graduate of Colby College ( B.A. in 1971) and the University of Maine (M.Ed. in 1976), and happily has a daughter and son-in-law who have chosen to stay in the Bangor region.