My adventures in behavioral health began in very humble surroundings. My first real job in the field consisted of degrading duties and even more degrading compensation. The bowels of healthcare so to speak, these kinds of positions were usually disguised by lofty job titles such as “Residential Mental Health Technician” or “Day Habilitation Specialist”. The fact that the educational requirements for such a position consist of a high school diploma (or equivalent) probably should have been a dead giveaway that this was not necessarily the gateway to a lavish career in medicine. If that was not enough, perhaps the fact that several of my coworkers were either recent parolees, or so disheveled in appearance that if they lost their nametag they may not be allowed to leave, for fear that we may accidently release a newly admitted psych patient.
The facility its self was like something out of a low budget horror movie from the 1960s. That also being the time period when any equipment upgrades or significant maintenance probably took place. The term “low budget” also seemed key on many levels. In the defense of those who run facilities such as this, it’s not their fault, it’s ours. The average United States citizen still cringes at mental illness, most are ashamed, embarrassed or even frightened at the very thought of it affecting someone in their lives. This primitive attitude toward mental illness of course carries over into our political system, and therefore our budgets. Mental health agencies largely depend on state and federal funding. It is by far the lowest priority on the political totem pole, and is funded accordingly. These agencies have to fight for every dime they ever see. Unfortunately money it seems is always the bottom line.
The truly ironic part of all of this is that psychiatry has by a large margin the most successful “cure rate” of any medical field. Unlike an oncology unit, or ICU, mental health patients are much more likely to report relief from debilitating symptoms, and go home after a hospital stay. In reality, what that means for a hospital, believe it or not, is less money. Under our current system, hospitals don’t make a profit if you are home and well. The biggest, most profitable disease currently known to man, is cancer. Cancer keeps hospitals in business. So when a budget committee meets to decide where to invest in its facilities, where do you think the money goes? We have all seen, or at least heard of the grand opening of a new hospital wing or public health clinic with all the new bells and whistles. What we don’t see are these kinds of improvements, or even upkeep at a mental health facility. These places remain hidden, in the closet, every hospitals dirty little secret.
This environment is where we attempt to heal the mentally ill in this country. I always thought it was the very definition of tragic irony. Sometimes, it seems the patient doesn’t get better because of our best efforts, but despite them.