Article by Patrick McNamara, LCSW, President and CEO, Palm Health Foundation
Published in Stay Thirsty Magazine
As a species, we human beings are profoundly social creatures. The more we come to understand about the human brain, the more we see how fundamental our social connections are to our well-being. Yet how we relate to each other has been changing rapidly in the 21st Century. Ironically, while we have never been so digitally connected, we are also recognizing that loneliness and social isolation are reaching epidemic proportions. In many ways, we are able to live in separate worlds, oblivious to the experiences of people we don’t encounter. Is there any connection between these phenomena and our rising challenges in mental health, or brain health as I prefer to call it? The emerging data, social neuroscience, and my experience lead me to believe that there absolutely is. As a clinical social worker turned CEO, I have had the privilege of learning a few key lessons along my personal and professional path that offer a way forward, a way to enhance our social connections while improving our brain health.
After finishing graduate school in 1995, I joined the Community Treatment Team at a local mental health center in south Florida. We were intensive case managers serving folks with severe mental illnesses and addictions. Specifically, our clients had been living in institutional settings, and we were charged with helping them to reintegrate in the community. On my first day of work, my partner Vinny and I drove to a boarding home to make a few home visits to our clients. As we neared a dilapidated building with newspaper covering broken windows, I saw a shirtless, skinny man standing on the sidewalk, wearing a large straw hat and spraying deodorant under his arms. “Joe” greeted us with a smile from ear to ear and he invited us into his room, with a mattress on the floor, for a cup of coffee. This was the beginning of my first lesson.
Lesson One: People living with a severe mental illness are some of the most resilient, incredible people on the planet.
Joe had grown up in the Midwest and moved to Florida with his brother in his early twenties. He was working in construction when he began to hear voices and develop delusions about aliens. After winding up in a local hospital, he was committed to the state psychiatric hospital where he remained for several years. He then preceded to cycle in and out of jail, boarding homes, and local hospitals. While Joe was never able to hold down a job again, he qualified for social security disability, the primary source of financial support for US adults living with a severe mental illness. He developed several friends, attended a drop-in center, and was an avid fan of the Kansas City Chiefs. Joe had a wonderful sense of humor and was known to be generous with his friends. Getting proximate and being in relationship with people living with a mental illness has transformed any sense of stigma I harbored into respect for them and the challenges they face.
Seeing Joe live in the squalid conditions of the boarding home bothered me greatly. Consider this for a moment: it’s hard enough for a person to learn to live with a psychotic disorder. It’s a challenge of another magnitude to consign that person to live in abject poverty. Can you imagine trying to live off of $650 a month, including all your housing expenses? This injustice made me angry repeatedly. This is when I learned my next lesson from an age-old spiritual leader.
Lesson Two: Saint Augustine said, “Hope has two beautiful daughters: their names are Anger and Courage. Anger at the way things are, and Courage to see that they do not remain as they are.”
I used my anger at the social injustice of deinstitutionalizing our most vulnerable neighbors without the necessary supports to live in the community. I made the case for supportive housing as an answer. And I scrapped, scrounged, and advocated to create new housing resources.
While history demonstrates that we’ve made progress in our treatment and understanding of brain disorders, we have a long way to go – particularly in reconciling our understanding with policy changes. The deinstitutionalization movement began in the 1960s in an attempt to provide more humane treatment of persons with mental illnesses while also cutting expenses for state-run asylums and hospitals. The conditions and practices of these hospitals were often brutal and destructive. New drugs and growing awareness of the plight of the mentally ill offered great promise. Unfortunately, good intentions have never garnered the necessary resources for properly transitioning care into the community. As a result, our neighbors with severe brain disorders constitute the majority of our homeless and disproportionate number of incarcerated adults in the U.S. This is beyond tragic. I have seen how well-crafted, evidence-based solutions, such as supportive housing, are not only cost-effective, but also significantly effective in improving quality of life. In fact, people with a chronic mental illness can and do recover with the proper supports.
Ongoing research on brain disorders and effective treatments are vital. The good news is that there has been an explosion of scientific research and understanding about the human brain over the past two decades. This is exciting – but continuing breakthroughs need to be supported! It’s beyond time to move from the headlines of our rising mental health challenges to meaningful action. Through public-private partnerships, the time is now to invest heavily in advancing brain research and effective treatments. Interestingly, one of the most consistent findings from this research is the powerful effect of a supportive relationship. The social nature of our brains has evolved to depend on relationships to both heal and thrive. Beyond medications, we have learned through advanced forms of imaging that relationships actually change our brain.
Lesson Three: A consistent, supportive relationship is profoundly important to smooth the ups and downs of a person struggling to overcome adversity. We are social creatures – our brains are wired to connect.
Acts of gun violence have recently been conflated with mental illness. The fact is that people with a mental illness are no more likely to commit an act of violence than the general population, and they are more likely to be victimized. That said, acts of violence and aggression are brain-based behaviors with multiple contributing factors. Social isolation and disconnection are among them. After the horrifying, nearby shooting in Parkland, our State has responded both with “hardening” the security of our schools and with funding mental health services in schools for the first time. Now the First Lady of Florida has announced her signature initiative to be “Hope for Healing,” focusing on improving mental health for children and families. It is my sincere hope that we will heal and find new ways to prevent future tragedies. I believe that social connection, advanced brain research, and access to treatment are major parts of the solution.
Reflecting on my personal and professional path, I learned:
Lesson Four: I was most impactful when I recognized the inherent dignity of each person I was trying to help and acted accordingly.
While I made many mistakes and had many failures, practicing dignity was the essential ingredient of the positive changes I witnessed. Relationships are hard, but practicing dignity calls us to rise to the challenge. Consider the increasing mental health challenges that we face, race and health disparities, our rapidly growing aging population, and the future of our children. How might the future look if each of us decides to draw closer to those we encounter in need? We just might learn together the art of practicing dignity.