Building Bridges with Mentally Ill Persons
In Singapore—where conformity and good behavior are paramount—the standard management of persons with mental illness is to lock them away in mental hospitals. While in many other countries the current trend is to deinstitutionalize such persons and look for ways to reintegrating them into their families and communities, Singapore still takes a very segregating, approach.
Ken Jue, one of the main speakers at the Symposium, is a psychologist from Vermont, USA, who for 30 years has been a pioneer in the productive re-integration of persons with mental illness into the community. In his talk in Singapore, Ken told of his experiences in this domain, and challenged the rehabilitation establishment in Singapore to respond more humanly and creatively to the needs and potentials of persons with mental illness. With Ken’s permission, we include here the part of Ken’s talk where he describes his own discovery of how important it is to build on his clients’ strengths, not their weaknesses.
In 1996 and 1997 I worked at a large state mental hospital in the US. I was assigned as a caseworker to a ward with 50 female patients. The ward was always locked. The average length of stay for these women was 15 years. Some had been there for 30 years without any leaves of absence or weekends home. Usually they had no homes, or no one wanted them anymore. Almost all had been diagnosed as schizophrenic or with some other psychotic condition. They were all heavily medicated and shuffled around the ward in their formless hospital shifts and slippers. Many were unwashed and smelled badly of urine or stale body odor. If they acted out, they were given stronger medication, placed in strait jackets, isolated in their rooms to rage, denied “privileges” and activities, or moved to another ward. Some were removed for a time and were returned having undergone a lobotomy, which was a poorly researched and imprecise form of brain surgery at that time. These people came back docile, unresponsive to conversation, and appeared never to be the same person… These were horrid circumstances.
A group of hospital staff, including a new ward psychologist and myself, eventually succeeded in convincing the hospital administration to allow us to unlock the ward for several blocks of time each week. We accompanied patients on walks around the grounds. This lead to “picnic” outings in a large unused field. Our staff cleaned off the field for games and other activities. The hospital administration was pleased at our success with the patients and became more supportive of our activities as there were no adverse incidents.
As time passed, we convinced the hospital administration to allow us to construct a day camp across a small stream bordering the edge of the field, where there was a small grove of shade trees on the other bank. We proposed to build a small bridge across the stream. However, none of our staff had ever done that kind of thing before.
Our patient outings had grown to include the women on our ward and also men from another ward in an adjacent building. One afternoon during a picnic, several of our staff were discussing what to do about the bridge. An unfamiliar voice behind us quietly said that he knew how to build bridges since he used to be an engineer. We turned and were surprised to see one of the male patients. He was in his early 50s. We had not held any kind of conversation with this man before. We had assumed he wanted to be left alone to enjoy the few precious moments outside his ward. He went on to draw a picture of a simple but charming bridge. He told us how it could be done and the tools we needed. We were astonished at the discovery of this talented individual.
We asked the man if he would help us build the bridge. After some hesitancy, he agreed to work with us, but said he could not do it alone. He called to one of the other men, who turned out to be a former carpenter, and spoke aside with him. Both agreed to help. Before we could say anything, both took off their shoes, rolled up their pants, and crossed the narrow stream. We did the same and followed them to the grove of trees. That afternoon we designed the day camp. The two men helped us explain the project to the other patients out with us that day. We had a lively discussion with many questions and answers.
It took several weeks of bureaucratic negotiations and pleading, but we finally got all the necessary tools to build the bridge and camp. We made no mention that patients would be involved in this project and would be using the tools, which included axes, hammers, and saws. You can just imagine the alarms this would have set off with the hospital administration..
When the camp was done, it was a sight to behold.
In the meantime, the two men organized co-ed work teams to carry out certain tasks, including chopping down small trees to use for the bridge, for seats and tables and lean-to shelters to use for rainy days, and to clear out eating and cooking areas in the shady grove.
The organizational skills of the two men were very impressive. They ended up as the project managers by default. They instructed us on our tasks and roles, and showed us how to do certain things.
When the camp was done, it was a sight to behold. The bridge was sturdy and had a wonderful rustic look. It took a few weeks to do all this. We took photos of the project and showed them to the hospital administration. The whole hospital used the camp.
We did not lose a single tool or nail. No one got hurt. No one ran away. No one fell apart during this entire experience. Some of the patients who worked with us on this project soon left the hospital for the first time in years, to live in an outside community.
The two men left. We never saw them again. Both had been long-timers in the hospital, and neither appeared to be leaving any time soon when we first met them. The two men had regained something. We didn’t do “talk therapy” with them. We allowed them to take charge and be responsible. They were not the lifeless men we saw when we were first introduced to them. They became animated and alive. In a few short weeks their whole demeanor and bearing had changed. They possessed a capability and competence that had not been detected earlier, but that had been submerged.
This experience remains with me today. I can see the field, the bridge, hear the voices and see everyone working.
I learned many lessons from this experience, but one stands out for me. People have strengths, skills, capability and potential. I decided that summer to stay in a human service profession and that I would work to help bring out the positive aspects of each person’s being, and try to support clients to capitalize on their own capabilities in helping themselves do what they wanted to do to improve their own lives.
How These Ideas Evolved: The Situation Today (30 Years Later)
Today [as Director of Monadnock Family Services in Keene New Hampshire] I (Ken Jue) see people on a daily basis who are doing things that many believe severely mentally ill people could never or should never do. Some of the users of my agency’s services have become employed as skilled electricians, carpenters, restaurant workers, bakers, clerks, bank tellers, supervisors in area businesses, or have completed technical training programs or college degrees. A large group of [our clients] operate and manage a work cooperative that we helped them establish 10 years ago. They have a variety of small enterprises, including the design and manufacture of lawn furniture, a landscaping service, and a home renovation business.
Their newest venture is a vocational training institute, which is now under sub-contract to my agency, to prepare severely mentally ill people for real job experiences and eventual employment. The CO-OP has had its share of skeptics, detractors, and “non-believers.” Some state officials even tried to close it down.
First and foremost, at my organization we believe that the optimal place for most people with severe and persistent mental illness is in their own home community. This allows people to be close to their family, friends, and natural support networks. We have designed a system of community-based support services that make it possible for this to happen.
Another belief we have is that people with mental illness have the right to employment in whatever circumstances they decide they want to achieve. In our society one’s work status significantly defines one’s value and worth as a member of society. A person’s sense of personal value and dignity is directly related to our perception of whether we are needed by our family and our society. Being loved and being needed are essential to our humanity and to our individual sense of self worth.
“Supportive employment” is defined as a way to help people with psychiatric disabilities to choose, get, and keep paid jobs in integrated work settings by providing job development, training and support to reap the benefits of work. Its goal is to find paid employment for all who want it.
Mr. J’s Re-Entry into Society, With Work and Dignity
In closing, I would like to relate the following:
Three years ago a 45 year old man named Mr. J had already spent 22 years in a state psychiatric hospital. He had a history of acting out at the hospital and had assaulted some hospital employees over the years. No one wanted him out in the community. He was deemed to be assaultive and a safety risk. Our staff decided to bring him home. They devised a plan that included a daily companion and a place in our transitional group home. We asked him prior to discharge what he most wanted if he were to live in the community. He stated that he wanted a job and wanted to go eat in a restaurant. We got him a job through the CO-OP. With that we finally worked out Mr. J’s discharge.
Mr. J has been a near perfect citizen. There have been no assaultive incidents. The daily companion has long been unnecessary.
One evening I was sitting in a local restaurant with a friend. I looked up and saw Mr J enter the restaurant and wait for the host. Mr. J had on a suit jacket and was neat and clean. The host seated him, and Mr. J perused the menu and gave his order to the waiter. Mr. J has a loud voice, so I could hear him speaking to the restaurant staff. He was polite and appropriate. Although he was alone, he enjoyed his dinner and left after paying his bill.
I still often think of my early experiences in the state hospital and compare them with this image of Mr. J. There was little dignity evident among the state hospital patients I once knew 30 years ago. In that restaurant I thought that I could have reached out and touched the reality of Mr. J’s dignity.
For a copy of Kenneth Jue.’s complete paper, titled “Normalized Employment: Path to Personal and Societal Dignity,” from which the above article has been extracted, write to:
Kenneth Jue, Chief Operating Officer
Monadnock Family Services
64 Main Street, Suite 301
Keene, New Hampshire 03431