I see signs of systematic failure flash over and over again in the faces of the mentally ill who also battle with substance abuse. Mental health professionals are not always equipped to deal with these dual diagnosis patients, who are diagnosed with both a mental health issue and a substance abuse issue. People in a residential treatment center are not often equipped to deal with patients that are also mentally ill. In residential treatment, the behavior of the mentally ill can be disrupting. Their symptoms are simply shrugged off as symptoms of substance abuse, and these patients are often considered to be unruly and resisting recovery. The two diseases are often hard to separate when one first enters substance abuse treatment.
Too often, those mentally ill patients are sent home or back out into the streets without adequate treatment. It is high time we realized this is a problem, so we can find better alternatives for these patients. Dual diagnosis treatment centers, equipped to deal with both disorders at the same time, are becoming more popular. Too often the mentally ill end up homeless, or in jail rather than being treated in a dual diagnosis center.
In those weeks in jail, I also encountered a ‘crazy girl.’ She did not rock back and forth, but she often talked in circles madness. She stared at people. Her wild hair and blank, scared stare reminded me of Peaches.
The other inmates feared her insanity. But more than that, the girls in jail get bored and eventually the stirs of drama begin. Eventually, the shit seems to hit the fan in whispers and silent stirrings, until it all explodes…loud and reverberating against only concrete walls. Screams stalled on stale air and succumbing to the saturated truth.
The hushed stirs about the ‘crazy girl’ escalated, and many of the other inmates caught sideways glances at her, as she mumbled to herself, shaking her head back and forth. She started carrying her toothbrush around, trying to use the handle to pick under her fingernails. Slowly and methodically, she rubbed the plastic handle back and forth between her nails. The stirs began to rise, and the whispers became more audible. Then, she began slowly and methodically rubbing the end of the toothbrush against the table. She sat alone at the table, mesmerized by her repetitive action, still mumbling to herself. The whispers grew louder, and the word ‘shank’ began to rise to an audible cry for help.
Before long, the ‘crazy girl’ was taken to the infirmary. She returned to her cell much later that night, shuffling her feet in a medicated haze, persuaded by a guard on each side. For the next few weeks, she was not allowed out of her cell unless the rest of the inmates were locked down in their cells. I really do not think she was making a shank, but she was put under watchful eye, anyway. I remember watching her through my small window in my cell door, as I stood on my tiptoes. She shuffled her feet, as if she was shackled, and then she stared blankly at the television for the rest of her time outside of the tiny cell. At night, she screamed and screamed. She paced around many nights, talking and yelling until she was hysterical. Each night, the guards made several trips to her cell door, talking in calm and quiet voices until she was subdued once more. Some nights they could not subdue her, and eventually she was taken away again for several hours.
Many months after my release, I saw her walking down the streets in that small town in Virginia. She was still talking to herself in the same reassuring manner, with her head shaking back and forth. Her pants were tattered at the bottom and her shoes were worn where she had obviously walked and walked and walked. Her hair was a mess, and her eyes looked around wildly. She carried a 40-ounce beer, and I realized it was only a matter of time before she ended up in jail or the mental hospital.
I recently heard a friend of mine, as she cried out over the cyber wires, screaming out in frustration at the sober living facility her son recently moved into. Her son is, without a doubt, a dual diagnosis patient.
He is experiencing night terrors, screaming out in the night. And he was forced to leave sober living. His screaming in the night was disturbing the rest of the patients, and he had no choice but to leave. He did not leave to be taken to another facility that specialized in mental illness. He did not leave with the resources to find a more suitable treatment center. He did not even leave with the reassurance that he had anywhere to go.
That is where our current system failed him. I understand that certain behavior is disruptive in sober living and in residential treatment. And I understand that the behavior is not tolerated. But, what I don’t understand is why that behavior can go untreated.
My friend’s son has been staying at home, while they search for another alternative. This kid has been in treatment before, and he always seems to relapse. After the hell of detox, one’s emotions are riding on a roller coaster that has picked up enough momentum to feel out of control. For those who suffer from illnesses like depression, anxiety, bipolar, or schizophrenia, this emotional roller coaster is even more intense. The symptoms of their mental illness can overwhelm them, as both their natural chemicals are out of whack and everything in early recovery is intensified when you had become so used to numbing it all out. When the mental illness is left untreated, a relapse is often on the horizon.
On Dr. Drew’s sober living, the doctor comes to the rescue and the any situation of intense mental instability is immediately handled. The patient is most often sent along to some other kind of mental health treatment, or even physical health treatment, or possibly even back to detox, before returning to their regimen in sober living.
But, such is not the case with the rest of the world. That is what people see on television. People do not see the street corners. They rarely see under the I-10 Bridge some nights after Mardi Gras, littered with drunks and drugs, and instead they see the city littered with glitter and shiny metallic beads. People do not see the squats and abandoned houses. And most people try to look away when they see a sign held up on a busy street, begging for change to help a homeless veteran.
Dual diagnosis sounds like a death sentence to some, and even some mental health professionals are daunted by the presence of both mental illness and substance abuse. Healthcare costs in our country are outrageous, and so many people remain uninsured. Recent studies have suggested that mental illness is more concentrated in poorer areas, and most of us believe this to be true about substance abuse as well. Furthermore, the lack of health insurance is more concentrated among the poor.
I cannot even afford health insurance, and I work more than forty hours a week at two jobs. And I would not consider myself poor, as I know there are many more people out there struggling much more than I am. I think the high cost of healthcare has contributed to a rise in dual diagnosis patients. Many people suffering from a mental illness cannot afford a doctor, much less their medications. Instead, they learn to self medicate with drugs and alcohol.
Both mental illness and substance abuse seem to be on the rise today, and these two diseases can often go hand in hand. The two ailments are often hard to separate, especially in early recovery. But, these two also need to be treated together, giving the patient a much higher rate of recovery. We cannot keep throwing these people out of treatment and onto the streets, or even into jail. With more awareness of these realities, we can hope to more aggressively fight this problem.