Frank Tosiello: Contrasting care for mentally disabled

Traverse City Record Eagle Community Forum 12/8/13

Recently the Northern Lakes Community Mental Health Authority celebrated its 10th anniversary and the 50th anniversary of the Community Mental Health Act. Open House tours were conducted at four locations in the six counties where mental health services are provided to people who have a mental disability.

Without fanfare and limited press coverage, stunning displays recounted the evolutionary progress made in the effort to develop programs for the people whose lives were, and are, unfulfilled because of mental distress.

The history of this progress reveals practices which marginalized people through institutionalized segregation under conditions which were dehumanizing and even brutal.

Treatment goals were essentially focused on the control of behavior at many sites far from communities, out of sight and sound, where institutional practices were shielded from observation.

Communities were shielded from having to concern themselves with people who might display disturbing behavior.

History also describes a time when the “insane” were displayed in cage-like environments of “sanatoriums.”

The stigma of mental disability has existed over the years and continues as uninformed prejudices lead to social isolation.

Community based programs are directed toward the elimination of stigma through encouraging acceptance, providing continuous support as needed, for people who journey on their path to recovery.

Contrary to these achievable purposes, goals and expectations, voices are still raised to resurrect programs based in institutions. Perhaps knowledge of these warehousing conditions under which people were forced to live would still this clamor.

The history of some institutional practices, however well intentioned or compassionate, fell far short of keeping mentally disabled human beings from achieving self-directed goals toward recovery. A visit to a community based program might change the persistent belief that an institutional model of care for mentally disabled people would preclude any danger from those who are struggling toward wellness.

Dangerousness is a prediction used to justify rigid behavior control.

The validity of such predictions may be upheld only when made by clinicians, or others competent in the use of diagnostic procedures having a high probability of success in affirming unacceptable risk.

Questions can be raised about the vigor with which mentally disabled people who had a potential for violence was pursued. However, those voices which stridently call for the return of brick-and-mortar structures, with all of their potential deficiencies, demonstrate a need for strong resistance.

Mental disability, no matter its origin, interferes with problems in living. The Community Mental Health Act has stimulated the development of community based programs poised to evolve into an expanded focus on early intervention and prevention.

About the author: Frank Tosiello of Traverse City hold a doctor of education degree and was a registered nurse and a teacher in undergraduate and graduate programs in state hospitals and academia. He was a 10-year member of the Community Mental Health Board.