From my house I can see the buildings of the Dorothea Dix campus. At night its lights shine through the trees. When I walk my dogs, I pass the sign at its entrance: established for the humane treatment of those with mental illness.
My son has what is called “a severe and persistent mental illness.” Since he was 18, his life has been marked by periods of health and periods of complete break down. You know the guy who sits in the park mumbling to himself? The one who talks about aliens and his best friend Queen Victoria?
Recently, after six years he had another breakdown and walked away from his home and all he had worked to build for himself. A police officer in Gore, Oklahoma, found him. He was unable to speak one coherent sentence. He was unable to tell them who he was or how to contact us. While the officer began to call the numbers in his phone, they hospitalized my son. When they finally reached me, they told me they could keep him only three to seven days. Exactly what we here in North Carolina provide.
During that brief reprieve, in the moments I knew for at least that minute, that hour, he was safe, I began to try to find the care he would need next. I have been through this before. I knew that on the day he was released, while he might be coherent again, he would not be well. He would not be able to take care of himself.
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The hallucinations, the delusions will begin to subside. If it goes well, maybe in a month they will have receded enough that the stark terror that led him to flee – leaving everything and everyone in his life behind – will resolve. What will take longer is the healing of his mind, what they call the negative symptoms. He will not be able to remember things. Much as someone with a closed injury struggles, he will struggle. He will want to brush his teeth, clean his home, go to the store, but his mind will not be able to figure out how to start. If he can take the first step, the second or the third will elude him. He will not be able to reason. Technically you would say that his most basic cognitive skills, those things that allow each of us to carry out the most essential tasks of our day, will be impaired. When the mind breaks, it takes time to heal.
I began the task of trying to find the treatment he will need to heal,
to put the pieces of his life back together, to once again learn how to function. Unfortunately, this does not exist in North Carolina. It is not that we do not know how to treat him. It is not that we do not know what he needs. We have chosen not to provide it. We do not provide hospitalization for those whose minds are broken for longer than the three to seven days it takes for the medications to get into their system. We provide no sub-acute care in a safe, structured setting until those medicines have taken their full effect. Services such as Assertive Community Treatment Team or Case Management are provided only to those on Medicaid or who can afford to pay themselves. In any case, these services provide only a brief home visit.
My son is not eligible for Medicaid. The $1,082 per month he has to live on is too much money for him to get Medicaid. He cannot afford private insurance. Our anti-Affordable Care Act legislature has determined that those people who earn too much for Medicaid, but too little to buy their own insurance should not have access to the alternatives.
What this means is that an individual like my son who has a physical disease that renders him unable to work full time and support himself will not receive the hospitalization he needs to recover. He will not find any resource for sub-acute care that would provide the treatment he needs until he is able to function again. He will not have access to the treatment and services that will continue to support his recovery. The only way he will even get care for three to seven days is if he deteriorates to the point he is found by some police officer unable to form or speak a coherent thought – and even then, only if he is a danger to himself or others.
Every single day I see Dorothea Dix from my back porch. I walk across its roads, past house after house and building after building that lie empty and at waste. Every day I pass the signs in my neighbors’ yards: Dix 306. Every day I read the marker at the entrance to our future destination park: for the humane treatment of those with mental illness. Every day I pass another person mumbling to himself as the weight of an illness he did not choose holds him in its grasp or read of yet someone else with a mental illness who has died while the people who were to protect him sat down the hall and played cards.
The way in which we choose to respond to and care for the most ill and vulnerable among us says nothing so much as who we are and what it is that we value as persons and as a society. What we in North Carolina have chosen is a theme park where those with a mental illness certainly will not be allowed. Their presence might distract from our enjoyment of the day. We may say it is my son and those who share his illness who are insane. I know of nothing that is more insane than our choice to not provide treatment to those who are ill, vulnerable and unable to care for themselves. Dix 306 indeed.
Donna Kay Smith lives in Raleigh.
Online: Nowhere to go
Watch a video of Donna Kay Smith talking about her son, North Carolina’s mental health system and the end of Dix Hospital with this piece at newsobserver.com/opinion.