Since the 1400’s, the town of Gheel (also spelled Geel) Belguim has done an incredible “community project,” that as a psychiatrist I have read about periodically, and marveled at for decades. In short through an unbelievably improbable religious fluke of an event of historical Christianity, started a custom of taking in the mentally ill by families. In Gheel, families would care for the mentally disabled for as long as they could. If the parents of the caretaking family died, and the disabled ‘adopted’ member of the family was still alive, the grown children would take over their care. The system was unique in the world and still is. In fact, in some ways because of its historical longevity, it has in some ways become stronger. All this occurred centuries before any semblance of modern mental health care and it worked. Of course some of the mentally ill were so disturbed they could not be housed in families’ home but most could. The above link takes on to one of the best all around explanations of this social experiment, namely a Wikipedia article. In modern times, hundreds of social researchers and mental health professionals have made pilgrimages to Gheel to observe and study this centuries-old social ‘experiment.’
In an article entitled, “Unique programs offer people with mental illness a place in their communities, published recently in the New Haven Register, a somewhat similar social good work was profiled in the Frederick VA area, with photographs from the Washington Post. I have excerpted the following pictures and captions from that article, taken by the Post photographer and given due credit.
POSTED (in the Washington Post: 01/22/17, 8:32 AM EST
David Weiss, above, who is successfully dealing with several serious mental health conditions, plays a song he wrote about his sister Faith while his cat, Bab-Babes, rests close by in Weiss’s one-bedroom apartment in Frederick, Maryland. Way Station provided Weiss with the apartment as well as a case manager. Washington Post photo/Katherine Frey
The profiled recipient of this comprehensive program, though lives on his own, attends community college classes, receives his care through clinical services of the renowned Shepherd Enoch Pratt Hospital system and lots of what we would call “ACT team wrap around” services in his apartment with visiting clinicians and by appointments in a clinic in the traditional manner. But he is overseen and in touch frequently and regularly by caring clinicians. And he still has active schizophrenic symptoms of hallucinations. He has had, it sounds like very good, cognitive therapy to help him manage his hallucinations and live with them with little or no disruption to his everyday social functioning.
Most of all he has his dignity, continues his education part time at age 64, has his dignity and his own “digs,” or place to live on his own.
His clinic program and home base for his outpatient care is a unique organization/clinic called Way Station which works very much in nontraditional ways, with its emphasis on integrating and maintaining clients in the community. It is an American derivation of sorts of the Gheel approach and seems to work well for at least some patients. The article cited above gives much more detail and background and is worth reading.
But programs like this are still too few are far between. What is usually happening now in this country is that such programs are not yet the norm, not funded and largely nonexistent. Patients who do have their own families to live with upon discharge are placed in “placements,” which range from nursing homes to entrepreneurial small to large group homes run by operators all over the country. And there are usually few to none of the social outlets, programs, educational or otherwise to further prepare and integrate clients into the ordinary fabric of our society.
We still have these new remnants of the “welfare hotels,” that were so prevalent most famously of all in New York City where out of business hotels or projects buildings, were renovated more or less well, and persons on disability income or the discharged mentally ill were housed in small hotel rooms as apartments. These places were rife with crime. They still exist typically in very large cities and are often little better managed or integrated into active treatment or rehabilitation programs and have turned into wellsprings of crime and drugs and all that goes with those scourges.
But now the funding nationally with the perhaps certain repeal of Obamacare may seriously in the future be threatened. One would hope not, and that instead these sorts of programs are replicated nationwide with links to education, employers and the levels of outreach outpatient care that is needed. But again it all boils down to money in this country. It costs money and a fair amount of funds to sustain these people-labor intensive community-based programs. We have made substantial progress in moving patients out of the state hospitals. But our high recidivism rates, readmission rates, at all state hospitals in this country demonstrate clearly that the above minimal “placement,” endpoints we now rely on, are neither working all that well nor sufficient. Let us hope that gradually our national commitment to those needed these levels of services becomes the norm in the future.