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Letter to the Editor: Navigating the Complex Intersection of Mental Health and Community Care, by Jennifer Stefani, CSAC’s Emergency Team Coordinator

As the Emergency Services Coordinator at CSAC, I read Chris Mason’s article ‘New Mental Health Strategy Needed’ from last week’s paper with concern and an active desire to connect with him and others in the community about this issue. Chris repeated some common and understandable misunderstandings about how and why crisis counselors work the way they do. My hope is that despite low funding, workforce shortages, and the myriad pressures we face, that CSAC staff members can work together with law enforcement officers and community members to bring more peace and safety to everyone who lives in Addison County.

The Counseling Service of Addison County is our county’s designated agency, charged with providing mental health treatment to those in the community who need it. Our main missions are to provide youth and family counseling services, services for those with developmental disabilities, care and treatment for those with persistent mental illness, and emergency crisis services to those who seek help and support during the hardest times of their lives.

Seeking treatment is an individual decision that people come to on their own. Often, it takes some time, courage, and trust to decide to take that risk. Therapy requires facing what can be a frightening inner world, and a willingness to tolerate a certain amount of pain. One of the first tasks in therapy is to build a good relationship between client and therapist. Then, there are skills to learn, emotions and memories to process, new dreams to dream, new steps to try. It takes work and will as well as a certain amount of stability and a sense of safety to look within and dare to be vulnerable. For this and many other reasons, people often refrain from, delay, or decline mental health treatment.

We respect these choices and difficulties. Forcing mental health care on anyone is a difficult and ineffective proposition. Without connection, interest and desire, there is not much a counselor can do that is likely to lead to lasting change.

When, because of mental health symptoms, a person is an immediate danger to themselves or others, we have one small tool, called an Emergency Evaluation, which can be used to force people to be evaluated in psychiatric wards of hospitals. This is what people know as involuntary hospitalization. Like law enforcement officers, counselors have legal restrictions on when and how they can use this tool. As police officers are charged with protecting constitutional rights of all citizens, so are the qualified mental health professionals who decide to make these requests. The Department of Mental Health (DMH) reviews all requests for involuntary hospitalization. The individual situation must meet several strictly interpreted criteria. Involuntary hospitalization requires an evaluation by three separate individuals. If all three agree, we send the request to DMH. There, a clinical and legal team review the request to determine whether the situation is dangerous enough to warrant taking away a person’s rights and treating them against their will. A lot goes into these decisions and no one makes them lightly. 

Many times, after a short stay in the hospital, a person who has been hospitalized in this way is released having no lasting plan for treatment in place and feeling further alienated from the system and people who sent them away. Involuntary hospitalization can be traumatizing to the person to whom it happens. It can feel like invalidation, punishment, and fundamental violation of a person’s autonomy. Because a person with this experience does not enter into treatment with the will, intent, and connection I was talking about before, it does not necessarily lead to the lasting peace and calm that the public, hurting families, and all of us might hope for.

We live within a system. To me, it often seems aloof, cruel, and distant from reality. The system seems to ask law enforcement officers and mental health counselors to 'take the troubles away' from ‘the community’ and deal with them elsewhere. There is an attitude of ‘If we can’t see or be affected by the problem, it is okay.’ That attitude is the essence of mental illness, and one of the things we work on in therapy. Let's not accept the attitude of willful blindness in ourselves. ‘The poor will always be with us' and they are us. We are not apart from the pain of this world. Turning with compassion toward discomfort, and towards each other, ugly, wicked, and ridiculous as we sometimes are, and working to hold those who are suffering most takes patience, takes vulnerability, takes courage in the face of uncertainty, and takes a village—every one of us.

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