“The biggest human temptation is to settle for too little.” Thomas Merton, 1980
People I meet here in Trieste are confused when I tell them that I am not a psychiatrist. (“You are not a dottoressa?”) Nope. Nor am I a nurse or a social worker. Then why are you here? The first blog I wrote about Trieste answered this question, and I have felt unsettled ever since. I’m feeling called into this work and I have no other explanation.
I cannot walk down Hollywood Boulevard and assume this is the best we can do for people in the United States of America. A picture is worth a thousand words, and here are several grabbed from my iPhone from 2018 alone. You’ll notice that all but one are located right on the world famous Hollywood Walk of Fame. I am here because there are too many people with mental illness left to aimlessly wander the streets of Hollywood, of Los Angeles, of cities throughout California, for that matter. Nothing we do that is incremental is going to change this. Absent some bold intervention, I don’t see a solution in sight that will improve their living conditions.
If you know something is possible, why settle for something less? We see this play out in America all the time. Children of privilege enjoy access to educational and extracurricular experiences, therefore improving public education for all is a passion for many strong advocates. If you or a loved one were diagnosed with cancer, and you were aware of an exemplary treatment modality available in another city, you’d do what you could to avail yourself of that opportunity. Having seen what is possible in Trieste, I cannot give up and assume this is beyond our reach.
One of the comments that came into my blog this week was completely understandable. A reader said: “How could a system that relies on universal health care and societal connectedness ever work in LA? Or work for the more than a small %? Wouldn’t exploring models closer to home be more valuable/practical?”
This is such a great question, and one that I’ve wrestled with also. We could fold the tent and stop right now. Here are 10 reasons, right off the bat why implementing a Trieste-inspired system will absolutely not work in America:
- Risk management. Our governmental systems are risk-averse. If we, God forbid, give our good-hearted work force the discretion to apply their common sense judgement to handle arguably messy human situations, they might make a mistake. This might result in a lawsuit. So, it is better to make rules that create a more tightly defined set of parameters within which people will work.
- 9-5 work week. Other than police and fire, our service providers – public and private – largely work a traditional banker’s week. To move to a 24-7 model might raise the ire of the labor unions, and people in general, who are not inclined to work graveyard.
- Funding predicated upon a medical model. Medicaid reimbursement systems only reward for medically-oriented interventions, not human-focused interventions. If the client needs a bus pass in order to achieve some level of independence, the Medicaid system will not pay for this service.
- Hierarchy. Our American system is predicated upon unequal relationships: doctor to patient; law enforcement to suspect; case manager to client. The consumer with mental illness is not seen as an equal party in our system.
- Marginalization of friends and family. Privacy laws and bureaucratic efficiency preclude a robust attempt for the system to reach out to and find friends and family that can help set context or be influential with the client.
- Lack of housing. There is no visible improvement in sight for our affordable housing crisis, and the prospects of supportive housing coming online within a reasonable time frame are ephemeral at best.
- Lack of purposeful or community-based pursuits. We don’t have a system in place to facilitate the users of our mental health system to take advantage of work, vocational, social, cultural or educational opportunities.
- Limitations on income. For those who are receiving disability income from the government, there may be an inherent fear involved in agreeing to some supplemental work, because of the potential to jeopardize social security benefit.
- Board and care system (AKA Adult Residential Facility). So many people live in these facilities that are woefully underfunded and there is no realistic prospect on the horizon to increase the funding to improve the living conditions.
- Labor rules. If you live in a board and care home, you are precluded from being assigned any chores. Assisting with kitchen chores, laundry, and general clean-up could be a purposeful pursuit, but is not allowed.
Arguably, people who live with mental illness and are homeless and/or incarcerated in America are the poorest of the poor and have been stripped of their voice in our society. I am spending a month in a city where that is not the case.