Unwanted voices: Mental illness can strike anyone

Q&A

March 01, 1994|By Jonathan Bor | Jonathan Bor,Sun Staff Writer

When psychiatric hospitals began emptying their wards of patients in the 1970s, families suddenly were faced with the terrifying task of helping loved ones suffering from complex and at times unpredictable illnesses.

Many families felt isolated, not knowing how to care for someone tormented by voices, delusions or other symptoms of severe mental illness. Agnes B. Hatfield, a professor of education at the University of Maryland, recognized the difficulties and did something about it.

She helped to organize the Montgomery County Alliance for the Mentally Ill in 1978 and the National Alliance for the Mentally Ill (NAMI) a year later. Since, local alliances have formed across America. Together with the national organization, they have become leading voices for the rights of the mentally ill and networks for families needing services and understanding.

Today, a resident of Greenbelt, Dr. Hatfield is an emeritus professor at UM, family education director for the National Alliance for the Mentally Ill and author of a new book, "Surviving Mental Illness: Stress, Coping and Adaptation." Recently, she received the Maryland Schizophrenia Service Award for her role in helping families care for the mentally ill.

Q: One of the goals of NAMI has been to end the stigma of mental illness, to make society as accepting of psychiatric illness as it is of other diseases. How are we doing?

A: Things have improved. Certainly, the stigma is not quite what it once was, and there has even been a little research to show that. It doesn't mean the stigma is gone. But there is quite a lot about mental illness on television and in magazines. In general, the public understands these illnesses a little better.

Q: Where are we as a society still lacking?

A: The public now realizes there is something called serious mental illness, that it is a long-term, highly disabling kind of disorder and that these people can't help being sick.

One thing the public doesn't recognize is that these kinds of illnesses can happen to everybody. If they understood that, they would be more willing for more money to be put into services, so in case it did happen to them, it wouldn't be as devastating.

There is no way to predict who gets it next.

Q: What sort of discrimination do the mentally ill and their families still suffer?

A: They still suffer discrimination in the sense that many can't get insurance coverage. In Maryland, we got a bill passed that corrects this to some extent.

Q: Yes, the Mental Health Insurance Parity Act seeks to put mental illness on an equal footing with other diseases -- mandating nearly the same level of insurance coverage. How important will this be to families?

A: It will be important to families who have insurance for their relatives. But that's not a large percentage because most of these folks with mental illness are no longer on their families' insurance and can't get insurance on their own. And that, alone, is discrimination.

Q: There has been a virtual revolution in the development of pharmaceuticals for the mentally ill -- drugs, for instance, that reduce the symptoms of schizophrenia, severe depression and bipolar (manic-depressive) disorder. To what extent have drugs transformed the lives of the mentally ill? And are we expecting too much of such drugs?

A: With schizophrenia, drugs have transformed patients to a degree, but it has not made the majority of them well. They tend to control the symptoms fairly well, but have lots of side effects. New ones are coming down the pipeline and that should make for a better situation.

Probably, the situation is better for people with bipolar disorder and depression. The drugs seem to be more effective.

Q: What have the drugs meant to people suffering from schizophrenia?

A: It varies. I would say it can mean that most of them can stay out of a hospital maybe 90 percent of the time. The majority do not need long hospitalizations. Most of them will maintain their tenure in the community.

In today's market, something like 20 percent are working competitively at any one time, although that may be part-time work. And they may not stay in a job year after year.

The main function of the [drugs] is to cut down or eliminate delusions and hallucinations. They do, in varying degrees. I would guess the majority have some voices off and on, even on medication. Many learn to live with it.

Q: How serious a problem is mental illness among the homeless?

A: It's a very serious problem. Most people working in this area think that 30 to 40 percent of the homeless population are seriously mentally ill.

And they need more than just housing. Just a roof over their heads doesn't solve it. They need housing and treatment.

Q: It's fair to say that most people feel uncomfortable around the homeless mentally ill. Should we be afraid of them?

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