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OPINION: Continual decline of mental health services

Fergus Falls Daily Journal - 5/29/2024

May 28—In a past professional life, I worked as a youth counselor at a locked treatment facility for adolescents who were often in court-ordered placements due to severe behavioral issues. The kids' various reported behaviors ranged from too aggressive to be placed with other teenagers at a juvenile detention center to struggling with severe mental illness that no one knew how to manage.

Often, behavior issues and/or criminal activity and mental health have incredible overlaps. In fact, in my time working at the facility, not one of the kids wasn't on some sort of medication relating to their mental health, and therapy was court-ordered for all of them.

Fast forward a few years. I had moved on in my professional life and was shocked to hear that the treatment facility was going to be shut down. I still had friends working there and was very familiar with the — let's call them antics — of the kids placed at the facility. Staff were being placed on disciplinary leave left and right because the kids were getting injured. The kids were getting injured because society and government was moving away from allowing the staff to take measures proven safe to protect themselves from aggressive teenagers who were actively trying to hurt not only the staff, but the other kids and themselves.

Allow me to set the scene.

I am 5-feet-4-inches and, at the time, weighed about 130 pounds. The majority of the boys in the facility were larger and stronger than I was. A number of the girls were, too. It wasn't uncommon for one of the kids to come at me swinging wildly, ready to fight. (Or trying to stab me with a pen.) These instances were often unpredictable. It wasn't abnormal to arrive to work to find a child closed in a trashed dining room because the kitchen ran out of dessert — so they would flip a table, try to stab someone with a fork and simply wouldn't calm down. For some it was a choice; for others, they truly couldn't help themselves.

Having to restrain a child who is bigger and stronger than you is not fun. No one wants to do it. In fact, it breaks your heart when it comes to that. Fact of the matter is, though, sometimes it did come to that, because that 6-foot boy doesn't get free reign to punch anyone in the head over the lack of dessert, and that teenage girl cannot start a brawl in the hallway because she doesn't like the T-shirt another girl has on. Or, the saddest of all, the timid kid cannot be allowed to bleed out from carving an ink pen so far into their arm that life-saving measures are necessary, especially when it could be prevented in the first place.

I wish I could say I am exaggerating. I'm not.

When the extent of the mental health results in such extreme behavior — complete and utter disregard for their own well-being and that of everyone in their vicinity — sometimes it is necessary to safely place yourself, as a trained and safe adult, behind that child, cross their arms in front of their body, and hold onto their wrists to ensure that they come out on the other side OK, along with everyone else.

Manual restraint is controversial. There are therapists and medical professionals out there who are adamantly opposed to it. Those such therapists were the ones who came into the facilities that operate at such a high level of severity and often lead to their closure — because everyone starts getting hurt, and that simply cannot happen.

There is longstanding and proven history of mistreatment in the name of mental health (or mental illness). There have been women sent away to die in mental hospitals due to a bout of postpartum depression, or because their husbands just didn't want them around anymore; so, they had a diagnosis of hysteria (for the opinionated woman) or melancholy (too much sadness) slapped on them and away they went. With such outrageous misuse of power masked under the guise of mental health/illness, it is certainly understandable why drastic measures are taken to ensure the same mistakes aren't repeated.

But ... there is always a but ...

Going too far in the opposite direction does damage, too. Not having adequate services for those struggling doesn't help them, it hurts them and often hurts those around them. There isn't a one-size-fits-all approach to mental health treatment and there isn't a one-size-fits-all mental health professional who is equipped to handle every aspect of mental health treatment.

The closure of state mental hospitals across the country led to decreased services and increased homelessness and crime rates. For those who were legitimately in need of mental health treatment, but who ended up incarcerated instead, did we do them a favor? Prisons offer mental health services, to an extent, but often not nearly the extent needed.

What about the individual who is dangerous to society due to mental health, but who isn't removed from society because of the legal loopholes in place for the "mentally unfit" population? What favors are we doing them and innocent community members by letting them off the hook, so to speak? They need help, but can they get it? Not really.

Rural communities have an incredible lack of availability for mental health services. Extensive waiting periods exist. Inpatient facilities are shutting down left and right, and those that exist are bursting at the seams. Mental health providers are getting burned out and they simply cannot keep up with the demand for services, and high-level services seem to be becoming more and more a thing of the past.

Should we have shut down the state mental hospitals, or should we have put more focus on reform? Should we now consider the legitimacy of the mental health crisis and reevaluate the mistakes of the past and reinvent the wheel, developing a new model with new laws and new methods that are safe and effective for all of the varying levels of mental health?

I may not have the answers, but I do know one thing — something has to be done.

Heather Kantrud is the general manager of Daily Journal Media in Fergus Falls, where she resides with her family.


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