This Washington Post article from today, highlights just how little it takes to operate or work in a mental health facility. It also references the Miami Herald’s 2011 investigation into the rampant abuses taking place in these group homes.
“You’re skinny, Pete,” Rashid told me. “But that’s okay. I’m handicapped, too. I’m paranoid schizophrenic.” We were at the end of a long line at Jack-in-the Box, and he was getting restless.
“Well, I guess that’s good,” I said. “I mean, to have something in common.”
Rashid smiled. “Now you’re making me have a bad day.” He said he wanted to eat at Taco Time instead.
My stomach turned. On other “bad days” (code for out-of-control moods that came on in seconds), Rashid had rammed his L.A. Lakers backpack through a glass door, hurled a metal chair at an unsuspecting passerby, or brandishing a knife at friends. He was 6-foot-1, 240 pounds, and completely erratic—behavior that had gotten him banned by every fast-food joint in town, unless accompanied by a minder.
Often, that was me.
But I’m no expert in calming violent ex-convicts in busy restaurants. Though I work at a home for the mentally ill, I have no training in social work, treatment or psychology. In fact, I have no qualifications at all. I found my care-giving gig on Craigslist.
At the time, I was a self-employed writer looking for an excuse to get out of the house. I took this $10-an-hour weekend job, spending 12-hour shifts with schizophrenics, 275-pound sexual predators and the occasional murderous resident found not guilty by reason of insanity. It seemed less odious than becoming an adjunct professor.
That day, desperate to avoid trouble, I took a chance, praying it wouldn’t set him off. “The last time we went to Taco Time,” I reminded him, “the jalapenos in the Stuffed Mexi-Fries gave you indigestion.”
Somehow, it worked. Rashid placed his warm, sweaty palm over my forehead. It was his ultimate expression of approval. “Thanks for reminding me, man. That’s why you’re good to have around.” Just like that, he was calm again. A lucky guess was the only thing between us and a potentially violent scene.
* * *
Historically, Americans have housed the mentally ill in hospitals. The population peaked in the 1950s, with some 500,000 individuals institutionalized.
But reports of widespread abuse led to widespread closures. Between 1955 and 1994, according to a PBS Frontline report, the number of patients in public psychiatric hospitals nationwide dropped by an incredible 82 percent.
Today, many are sent to group homes in ordinary neighborhoods, known as casual living environments. There are thousands of these facilities across the country. According to the National Alliance on Mental Illness, they’re regulated state-by-state, and standards for care-givers are often lax. Often, authorities rely on small nonprofits operating one or more homes in widely scattered neighborhoods to provide their clients food, shelter, and safety.
Residents are often supervised by minimum-wage employees with no prior experience administering controlled substances, working with vulnerable individuals or handling their personal affairs or money.
Which explains how, in 2012, I found myself climbing the front porch steps of Rhapsody House, a group home on the outskirts of a major city in Oregon. (To protect the patients and comply with privacy laws, the name of this home and all the people who lived and worked there have been changed.) The facility housed five male tenants in their mid-20s, assigned by the county.
I knocked. The door was answered by Mack, the 50-ish program manager whose mental health credentials consisted of a prior career as a roofer and an ongoing gig as the guitarist in a country western bar band.
He resided in a tiny bedroom in the house with his girlfriend Donna; the detritus of their former lives was packed in teetering stacks of plastic storage bins that brushed against the ceiling.
Mack conducted the job interview while absently playing with a video game on his laptop. After a couple of questions, I was hired after a routine background check.
For the most part, I liked the work. I was usually alone on a shift. My “uniform” was a T-shirt and blue jeans, and my chief responsibility, other than purveying pills, was hanging out with — and keeping the peace among — the residents I came to know and (mostly) love.
They were: Lester, a heavy-set sex offender and allegedly lapsed neo-Nazi; Erick, a self-styled Islamo-Communist and part-time Christian evangelist; Aaron, a shy, selective mute who communicated via notes; and TC, a video game addict and aspiring rapper who claimed to have tried to set his step-father’s house on fire. Most captivating was Rashid, the sweet, multi-racial schizophrenic and fast-food aficionado with a talent for pithy, tweet-like observations.
On good days, we’d watch football and play video games in the living room; a bunch of guys doing what guys do to pass the time. I’d break out a bag of barbecue potato chips and pass around sodas, although the guys preferred energy drinks, a habit that I had no legal right to interfere with.
After one or two, Aaron would often try to dance Gangnam Style; the boys would egg him on until I’d offer to watch him play one of the many WWE games he kept in his room.
Typically, when I returned, Lester had changed the channel to MSNBC’s “Lockup,” his favorite program after any Nickelodeon show. I’d have to convince him to turn back to what we’d been watching; he’d served time in an Oregon prison, and his therapist thought”Lockup” viewing was unhealthy for him due to his enthusiastic embrace of the inmates’ antisocial world view.
There were times, though, when the needs of this quintet exceeded my “skills.” The residents were erratic. Fights were frequent and came out of the blue. Chairs were thrown and holes punched in walls.
Once, Lester flung a flashlight battery at my head. He laughed when it missed by inches. I’d politely asked him to turn his boom box down. Another night, TC threw a metal kitchen chair across the room, bending two legs; he’d seen on a wall chart that it was his turn to wash the dishes.
Rashid shattered a storm door window for no reason at all. One night, he broke into Lester’s room and began pummeling him because he thought Lester was making the strange noises that were keeping him awake. (Lester hadn’t made a sound, but when I searched the house the next day I discovered a family of raccoons in the attic above Rashid’s room.)
Rashid was the most engaging resident and most difficult, too. We’d joke around, and I’d feel like I was making progress, really bonding, with him. He had a deep, resonating laugh and a comfortable Buddha belly. A moment—a millisecond—later, his face would darken, and he’d be ready to strike. Maybe a dog had barked down the street. Dogs terrified him. Or Lester had come home. Rashid hated him. In his mind, Lester was plotting to get him kicked out of Rhapsody House.
I’d tense up but take great pains not to show it. Rashid outweighed me by a good 90 pounds. Yet I was always able to redirect him before the blows began to rain down — by offering to deep-fry three or four Idaho potatoes, his favorite dish — or to help him rearrange his DVD collection. He was always open to fresh ideas on that score. I often wondered how the other (equally underqualified) employees fared.
When my residents misbehaved, my boss always encouraged me to look the other way. And I have to confess, there were times I did. I developed a bond with several residents and didn’t want to get them in trouble.
But some behaviors I couldn’t ignore. I caught Lester masturbating while peering through the backyard fence at a neighbor. Mack never submitted my incident report to the county, and Lester suffered no consequences. He and the income that came with him remained at Rhapsody House.
Good-hearted Rashid twice brandished a knife at fellow caregivers, who called the police. In both cases, charges were dropped. Today, his whereabouts are unknown to me.
* * *
Of course, with undertrained workers, problems flow the other way too. A 2011 investigation by the Miami Herald and public radio station WRLN uncovered dozens of cases in which mentally ill residents of Florida group homes were abused. According to their report:
State agents caught employees in nearly 100 homes [out of 1,109] illegally doping residents, tying them up or locking them in isolation. Agents then caught each home committing the same violation again.
In Florida, it takes just a high school diploma and 26 hours of training to run one of the state’s mental health assisted-living facilities.
There’s no easy fix. Re-institutionalization would run into familiar headwinds — the belief that mental hospitals are expensive and abuse patients as a method of treatment.
At a minimum, I think, caregivers should receive a higher level of pay. The end result would be a more professional employee. Perhaps recent college graduates with social sciences degrees would see it as a challenging entry-level job. If fast-food workers warrant 15 bucks an hour, the ground troops who care for some of our most fragile citizens should receive the same fair shake.
I left Rhapsody House after a year. My weekends are now spent at another group home with 10 residents, older and less nimble. But even they occasionally act out — a shattered lamp, a paranoid fixation on the comings and goings of the mailman.
I found that job, too, on Craigslist.
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