I have heard people say that a person receiving care in the adult system for years, a person with Schizophrenia and a history of substance abuse, will not get better. It’s a story I have heard told over and over about many of the adults in our system of care. In my first years working in public mental health, a woman (who we will refer to as Anna for this post) was assigned to my caseload who was in a state hospital. I was told by other case managers and supervisors who had worked with her that she was a client who was known for using too many resources and too much time, that Anna would never be capable of living outside of locked care.
Years before I met Anna, she had been wrapped in a giant sticky label with the words “personality disorder” printed across in bold. The normal reactions she had to living for years in locked psychiatric facilities were called “needy,” “dependent,” and “pathological.” In Anna’s fight for her own life, her stumbles were documented, shared in meetings, transferred from one case manager to the next. She had a series of case managers who started out seeing her as a person, but after years of working in a system that called her unfixable, a system that chipped away at each case manager’s hope and belief in Anna’s strengths and abilities, they left, one after the next to work with a “more hopeful” population or for a job outside of the public sector.
Anna was moved from one locked facility to the next, told to go to groups all day every day, to get out of bed every morning and take handfuls of medication, to never insult the staff or behave in a way that made her seem threatening or dangerous. She did all of these things and still never moved out of locked facilities because the belief in her ability to overcome had been lost. Every ANSA (Adult Needs and Strengths Assessment) reflected this same bleak view of her.
When Anna was referred to our team and assigned to my caseload, I remember the stories I had heard of the time she hit a staff member, the story of another case manager she had “spit at.”
Every time I mentioned her name in meetings about moving her to one of our local treatment programs, I heard snickers ripple across the room. People knew her by name, had heard amplified stories about her stumbles, and called these the defining truths of her life.
I first met Anna at Napa State Hospital. I was assigned to do her ANSA and report back to my managers on her current “functional impairments.” As Anna and I sat in a sterile tiled room in heavy metal chairs, I studied the bands secured tightly around her wrists, attached to a cord that led to her waist; walking restraints.
I wanted to leave, to fill out the ANSA in my safe little office, to ask her one question about her talents of her use of recreational time, and to get out of that suffocating room.
“I was a little girl once,” she said. “I wanted to fix cars when I grew up.”
I opened a new chapter in my work that hour I sat with her and began the discovery of what it means to build on the strengths in a person whom a system defined with needs and impairments.
Join us next week as Ella shares her journey with Anna and how she continues to use her experiences to support others in navigating the system that is not always focused on the recovery of the person in care.
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Ella Jackson, MA, LMFT is a Clinical Specialist for Sonoma County Behavioral Health. As a Specialist, she supervises a team of clinicians and case managers who work with adult clients with severe and persistent mental health conditions. She has worked extensively with children and adolescents and is trained as a Floortime Therapist. Ella is a CANS/ANSA trainer for Sonoma County, and supervises staff on the use of the ANSA specifically in assessing adults in locked psychiatric facilities for less restrictive placement. She graduated from Pepperdine University and has worked in direct service and as a supervisor with child, adolescent and adult populations for 15 years.
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