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​​    the war on mental illness

           BY BOB  FRISBY, M.S.

There is a critical service needed for anyone with a severe and persistent mental illness; that is a "Case Worker". Some programs call them "Case Managers" but my Hindu buddy said management sounds like your controlling somebody. The reality is that the worker is helping the client proceed in life in a healthy and safe manner.

This was part of a letter to the editor I sent to our local press in March 2018:

The concerns these days about persons with severe mental health issues having access to weapons such as the AR-15 rifle are well founded. I worked with these people for forty years as a case worker. A major part of my job was to make sure the person assigned to me wasn’t a danger to themselves or others. These people need a case worker assigned to them that will monitor them on a monthly basis at the least and more frequently as crisis situations arise. When services to the person are closed, we need to be sure the support system stays in touch with the previous case worker; and that the previous case worker makes contact with the client and the support system every three to six months minimum. We need to make sure the health plan is still going in the right direction.

Making sure these case workers have no more than twenty-five on-going cases assigned to them, should allow the case worker to include in their services the closed case monitoring.

The case worker with the trusting relationship already previously established has to be the one contacting the person and the support system. This service will give the person and public the best hopes for a safe and healthy life.

In most cases the case worker develops a trusting relationship with the person and the person sees the case worker as a caring person, trying to be helpful to them as they pursue their life goals. This caring/trusting relationship is critical to the person accomplishing their goals in life and staying healthy. Just sending a person to a psychiatrist or therapist, may not be enough; just taking medication as prescribed isn’t enough; sometimes you need to add the services of a case manager. This service will cost the taxpayer, but save money and lives in the long run. How much is an ER visit these days? How much for the SWAT team to do a crisis intervention? How much does a court commitment and following hospitalization cost? How much money goes out to treat those involved that experience Post Traumatic Stress Disorder following a shooting event?

Let’s make sure our case workers for these people have good morale and feel they can handle what they’ve been assigned. I’ll count on the our local county commissioners to keep tabs on this situation in my home town......end of newspaper write-up.

For you very wealthy folks, you need to purchase the services of this case worker from an agency in your area. Making sure the case worker has at least a four year degree in a human service field and at least three years of experience working with these seriously ill clients; including the provision of "adult protection services", where they go to court to make sure the client gets treatment. Anything less than this and your putting the client at risk of hurting themselves and others. Make sure the worker gets my book and follows most of my advice; I assure you, this book will save lives. $20 for forty years of experience in this field; you can't lose. You can hire a psychiatrist to do this job if you wish, but most of them won't want to go visit the client at their apartment or help them move to another apartment, or help them get connected to employment counselors, etc. I think this would be a good thing for a psychiatrist to do, at least take on one case and do the job of a case worker, adult protection worker. It would give them invaluable experience!

Remember that the long term relationship between the case worker and the client is the super critical part of keeping these folks healthy and as happy as they could expect to be. You don't change case workers every few years and when you do change, you make sure the new worker has met the client with the current case worker and that the client agrees the new connection could work for them. If there is any hesitancy within the client, the case worker needs to talk to them the week after the meeting and make sure all is going to be OK. If not, look for another worker and start the transfer process all over again.

And for all who read this, here's a final piece of very important advice: keep all guns out of the home of a person suffering from these serious mental illnesses. Locking them in a gun cabinet isn't secure; they will just break the cabinet to get to the weapons. Locking them in a gun safe would be fine, if only the healthy owner knew the combination. Better to store your weapons with a healthy relative or friend, and get them when you plan to use them.

​RECENT PUBLIC COMMENTS:

TO:  Senator Amy Klobuchar, Governor Tim Waltz              5-17-23
         and Lt. Governor Peggy Flanagan

RE:  Treatment for those with severe emotional problems / Mental Illness

Recent news media reports showing persons with untreated mental illnesses, causing harm to themselves and others, shows a complete breakdown in treatment being provided to those with severe mental illnesses.

My previous co-workers on the streets here in Rochester, Minnesota indicate that here in our town the committed mentally ill individuals can expect to stay for an average of six days in the emergency room pending finding them a place to go for treatment. Added to this problem is the mentally ill staying for months in our jails because they don’t have a proper place to go for treatment. And the same can be said for those who do get into inpatient treatment; they stay in there longer than necessary because of a lack of placement options.

 I gave you (except Peggy and I’ll include that with this letter) each a copy of my book: The War on Mental Illness (Street Version). I hope you have read it or will read it now. If you lost it, let me know, I’ll send you another.

A lot of what I’m seeing in the news is delusional behavior; fixed erroneous beliefs that can’t be changed by logical evidence. Such delusions eat at a person and agitate them; make them irritable and in a significant percentage of cases, result in assaults on those they feel fit into the negatives of their delusions. As for example: one of my clients felt the 14th floor of the Mayo Clinic had a computer that was controlling his brain functions. He was going to ram his truck through the locked doors at night and go up there to destroy the computer. Instead, I had him taken to the hospital against his will and got him necessary treatment. In another case, a client felt he could tell who the homosexuals were that were walking down the sidewalks. He attempted to run a person over with his car and we did a commitment on him. The examples are endless; and the question remains: where are those two men now and are they being treated for their illnesses?

Lots of these folks will flee the area where they get treatment and end up in other communities, other states. Most are getting SSI or Social Security Disability funds. All they have to do is call social security and indicate they moved and the checks keep coming. I believe social security stopped requiring disabled folks from cooperating in treatment, after incidents where the disabled hurt themselves thinking they would have no place to live, etc.

My book talks further about this situation and again I want to be clear: we can get cooperation in treatment without the person being homeless, without food or without clothing; we just have to establish a payee of their disability checks and make sure they have an assigned case worker. If they move to another location, a new case worker is assigned and the person is given assistance to acquire housing, food, and clothing. We would frequently see clients weekly and give them their personal spending allowance; allowing us to monitor their mental health functioning. Clients knew that if they used the funds for drugs, we would stop giving them checks and instead purchase for them the other things they needed in life. Across America we need to treat these people before they act on their delusions. If we continue to not require them to get treatment, you will continue to see horrors on our streets.

 Which brings me to another point: we need more facilities to treat our mentally ill in our state of Minnesota. I’ve stayed with clients for four hours or more in emergency rooms, waiting for them to see a psychiatrist; it’s time willed with anxiety and risks of harm or destruction of property. I remember one case where I was about to take the client out of the ER and just walk for awhile, as they were so agitated I thought they were going to start destroying the place. They need to get out of that ER within two to three hours tops!  So, we need places for them to go.

Here’s an option: find closed up wards in hospitals and clinics across the state and rent those units from the private sector. Hire staff to man the facility and use students from the psychology/sociology/criminal justice/nursing colleges as augmenting staff. Pay them a decent wage to come there part-time to assist the state workers in helping this population. After they graduate, they’re hired as state employees and they already know the system; and we know their character is appropriate for this population. Have the Minnesota Department of Human Services look into this option.

Here’s another option that requires federal help: There are immigrants at the border who want to learn how to be psychologists, social workers, nurses. Give them work visas or whatever is needed, to come up here and be trained, educated, employed. Vet them as best you can before bringing them. We have some psychological testing they could do as a preliminary test for participation in this program; we also have employment testing that would tell us that they are indeed suited for the helping professions. Skilled staff at the border may encourage some for placement versus others, having seen them all interacting with others on a daily basis. They could sleep in a dorm like setting; get their class assignments and their part-time work assignments. They become augmenting staff to the state employees. We have to pay for their room, board and tuition; and we have to pay them an appropriate wage for their part-time work. We win in the long run; we come out ahead financially. The state gave me food stamps for our family as I was going to college and they certainly got that back and a lots more in the taxes I paid after 37 years of work here.

Finally, I would urge the Department of Human Services to plan for more state run institutions that would mimic what Rochester State Hospital was, just on a smaller scale and spread throughout the state. This is how RSH did it: I came to the hospital with a client; I give them the critical forms and interviewed the client with a psychiatrist or ward social worker. I’m out of there in fifteen minutes!  I come back later in the week and participate in a professional ward meeting where the doctors, nurses, social workers and nursing assistants and others that may be available to help the client meet for an hour or two and talk about client progress in treatment. As the client gets healthier they get more freedoms, like going into town for the afternoon; going to a family gathering. Eventually, the client is discharged with an aftercare plan. If the client chooses, they can come back to the hospital and participate in some of the specific programming they appreciated. They can come back and have a chat with a particular nurse or social worker they felt comfortable with. They can tell the state social worker they aren’t jiving with a particular case worker and end up getting a different one if necessary. We frequently exchanged clients when clients were expressing dissatisfaction with what we may have said or how we may have done something. We did focus on what seemed in the best interest of the client. The clients felt safe returning to RSH for services when they needed in-patient help again. They knew the staff and they knew some of the other residents. They knew they would be released after they got healthy and that they would be welcome to return as they wished. It wasn’t a frightening experience to be admitted for help. This “security blanket” just gets better as the years go on, especially if you work hard at keeping your staff healthy. The thoughts of the nursing assistant are given just as much weight as those of doctors and nurses. Everyone is heard in those meetings and respected.

I also want to express serious concern when I learned that Medicaid won’t pay for a medication supervision program that we started in our county and of which I wrote about in my book. And I also learned recently that we don’t have a drop-in-center for those with mental illnesses. That drop-in-center was a great time for the mentally ill trying to get back on their feet. They have to have a place where they can have fun and feel accepted; a place where they can play some bingo and walk away with a prize; a place they can practice their art skills, poetry skills, etc.; a supervised caring place that strives to meet their interests so they keep coming back. This socialization is critical to human health!

 I rest my case….

With Great Respect,
Bob Frisby, Retired LICSW
thewaronmentalillness.com

Case Worker Services / Recent Public Communications

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