I fully expect to one day be tapped on the shoulder, turn my head and have my face meet the clenched fist of Ms. Gwendolyn. It would be justified. As a mental health professional, I’ll take one for all the social workers, nurses, psychiatrists, LPC’s, psych tech, pharmacists, case managers, outreach workers and administrators who play in my sand box. After all, mental health is a team sport. At this point, Ms. Gwendolyn would have a pretty good reason.
Ms. Gwendolyn doesn’t know me. She knows my yellow shirt. She knows my blue van. Hopefully, she’s never connected the two with her forced institutionalization, with the hours strapped to a hospital bed in four-point restraints and the syringes of generic Thorazine the nurses periodically inject into her arm. I’ve put Ms. Gwendolyn in the hospital four times now under an Order of Protective Custody (OPC). It’s a psychiatric hold used to get gravely disabled people into a hospital to be evaluated for care, to get them in the system.
My first meeting with Ms. Gwen was a hot August afternoon more than three years ago. In the devastation of Post-Katrina New Orleans, Ms. Gwen decided that she needed to collect all her belongings and start camping in a card board box. It was this card board box, affixed with religious paraphernalia, trinkets scavenged from slimy garbage bins and left over food containers that provided her base for religious worship. She spent her days running in and out of traffic pontificating to the startled drivers and periodically dropping to her knees in religious ecstasy. She relieved herself in old pickle jars which were immediately placed on a shelf. She had dozens of them. Ironically, her box was placed in front of a shuttered mental health clinic. The irony was not lost on me.
Through the years, I’ve watched Ms. Gwen cycle through the mental health system. Her quarterly trips to the hospital, the inappropriate, unethical and unprofessional discharges culminating in her homelessness. I’d find her months later clearly psychotic and OPC her again. I’m tired. She’s tired. The system’s tired.
Last Thursday I encountered Ms. Gwen again. Her psychotic ramblings where tagged on a telephone pole and she was tap dancing in traffic again. Before I even got the OPC, I set the plan in motion. I was going to make sure she got to psych ward from the emergency room and I was going to connect with the psych social worker before she even arrived. I set up her discharge plan into housing with the most intense mental health case management the system has to offer before she even made it off the Crisis Unit Van. I connected with her psychiatrist. I phoned the nurses. I would have sent a cake but the bakery was closed. Ms. Gwen even had a clinic appointment before they peeled off her greasy clothes off and put her in a hospital gown, before they even removed the silver baby shoes dangling from her matted hair. My plan was some of the sexiest social work you can do. Textbook. No way to fail. Ms. Gwen will finally get the help she needs and so desperately deserves.
How did it end? The hospital failed to fill out some administrative paperwork and had to legally release her while her OPC expired. Last night, at seven o’clock in the evening, Ms. Gwen could be found standing in the same hospital gown waiting for the streetcar to take her to her next delusion. The institutional green paper gown wet from a cold November rain showering.
Either I have to dig a semi-medicated, psychotic woman out of the streets of New Orleans again or I have to start wearing a mouth guard to work. At this point I think I’m going for the mouth guard.