today!
order
the war on mental illness
BY BOB FRISBY, M.S.
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 Supplemental Security Income 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 the Rochester State Hospital 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 the Rochester State Hospital 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 theycan 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
-----------------------------------------------------------------------------------------------------
Sent to MSNBC staff on 5-12-23:
I want to begin by thanking your agency and your staff for getting us through the Trump years in the White House. Your anchors have done just a perfect job of presenting appropriate news to the American people. The professionals chosen to sit on the panel discussions are all impressive in their humanness and interest in seeing what is best for America. Please keep up the great work.
Recent events regarding delusional people being behind mass killings and the frustration of the people in dealing with this experience has made me think my message is very important for America to hear. I worked with these people for forty years, on the street, being their case worker; in many cases, their only really close confidant and person they could trust. I had to help them get treatment, sometimes when they didn't want it; and I had to help them stay in treatment when they didn't always want to. It takes years of skill development to be able to work effectively with people suffering from various mental illnesses. The thanks in the job come from the "client" appreciating your services and the family and friends saying thanks for your services. Our co-workers on the streets were a huge support and having an esprit de corps within our staff kept us healthy and able to deal with all the negatives that confronting mental illnesses can deliver, including threats to your life. I just heard "The Rev" today with Nicolle say he didn't like doing his job, visiting all the death scenes, because it's hard on you. He'd rather be doing his traditional Reverend duties instead, but knew this was his calling. I'm grateful to him and your staff for hanging in there and coming to work each day!
I would encourage your anchors and all your staff to visit my website: thewaronmentalillness.com I have been running that site and adding unto it for around ten years and plan to continue to run it as long as I'm able. I know it can save lives. The book I wrote: The War on Mental Illness (Street Version) really tells the story of what I did for forty years and how I did it. It talks about reforms within the system. It's a great book I think for those who want to understand and help those suffering. I've told my clients that the website is for them and the book is for everyone else, but I may have to change that someday to say they should read it too. I just worry that what's in the book may get them too anxious, or get stuff into their heads that they don't want there.
I've written letters to our local newspaper saying those suffering need a constant companion in life that they can turn to when in need, or will help them when they're hurting; that would be a caseworker. And I would say our country needs to look at the foundation our kids are built upon. Is it built upon rock or sand? Are the children of today taught to respect all people; taught to follow some moral code like the Ten Commandments; taught to find their strengths; taught to work at jobs they enjoy? Quite a lot to cover in that realm.
Here's hoping you all continue doing the fine job I've been witness to; it does my soul good.
With Great Respect,
Bob Frisby
---------------------------------------------------------------------------------------------------------
Governor Gavin Newsom February 8, 2024
1021 0 Street, Suite 9000
Sacramento, California 95814
RE: Your state’s effort to treat the severely mentally ill
As a mental health professional and manager of the web-site “thewaronmentalillness.com, I and my supportive assistants want to applaud your recent decision to get the severely mentally ill of California treated. I’m sending along the book I wrote on this subject and hope you and your leadership team will review this and the web-site, to better understand the battlefront your entering. I’m sure your team has as many years working with this population as we here in Minnesota do, but it may be wise to hear us out; we may be able to contribute to your success in this effort.
It is disgusting to see our untreated severely mentally ill and often times chemically dependent persons sleeping under a blanket, on the street, lying on their back and being vulnerable. They are easy prey for those who want to get folks addicted to drugs. These vulnerable folks have impaired judgment to the point where they are vulnerable to the many traps set by the criminal types. The severely ill will believe falsehoods, especially if they have a paranoid illness. This poor judgment and their delusional beliefs is what gets a lot of them to commit crimes of all types, and sometimes seriously hurting themselves.
What you’re attempting to do in California really isn’t an experiment. The mental health professionals of the world know that taking medications is the least restrictive process for beginning to treat severe mental illnesses. That must come first; the rest of the rehabilitation services can follow. The advocates for a comprehensive mental health program, as a solution to the current problem, are just not acknowledging that this national crisis can’t wait for the extensive programs they espouse. We will need to invest in those programs after we get the seriously ill treated and stabilized in a treatment facility.
Your “Care Court” is comparable to Minnesota’s Veterans Courts process, where the veterans are given opportunities to participate in rehabilitation programs versus going to jail. And our Civil Division, in conjunction with the Minnesota Court System has done well in helping the severely mentally ill get necessary treatment. Your "Care Court" should be very helpful to your success.
When I started work on the streets as a case worker with the severely mentally ill and chemically dependent in 1972, my supervisor said my job was easy to say and hard to do: “Go out and find mental illness and get it treated.” Give each of your case workers 25 of those severely mentally ill, untreated persons on the street, and see if they can get the job done. It may be advisable to have them accompanied by an untrained assistant who speaks Spanish. After 5,000 hours of supervision, this assistant could then be allowed to take on 25 of their own clients and teach another person how to do the job. The workers have to enjoy working with this population, or at least be willing to ride along to confirm for themselves if they could handle the job. You pay the assistant minimum wage until they finish supervision, then they get raises each year that make sense for all. Assistants should be able to study necessary subject matter without cost, like taking college courses.
We wish you well in this endeavor and look forward to seeing how this process proceeds into the year ahead. We are always available for consultation via the web-site email address.
With Great Respect,
Bob Frisby, MS, (retired Licensed Independent Clinical Social Worker #698)