Even when the VA does act, it still fails our veterans
07/23/2014 1:54 PM
07/23/2014 1:56 PM
Jymm’s preferred attire is a skin-tight Minnie Mouse T-shirt with bright pink windbreaker pants. Even when not sporting his outfit of choice, he dons short shorts and shirts with holes in them, because that’s what he finds most comfortable. His Santa Monica apartment was furnished with broken chairs and tables he dug out of dumpsters. He held onto his favorite old drinking glass long after it broke. Jymm is a Vietnam veteran (who holds two Purple Hearts), and he’s definitely a character. But he’s never hurt himself or anyone else.
Yet this spring, the Veterans Administration locked him up in the psychiatric ward of the West Los Angeles VA hospital, stripping him of his freedom and dignity and claiming that his physical health was at stake. The incarceration was potentially indefinite, and the due process was minimal. The VA — in Los Angeles and elsewhere — thinks it knows where the line is between personality and pathology. Between eccentricity and erraticism. Between frugality and irrationality. And it’s locking up veterans who it thinks cross those lines. Is a drab hospital really an improvement over letting Jymm live the life he chooses?
When I met Jymm in 2008, he had lived on the streets intermittently for about two decades and was highly suspicious of shelters, homeless services organizations and the Veterans Administration. He did not want to be subject to someone else’s arbitrary rules and curfews. Staff at the nonprofit homeless services access center in Santa Monica, where I worked as a homeless services case manager, didn’t always know how to deal with him.
After I left my case management job in 2010, I stayed in touch with Jymm. I was happy to see him move into his own home in Santa Monica with the help of the VA. Still, he struggled to acclimate to apartment living after decades of a subsistence lifestyle on the street. Many of his decisions — about hygiene, cleanliness and food storage, for example — could seem unreasonable, but Jymm valued his freedom and independence.
Over the next three and a half years, I wasn’t able to check in on him as often as I’d hoped, since I was doing some traveling and was busy with work and graduate school. And I worried. At first, I was reassured to know that he would receive case management from the VA and be followed by a team of clinicians. But when I visited Jymm, I saw little evidence that he was receiving the level of support he needed, based on the condition of his apartment and comments he made about the VA.
In late May, Jymm called me from the psychiatric ward of the VA hospital. “They’ve got me under lock and key,” he told me. He’d been involuntarily hospitalized over concerns that he wasn’t properly caring for himself. A conservatorship hearing was set.
At the hearing, it quickly became apparent that the VA’s agenda was to strip Jymm of his rights and keep him hospitalized. Representatives of the VA testified that he had been visited weekly. They cited legitimate concerns about his well-being given the state of disorder, but it didn’t appear to me that anyone had worked with him to develop strategies to address these issues. Jymm’s many idiosyncrasies were treated as evidence that he was gravely disabled.
With the right level of support, Jymm could maintain a level of autonomy. When he had a chance to speak at the hearing, his voice broke as he told the judge that he just wanted to go home to his apartment.
We owe our veterans — and all those who are socially marginalized — adequate support without undermining their freedom. We’ve embraced this idea with our intellectually disabled, where some regional centers provide 24-hour support with individual autonomy as the goal. Why not do the same for those struggling with mental illness?
I’m no stranger to the challenges of enabling folks like Jymm to live successfully on their own. I’ve managed a supportive housing program for homeless people with mental illness for the past year, worked in the field of homeless services for more than four years, and completed original ethnographic research on exactly this subject.
I’m also not opposed to the idea of involuntary hospitalization when someone clearly lacks the insight and ability to meet their own basic needs, or when they represent an immediate threat to themselves or others because of a psychiatric disability. In my work, I have decided to have people involuntarily hospitalized for this very reason. And I know of situations when mental health professionals decided not to intervene, with tragic consequences.
But Jymm has strengths that could be built upon. Certainly it’s possible to acknowledge both that someone requires a higher degree of care and that they deserve freedom and autonomy.
Jymm called me about a month after his hearing. He was discharged from the VA hospital and deposited at a board and care facility way out in the San Fernando Valley. He told me that it was nice and that the staff was well-mannered — a sharp departure from his reports on the psychiatric unit at the VA. He said that he was glad to have a little more freedom, but that the location felt remote and unfamiliar. He shares a room with two other people and is uncomfortable with the lack of privacy and regretful that his roommates are not good conversationalists.
I was heartened that Jymm sounded OK. But his desire to return to the freedom of his own apartment has not diminished. He is receiving care that he needs, but on terms and in a location that someone else wants. I can’t help but question whether this was the only solution.
Jymm fought for us. Why aren’t we fighting for him?
Tully MacKay-Tisbert is an associate director at a nonprofit organization serving homeless individuals with mental illnesses in the Los Angeles area.
Special To The Washington Post
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