Photo submitted to Times Observer From left, Nicole Bialas Harrison, M.D., Bill DeVlieger, Behavioral Health Tech, and Darlene Schultz John, RN, BSN, with “Bob,” referred to in the column.

What About Bob?

That question may remind movie goers of the 1991 American black comedy starring Bill Murray and Richard Dreyfuss. Murray plays a psychiatric patient (Bob), who follows his egotistical psychiatrist on vacation. Painfully neurotic, Bob purses Dr. Marvin’s recovery approach called “Baby steps” and “take a vacation from your problems”. Using the approach, Bob stabilizes. However, in the process; he pushes the doctor over the edge. Despite driving his doctor crazy, Bob’s silliness and humor win over Marvin’s family, injecting mirth and fun into the once too serious household.

“Bob” might remind you of some you know. Mental illness is exhausting, to the person experiencing it, to those who support the person and sometimes to those who treat it. A stable home and/or a supportive family are essential for mental health and mental health recovery. In this case, the hopelessly neurotic Bob gets better and happily finds a ‘family’- one that accepts and loves him for who he is and what he brings to their lives. The key word here is family.

What do we mean when we say “family”? The word conjures images of parents and siblings, our wife or husband, and children. For most, it evokes warm thoughts and memories. Close friends and family pets are family. We hear the word family values and we think about the teachings we received as children and seek to pass on through the generations. Family, however it is defined, is everything.

Sometimes, it’s easy to forget that there are people living in our community who do not have anyone they identify as family. There are those among us who don’t feel warm and fuzzy, or have happy memories. Sadly, some people have outlived their loved ones or, worse, those who have been shunned or abandoned. Those diagnosed with mental illness are often victims of a stigma that pervades our society and portrays the mentally ill as dangerous or below everyone else. Imagine how it must feel if the people closest to your heart were afraid that they might, “catch” your depression, anxiety or voices. For the mentally ill, already in a vulnerable place, where the need for support is the greatest, the effect of being ostracized is a crippling blow.

Working at the psychiatric unit at Warren General Hospital, too often we see those dispossessed by their families. We see the elderly or aging patients who have either outlived their loved ones or have become a “burden” on the generations that follow from them. We see the effect of stigma within the health care system. There are times when our social worker labors tirelessly to find a safe and appropriate place for the patient to go after hospitalization. We see nursing homes and assisted living facilities that, time and again, reject those diagnosed with mental illness because they are “not equipped to handle the psychiatric patient”, effectively leaving them homeless. Often, we see prior medical records further stigmatizing, those with a mental health diagnosis, because previous caregivers document apparently frightening scenarios that portray the patient in an entirely negative and unflattering image, effectively reinforcing stigma. Imagine that the power of someone else’s words can reduce you to being homeless! Few people want to take the risk to care for someone who is portrayed at irritable, yells, occasionally strikes out, or has at one point in their life, become aggressive. Unfortunately, many people reduce those with a diagnosis of mental illness down to their worst behavior. They often don’t ask themselves the question, how might the caregiver have contributed to the person’s behavior? Think about it. When you’re confused, struggling to think straight or communicate your needs (like pain or fear) and no one gets it, how would you feel when someone isn’t getting the point?

Here at Warren General’s psychiatric unit, we treat people with dignity and respect. Because we begin there, very often, we do not encounter the on-sided person on paper. Very often we do discover a delightful (and quirky) human being. One that inspires us amuses us and often times offer something of them we take home. Most often we see a desire for independence and resilience. It is heartbreaking when we discover that this person, with a mental health diagnosis, has become an unwelcome person- without family or a place to call home.

Over the past twelve months, we have encountered a series of patients who have experienced this stigma. We have realized that how the one-sided views of others further impact those people, reinforcing stigma and reducing them to the unwanted.

Taking our name from the title of this article, one of those people was someone we will call ‘Bob’. Bob came to our psychiatric unit, without actively involved family, friends or other supports. Bob, an elderly veteran, suffering from a debilitating physical disease also had a psychiatric disorder. (A mental health disorder is an abnormality in the function of the brain). Since his mental health diagnosis, Bob had spent a majority of his life being discharged and transferred from facility to facility, whenever his psychiatric symptoms worsened. When we met Bob, he had been evicted, without notice, from his current nursing home. We admitted Bob to our Behavioral Health unit to treat “violent” behaviors.

Our initial experience with Bob is that he was occasionally irritable. No matter who you are, when someone is irritable, it makes sense to work with them by making certain the person has their care delivered on their terms. No one wants to lose control of themselves, which is why we ask lots of questions and we are patient with them.

Using this approach, within a couple of weeks, Bob’s medical and psychiatric conditions improved. Instead of viewing Bob as a “mental health patient”, we treated him like any other person suffering from things that they have little control over. We chose to see the good in Bob, not the diagnosis or his behaviors. From the beginning, we treated him with kindness, dignity and respect. We didn’t encounter the behaviors described in his previous medical records. Was Bob sometimes irritable? Yes. Did he want things on his terms? Mostly yes. Did those things go away once we developed a relationship of trust? Mostly, yes! When Bob was cranky, it was generally because he was in pain or feeling ill. How many of us without mental health disorders don’t become anxious, irritable and impatient when we are in pain? Bob is human!

Greatly improved, Bob was ready to go home. But, where? With no family to support him, and any history of being aggressive, no one wanted to take the risk of accepting him. Our social worker, Deb, spent endless hours trying to locate a facility that could care for Bob. Rejected by facility after facility, Bob remained in the hospital for six months. Six months of hospital food, six months behind locked doors, six months of stale hospital air. Bob still required 24 hour nursing care and support. Despite our perspective, the frightening reports from the other facilities, painted a picture of an unmanageable person. Fearing a “dump”, potential facilities were weary that accepting Bob would mean a safety risk or nightmare of care for them. We were heartsick for Bob. With our approach, Bob was not the person they described. It seemed that Bob was being punished for how other facilities approached their care of him.

In the intervening months, we had to the rare opportunity to get to know Bob more so than the average patient. We looked forward to greeting him when we came on shift and bid him goodbye when we went off shift, assuring him when we would next see him. We came to consider Bob a member of our family. Cooped inside for months, the doctors provided him with a rare opportunity to venture outside with staff. Pushed in a wheelchair, Bob visited our creek-side neighbors, the geese and picked flowers for the not only his room, but for others. The simple act and the summertime warmth brought a smile to Bob’s face like the horizon at sunrise.

Bob’s physical care required a lot of assistance and his intermittent confusion resulted in him losing his wallet five times in the six months we cared for him. All of Bob’s money was in check form, because there is nowhere in the hospital for someone to deposit it or cash it. Each time he lost his wallet; we purchased a new wallet and donated several dollars towards it. You see, Bob’s sense of independence is strongly tied to his wallet. With ‘money’ in his pocket, he would often offer to buy us things as a thank you for our kindness. The last time the wallet was lost, Bob became distraught. His independence lost with all of his money. Knowing the pattern would repeat, we gave him play money to assuage his anxiety. Presenting him with the “found” wallet, he looked down, and up again, proclaiming brightly, “Wow, money got small!” We looked at him sincerely and replied, “Well, Bob, you have pretty big hands!” In his gratitude he offered to spend his “money” to buy us pizza and pop. His generosity and gratitude were charming. Bob entered our hearts. He hugged each of us and held our hands. Bob’s attempts at independence were not limited to his wallet. To recapture some measure of the independence he had known most of his life, Bob would attempt to get up and walk by himself. Unfortunately his medical condition prevented this without our support. Many times, we had to rush to his side to ensure that he didn’t fall. Despite the work it took to care for him, somehow Bob magically entered our hearts. We viewed him as family and it became obvious that he viewed us that way as well.

After months of searching, consulting and being denied by nearly a hundred facilities, we found a nursing home willing to take a chance on Bob. As the transfer to his new home drew closer, our staff experienced a mix of emotions. We were relieved, that after the long a sojourn on our psychiatric unit, Bob was finally going to have a new home. He was excited and we were excited for him. At the same time, though, we were sad. Bob had become a familiar and bright part of our work day. Each day, we often found Bob sitting near the desk with staff. We had spent eight hours a day with him, which was more than some of us spent with are able to with our own families. We helped him with nearly every life task and then at the end of our shift, we would say good night and go home. The idea that our time with Bob was drawing near its end, was melancholic.

The night before Bob left, the staff hosted a unit pizza party in his honor. Bob was delighted. Hospital pizza isn’t like takeout. We situated Bob with us at the nurse’s station, watching his favorite singer on you-tube videos. Singing and tapping his foot in rhythm to Johnny Cash. His favorite songs came from “At Folsom prison” album. Another wallet lost, another purchased. With a new watch and clothing- at staff expense, he was prepared for the transition to his next home. One of our nurses, Stephanie, used her culinary prowess to make Bob a gourmet “welcome home” cake, coordinated with gourmet “Thank you” cupcakes to share with the staff at his new home.

Even though Bob moved to his new home, he is not forgotten. Due to mental health privacy laws, we no longer have the ability to call him and check in. His intermittent confusion is most likely the reason why he doesn’t call us. We miss Bob and we don’t want to forget him. In honor of Bob and those who have encountered the same plight, the Behavioral health staff commemorated a tree to the hospital waiting area near our unit. Our tree is affectionately named “Bob”.

Every day, our behavioral health team works hard to care for those with a mental health diagnosis. Our goal is to reduce the stigma of mental illness within our community. We help people along the way and we have some wonderful experiences. In the mental health field, we face stigma every day. Many people have either been forsaken by family and friends on account of their illnesses or have outlived their relations. Though Bob came to us without family or friends, he left with a Warren General family that will never forget him.