This amazing women from ACT, come into the patient’s darkness. These heroines do this often as their day-to-day, uplifting them and bringing light into their lives.
Samuel Wesley Berg
The status of being chronically mentally ill is often accompanied by stigma. In the medical field, providers range in response to this status from embracing it and trying to be of service to avoiding working with these patients as much as possible. The latter is not the case for my experiences during my clinical rotation in Psychiatry at Tropical Texas Behavioral Health in South Texas. In particular, working with Assertive Community Treatment (ACT) daily in one form or another rewarded me with what ended up being a genuinely humbling and enriching experience. Coincidentally at the time of my rotation, all of the staff members of the ACT Team in Edinburg were female.
As students, we had the opportunity to visit patients, many largely incapable of caring for their own basic needs, taking their medications, and progressing past their diagnosis. The women in ACT seemed made of magic at times, accomplishing impossible feats no medical professional could do. After reviewing a chronically mentally ill patient’s chart and expecting a poor outcome, I was impressed with how well they were doing in my clinical assessment. Caseworkers in ACT visit these patients numerous times throughout the week and provide:
- Guidance.
- Insight into improving the patient’s life.
- Access to resources for things as essential as food and housing for these individuals that cannot do for themselves.
Ensuring patients are not forgotten, abandoned, and sidelined, as often happens in the chronically mentally ill. They are the healing hands outside the hospital and clinic. These individuals do the often bitter work that we, as healthcare providers, unfortunately, do not have the time to do. Healing requires a myriad of techniques to achieve the goal of stability and functionality in the mentally ill. Medication and counseling can only go so far, and ACT does precisely what its abbreviation states: they ACT in the patient’s best interest to improve their day-to-day lives.
This experience for all medical students who rotated with ACT was in our best interest, a chance to enhance our medical knowledge and, more importantly, our hearts. I cannot think of many other medical fields where you get an intimate understanding of why your patient is non-adherent, a no-show for their appointments, or even resisting treatments. In medicine, you often encounter statements such as “All they have to do is take their medications; it’s not hard.” or “They just don’t want to get better; it’s their fault.” It is easy to see why people make these statements when they cannot know how a person lives. To get, even for a moment, the experience of walking in the patients’ proverbial shoes. To comprehend how many of these patients are isolated within their community and minds. Stuck at the bottom of a well, unable to see the light. It becomes crystal clear that there are many barriers to their improvement. That the trauma some of these chronically ill patients endure or have endured prevents them from escaping the claws of mental unwellness.
Spending an hour with these patients was often enough to truly understand why treatment is not a straight path to health. To know why ACT is essential, a beacon of light ushering them on the winding road to recovery and stability. Seeing these patients and understanding who they are within the confines of their homes was challenging in ways no clinic or hospital environment could ever hope to provide for a student. Staring into their eyes like tiny mirrors, I found reflections of moments from my childhood staring back at me. Buried trauma, as so often we do to survive, bubbling to the surface after my time spent with the patients in the community. One might imagine my feelings might have been of melancholy, rage, or even despair from the memories of living with someone with a severe substance use disorder compounded by being chronically mentally ill.
However, the first thing I felt was jealousy. Jealousy that these individuals had the amazing women from ACT coming into the darkness that is often their day-to-day, uplifting them and bringing the light into their lives. Intervening when things were so tumultuous, the family suffered the collateral damages of their mentally ill family member. I wish someone had been there for my sick family member when I was a child, someone who might have been able to reach them the way these women reach many patients daily. To stand as a fixed point to lead them out of the abyss when no one else seems capable of doing it. What a treasure that is for the rest of their family.
Individuals have hearts of such magnitude that they help safeguard the rest of the family as best they can from the potential dark times of someone with an incurable mental illness. When people speak of invaluable things, that is precisely what these caseworkers are: invaluable. You can not put a price on or even hope to describe in words how they are helping to alter the trajectory of the patient’s and their family’s lives for the better.
In the future, as I progress toward becoming a physician, I will encounter comments about what one can fundamentally do for a chronically mentally ill patient or any person afflicted by a disease with no cure. I will tell them to do what these women of ACT do EVERY DAY: Bring the Light in.
