Approach all with dignity, personalize accommodations, educate, advocate

By S. Frances Smalkowski, CSFN, RN, PMHCS, BC, BCC

The Monroe convent home of 30 sisters of the Holy Family of Nazareth is less than nine miles from the December Newtown tragedy. Our sisters were and still are intimately involved in prayer and presence as the Spirit directs. The actual day and time of this horrific happening I was out of state with a college friend en route to breakfast. “Prophetically,” as we were driving out of her living development, she commented on all the parents who were waiting with their children for the arrival of the school buses. Her words contained a word that was painful for me to hear (since I consider myself a mental health advocate). That I did not address that “word” was a testament to my own “lapses” in the same area of using insensitive and stereotypical speech about those who live with mental illness. She said: “It’s a shame that the parents have to wait here until the last minute to put their children on the buses. They never know when any of the ‘crazies’ will come around.”

Later on, I reflected on my seeming inability to address what seemed so simple. My friend and I had known each other for 50 years; we are both professionally educated and engaged in different ministries. Why is it so easy to slip into the street language that we both abhor? This made me ponder how often I, too, add unhealthiness to the pure drinking water our God has given us. Furthermore, how can I, as a chaplain in any setting, contribute to or teach those I am with about mental health?

Close to 15 years ago, I answered the question: “What psychiatric nurses should teach the public about mental health?” in the Journal of Psychosocial Nursing. During my chaplaincy internship 25 years ago, I wondered how differently a chaplain and a psychiatric nurse would approach situations. Needless to say, the parallels are more than obvious. Some suggestions for chaplains follow, and are already part of our basic education, and continuous education.

1. Approach each person with equal dignity regardless of race, color, creed, gender, orientation or illness. (For myself, I find that those prejudices simply “sneak” up on me in unsuspecting ways. Transferences, we know, are like that.)

2. Integrative (holistic), relationship-centered, consumer-driven care should be the norm for each person. Stigmatizing persons because of their mental illness deprives them of the necessary specialized service. (For me, since I have been involved in ministry with the aging, seriously ill and dying, it is easy to forget how dementias and chronic mental illness impact those areas. Also, outside of my long-term setting, I have had the gift of walking with persons in spiritual direction who also live with persistent mental illness in the community. It is very moving to witness God’s Hand gently holding the directee’s hand.)

3. Individuals coping with persistent mental illness can live full lives with personalized accommodations. Supportive, loving relationships facilitate that possibility. (Experiencing family members’ love and support of their loved ones has been a wonderful witness to me. Seeing those living with mental illness make gains, and being there with them for those as well as for their setbacks is a regular reminder of God walking along with us in similar ways each day. Giving praise for holding a job for a short time, maintaining one’s self in a room/apartment, or going on a vacation with a family member are monumental gifts for some among us whose challenges are beyond our comprehension at times.)

4. It is very important to take every opportunity to educate one’s self about mental health/illness. New treatment methods and medications are the direct results of research and funding that need to be supported in whatever ways are possible. (This can be clearly seen by how well so many can live independently and serenely in the proper environments with the needed services. What a difference from my experience of psychiatric nursing in my basic nursing education in 1967 at St. Elizabeths federal hospital in Washington, DC!)

5. ADVOCATE! ADVOCATE! ADVOCATE! How? Through one’s own personal relationships ¬¬– we all have family and friends who struggle with mental illness. Can I find time to be with them or write them? Do I confront stereotyping words and behaviors? Can I give some time to be involved on mental health boards? (I had the privilege of being on the board of the Newtown State Psychiatric Facility – Fairfield Hills for many years before it closed. Besides being a presence there, opportunities for teaching about spiritual care with the residents and with those who were dying were afforded me. This was all very humbling. Also, being prsent for more than 10 years on the Connecticut Southwest Regional Mental Health Board was an enriching forum to surface concerns in the presence of other mental health advocates). And legislative efforts? Oftentimes, there are opportunities to speak, write, or sign one’s name in support of clearly needed legislation. (Recently, I gave testimony against the bill H.B. No. 6645, “An Act C
oncerning Compassionate Aid in Dying for Terminally Ill Patients” that would have allowed for self-administered physician prescribed medication.)

6. Remember that mental health can be cultivated throughout one’s life through practices that enhance one’s self esteem. Other self-care habits and counseling as needed point to one’s own recognition of need and maturity at given times. We need to remember that mental illness can be experienced in any family at any time through no fault of one’s own. (Inheritability is becoming clearer and poignantly more scientifically proven). We are regularly invited to walk with the Anawim, who were called “the weakest and the neediest” by Pope Francis I during his parting words to the Easter crowd in Rome. I feel this is our newest call!

S. Frances Smalkowski, a nurse and psychiatric clinical specialist, is director of pastoral care at Pope John Paul II Care and Rehabilitation Center in Danbury, CT.