THIS BOOK IS CURRENTLY BEING WRITTEN
It was my first shift on call in the psychiatric emergency room at the University of California-Irvine Medical Center.
I had been a psychiatric resident for only 4 days and admit that I knew very little about psychiatry and even less about the
reality of what was happening on the streets. When one was assigned to the Emergency Room, a resident would work a shift and
then return to the treatment units where patients had been transferred after stabilization from the E.R.
Within the first few hours on call, I answered
a phone call from a frantic mother who said “the police took my mentally ill son from our house a while ago and said
they were taking him to your E.R. I was calling to see if he was there and O.K?” Not knowing what to do I turned to
my Attending Superior and was told “Tell her you can’t tell her anything and hang up!” My response was “You
must be kidding?” To which I was told again to “Tell her you can’t tell her anything and hang up”.
I was stunned and needed a minute to collect my thoughts. When my attending walked away I went into a private room
and got back on the phone. I told the mother “I am a first year resident in my first days of training. I was just told
by my Attending that I cannot tell you anything. My name is Dr. Massimino and I want you to know that you can go to sleep
tonight knowing that your son is safe. Also please call me tomorrow morning on the treatment unit”.
The next morning on the treatment
units we would have rounds on the new admissions to the unit. If the families were knocking at the locked door wanting information
we would describe them as intrusive and over involved (they were just in a panic to know). If no one knocked at the door we
would describe them as indifferent and un-caring (they were just resting from the trauma at home). Families could not win!
Thus was my introduction to the treatment of chronic mental illness and their families. Something was very wrong and I was
determined to figure it out.
Within a few days I went to the Public Relations Office of the University and asked if I could start a free support
group to help families of the severely mentally ill. I was supported and an ad was placed in the newspaper to announce the
start of this support group. Within several days I received a call from a mother responding to the ad who said she was part
of a small group of parents of children diagnosed with Schizophrenia. They had been meeting but were struggling to help one
another because they didn’t know what to do. I responded that I was a first year resident and that I did not have any
participants in my group. We agreed to merge my group and their group. They were called “The Friends and Relatives of
the Mentally Ill of Orange County. They would later become the Orange County Chapter of NAMI. My true education on chronic
mental illness began with the start of this support group. The families taught me what I needed to know, not my department
When the Alliance for the Mentally Ill (AMI)
was first forming in the early 1980’s, the primary organizers were families or friends of someone with a psychotic illness.
The majority were parents of someone with schizophrenia. This group was already experiencing the transition from institutionalization
to criminalization of the mentally ill. They were desperate to find adequate medical care, inclusion into the treatment process,
commonsense interventions at times of crisis and dangerousness and continuity of in-patient and out-patient services. We have
seen more than 30 years of NAMI development and growth. Under their watchful eye, the jails, prisons and state mental hospitals
have become overpopulated with the seriously mentally ill and are the default psychiatric treatment settings in this country.
How did this happen? How could an organization which was birthed to prevent prison settings from becoming their children’s
future, allow this to happen? I believe NAMI, just like the American Psychiatric Association (APA) and most other organizations
concerned with serious mental illness have abdicated responsibility for this group to the public mental health care system.
How could these organizations be co-opted by the public mental health care system? Like most things in a capitalistic democracy,
the answer likely has something to do with money. Equally important to this answer is the influence our laws have had in extinguishing
the private sector involvement and response to the care of the seriously mentally ill.
I have said my entire career that Psychiatrists who do not treat the seriously
mentally ill are like Cardiologists who never treat patients with a heart attack. Since most Psychiatrists and The American
Psychiatric Association have refused to weigh in with action and commitment to criminalization of the mentally ill, I continue
to be embarrassed by my profession.