NOTE: the term "Mission Therapy" is slang - often used by mental health people. A "Placebo" is a fake medicine that the patient thinks is real. Placebos are seldom prescribed and this is a rare photo of an actual prescription. I have used the term for "treatments" that have no real value.
Every so often, a car pulls up to the Local Mission.
Another client has been dumped at the Mission.
All of the names in this report refer to real people and events in . We have changed the names for confidentiality and to emphasize that Mission Therapy happens all around the US.
Also, I have named the people in this report "Patient # __". This does not tell much about them, but it does show how real people become Numbers. Paperwork is valued over people.
"Mission Therapy," the dumping of mentally ill clients at the Local Mission - or on the streets - is widely practiced, but not often reported. This report will focus on this and other practices of one agency, Blue Bayou Mental Health.
Nothing in this report is
intended to discourage anyone from seeking help at Blue Bayou
Health or anyplace else. Treatment usually works well and BBMH
good overall record of providing services. However, even in
agencies, problems can and do occur. This report explains what
learn from the "failures". If these problems happen
at BBMH, they could happen at any agency.
Most of the people in this report were asking for some type of help for their mental illness. It is well known that people who are refused treatment or dropped from treatment programs often injure themselves or others. The people in this report were severely ill, disabled, homeless or in jail. They cannot easily "file a complaint." They need people to help them advocate. Hopefully, this report will help end "Mission Therapy".
The case of Patient # 22 is the
worst series of treatment mistakes that I have seen in 10
working in mental health in . It would be almost comical
the outcomes were not so tragic for Patient # 22 and the
Patient # 22 was known to be a challenging client. However, he had lived for years in Local without being arrested for any crime. In late 1995, Patient # 22 moved to Blue Bayou to work with Blue Bayou Mental Health. Despite intensive support he had many problems living in Blue Bayou. In 1996 he began having problems with BBMH staff and community members.
Patient # 22's first case
manager at BBMH became so frustrated with him that he hit
22 (and was arrested and fired.) His therapist and the
for his Social Security disability money was __________. Her
management for Patient # 22 was highly unusual in a mental
agency. First, she and Patient # 22 opened a joint bank
her - outside of the agency. Client funds are held in agency
accounts for individual clients. _________, who is generally a
therapist, has only a B.S. degree in Sociology. Patient
liked and trusted her but was also good at manipulating
Patient # 22 was already on a budget plan because of being heavily in debt. However, she then sold him $500 worth of her personal household items. There is a list of the items enclosed. This was done with the full approval and approval of the agency director, _________. He wanted to keep Patient # 22 happy after his first case manager had struck him. This financial arrangement is clearly inappropriate due to the ethical problems it raises in therapy. His therapist paid off Patient # 22's debts to her - but may not have paid his older debts to stores like Sears. Over $1,500 was returned to Social Security that might have been used to pay off his other debts.
In the late summer of 1996 Patient # 22 wanted to move from his apartment that was subsidized under 's Section 8 housing program. His case notes show that he was becoming increasingly delusional, paranoid and threatening to neighbors. He wanted to move from his apartment - but his lease ran until November. (See notes 9-16 & 9-19-96)
The nurse practitioner at BBMH, ____________, prescribed psychiatric medicines for Patient # 22's mental illness. Two of the prescriptions were highly unusual - "Placebo" and "Placebo Plus." These were vitamin C tablets prescribed "for pain." His thinking and mental state was so disorganized that he did not realize the pills were only placebos - although he kept both labeled pill bottles at his home and took them "as needed." Patient # 22 trusted Blue Bayou Mental Health staff completely. He did not question the word "Placebo."
Placebos are seldom prescribed because of their ethical problems. When they are used, it is commonly under the supervision of a doctor. county and state medical officials should review this practice - and track the client outcomes using "placebos." Included in this report is a photo of the "Placebo Plus".
For months neighbors had been phoning the police and BBMH to complain about Patient # 22's aggressive behavior around women and children. But he had not done anything serious enough to be arrested for. However in case notes for Sept 26, Patient # 22, having had no sleep the night before and delusional, told his therapist that he felt urges to have sex with children and young women. Her case notes say that she tried to get him into a sex offender program that same day - but he had not been arrested for anything. The agency then wanted to have Patient # 22 confess to being a sex offender to Blue Bayou police. However, there was no real evidence of a crime. (See BBMH file notes 9-25 & 9-26)
The agency's director, phoned
Patient # 22's landlord and advised them to evict him. Patient
was dumped at the Mission even before he was evicted from his
apartment. (Notes for 9-26-96 & 9-27-96)
staff then told Patient # 22 that effective immediately he
no further help from Blue Bayou Mental Health. Clients are
to be given a 10-day notice and a referral before they are
terminated. However, BBMH simply drove Patient # 22, whom they
believed was a sex offender, up to the Local Mission and
The next day the director phoned Mental Health to tell
that the agency had "fired" Patient # 22 and dumped him at
the Mission. His intake with the County was over a week away.
offender was made homeless by the agency. He then hurt a
Although they felt Patient # 22 was too dangerous to be in his own apartment with support they dropped him off at the Mission with no support at all. This was a man who was being seen 10 times a week by staff. His Mental Health Assessment of 7-1-96 states "Without staff support every day, Patient # 22 would definitely be in jail or the hospital." BBMH tried to get emergency housing from (____________) but it was denied.
BBMH did not have him evaluated at the psychiatric hospital in Local. The case notes say "I could not say that Patient # 22 was an immediate danger to others" (despite the fact that they were trying to have the police arrest him for sexual offenses.) BBMH had four staff living in Local at the time - any of whom could have seen Patient # 22 at the Mission until a proper contact with Mental Health could be arranged.
Patient # 22 did not last long
at the Local Mission. I telephoned his new case manager at the
County, and told him my concerns. I felt that the way his
and service termination were handled would enrage him and that
something bad would happen. This made several staff members
but I felt that Patient # 22 was a very high risk.
Patient # 22, confused and crying, returned to Blue Bayou the next day. He went to the Blue Bayou Mental Health office and asked them for help and support. The agency director called Blue Bayou police and had Patient # 22 arrested for trespassing at the office when he was there asking for help. (9-27-96)
Blue Bayou Mental Health had
made it clear to Patient # 22 that they would not help him -
his next appointment with was at least a week away.
support his mental illness became much worse. BBMH had four
live in Local. Any of them could have seen him at the Mission.
However, BBMH had terminated all services to him with no
made his mental illness worse. In hindsight, how could it have
Patient # 22 returned to his old apartment to "get my mail" on 10-1-96. He had an altercation with a neighbor and shattered the man's wrist and arm. The victim was a guitarist. He now wears a brace on his arm. He needed months of physical therapy to play guitar again. In the beginning, as a neighbor, he had tried to help Patient # 22 and BBMH.
Patient # 22 made a number of
requests for help after being fired - and for an accounting of
money. However, no one from the agency returned his phone
met with him. He did not hear from them until December, when
therapist wrote him about his money and reminded him of his
her for buying her household furniture. He was sentenced to
State Hospital program for violent mentally ill offenders.
The Case of Patient # 22 points out the horrendous problems that occur when treatment is stopped and the client is dumped at the Local Mission. Without support, Patient # 22's illness became much worse. In this case Blue Bayou Mental Health dumped a man it believed to be a sex offender at the Mission.
Perhaps the County erred when it did not admit him to the crisis system - but BBMH still could have made the transition easier by not dumping Patient # 22 at the Local Mission.
(Documentation for Patient
22's case comes from his file notes, conversations with
Patient # 22
and the people he injured. Although this case happened a
decade ago, Mission Therapy is still practiced.
Patient # 66 age 31, lived at the Bohemia Residential Center operated by Blue Bayou Mental Health. She was a native of Blue Bayou. Patient # 66 had been given a 30-day eviction notice due to her behavior and drinking. Then, she hit the agency's director. She was taken to the Local Mission as Mental Health did not have emergency housing for her. No worker came to the Mission or contacted her about getting into treatment.
Patient # 66, who was judged to be too "out of control" to be in a mental health group home was dumped at the Local Mission with no support or follow-up treatment although she requested help several times. She expected to see staff from Blue Bayou Mental Health again - but they never even contacted her to see if she had gotten into another program.
Without any support it was not
long before Patient # 66's mental illness began to worsen.
months later she was hit by a train near the Mission. She lost
right leg. Her rehabilitation and physical therapy have cost
thousands of dollars in the past year and will for the rest of
life. She also deals with "phantom pain", which is common in
Blue Bayou Mental Health did not follow-up with this woman, but just dropped her off in Local. Most agencies do some follow-up of clients that they drop off but in this case, BBMH did not. She never saw BBMH staff again. She was not told of her right to file a grievance - or to get the treatment that she requested. It was not until several months later, after she lost her leg, that she was accepted into another Mental Health program.
Group home rules at BBMH can be applied differently from client to client. Another resident at the house had struck several BBMH staff members - but was never evicted for it. Patient # 66 was a challenging resident - all the more reason not to dump her on the streets - especially after she had hit the agency's director.
(Information for "Patient # 66's" story came from conversations with her - also, I worked at the agency when this incident occurred and remember her eviction. She hopes other people will not be dumped at the Mission)
"Mission Therapy" is wrong, and dangerous for clients and community members. This practice should be ended. We need more places for homeless people with mental health problems to go. At the very least we should maintain a list of clients sent to the Local Mission (or the streets) and track what happens to them. Most of the people I know of who were dumped at the Mission or on the streets were never followed up with. Women are especially vulnerable to being abused, raped or injuring themselves. No list is currently kept, and there should be.
The Local Mission may be 's largest "mental health facility" with more mentally ill people staying there than in any other residential or inpatient program. Yet, the Mission, being a church organization, gets no public funds for its work with our clients. Often churches are the first and last resorts of people with mental illness and their families. They should be represented on our advisory boards.
Laws about ending treatment to people and giving notice and referrals should be enforced. Under law agencies must give a client a 10-day notice of termination of services and a referral to a new provider. Yet, no officials check this. It is left up to the client, who is often severely mentally ill, to file a complaint. We need to keep lists of people who are kicked out of programs and what happens to them.
We need to listen to people who say they need help. Clients and family members often know their own mental health needs. We need to offer some follow up support for people who are in distress but are rejected by the hospital. People should be able to voluntarily admit themselves to treatment - before their illness worsens and they are jailed or committed involuntarily.
Clients should be protected from possible financial abuse. It is usually unethical for a mental health worker to sell a client hundreds of dollars of their personal household items. It blurs the boundaries between therapists and their clients and almost always leads to bad outcomes for staff and consumers. Agencies should keep client funds in trust accounts in the agency's name - not in the names of individual therapists.
The practice of prescribing "placebos" should be reviewed by medical officials. At BBMH, at least one client, Patient # 22, was prescribed a series of placebo pills. We need to look at the success or failure of placebos for mental health clients. It may be an indication that treatment is not going well for the client or the doctor. At least the use of placebos should be monitored by County medical officers.
Blue Bayou Mental Health is not the only agency that has practiced "Mission Therapy." When the State Hospital was closing vans of mental patients were simply dumped at the Local Mission. In the rush to downsize we've lefts some of our most ill citizens in need of help. Mission therapy is wrong. It puts clients and community members at risk. We need to learn the lesson that mental health clients don't "get better" in jail or on the streets. Sometimes the system acts crazier than the people it serves.
Also, these are just the cases that I am personally familiar with. There may be others. There is no way to know unless staff come forward with their personal stories. Severely ill and homeless people often do not have the capacity to rationally make complaints. They sometimes "complain" by acting out - as some of the people in this report have done.
Some of BBMH's problems are
problems with our overall system of care. Blue Bayou Mental Health is no worse
than any other agency. It serves many people very well.
However, it has also
made mistakes where people have died, been arrested, injured
themselves or hurt others. We can learn both from BBMH's
well as their failures. But, we can only learn from
mistakes if we acknowledge them and take steps to correct
two things could have
preventing this "unfortunate" series of events. First, if
been a union in the agency both the level of professional care
have been higher and the agency would have been more
also possible that it wouldn't have happened if there had been
consumers involved in planing care. The whole idea of helping
hoard medicines is so foolhardy that it's not likely a
council would have approved of it.