An Atheist Asks How To Care for the Mentally Ill

Spencer Troxell is an atheist social worker (a rare breed!) and he explained why he chose this line of work earlier this year:

The spirit that led me to my current station was the realization that there was no other kingdom, and there was no greater glory to be found in the needless suffering of my fellow primates…

Homelessness offends me on different levels. On one level, I’m offended by the sheer callousness with which mankind can treat his fellows. In a society with a supposed safety net, an awful lot of people end up hitting the concrete pretty hard. I am also offended for selfish reasons. Isn’t it obvious to everyone, that if you want yourself and the people you love to be safe and sound and free from the twin sins of want and ignorance, maybe it would be a good idea to make sure our neighbors are safe from them as well?

I feel a sense of urgency compelling me to try to contribute positively to our current (and only guaranteed) situation, and since I am able to do this kind of work, why shouldn’t I?

Spencer works at a large (secular) homeless shelter in Ohio and he just wrote a piece for the Cincinnati Enquirer about the broken health care system as it concerns the mentally ill. I’m not an expert in the subject, so it’s an enlightening piece to say the least:

Cincinnati’s Drop Inn Center has a safe shelter for individuals experiencing homelessness to stay in, and — hopefully — to receive further appropriate services. A large portion of the population at the safe shelter could be classified as the “most difficult to serve.” These are individuals who are experiencing various degrees of behavioral decline as a function of either substance abuse or mental illness. Among this population is a sub-group of individuals whose behavior is such that — for the safety and peace of mind of other residents of this shelter — they must be asked to leave until they have received treatment that would allow them to function passably within the community.

When these individuals are not in the safe shelter, they are roaming the streets. They’re sleeping under bridges, on benches, in doorways, or in the jail house, because their behavior has caused them to break a law that has led to their arrest. It is possible for mental health agencies or police to “put a hold” on a person (requiring police to take them to the hospital for observation for up to 72 hours), but treatment cannot be administered without permission. Often these individuals are released to the street for the cycle to begin again, often only stopping when a severe enough crime is committed to warrant sending them to prison for prolonged periods of time.

He offers one possible path to a solution in the article.

Those of you with more knowledge about how this all works can chime in about whether his proposal will work.

In any case, if you’d like to support a secular homeless shelter, the Drop Inn Center in Cincinnati seems to be in good hands. If you donate, let them know you’re a friendly atheist :)

About Hemant Mehta

Hemant Mehta is the editor of Friendly Atheist, appears on the Atheist Voice channel on YouTube, and co-hosts the uniquely-named Friendly Atheist Podcast. You can read much more about him here.

  • Trina

    I’m glad for Spencer’s concern – and it’s a very valid one.  There may be some variation by state, but my understanding is that a 72-hour hold can be extended to an involuntary commitment by court order – thought I believe the litmus test for that is ‘danger to self or others.’  Overcrowding in existing hospitals, as well as lack of funding, seem to exacerbate the problem

    I have depression & anxiety disorders, myself, and am glad to have a roof over my head and some treatment.  I’ve known many mentally ill people over the years (there can be a tendency to gravitate toward each other, especially when treatment is lacking), including some who were dangerous. 

    I hope that Spencer is able to get a good dialogue going to find some solutions in his area, and that it will spread. 

    People are falling through the cracks of the current mental health care system; this dates back, to my knowledge, to the decisions to move many people from hospitals into ‘the community.’   Unfortunately, with that, a number of those people didn’t keep up their treatment and/or had so much trouble functioning that they needed more help than they were getting.

    Community mental health centers have been underfunded and under-serving for a very long time, but the situation has worsened with government cutbacks at multiple levels since 2008.  State medicaid funding cuts has also played a part in some people’s inability to get the help they need, especially in more rural areas.  It’s a scary situation for many of us, whether it’s our own safety on the line or that of a friend.

    A good resource for further information and state-by-state statistics is NAMI – the National Alliance on Mental Illness.  It’s a support, education and advocacy organization.  I have been a member in the past (am not at present, on disability & with no vehicle) and have had very good experiences with them.  They can also be a help to family members and friends of those who are struggling with mental illness.

  • Anonymous

    I think this is an example of an overall trend as people become more informed about biopsychology and mental health, where society recognizes that some criminally insane people cannot control their behavior and should be helped rather than punished.

  • Newavocation

    We do have homeless shelters, they are call prisons. And we are building more of them!

    • GentleGiant

      Of course, because prisons are usually private businesses, so they are profit makers. Take the “dreg” of society off the streets while making a (very large!) buck at the same time!

  • Sf2024

    Just a comment re: rarity of atheist social workers- I’m a social worker, and actually, I think that its a lot rarer to find conservative Christian social workers than it is nonreligious or atheist ones…if you look at our code of ethics, its very much about freedom of decision, dignity of the person, etc. and for the most part social workers lean way left both politically and religiously.  I’m not sure which comes first- our religious beliefs or our choosing of the career, but I think most of us social workers would have a hard time reconciling a  God to the stuff that we see in society.  I know that I utilize a lot of faith based resources for my clients, because thats whats out there, but those are staffed largely not by social workers.

    • GentleGiant

      Which is, curiously enough, the opposite of what you would expect, seeing how some of the supposed tenets of Christianity is the taking care of your fellow man…

  • Defiantnonbeliever

    There are additional barriers to help and support for atheists besides the gross underfunding and mental health systems mistakes and failure at follow up once a crisis situation has temporarily passed.  I experienced very poor systemic competence to guide people suffering from depression into any sort of life and career counseling coaching and guidance needed to overcome the very cause of my depression.  Additionally atheists are discriminated against at online mental health support sites where ‘spiritual support’ and all sorts of ‘religious support’ are deemed more important than reality based support and mental health.  There is great need for mental health support sites that actually support mental health over mass delusional support.
    -Defiantnonbeliever

  • Elizabeth Burgess

    I’m a recovery advocate at a crisis center. We’re a short term facility that provides counseling, medication, and other things to people suffering from a mental health crisis. Our facility does amazing things for the community, but it’s not uncommon for one of our consumers to end up back with us not long after discharge. 

    Spencer has an interesting idea about having a forum. When people discharge from our facility, we do what we can for them by providing referrals and many of our consumers leave with a ‘pep in their step’ if you will. Unfortunately, there is a big gap between the hospitals, what we do, and what other organizations do (or don’t do for that matter). The hospitals around here don’t like to hold consumers and will do whatever they can to get them to a center like ours. That’s fine, we usually are able to do a lot for that person, but I can’t even tell you how many times we’ve discharged people to the street. Or they find temporary housing and other agencies don’t do their part to help the person out. 

    It’s hard to explain without getting into painstaking detail, but we just talked at our last staff meeting about how one of the agencies known for providing counseling to individuals with no insurance or medicare/medicaid is waiting six weeks or more to get our recently discharged consumers in to see the psychiatrist and the therapist. This is unacceptable. We do what we can, as long as we can, until Community Health decides that a person doesn’t need to stay with us any longer. After that, it’s out of our hands.

    If there was an open line of communication between hospitals, community leaders, and the various agencies working to help those who are disadvantaged, we might be able to serve members of our community to a much greater extent than what we are now. I don’t think having a forum would solve every problem, there’s lots of red tape we deal with each day, but I think it would absolutely help.

  • http://www.agnostic-library.com/ma/ PsiCop

    As someone who’s known several folks who suffer from mental illness, who’ve been through the “revolving door” of the mental-healthcare system, this is a concern I’ve long had. Unfortunately there are few solutions, given the common American beliefs and the fact that treating mental illness competently costs money.

    I’m sure the forum Spencer suggests could help, but it can only address a part of the problem, i.e. the ability to “hold” the mentally ill and the length of time they can be treated. As long as there are too few treatment facilities (both in-patient and out) to handle the mentally ill, and as long as there are too few treatment dollars available to pay for their care, his “forum’s” impact will, by definition, be severely limited.

    We live in a country which, for the most part, does not want to acknowledge that mental illness exists. Most Americans think the mentally ill are “lazy” or eccentric or just looking to be cared for by the government. This means many Americans object to money being spent on the mentally ill. This, in turn, means it will be all the harder to spend what’s needed to build a mental-healthcare infrastructure that’s sufficient to actually treat the mentally ill.

    What the majority of Americans don’t understand is that, with proper treatment, the mentally ill can be as productive as anyone else, so that the money spent on a sound infrastructure would provide massive returns; many of those now spinning through the “revolving door” would no longer do so. This upfront investment would save money in the long term. Moreover, a sound system of care would assuage the concerns of the “mental healthcare advocates” who now work hard at preventing the system (as it is) from coercing patients into getting the care they need.

    It’s very sad that we have an entire class of our society which is being actively undermined by a large number of folks who don’t understand them and would prefer they just drop off the face of the earth, as well as by people who claim to be their “advocates” who, in reality, are getting in the way of them getting the help they need.

  • Psychotic Atheist

    I wish I had the wisdom to succinctly propose a solution to the problem.  It is, however, too big.       I have heard some suggestions that the structure of society itself forms an environment that creates more mental health issues – which would mean that fixing the problem is monumental and would require near omniscience to do correctly.

    I do know that the one thing that kept me from seeking professional help for as long as I did (18 years) was the fear of losing my autonomy.  So one has to be careful about detaining the mentally ill so as to avoid the appearance of a hostile system.  We psychotics tend to have paranoia issues that inhibits us from coming forward.    Again – the solution is not particularly straight forward.

    If I had any suggestion, it would be that if there was a forum that it would not just be for human services and civil rights organizations but also those that suffer from mental health issues (but are not seriously cognitively impaired) be allowed to voice their concerns too.

  • Quietly we weep

    My issue is that while I get treatment for free (I have depression/anxiety issues and no insurance), I have a limited number of therapy sessions a year — eight. Just eight. However, I have unlimited meetings with my psychiatrist. My meds are stable, but my problem is poor learned behavior patterns. Doc can’t help with that! This is particularly silly because therapy sessions are cheaper. I wish I had better control over my treatment care plan. I have control over the choices they offer me, but the sessions numbers are determined by an outside agency. 

    I count my (non-religious) blessings every day that I have never been committed because I have amazing friends.
    Just my five cents.

  • Tori

    Ha, I’m going to school for my MSW (masters in social work) and I’m an atheist. I didn’t realize we are so rare. What’s a typical atheist vocation?

  • Kathryn Moldenhauer

    I agree, the lack of logic in homelessness hurts in ways people do not have words for. It is unspeakable, and it is often christian charity that is feeding them garbage. I know from personal experience. I am a secular in the Madison area, and would love to be in a shelter that supports my beliefs instead of having to fill out civil rights cases based off discrimination as to, christian songs being played to the homeless, or discriminatory behaviors based off familial or marital status. As far as how to care for the mentally ill, I have a supposed severe mental health complaint, and when you get into some strains of cognitive, you start realizing that the psychoses are not as severe as the neuroses. Often. Yet disproportionately, it is schizophrenics and bipolar people who are being singled out for torture type tactics. Many steal some food and get put in prison, yet when you meet them, some of their artwork, or see them walk on film, they have cultivated such a lovely disposition. Yet people with depression or addiction issues are being singled out for jobs working with these “severe” type cases. It is getting to the point that as someone who has experienced psychosis, I know that I could do alot at the v.a., or with helping people get out of prison, after how traumatizing prison is, it drives everybody crazy on some level. From my point of view, if people are not behaving severely violently, never kick them out, no matter if they say some of the most prejudiced things imaginable. Often even severe cases clear up on their own, with qualified staff, or a worship of servants mentality–those that understand a pleasant home. No one is so gone that they don’t appreciate their surrounding environment. Tenderness first, many psychiatrists have written popular science books, and they will tell you why the mentally ill refuse medication. They are mind altering, they do offend the constitution, and often they are not explained to, as to how to manage uncomfortable side effects, often the drug is worse than the disease. Heroin was a mental health drug at one point. Morphine also, and it is very painful, not a high. So from my perspective, it is a stressful situation people can be taught to manage better, with men’s health, keep them task oriented, and involved–excercise vouchers, decent food. etc.

  • Kathryn Moldenhauer

    and an edit on my previous comment. to clarify servant worship, alot of what we know about severe psychoses, is about combat syndrome, or testing on them through illegal drug use. Psychiatrists at one point were giving psychotics cocaine to see if it made it worse to prove the dopamine hypothesis. By the time most people develop psychosis, they have been on a plethora of drugs they don’t even know about, steroids, to antibiotics, to marijuana, to alcohol, that to subsume a complex issue under, we have figured out the brain, is a form of megalomania that comes off like greed.

    so focus on sound, on an efficient system. if possible make sure people’s clothing is wrapped in some type of cloth if they have to keep luggage. If sheets are washed in pleasant weather, a pleasant snap as they are being hung to dry, is soft on the ears. Uhm, a decent gardener, if a kitchen garden can be established, saving money on the tax payer. Someone who can show the place around in a completely informed way–i.e. we have chosen these mattresses to dispel these allergies, they are made of some synthetic materials–someone that knows just how to conduct air flow, where fans should be kept–someone that dims lights, on putting people to sleep, and slowly raises them to wake them. A pleasant experience to the food, so people don’t focus on all the drugs in the food, that is harming their physiology, their reproduction etc.
    I am sure you can think of more from your own experience of when capitalism entailed certain behaviors that aren’t getting done for anybody anymore. Somehow petroleum products are all you own?  Most psychiatrists speak of giving the mentally ill stigmata. and as life has changed through history, it is important to realize that mental illness isn’t what it use to be–different products are being used than in 1926 for instance, and most mental illness, especially schizophrenia is environment dependent–why they are often discriminated against at work, needing to eat to build their tissue loss and things. good luck.


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