In these days with limited access to mental health facilities, and when in-patient or out patient treatment might be focused on invasive treatments and not on recovery, you may be tempted to “provide sanctuary” for a friend or family member who is experiencing serious mental health challenges. Many of you have probably already done this.
I have been interested in “sanctuary” ever since I heard of the work of John Weir Perry at Diabisis House back in the 1970’s. Perry believed that people who were having mental health difficulties could heal themselves if they were allowed to talk about and act on their feelings in a safe place where they were supported by caring individuals. His research on this project showed astounding results. He found that even people who were most seriously affected would, if given the opportunity, heal themselves in about 40 days with often no recurrence of the mental health difficulties over time. In this sanctuary, people could do whatever they felt they needed to do to relieve their distress. People did things like yelling, singing, ranting, raving, drawing, painting, and making music. Supporters listened and listened and listened without judging or interpreting what they were hearing, and without interrupting with stories of their own or advice. The program was remarkably successful. Perhaps that is why it was not widely replicated until recently when I have heard more and more discussion of creation of these facilities–especially since the publication of “The Anatomy of an Epidemic” which challenges the safety and efficacy of psychiatric medications. I recently toured a new facility, Hilltop Recovery Residence that is near my home in Vermont, a facility that is replicating Diabisis House. This is so exciting. This new program is being carefully studied. I hope that sanctuary with good supports will soon be available to anyone who is dealing with mental health issues and who wants to recover.
Recently my spouse and I have been providing sanctuary for a young man who is experiencing Post Traumatic Stress Disorder including hallucinations, flashbacks, dissociation, intrusive thoughts and nightmares that were so serious that he could no longer live with his family. I have found that there is little guidance for anyone who is taking on such a project. I thought it might be helpful if I shared some of the things I have learned in the three months that he has been sharing our home.
1. Everyone in the household must be willing to provide sanctuary and be part of the “therapeutic milieu” that is created.
2. Taking another person into your home when they are having mental health challenges changes the dynamics of your family. This may be more stress than your family or you can handle. Your family may already have acute stress. There may be issues that have to do with things like illness, relationships or employment. If these issues are sometimes overwhelming too your current family, don’t try to take on and help another person. It won’t help anyone. And could make it worse for everyone, including the person you are providing sanctuary for.
3. Develop a Family WRAP® (Copeland, M. 2013 Dummerston, VT. Peach Press). If possible include the person who is receiving sanctuary in the Family WRAP® process.
4. The person who needs sanctuary must have a separate bedroom. A couch in the living room or family room, or a room that is shared with others is not sufficient and will cause more stress for everyone. People who have mental health difficulties often have sleep issues–an inability to sleep or sleeping a lot. They may need to have a light on at night, be journaling, using a computer, be pacing or making unusual noises. It is important that these issues not affect the sleep of other members of the family.
3. If possible, the bedroom for the person who is having mental health difficulties needs to be out of the general stream of household traffic. It may get very messy. And it may be hard for the person to keep it neat at this time. In my situation, I got permission from the person who is staying with us to “tidy up” his space when he was at an appointment. When I did that I was careful to be respectful of the things that are important to him. But I could easily gather up dirty clothes for the laundry, change the sheets on the bed, toss out used tissues and scrap paper, dust and vacuum. That helped a lot.
3. Everyone in the household needs to agree to accept unusual behaviors like the person talking to themselves or yelling at someone who isn’t there, loud playing on a musical instrument, not having regular sleep and wake schedules, hollering, ranting, raving, pacing, foul language. The limits or boundaries of acceptable behavior can be determined in a family meeting with everyone present–and the limits must be acceptable to, and adhered to by everyone who lives n the home including the person who is receiving sanctuary.
4. Be absolutely clear about behaviors that are not acceptable and the consequences. For instance, you might say, shaming, blaming, teasing, bullying and threatening anyone is unacceptable. If these things happen we will talk about it once. If it happens again, you will have to find a different place to stay.
5. Limits or boundaries may need to be set up around clean up, tidiness, times when noise is acceptable and not acceptable, phone and television usage, friends stopping by and leaving lights on or having them off.
6. Listen, listen , listen as much as you can. The person’s sharing doesn’t have to be rational or make sense. The talking itself is healing. Have clear boundaries around your ability to listen. You can say something like I have 10 minutes when I have to listen and then I have to go. Or you can say, “I can listen to most things, but when you talk about how your friend was hurt, it is too hard for me to hear”.
7. If possible, have opportunities for the person to express him or her self in whatever way they choose–drawing, painting, making music, exercising, hitting a pillow, etc.
8. Get help. In our case, other families agreed that he could stay with them part-time, sometimes for several days. That helped a lot. At other times, a friend would take him out to an event or for a meal. (I had to instruct that friend that I needed him to take our person away for a period of time as I needed a break. Otherwise they would stay in our small house, talking, perhaps cooking and it wouldn’t be a break for me.) Friends have helped with shopping, meals and getting him to appointments. Our biggest need has been respite. I was realizing that staff in hospitals work 8 hour shifts and we were working practically around the clock. That gave me some perspective. Ask for help and be ready to tell people what to do that would be helpful.
9. Do good things for yourself, with your partner and with other family members. Follow your personal WRAP®, your couple’s WRAP® and your family WRAP®. Take time to do whatever it is you love to do by yourself and with the people that you love. Don’t neglect or negate yourself or your family in this process.
10. As soon as possible, and the person who is receiving sanctuary is willing, begin working with the person to develop a personal WRAP, or tell them how they can develop there own WRAP®. In our case, we have begun the process very slowly by identifying many, many Wellness Tools. You might encourage the person to attend a WRAP® group or a WRAP support group. Perhaps they could find a WRAP buddy. Or you could connect them with a Community Links Project (Copeland, M. and Mead, S. 2007. Community Links: Pathways to Reconnection and Recovery. Dummerston, VT: Peach Press).
The person should have other supports in addition to you and your family. Take advantage of any appropriate services that are available in your community. Case managers, counselors, health care providers and advocates can all help.
“Sanctuary” should be a temporary arrangement. Work with the person or have other supporters work with the person to help them make plans and begin their transition to a life on their own or with their family.
There are lots of materials in our bookstore and on our website at www.WRAPandRecoveryBooks.com that may be helpful to you in this process.
As I continue to further educate myself on what happened to my 25 y/o son who took his life 18 months ago, I will forever blame ” the system” for what it did to him, to create a path of hopelessness by labeling, massively drugging him with neuroleptics, mood stabilizers, benzodiazepines once he had a psychotic episode following a sea of horrific stressors that hit him over a short span of time. Despite my family and my well-intentioned, but misguided quest to find help by throwing our son into more harms way by getting him admitted to a psych hospital where HELL truly began. Seeing the assault to his body by these drugs he was forced to take, the mantra ” mentally ill for life, bipolar for life, meds for life” the experiences inside this locked psych unit which terrified my soul each night I visited my son, along with so many of his friends. I began calling every MH professional begging for someone to help my son. Where could I bring him for better care and treatment?
My husband and I were with our son the night of his first nervous breakdown ( a far more accurate description of what we witnessed than the bipolar label he was quickly assigned once inside this psych hospital). Yet, now with the massive drugging our son was in complete psychosis and if a person has never witnessed it, it is horrific and if it is your own kid in this kind of fragile, beyond troubling state, it is more than we could bear. I would have taken him home IF someone like yourself could have been there to advise, to give us a set of instructions and the detail you just provided here. IF we could have projected he would be released still in psychosis ( and I believe the massive quantity of neuroleptics actually fueled him into full blown psychosis) since it took his brain ten weeks for his psychosis to abate, both ” episodes” Oct, 2009 and May, 2011 after returning to using a ” recreational” drug, cannabis along with alcohol. There were NO guidelines the locked psych ward provided, no direction, no suggestion how to keep a person in psychosis save at home,how to prevent a young man who was 6’5″ from driving his car ( we had to dismantle it ourselves), what to do when he insisted on roaming the neighborhood and one time the police showed up after a ” suspicious person” call. How does a family who works stagger their hours now to care for a loved one in psychosis ( no family leave options with both my husband and my employment). My 84 y/o mother, my son’s grandmother stepped in and insisted she could help her grandson get mentally healthy again, and she did while we worked during the day. We, as a family, made it work but it takes tremendous patience, resilience, coordination, infinite resolve and mostly unconditional love. I was less than perfect in this role. I kept asking how could this happen to my kid, to us, his parents?
I was SO mad as my son was brought up never to use illicit drugs, both my husband and I never ventured into drugs. BUT it did happen and IF I had known what I know now, I would have NEVER institutionalized my son, twice.The second hospitalization was to get him into a drug rehab program to get healthy, but he was moved to the locked unit 36 hrs after admission and his rights violated, no drug education, just massive overdrugging, warehousing and then dumping once the insurance refused to confine the confinement, as well as the $7500/ week we paid believing our son would be given the drug education program promised us before he was admitted. Our son was forced to return to his parent’s home after his wife ledt him during the second hospitalization for a new lover….
I have read about the WRAP recovery after my son’s death. We believed our son had weathered the hump past all this trauma because he led us to think he was healed, but in the end, something took him out. I will forever believe he could not stand the hopelessness instilled by ” the system” that he was ” mentally ill for life, bipolar for life” and even though he weaned himself off all those ghastly neuroleptics etc…( with the blessing of his psychologist) being so young and impressionable and holding the all powerful mental health system paradigm of care as gospel, especially the intimidating psychiatrist who seemed to have some sort of power over my son. I can’t help but have regrets that I was not able to find RWs book, Anatomy… Epidemic in time. My son needed to be empowered that he could and would make a full recovery and the stigma of his experience could be put to rest in time.
I salute you and pray other parents find the right help, the right answers in time as I know now given the unfortunate sea of stressors, add to it the rampant use of ” recreational” drugs this generation uses and more bright, sensitive teens and young adults were fall prey to ” the system”. But I will forever believe my son could and should have been saved. This writing today is such a powerful tool that very well may save another son or daughter, like the beautiful son I lost so damn tragically.
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I know from personal experience that the advice you give here is excellent. It is not always possible to put everything in practice though when you are dealing with a family of 6 growing up teenagers wrestling with problems of their own. Tolerance and resilience can be in short supply in these circumstances and yet what do you do if no other help is available in your area. I had to battle on and hope for the best and luckily I succeeded.
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I think this is a good idea. I have been thinking along these lines myself. We used to say, “Why not go to a hotel if you need to get away?” since the hospitals did more harm than good. A change of scenery works wonders. That’s probably the main reason people breathed a sigh of relief as soon as they got there. It wasn’t that the hospital was great. It was that wherever they came from sucked worse.
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