Imagine that you’ve been diagnosed with a mental disorder, but instead of being shunned by society as “strange,” you are welcomed into a new family and made to feel completely at home.
This is exactly what has been happening in the town of Geel, in Belgium, for over 700 years. Since the 1300′s, the citizens of Geel have taken the mentally ill and disabled into their homes as guests or ‘boarders.’ Guests have numbered in the thousands, arriving from all over Europe. There are still several hundred in residence today, sharing their lives with their host families for years, decades or even a lifetime.
Writing in Aeon, Mike Jay describes how it works:
Among the people of Geel, the term ‘mentally ill’ is never heard: even words such as ‘psychiatric’ and ‘patient’ are carefully hedged with finger-waggling and scare quotes. The family care system, as it’s known, is resolutely non-medical. When boarders meet their new families, they do so, as they always have, without a backstory or clinical diagnosis. If a word is needed to describe them, it’s often a positive one such as ‘special’, or at worst, ‘different’.
For the awesome people of Geel, this isn’t therapy; it’s family care.
Family Care For the Mentally Ill
A boarder is treated as a member of the family, and his or her conduct is expected to match up to everybody else’s, although of course there’s the realization that he or she might not have the same coping resources as others.
In 1861, a hospital appeared in town, but it was simply a place where boarders came to be assessed before taking up their lodgings in town. In fact, this combination of medical supervision and family care became immensely popular, as doctors and psychiatrists from across Europe and America came on fact-finding missions, and dozens of towns in Belgium, France and Germany established their own versions of the ‘Geel system.’
What a beautiful idea!
How does this notion of family care compare to the way that the U.S. treats the mentally ill?
The United States spends $113 billion on mental health treatment. That works out to about 5.6 percent of the national health-care spending, according to a 2011 paper in the journal Health Affairs. Mental health dollars mostly go toward prescription drugs and outpatient treatment.
Fifty years ago, states began shutting down asylums in favor of community mental health centers. The Community Mental Health Centers Act of 1963 pushed for more treatment in community settings rather than in state-run, psychiatric institutions. It was a major policy shift in mental health, allowing patients to go home and live independently.
OK, so that sounds more like the Geel picture, with its emphasis on community care rather than locking patients up in asylums.
Billions Cut From Mental Health Budgets in the U.S.
But there’s a catch.
Over the past decade, city and state governments have cut billions from their mental health budgets, shuttering clinics across the country. The result is thousands of mentally ill people funneling in and out of the nation’s jails.
In the face of budget shortfalls, according to NPR, Chicago officials have closed six of the area’s 12 mental health clinics in the past three years. Illinois officials closed three of the area’s state hospitals. With nowhere to go and without medication or counseling, the inmates wind up in front of police and pretty soon they’re locked up in places that look like old-fashioned asylums.
On the bright side, the Affordable Care Act creates more mental health mandates, by requiring all insurers who sell on the exchanges to include such treatments in their benefit packages. The pre-existing condition coverage mandated as part of ACA also benefits mentally ill people, many of whom have been struggling for years with their illnesses and who may have had difficulty getting insurance as a result.
Can the Affordable Care Act Provide Better Access to Mental Health Care?
Health insurance reform, in other words, has taken some significant moves when it comes to helping people access mental health services. Insurers now have to pay for medically necessary therapy, medications and other treatment options as determined by a patient’s care team.
These are important steps forward in recognizing the importance of mental health.
But none of this can match the beautiful inhabitants of Geel, with their insistence on treating all human beings with dignity and respect as unique individuals.
This is a model for life, as well as for the treatment of the mentally ill.
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