Friday March 3, 2017

Have you ever been to Geel?

Have you ever been to Geel?

Neither have I.  But Geel, a small town in Belgium, has recently moved to the top of my list of places to visit.  It is not famous for its beaches or art museums, but rather it has captured my curiosity for the community’s approach to serious mental illness.  Working in global mental health and engaging with different cultures and communities on a regular basis, I routinely discover assumptions I didn’t even know I had and am prompted to rethink how I understand mental health and mental illness. Geel has prompted a serious rethink for me.

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What is so unusual about Geel?  Instead of the “NIMBYism” that is common around the globe when it comes to finding a place to call home for individuals with mental illness, according to a recent NPR podcast, Geel, actually embraces and invites strangers with mental illness to be part of their families and community, supposedly with no stigma.  Really? Really.

1.

No walls. Geel has about 35,000 inhabitants, and about 250 of them have severe mental illnesses. But you won’t find them isolated from the rest of the population living in sub-optimal housing on the edge of town. You’ll see them riding their bikes to work, around the family dinner table, and interacting with friends at the local coffee shop. Geel’s patron saint, Dymphna, inspired the town’s home-based community care system for individuals with mental illness. Beginning in the 14th century, pilgrims traveled to Geel seeking Dymphna’s healing power, and when the church beds were full, community members opened their homes. It was an honor. The tradition stuck.

2.

No stigma. The waiting list of families who wish to take in a “boarder” (the term for the individuals with mental illness placed in host families) far exceeds the individuals requesting placement.  According to NPR, host families adjust to peculiar habit of the boarders – one host mother sews the buttons that her boarder pulls off his shirt every day. Another host father chases the “intruders” out of his boarder’s bedroom at night when they come to bother him.  Many boarders stay with the same host family 20, 30, 40 years and are even passed down to grown children when the original host dies- perhaps a testament to how the boarders become part of the family?

3.

No solution is Geel’s solution. Americans are problem solvers and we love solutions.  But in Geel, the host families are unlikely to know the diagnosis of their border, and they are not trying to solve or cure their border’s illness.  As Ellen Baxter discovered during her year in Geel, there “the solution to healing a person you love with mental illness was oddly enough, to not seek a solution.”

4.

No cure? But can’t we do better? Where would we be today if we had taken a “no solution” approach to polio? Geel has built a culture of accepting the limits of science and the potential of community today. But Geel is not anti-psychiatry or anti-treatment. Providing the best possible community care for people living with mental illness doesn’t mean that we stop trying to understand the basic biology of mental illness and work toward discovering cures and prevention.

5.

Yes, dignity. In Geel, people with severe mental illness live with dignity in the community. Ellen Baxter has championed this model in the US, but since the sixties, NIMBY policies and practices have overshadowed the US community mental health movement. And Baxter continues to meet resistance today. So maybe Geel will remain one-of-a-kind, but Baxter is succeeding in promoting community living for individuals with mental illness in NYC neighborhoods. Obviously, Harlem is not Geel, and each destination has its unique character, but their common message is that dignity is well within reach along every step of our race for the cure.

Kathleen Pike, PhD - Is Professor of Psychology & Director of the Mental Health Prgoram at CUMC kmp2@cumc.columbia.edu