When I met Dorothy, she was always counting. Her chapped lips moved nonstop as she chanted random numbers. She’d increase the speed, as if that would help her to reach the end quickly—but since the numbers didn’t appear to be in any sensible order, this loomed before her like an impossible task…

The challenge of mental health nursing.

Illustration by Pat Kinsella. All rights reserved.

This month’s Reflections column, “Dimensions of Dorothy,” begins with this harrowing look at a woman in the grip of a mental health crisis. Author Maureen Bonatch goes on to poignantly describe how this illness can “steal someone’s identity and overwhelm their self-control.”

As a new nurse at the state psychiatric hospital, Bonatch definitely had a “new normal” to adjust to at work. As she observed the manifestations of severe mental illness, she also developed insight into why some had so few visitors: “It had to be difficult,” she writes, “to helplessly observe as an illness crept in to hold the person you knew and loved hostage.”

An inadequately valued area of nursing.

I have great respect for mental health nurses. Many work in home care in New York City, managing—with minimal resources—frail elders who have battled schizophrenia for decades. Some home health agencies are eliminating these clinical specialists, having decided that the acute care team can follow them and simply handle exacerbations by arranging for a psychiatric admission. Hospitals, too, seem to be marginalizing expert mental health nursing, sending patients with mental illness who have critical medical needs over to “the acute care side” without adequate mental health support.

A hopeful reminder of the possibilities of recovery.

I’m hoping that some of the administrators involved in these cost-cutting decisions will read “Dimensions of Dorothy“ and perhaps reinvigorate their understanding not only of the great suffering experienced by people who have mental illness, but also of the possibilities for recovery. These people need expert mental health nursing care, wherever they might land in the system.

I never forgot Dorothy and the lessons she taught me: how you can show care and compassion even if you can’t verbally communicate with or understand someone—and that sometimes that’s exactly when a person needs you the most, and can hear you the best.

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