Slap: Story on mental health challenges goes beyond blame game

Threatened by a lawsuit from a hospital chain, The Boston Globe and reporter Jenna Russell pressed on with a series about the challenges of coping with mental illness.

Steward Healthcare sued the Globe at the 11th hour, claiming that Russell was out to smear the chain and should be forced to turn over her notes. A judge shot down the lawsuit.

The lawsuit certainly made people think that the Globe was about to decimate Steward Healthcare on page one. But the series isn’t a finger-pointing exercise. Steward is only mentioned twice over three long articles. Instead, the stories beautifully describe how the immediate community around a mentally ill man named Mike Bourne, and, in effect, the larger community that includes you and me, have not been able to come to grips with the fact that a huge proportion of people suffer from life-wrecking mental disorders. Bourne himself laments this during the series, as described by Russell:

The real problem, it seemed to him, was that the world had become restrictive and intolerant of people who were different. He meant no harm to anyone — if others felt threatened by the things he said or did, that was their problem to solve, not his.

Here are some reporting lessons from the series that should interest even the chain that sued the paper before the stories even ran.

Show the worlds colliding. My favorite aspect of the series is how Russell brings us right into the everyday confrontations people with severe mental illness have with the rest of the world. Because their brain chemistry is showing them a vision of the world that is radically different from many of the people around them – including those struggling with their own mental illnesses – they often collide with others. They collide with the health care system. They collide with 9-5 work environments. They collide with the police. They collide with all the people trying to help them, too.

It requires a careful eye to pick up on those details and to present them in a way that provides context, judgment even when necessary, but mostly that presents the facts as dispassionately as possible to allow readers to draw their own conclusions. Here’s Russell describing Bourne – a 33-year-old who has been diagnosed over the years with schizophrenia and schizoaffective disorder – going off his medications, dancing in the street, having what he thought was a good time on New Year’s Eve, and ending up in jail.

He’d been feeling good, confident and fearless, the way he always did without his medications. The cops had showed up and assumed he was drunk. They didn’t listen when he told them he was sober; he got frustrated and called them Nazis. That had been wrong; he understood now. He just wanted to put that night behind him. The judge studied some papers and looked up, regarding Mike benignly from between the glow of two old-fashioned glass lamps.

“Are you taking your medication?” the judge asked him.

“Yes, sir,” Mike said.

“And are you thinking clearly?”

“I believe so,” answered Mike. He hadn’t meant to be funny — only honest — but something in his earnest tone struck a comic note. Laughter rippled through the crowd behind him.

“Well, only one person in this courtroom would know that,” the judge said.

My conclusion from this scene, for example, and from many of my own experiences writing about someone mentally ill in the judicial system, is that police, judges and lawyers need better training on how to talk to someone with mental illness. Making jokes about them in public seems self-serving, to say the least.

Describe the delusions in real terms. Russell does a very nice job taking you into Bourne’s head and describing how reality shifts into fantasy for him in the same way someone without a mental illness might find themselves daydreaming about playing quarterback for the Seattle Seahawks. The difference is that Bourne and so many others don’t have any demarcation in their minds telling them that they have crossed over. All the more reason to try to capture the intensity of these fantasies. Here’s how Russell describes one of Bourne’s conspiracy theories:

He believed former president George W. Bush had been involved in the Sept. 11, 2001, attacks, and he wanted the truth to come out. Only then could America be great again, he said. But he feared the Bush family would seek revenge. Mike had called the local police and warned them to wear their bulletproof vests, in case assassins came after him. He had called the FBI and White House to offer his help.

Don’t skip the complexities. If Steward Health Care was expecting a story presenting a profit-focused hospital chain mistreating patients, the company was wrong. The stories present the mental health care situation with all of its complexities. Many still assume that people with mental illness can just be shipped off somewhere to be cared for. And others assume that the era of “One Flew Over the Cuckoo’s Nest” is over and that people are doing far better, living side by side with everyone else. But when someone with mental illness is in crisis, the options often don’t meet the needs of the patients or the families. Here’s Russell describing how hospitals are caught between their own limitations, the rights of patients, and the families’ need to have a healthy person at home with them:

Though he was in the hospital now, it wasn’t likely Mike would stay there long. Norwood Hospital was not equipped for long-term care. For that, the staff would have to send Mike to another hospital, and Rhonda suspected that wasn’t likely. Over the past dozen years, the number of state hospital beds for adult long-term care declined by roughly half, to 626. The downsizing saved money, and improved many patients’ lives, closing some hospitals that had been rife with mistreatment. … It was complicated for hospitals, too. They had to respect the rights of patients — if patients aren’t deemed a danger, they have to be let go — and there were legal hurdles to clear if they pursued further involuntary care, by petitioning a court to commit a patient.

Bourne’s mother sums it up best: “‘Yes, the community is the best place for people with mental illness. But when they can’t manage in the community, it needs to be dealt with.’”

The problem is that it’s not being dealt with, as this series nicely illustrates. More reporters would do well to take some cues from Russell’s approach.

Image via The Boston Globe/Suzanne Kreiter.