Living in the Community

Most people take living in the community for granted. They pay rent or mortgage, have relationships with spouses, raise families, work, and grow old. Some wonder if it's worth it. For someone with schizophrenia, living in the community is a major series of challenges, depending on the degree and type of disability they are enduring. It is definitely not something you take for granted.

Before 1954 almost everyone with schizophrenia lived in lunatic asylums completely unable to manage their lives because there was no treatment for their illness. The prisons were nicer. With the advent of antipsychotic medications more and more people with schizophrenia have been discharged and live in the community. This deinstitutionalization has occurred in several waves. We're kind of in the middle of one right now. Treatment in the community is the goal of most mental health services restructuring at the moment. The abilities of any mental health system to actually accomplish that is doubtful at best, and often jails and homelessness have simply substituted for the psychiatric hospitals as they closed. That is a column in its own right though.

Follow-up has never been forthcoming as mental health services restructuring takes place. It almost costs as much for ex-patients to live in the community as in the hospital. It not just the community treatment and support that costs money, it's living in the community. Many people I know run out of money near the end of the month. Since 1995 the percentage of applications by people on psychiatric disability benefits has doubled at my local food bank. With nothing to do it is very difficult not to spend money. To spend money is to be alive, to be a part of society, to reward yourself, to feel a little less marginalized, and a little more ordinary.

Part time work is often possible, career employment much less so. Marriage is possible but rare, except to other people with schizophrenia. Competing for housing on the open market is very difficult when the benefits you receive are considerably less than the market rates. The isolation of living alone can be unbearable and is considerably more expensive.

I remember a period when my friends and I all wanted to move back into the hospital. We were in our thirties and couldn't find any kind of work at all. We were living in marginal housing and couldn't meet any women. They were cooking for one every night and the dishes were kind of piling up. In the hospital we would always have people like us to talk with, we'd have three hot meals served to

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