Local support groups:

Greater Chicago Area AMI: 
(312) 642-3338

Olympia Fields AMI: 
(708) 798-0434

Mental Health Awareness

This series of articles were printed in the 
St. Julie Parish Bulletin 
and were submitted by the 
Human Concerns Board.
Deacon Rich & Irene Miska

3/7/99

As we begin the season of Lent, we are called to stop and reflect on many aspects of our lives. One of these aspects could possibly be the effects of serious, chronic mental illness within our homes, our parish and the community at large. The challenge to us as Church is to develop a ministry appropriate for each person suffering the effects of this tragic disease. The U.S. Bishops in their tenth anniversary pastoral statement on Handicapped People stated: "Those parishioners with prolonged mental illness ... require pastoral outreach and programs specifically designed to accommodate their needs and to foster participation."

"When mental illness strikes in a family, it is like being struck by lightning. It is unexpected and it is devastating. The experience is not unlike a death in the family. The family must cope with and adapt to a terrible loss. Because of society's misunderstanding of mental illness, it often can seem similar to the experience of some terrible humiliating event which brings shame to family members. It is a tragedy. Like all tragedies, it raises profound human questions for those who are affected by it. For a religiously committed family, it may, as other tragedies often do, initiate a crisis of faith." (Rev. John Baggett) In the weeks to come, we will offer information about mental illness, what it is, its effects on the victim, their families and the communities in which the live.

How blessed are those who know their need of God; The Kingdom of heaven is theirs. (Matt. 5:3)

"There is a profound suffering in mental illness. When the illness carries with it a diagnosis such as depression, manic depression, schizophrenia, or obsessive compulsive disorder, the experience of loss is substantial.

The onset of these diseases occurs frequently in late adolescence or early adulthood. There is a major change in personality and in ability to function socially and to cope with every day problems. The victim is frequently tortured by disturbing thoughts and feelings that cannot be escaped. For the family, it often seems that the person they once knew, loved, and for whom they held so many dreams, no longer exits. In that familiar persons place is a stranger whose behavior is un- bearable. As time goes on. Unlike some tragedies, this one seems unending. The family lives in constant anxiety, often moving from crisis to crisis with respite." (Rev. John Baggert)

There are 900 (40 in Illinois) Alliance for the Mentally Ill (AMI) support groups located throughout the United States to serve the families of the seriously mentally ill. These groups meet monthly offering reading materials, guest speakers, an outlet for listening and encouraging one another, and a vehicle to pool the gifts and talents of its members to make a better world for all those suffering from mental illness, their families and their communities.

3/14/99

"Blessed too are the sorrowing; they shall be consoled."
(Matt.5:4)

Mathew reminds us that we need to identify the sorrowing and troubled so that they and their families may be strengthened and consoled.

In the last few years, research into the schizophrenia and depressions has blossomed. Evidence is emerging daily that these illnesses involve biological factors. Scientists now understand them in much greater detail than they did ten years ago, and they have made substantial progress in their efforts to develop specific ways to control, cure and even prevent them.

Schizophrenia commonly strikes individuals when they are between the ages of 18 and 25. Depressive disorders, on the other hand, can occur at any age and often make it difficult for individuals with familial and professional responsibilities to meet their obligations.

It is time to acknowledge that both are complex and heterogeneous diseases that affect people in widely different ways, depending in part on the particular form of illness a person has. Schizophrenia and depressive disorders are caused by factors that include strong biological elements; they are primarily medical illnesses and should be treated as such. Doctors today can frequently control the symptoms at least temporarily, though too often they are still unable to help patients get well. Whether they can be treated or not victims are very much aware of their condition and of their agony, and the stigma attached to them only makes their condition worse. (NARSAD)

3/21/98

"Blessed are those who hunger and thirst for justice, for they shall be satisfied." (Matt. 5:6)

Why is the plight of the mentally ill a peace and justice issue?

In 1963 President John Kennedy signed into law the Community Health Centers Act (PL.88.164) which mandated the de- institutionalization of mental institutions, asylums, and hospitals. It seemed evident to the joint com- mission who recommended de-institutionalization is that the local communities never received the necessary and promised funding. As the hundreds of thousands of patients were released they had no place to go.

Now, twenty-six years later we are faced with an alarming dilemma which is felt nation- wide. Many of the mentally ill are homeless, (140,000) living back home with their families, (800,000) residing in nursing homes, (280,000) members of foster homes, board and care homes, county homes, (420,000) living by themselves, (160,000) are in prisons or jails (60,000). (Care of the seriously ill by E. Fuller Torrey, PhD.)

Some institutions that are still in existence are overcrowded, understaffed and being investigated for incidents of neglect and abuse. The mentally ill, like all of us, share in God's love. They need to be looked after, supervised for their medication and behavior, befriended, empowered to share their gifts and talents, protected, and spiritually ministered to and nurtured. They are the marginal, often forgotten and seemingly misunderstood. They are our brother and sister filled with the dignity of the Lord Himself. They cry out for understanding and companionship.

3/28/99

"How blessed are those who show mercy: mercy shall be shown them." (Matt 5:7)

The mentally ill and their families in the past have looked to their local and state officials to mercifully reach out and case the burden brought on by mental illness. Unfortunately little has been realized on both local and state levels in the area of housing, job training/employment, socialization programs, reach-out to the homebound, ongoing therapy and empowerment of the mentally ill to utilize their gifts and talents. "The State of Illinois is the 11th wealthiest state in the country, yet is 29th in per capita spending on the mentally ill. Illinois trains large numbers of mental health professionals with state funds (at least $1.2 million per year), it demands no public service from them as a payback obligation - most go directly into private practice." (Care of the Seriously Mentally Ill by E. Fuller Torrey, M.D.)

The cry of the mentally ill for services is being heard louder and louder with each passing year. In 1955 there were 38,001 patients in the Illinois State Public Mental Hospitals. In 1984, as a result of de-institutionalization mandate of 1963, there were 4,141 patients in the Illinois State Public Mental Hospitals. (Nowhere to Go by E. Fuller Torrey, M.D.) The 33,860 who are no longer in the State hospitals have not been cured. They have been sent back to live in their communities or have become numbered among the homeless population.

People with serious mental illness often cannot speak in their own behalf and therefore need advocates to work for them. "Citizens have a number of opportunities to have an impact on the mental health system. They can join an advocacy group or perhaps a citizen advisory group. They can become volunteers in state facilities or local agencies. They can testify at hearings or comment on regional plans, block grants, rule changes, accreditation, and appropriations." (111. League of Women Voters)

4/4/99

"Happy are those who work for peace; 
God will call them His children." 
Matt 5:9

The existing public health centers for the mentally ill are not environments of peace or facilities of care. They are warehouses for drug and behavior maintenance for most who are confined to live there.

The Chicago Tribune recently reported, that over 1000 employees at three Chicago area state institutions which called the state facilities "Downright disgusting and dangerous." The employee petition, signed by about 60% of the employees at the Madden Mental Health Center, Chicago Road and Illinois State Psychiatric Institute, said they "Are experiencing a frightening increase in assaults, patient fights and gross disrepair of facilities and equipment among other problems. It asks legislators to provide more money and to investigate the management of the state facilities. The author of the petition said he initiated it be- cause "Conditions at the facility were so overwhelming that you get to the point that you feel hopeless and helpless." One unit, he said, designed for 28 patients, often houses as many as 50. David Blanchette, a spokesman for the Department of Mental Health, conceded that "there are some problems" in the state's mental health system.

An attorney for the American Civil Liberties Union, Benjamin Wolfe, stated that at current staff levels abuse and neglect are inevitable in these institutions. Representatives of the League of Women Voters, the Mental Health Association, the State Coalition of the Alliance for the Mentally Ill and the ACLU are calling for an increase in funding and better management to correct these problems.

"...The church will not hesitate
to take up the cause of the poor
and to become the voice of those
who are not listened to when they speak up,
not to demand charity,
but to ask for justice."

-Pope John Paul II

4/11/99

"Blest are the lowly; 
they shall inherit the land.” 
Matt. 5:5

The lowly are oftentimes referred to as the least among us, the forgotten, or the marginal of society. The mentally ill have fallen into this category and yet they are as pleasing to God as all else that He has created.

"Deinstitutionalization (of mental institutions) has become in the words of New York Times editorial, "a cruel embarrassment, a reform gone terribly wrong."

How bad are the effects of the policy of deinstitutionalization - a policy that effects an estimated two million seriously mentally ill people in the United States?

Here are the eight aspects of the problem:

1.) There are at least twice as many seriously mentally ill individuals living on the streets and in shelters as there are in public mental hospitals.

2.) There are increasing numbers of seriously mentally ill individuals in the nation's jails and prisons.

3.) Seriously mentally ill individuals are regularly released from hospitals with little or no provision for aftercare or follow-up treatment.

4.) Violent acts perpetrated by untreated mentally ill individuals are increasing in number.

5.) Housing and living conditions for mentally ill individuals in the community are grossly inadequate.

6.) Community mental health centers, originally funded to provide medical care for the mentally ill so these individuals would no longer have to go to state mental hospitals, are almost complete failures. 7.) Laws designed to protect the rights of the seriously mentally ill primarily protect their rights to remain mentally ill.

8.) The majority of mentally ill individuals discharged from hospitals have been officially lost. Nobody knows where they are. (Nowhere To Go by E. Fuller Torrey, M.D.)

"I tell you, whenever you did this 
for the least important of My brethren, 
then you did it for Me." 
Matt. 25:40 

4/18/98

"Happy are the pure of heart; 
they shall see God." 
Matt. 5:8

William Barclay, in his commentary on this verse from Matthew's Gospel has this to say-. "It is one of the simple facts of life that we see only what we are able to see; and that is true not only in the physical sense; it is also true in every other possible sense."

The answer Jesus gave when asked the question, "Who sinned?" "It was not that this man sinned, or his parents, but that the works of God might be made manifest in him." This scriptural text refers to a man's blindness. Yet there is a similar question in the minds of many today when encountering a person who has mental illness.

Society is laced with mythical beliefs about mental illness. Check your own knowledge by answering "Myth" or "Fact" to the following statements:

1. Recovery from a mental illness is possible if the person just turns his or her thoughts positively and prays.

2. A person experiencing mental illness is possessed by an evil spirit.

3. Most of the people who are mentally ill live on the streets of the nations largest cities while the rest of the people reside in the mental hospitals.

4. Mental illness is different than mental retardation.

5. Mental illness can affect anyone, no matter race, economic status, intelligence, or religion.

6. Mentally ill persons are dangerous.

(Answers in next week's bulletin.) (Below)

 Religious communities are key in the on- going health of persons who have long term mental illnesses and who are striving to lead full and meaningful lives in the community. There is a good chance of recovery from a mental illness if a person receives medical treatment and has supportive services from within the community. Churches and synagogues offer the loving, long- term sustenance that all people need and is so essential for the people living with mental illness. But first we must overcome our fears and be willing to welcome the stranger in our midst. (Pathways to Promise, St. Louis Mo.)

4/25/98

Here are the answers to last week's questions "Myth or Fact" concerning mental illness:

1. MYTH - Recovery from mental illness is possible when the person receives the necessary treatment and supportive service.

2. MYTH - Mental illness is caused by physical disorders or chemical imbalances. The person is not possessed by an evil spirit.

3. MYTH - About two thirds of our nation's population with mental illness live in the community either with their family or in various types of community living settings.

4. FACT - Mental retardation is a developmental disability, usually experienced since birth and affects the intellectual abilities of the person. Mental illness is a physical disorder and can affect the person's performance in daily living; but this is not due to the loss of intellectual ability.

5. FACT - No one is exempt. There are as many people who have schizophrenia (two and one-half million) in America as there are people in Oregon, Mississippi, and Kansas combined. Approximately 6% of Americans (over 14 million people) are diagnosed as having depression.

6. MYTH - People with mental illness are no more violent than the general population. They are frequently the victims of crime rather than the perpetrators.  (Pathways to Promise, St. Louis, MO.)

“...The church will not hesitate to take up the cause of the poor and to become the voice of those who are not listened to when they speak up, not to demand charity, but to ask for justice”

-Pope John Paul II

5/2/99

"ANY MAN CAN MAKE MISTAKES,
BUT ONLY AN IDIOT PERSISTS IN HIS ERROR."
(Cicero, Philippics 6)

The treatment and rare of chronically mentally ill is a system gone wrong. The ideals of de-institutionalization never reached fruition. The chronically mentally ill are not being appropriately cared for, lack adequate housing, and are required to navigate a public health system that drowns people in red tape and "Catch 22" situations - for example, you cannot get public aid assistance with out an address. If you are homeless, you do not have an address or money to rent an apartment!!!

BLESSED ARE THOSE WHO HUNGER
AND THIRST FOR RIGHTEOUSNESS,
FOR THEY SHALL BE SATISFIED.

What is needed?

A mandate from the State Legislature of Illinois that gives clear priority and direction for the care for the mentally ill.

The seriously mentally ill must get first priority for public psychiatric services.

Psychiatric professionals must be expected to treat individuals with serious mental illness.

Housing for the seriously mentally ill must be improved in both quality and quantity.

Housing for the seriously mentally ill must be fixed at the state and local level.

Laws regarding the mentally ill must be amended to insure that those who need treatment can be treated.

Research on the causes, treatment and rehabilitation of the serious mental illnesses must increase substantially.

Funding must be used wisely and redirected to benefit the chronically mentally ill and support community programs.

(Reference Nowhere to Go - E. Fuller Torrey)

5/9/99

"When Lord, did we ever see you hungry or thirsty
and give you a drink?"
(Matthew 25)

Last week we outlined eight ideas that would improve the chronically mentally ill's ability to obtain help and receive proper treatment for this disease. The first idea was that a mandate was needed for the Legislature and the Governor that gives priority and clear direction for meeting the needs of those afflicted with " disease.

Why a mandate? The League of Women Voters of Illinois issued a report on the Public Policy on Mental Illness in Illinois. In the section titled "Major Conclusions" it found that The Mental Health System is not a system at all. It is a patchwork of state facilities and local programs varying in quality. People with serious mental illnesses have great difficulty in getting needed services because of the nature of their illness, the lack of resources and poor coordination of services ... Major gaps in the services are: resident programs, services for children and adolescents, and programs for the mentally ill substance abusers and mentally ill who are retarded (dually diagnosed)."

"Three groups stand out as the east adequately served by current programs: severely disturbed young people, mentally ill street people, and elderly and young in nursing homes." Other comment from the League's finding about care of the chronically mentally ill in Illinois: " planning ... still fragmented, uncoordinated, and short range ... budget insufficient ... continuum of services needed ... qualified professionals are discouraged from working in state facilities ... staff levels are at a bare minimum for adequate care in most facilities and there are critical shortages in the Chicago area."

What can be done? The mentally ill cannot speak for themselves, the need advocates from their families, friends, and communities. The State Legislators and the Governor need to be reminded that the needs of the chronically mentally ill are not being met. Future bulletin articles will deal with the specifics of how this can be done.

5/16/99

The second step of the eight steps that are needed to improve the plight of the mentally ill is that they must receive first priority for public psychiatric services.

"Individuals with serious mental illness are remarkably treatable, much more than most laypersons realize. They need access to a well run hospital for brief re-hospitalizations or adjustments of their medication, decent housing, vocational training and opportunities, a social network, adequate income if unable to work, outpatient medication, maintenance, medical care, and a supportive counselor." (Nowhere To Go by E. Fuller Toffey) Unfortunately, funds have been diverted for programs that would ostensibly serve the seriously mentally ill to programs for individuals with less problems. The state needs to ensure the funds that are set up for these programs do in fact serve those who they are designed for.

5/23/99

WHEN LORD DID WE SEE YOU HUNGRY 
OR GIVE YOU DRINK?

The third step that needs to be taken to improve the conditions affecting the mentally ill is psychiatric professionals must be expected to treat individuals rather than mental "Health' professionals and to expect professionals trained with public funds to repay that investment with a specified period of public service. Currently, a majority of patients are treated by doctors who are paid out of public aid or on a charity basis. Unfortunately, there are not sufficient professionals who will work under these circumstances. The quality of professional care is very poor and follow-up which is critical for those who are being treated with psychotropic drugs, is very limited. This creates a harmful situation for both patient and community.

5/30/99

Peace and Justice

 The people who were not mine I will call my people. The nation that I did not love I will call my beloved. And in the very place where they were told, you are not my people there they will be called the sons and daughters of the living God. (From the book of Hosea.)

The fourth step that needs to be taken to improve the conditions of the chronically mentally ill is that government responsibility must be fixed at the local level. Currently, public funds that support the mentally ill come from a mixture of Federal, state, and local governments. The shift in recent years has been away from state government funding to federal government funding. This causes confusion, inadequate distribution of funding, and duplicity of costs. The League of Women Voters two year study of services in Illinois for the chronically mentally ill, completed in 1989, states, "providers pointed to gaps in programs and services in all areas of the delivery system which they said are a direct result of inadequate funding." Illinois has statutory responsibility only for treatment of people admitted to state hospitals and for one year follow-up ... only 10% of the mentally ill are in state facilities (which receive 2/3 of the budget), leaving 90% in local communities.

Improvement in the present situation is not likely to take place until responsibility for the seriously mentally ill is fixed at a single level. Funding needs to follow that responsibility.

June 6

BLESSED ARE THOSE WHO HUNGER AND THIRST FOR JUSTICE FOR THEY SHALL BE SATISFIED...

The fifth and most immediate and pressing problem for the mentally ill is housing which must be improved in both quantity and quality. Less than 10% of the mentally ill who should have housing are in a housing program. There are almost no community based housing facilities for the mentally ill. Some mentally ill live in distant intermediate care facilities that are widely recognized as inadequate and providing very poor care. Most live at home where families are not equipped to handle the myriad of services needed and are financially unable to obtain needed services. There is a tremendous emotional and financial cost.

According to the League of Women Voters report on Community Services for the Mentally Ill "because of the failure to provide housing for the Mentally Ill many have been inappropriately placed in nursing homes".

The Department of Mental Health estimates 12,000 mentally ill persons are living in nursing facilities - half in intermediate care facilities and half in general purpose nursing homes. Some League members observed during their visits that a scheduled listing of therapeutic programming did not mean the program was actually offered. In fact parents often find that posted activities in these facilities do not take place but are posted for the benefit of State inspectors.

Legislation has made the housing issue an even more pressing problem. The State Comprehensive Mental Health Service Plan of 1986 is a federal plan that requires states to develop a three-year plan for a community-based system for the mentally ill. The Omnibus Reconciliation Act of 1987 requires nursing homes be appropriate placements for the mentally ill. Since the vast majority are not appropriately placed, it is estimated (very conservatively) that 12,000 people must move to better facilities -OF WHICH NONE NOW EXIST.

What is needed is a community based housing and services program that serves the mentally ill person with dignity and respect. A person should be able to live in his own community where they are close to family and friends who can provide love, support and care so necessary in the healing process and so basic a human right and so clearly a Christian value.

June 13

People of God that you are, seek after integrity, piety, faith, love, steadfastness, and gentle spirit. (1 Timothy) Paul's letter to Timothy reminds us that we need to be persistent in our quest for Justice for all God's People. For the chronically mentally ill, the sixth step that needs to be pursued is to amend laws to ensure that those who need treatment can be treated.

Good care for the seriously mentally ill is never likely to be achieved as long as courts continue ordering hospitals to discharge patients to grossly inadequate living facilities: as long as laws make it very difficult to rehospitalize individuals who need further treatment, and as long as seriously mentally ill individuals are routinely able to refuse treatment.

The laws affecting each of these areas must be closely evaluated and, where necessary, changed. Patients' rights must be protected-, yet people who are in need of help must receive it.

6/20/99

The last several months we have been describing the problems of mental illness, and the need for better services, and the steps to be taken to change the deplorable conditions that now exist Now the question that needs to be answered is, what can we as a Catholic community, people committed to the gospel message, do to make a difference.

The first part comes from the Editorial Pages of a local newspaper the Daily Herald        "........ mental illness is surprisingly common, usually treatable and nothing that should carry a stigma.

Reaching an understanding now may be more important than ever before. Across the country mental health professionals are working to meet a federal mandate that the mentally ill persons living in nursing homes be moved to facilities more appropriate for their care. In all communities, including Chicago's suburbs, that means that some mentally ill persons capable of independent lifestyles, will be moving into group homes.

Such integration will prove beneficial to the mentally ill, but in order for the program to succeed, people in every community must understand and accept it....

Again, it's essential that people understand that mental illness is precisely that an illness. Not a character flaw. It is not the result of bad parenting. It is an illness. Because of basic misunderstandings, some people feel threatened as mentally ill people move from nursing homes into residential neighborhoods. But, Carol Taylor, of the Northwest Mental Health Center, notes that while some people who suffer mental illness exhibit unusual behavior, they are no more likely - and may be less likely - than other members of the general population to be criminally inclined.

In fact, many mentally ill persons who move from nursing homes to apartments and group homes during the next few years will be fearful themselves in new surroundings. Mental health professionals will need volunteers to help these people make the transition.

"What we need," Taylor says, "is for people to get to know them as individuals, not as stereotype."

That's a challenge that ought to be picked up throughout the suburbs."

 Next week we will offer part two of what we as individuals can do to make a difference.

7/4/99

This is the third part answer to the question, what can, we, as individuals living out the Gospel message, do to help those who are mentally ill.

We can recognize that the brain is a major organ of the body and it too can become ill! There should be no stigma attached to being mentally ill and those afflicted by it should not be avoided or unwelcome in our community, church, or family. Statistics indicate one in four families is affected by mental illness and that it can strike at any age and can occur in any family. The risk of a mentally ill person committing a crime or hurting someone is no different than the statistics for the general population and probably less. People can and do recover from mental illness. Just some of the famous examples are President Lincoln, Philosopher William James, Former Senator Thomas Eagleton, Singer Rosemary Clooney, Actress Patti Duke and Golfer Bert Yancey.

Long term mental illness tends to isolate people. We can be a friend to the person who may have no other friends or other support systems. We can write notes, call, visit and most of 0 avoid judging the person for saying or doing things they have no control over.

We should let the person know they are not alone, we need to welcome he or she into the church community. Their illness is not a punishment from God or caused by demons or the devil. We should integrate the person into the church community on a regular basis not just special occasions.

We can support efforts to obtain housing and jobs, be willing to work to improve the quality of life for the mentally ill and their families. Don't let stigmatizing statements about mentally illness or the mentally ill persons go unchallenged. Object in writing or by telephone when media and the public events stigmatize the mentally ill.

We can write our State Representative about the need to address the iniquities in the health care system. We can do volunteer work at a Mental Health Organization.

6/27/99

Last week we offered the first part of a three-part response that we as a Christian community and as individuals living out the Gospel message can do to reach out to the chronically mentally ill.

The second part calls for us to respond to the needs as seen through the eyes of those closest to those with the disease. In a survey of "Needs Assessment for Religious Outreach" sent to families and friends of chronically mentally ill of all denominations in the northwest suburbs, the first and second priority were housing and the education of the clergy. These two were the overwhelming top choices among the Catholics responding to this survey. Clearly, this survey affirms that there is a crying need for housing and people want churches to take an active role in solving the problem. It also underlines the need for clergy and all those involved in ministry to be more cognizant of the problems facing the mentally ill and their families. This will enable them to establish supportive ministries to those in this particular crisis.

Other top needs cited in the survey were, counselors who have been trained in mental health and theology, chaplains and ministers of care reaching out to those patients and those in nursing homes and intermediate care facilities. Compare programs matching volunteers with a mentally ill person.

As a community of believers, we are called for the to reach out to those in need. This survey gives both direction and priority. Next week, in our third and final part we will offer concrete suggestions for active outreach.  

7/18/99

"One of the emphases in contemporary moral theology is, therefore, an emphasis on the fact that our radical acceptance of God is tied to love of the neighbor - a love that secures rights, relieves suffering, promotes growth. God is speaking to us in history and we are not free to be involved. This means not simply individual one on one action for those we generally avoid (the mentally ill, the starving, the sick, criminals, poor minorities, etc.); it means organizing the corporate power of the community in such a way that so-called "sinful structures" are changed. The structures and institutions, which oppress people, alienate them, deprive them of rights, are embodiments of our sinful condition. The signs and selfishness of one generation become the inhibiting conditions of the next. The impoverishment of the exploited embodies the selfishness of the exploiter." (The Critical Calling by R- A. McCormick S.J.)

These words of the author bring to a conclusion our articles on mental illness. It is our hope that these articles have proved enlightenment on mental illness - what it is and its effects on the one stricken with the disease, their families and the broader community.

The state has all but abandoned its responsibility to provide adequate and appropriate care for the mentally ill. We look to the Church, to those trying to live the Gospel message, to come to the aid of the mentally ill. We look not just to the Catholic Church, but to forming a coalition of many faith denominations, who together would pool their resources of time, talent, and treasure to reach out with care and compassion to needs of the mentally ill and their families.