December 1st, 2012

Seeing the invisible community

There is nothing like misfortune to focus our attention on the importance of community. In the aftermath of Hurricane Sandy, we are hearing stories about the way the hardest hit communities have been coming together in their shared sense of loss to support one another emotionally and in more practical ways.

From mutual expressions of grief and resolutions to re-build destroyed homes and public facilities to small acts of charity like providing charging stations for cell phones, citizens are finding ways to help one another get through the kind of natural disaster that turns normal life on its end.

The call of disasters reaches out beyond those directly affected to the larger communities of the nation and the world. The Red Cross mobilizes and telethons are organized with toll free numbers to which people can text donations to help with the rebuilding effort. Even in these waning days of a hard-fought and rancorous presidential election, sharp political divides give way, all too briefly, to a spirit of cooperation. Disasters interrupt our normal unthinking routines and remind us that we need one another.

While the world reacts to the devastation of Hurricane Sandy with a heightened awareness of community, our new hospital continues its own efforts to build community in response not to disaster but to opportunity. When we moved to the new Worcester Recovery Center and Hospital last month, we closed the doors not only to our nineteenth century institution but also to routine ways of going about the business of treating people with severe mental illness.

Just as disasters interrupt unexamined routines, so too does any major change in the structures or procedures that guide our professional and personal behavior. Planned change, however, has the advantage of giving us the opportunity to design the environment for the purpose we are trying to achieve. While our new hospital was built to promote recovery and focus people on returning to their communities, these goals cannot be achieved by architecture and layout alone. We need other ways to remind ourselves of the complicated networks that define those relationships of interdependence that we call community.

Morning rounds and community meetings as well as monthly team meetings are the customary structures that psychiatric hospitals use to exchange information among and between staff and patients. Through these routines, staff keep up to date on the condition of patients and coordinate the treatment they provide with the efforts of colleagues attending to other aspects of patients’ needs. In a team ideally led by the person being treated, psychologists, psychiatrists, social workers, nurses and occupational therapists work together to promote the patient’s recovery and discharge.

There is nothing new about these kinds of meetings in our hospital or in any other psychiatric facility but, like any aspect of daily life, they can become so routine that we lose our appreciation for the opportunities they provide. In our new hospital, we are re-discovering the power of sitting together as staff or in community and team meetings with patients to discuss the issues that matter most.

When a new setting offers the chance of a fresh start and new problems need prompt and effective solutions, old structures can hum with unaccustomed energy. Take a seat in our community meeting and you will see how this works. The first thing you will notice is how full the room is. Unlike these meetings in the old hospital, often skipped by patients and staff, community meeting is well attended. Every morning a staff member from a different discipline leads the session with a patient as co-leader. After orienting ourselves to the date and the weather, we make announcements, take questions and briefly discuss a topic related to recovery. The subject matter may be the importance of not responding to an upsetting situation until you first notice how you feel, use your preferred coping skills to calm down and think through the probable consequences of your behavior.

On a lighter but equally practical note, someone may share how he has solved the problem of the new motion-activated toilet flushing every time he steps out of the shower. We often end with a joke, a song or a thought for the day. Our tone is always serious but rarely solemn.

After Hurricane Sandy devastated New Jersey and New York City, we took time to reflect on family and friends caught in its path and to acknowledge our gratitude for having been spared the brunt of the storm. We were one community reaching out to another, both blessed with a heightened awareness of the ties that sustain us even when we think we are going it alone. No one ever goes it alone. We would not be sitting in this room were it not for the architects, construction workers, tradesmen, government officials and fellow citizens who built this comfortable space where we now meet and share ideas. When we gather here every morning, we do so as an act of faith that we are doing the important work of recovery and doing it together. We are buoyed always by invisible communities that it sometimes takes a hurricane or a fresh start in a new place to see.

By Alan Bodnar Ph.D.

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