Jul 30 2012
Comments

Home Mental Health Care for Gunshot Victims

By Jooyoung Lee, PhD, assistant professor of sociology at the University of Toronto and a 2009 – 2011 Robert Wood Johnson Foundation Health & Society Scholar at the University of Pennsylvania

file

Ervin is a black Rastafarian. He has a calm and easy-going demeanor, something that he attributes to growing up in a small Jamaican village near Kingston.  On most days, Ervin rolls his long set of locks into a beehive that he conceals beneath brightly colored turbans.

He was one of the first gunshot victims that I met while conducting ethnographic research in Philadelphia.  On a chilly Friday in January, Ervin hobbled into the trauma clinic at The University of Pennsylvania.  His work boots were covered with tufts of snow and his puffy winter jacket hid a lean and muscular 35-year old body. 

When I first introduced myself and the purpose of my study, Ervin smiled from ear-to-ear.  He was anxious to tell his story and gave me a detailed play-by-play of how he had been shot twice in the legs—both 9mm bullets had been retained and were causing him great discomfort and pain.

Although he was nearly a year removed from his shooting, Ervin spoke openly about recurrent nightmares, trouble sleeping at night, and described feeling frightened by loud noises in his neighborhood—some of which were “false alarms” and others which were gunshots fired near his home.  Although I am a sociologist by training and have never been trained in counseling or psychotherapy, my gut told me that Ervin was suffering from post-traumatic stress symptoms. 

A couple weeks later, I visited Ervin at his home.  During my visit, I asked Ervin if he had ever spoken to a mental health professional about his trauma.  He shook his head and explained that he knew of free mental health services in Philadelphia, but could not afford to go.  As a day laborer, Ervin relied on landscaping, construction, and other manual labor that often required him to be ready for work at a moment’s notice.  He explained, “If they call me and I’m at some office, I might lose a job that could be the only one I get for a few weeks.”

In the next six months, I met 39 other gunshot victims whose experiences closely mirrored Ervin’s.  In different ways, each of these victims explained how getting shot was not only physically and psychologically trying, it was also a drain on their already fragile economic situation.  With the exception of two gunshot victims who had long-term employer-provided health insurance, other victims were working in the most precarious segments of the service sector or in unstable blue collar jobs like Ervin.  Taking an afternoon or morning off work to talk with a counselor was not a decision that many victims could afford to make. 

Economic reservations weren’t the only thing that kept victims away from free mental health care services in the city.  Other victims like Shawn—a 21-year old black man from one of the poorest and most dangerous neighborhoods of Philadelphia—explained that he didn’t feel comfortable talking to strangers about his experiences and disliked the idea of formally enrolling in therapy.  When I asked him how this was any different from talking to me—a second generation Korean American whom he had met at the trauma clinic—Shawn shrugged and said, “I dunno, it’s just different.  Going to one of those places just seems weird.  Like, who would I talk to?  With you, it just feels more natural cuz you come to me.  You come to my house, where I feel comfortable.”

“We, as a society, have not developed a mental health care model that works for the most disadvantaged and precarious victims of crime.”

Philadelphia is a city in which committed individuals and organizations have fought huge budget cuts to provide free mental health care services.  Groups like the Anti-Violence Partnership and Drexel University’s “Healing Hurt People” program offer important counseling services to some victims across the city.  These and many other small community-focused programs should be lauded for their continued efforts at rehabilitating victims of gun violence across the city. 

But, there are a number of victims who inevitably fall through the cracks.  What happens to these victims?  And why are some victims averse to using free community mental health care?

Part of the problem is that we as a society have not developed a mental health care model that works for the most disadvantaged and precarious victims of crime.  Although counseling has become a socially acceptable experience for many middle and upper-middle class people in the U.S., it does not have the same meanings within working poor black neighborhoods across Philadelphia. 

In addition to more immediate economic concerns, gunshot victims in Philadelphia also come of age in neighborhoods in which depression and anxiety—two of the most common mental health issues amongst young adults—are taken as signs of weakness. These conditions are highly problematic and stigmatizing in an environment in which toughness and ‘street smarts’ confer respect. 

It is a prime time to develop alternative ways of assisting victims of crime.  Some potential answers might lie in a home health care model.  For years, private companies have offered home health care for patients who don’t have easy access to hospitals.  The elderly and disabled have benefited greatly from home health care, which helps eliminate some practical dilemmas in getting to and from a hospital on a regular basis.

A similar model could work for gunshot victims and other victims of crime who can’t or won’t use community mental health services.  Indeed, the victims I met in Philadelphia appreciated that I could come to their homes, often in the evenings or on the weekends, and talk with them on their own terms.  As an ethnographer, I’m used to wearing multiple hats; for victims like Ervin and Shawn, I had become somewhat of a folk therapist. 

By adopting a home mental health care model, we can help ensure that victims who won’t or can’t use free services will have their needs met.  The home environment is not only more convenient for some victims, it is also a safe zone in which some gunshot victims are more willing to talk and share their feelings. 

An investment in home mental health care is not only an important issue facing those immediately affected by violent crime, but also a larger social issue. Victims are not only at risk of re-injury, they are also at risk of retaliating against people who have hurt them.  To help curb the cycle of violence on Philadelphia’s streets, it’s important to ensure that these victims are receiving the help they need before it’s too late.

Learn more about Jooyoung Lee’s work here and on his blog.  Learn more about the RWJF Health & Society Scholars program and read a blog “carnival” on the program’s 10th anniversary.

Tags: Behavioral/mental health, Community violence, Health & Health Care Policy, Health & Society Scholars, Home health care, Human Capital, Injury, Research, Research & Analysis, Violence Prevention, Voices from the Field