City of Gheel: Community Mental Health at Its Best

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The patients come from all over Belgium. Before entering foster care, a team from Gheel Central Psychiatric Hospital carefully screens them. Psychiatrists, psychologists, and social workers determine who will be eligible for the program. Dangerous patients, pedophiles, are automatically excluded. Once a patient is placed, a psychiatric nurse like Marc Hendrickx and a psychologist like Wilfred Bogart, monitor the relationship.

Do you see improvement in their conditions as they spend more time in this family situation?

I think they are feeling better. That's very important. After—after a time, they feel better. Because when they enter in a family, the family tries to give them responsibility. Even very light things—to wash dishes, to clean up the house, to work a bit in the garden, such little things.

And by getting this responsibility, they are feeling better. They feel someone. And in an institution, they never get such a responsibility.

[TALKING SOFTLY]

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For 45 years, Jeff and Clara have lived together as brother and sister. She was a mentally ill child when Jeff's mother took her in. When his mother died, he took over the responsibility. Today it's sometimes difficult to determine just who is looking after whom.

And so it is with Caroline, Paulina, and Liliane, who call themselves the Three Musketeers. Paulina spent decades in various institutions and has been cared for by Caroline for the last eight years. So has Liliane, who's been with the family for more than 30 years. They share household chores, go out together, and seem as inseparable as the musketeers themselves.

They are not dangerous. They—they tell- some tell every time the same thing. And then we laugh with them.

[LAUGHTER]

And we know them, so they are very friendly. We like them here. It's a custom here in Geel. So we can live very good with the people. It's normal for us.

Patients still have to take there psychiatric medicines. But still, by these patients, a number of them are getting lower and lower medication after a while.

You reduce the medication?

Usually after, let's say, six months, if we see some stability in the situation of the patient, then the level of neuroleptic medication that's given to a patient is reduced.

Marcelline is retarded and has serious behavioral problems. She's been living with the family of Chris and Magda [? Rohldaums ?] for eight years along with two other patients, Irma and Margaretta, and the [? Rohldaums' ?] four children.

The [? Rohldaums ?] receive about $13 a day per patient. That stipend is an important incentive. But according to mental health professionals, money alone cannot account for the warmth within these extended families.

Bert has been with the [? Lomalen ?] family for most of his life. He was first taken in by Joseph [? Lomalen's ?] mother. When she died in 1970, Bert moved in with Joseph. It's simply the done thing in this town.

Mark is 32 and has been diagnosed as schizophrenic. For four years, he's been living with Staf, his foster father, and Hugo, another patient. He keeps in touch with his biological parents but feels more secure with his foster family.

Why are you here in this foster care?

I don't really know, but I don't mind being here, so I don't ask myself why I am here. I think that people are good here and I like it here.

Do you feel at ease?

Yes. It feels very well. In the beginning, it was a little bit problem, but now it's going very well, I think.

How did you learn to speak English so well?

Um, first of all, in school and then university, I had some English. And then it's watching very much television, I also to learned much more English.

Jan Van Rensenbergen, the director of the Central Hospital, oversees the family care program.

We have our own hospital connected to the family care system, so whenever a patient is in a crisis or he has a problem, or he is not behaving properly in that family, he's taken in again—for one week, for two weeks, for as long as it takes until he is stabilized again, and then he can go back. So being taken away from that family, be put it our Central Hospital, even that small step within Geel is felt for a patient as a very severe punishment.

In an institution, I—I think all they do there is giving you pills and for the rest, they don't look at you. But here, you really get people who care for you.

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Of the 650 family care patients, about 250 go out to jobs in workshops run by the hospital. They do bicycle repair, simple woodworking jobs, electronic assembly, and packaging for local businesses.

Takka-takka-takka-takk. [LAUGHS]

Dr. Matthew Dumont, a psychiatrist at the Westborough State Hospital near Boston, was one of the first American doctors to study Geel's approach to the mentally ill.

It's not just the treatment of the patients and the fact that they're integrated in the town. It is the impact on the rest of the community not involved with family care of patients, of a social system where everybody else, everywhere else in the world, a population that is socially marginalized, treated with disdain, abhorred, feared, is accepted, tolerated, welcomed.

You would not see a person a lying in the street homeless in Geel. Whether or not they were a patient, there would be a sense of responsibility for that person. There would be a community concern for anything that looked bizarre or disorganized or threatening of a child.

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A population that treats the mentally ill with such acceptance, with such tolerance, is a tolerant community. It's a community defined by its inclusiveness rather than its exclusiveness. And I think that's quite beautiful.

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