This week’s guest posting is from Megan Cullip. A chaplain and mental health professional, she wrote this reflection on her time spent at Vision en Accion, the shelter for homeless, mentally disabled people in Juárez, Mexico.

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In 2008, when I was in my junior year of college, I saw a YouTube video about El Pastor, a man in Juárez, Mexico who had built an asylum in the Chihuahuan desert for those who are drug addicted, mentally ill, or developmentally disabled. I had a lump in my throat within three minutes of the video. I always had both an intellectual fascination and a tender-heartedness toward people with atypical brains. El Pastor, in the video, said that people referred to the residents at the asylum as: “human trash.” But what I saw, when I went there, was far from a dump.

Fast-forward about six years, the mental asylum in Juárez had been cemented in the back of my mind for some time. I had a deeply passionate compulsion to go.

I work in a state psychiatric hospital in the United States. We serve a wide variety of individuals with a spectrum of mental health issues: schizophrenia, bipolar, major depression, substance abuse, personality disorders. Because we are a state institution, we receive ample government funding. We are a multi-million dollar facility with about 1,200 staff members and, on average, 420 patients. We have professionals with lots of education and specialized experience. We have access to enough meds for everyone to receive whatever dose the doctor deems necessary, daily.

But we have codes daily. We have much conflict, patients fighting patients, patients fighting staff, patients harming themselves. We consider emergency restraints, where a patient has to be restrained in a chair or bed, “a treatment fail.” And it is.
Our patients are scheduled to attend groups throughout the day: psycho-education, medication management, spirituality group, individual counseling, music therapy etc.
But the patients rarely work with their hands, though some do get the opportunity to work in the greenhouse or the copy center. Thankfully we haven’t had to install the best selling SAD lights we used in more norther climates to help with winter blues, there are definite perks to working in the south!

Vision in Action has done something incredible without having millions of dollars to spend, nor teams of specialized professionals. I remember walking into the kitchen at the asylum. I was immediately handed a spicy dish of pork smothered in sauce and a plate of cheese quesadillas. Every morning, afternoon, and evening, the ladies and gentlemen who worked in the kitchen would offer me food-refried bean burritos with avocado slices, bottles of soda. They delivered their hospitality and quality cooking with broad smiles. They make 360 meals a day, and they don’t work in shifts.

During the day, people are working. They are cleaning, cooking, building, helping other low functioning patients perform their daily living tasks. When I was there, a new patient named Monica was dropped off from the local hospital. The other patients were at the gate waiting to receive her. She was placed in a cell for observation. She was despondent, when I asked her how she was. Monica appeared the same way many of our patients do upon their arrival at the hospital. But, as I looked around at the other patients at Vision in Action, I saw Monica’s potential. Monica would not meet with a treatment team. She would not be scheduled for groups. But I would not be surprised if, as I write this, she is putting her hand to cleaning, or laundry, or any of the other options. I wouldn’t be surprised if another patient is making friends with her and helping her adjust to this strange place of dignity and hospitality in the desert.

I had the privilege to speak at length with the medical doctor who works hard (for free) to try and give the patients the best quality of life possible. He showed me the supply of Haldol and Klonopin and other psychotropic medications that he locks in a tiny room in the asylum, out of reach from patients. If I were to take my own personal medicine cabinet, stuff it with psychotropic meds, and multiply it by three, that would be the maximum amount of medication that I found at the asylum. It was clearly not enough for 120 people, and definitely not enough for a consistent daily medication routine. The doctor told me that sometimes he has to cut one Haldol pill in half to serve two patients. It’s not enough. It’s inconsistent.

There is not a doubt in my mind that medication is helpful. And Vision in Action lacks the appropriate amount.

But there is also no question about the “success” (if you can ever talk about success when you talk about people) of this asylum. I did not see misery there. I saw sickness and poverty, yes. But I saw joy and community. I saw faith. I saw people who poured themselves out for others. I saw an energetic man in black slacks and a black blazer, named El Pastor. I saw him share the story and fundraise and care for his people, everyday crossing the border, praying to Jesus. Rabbi Abraham Heschel, when he marched to Montgomery during the civil rights movement, said: “I felt my feet were praying.” This is what I saw El Pastor, and all of those who help Vision and Action, doing.

Throughout the week I met many people involved in many different things: art dealers, curious givers, and a man with a landscaping business building an irrigation system for the asylum on his own dime. These people came and went, like the wind passing through from different directions. My last afternoon at the asylum, a pastor from Oklahoma came to pick up blankets. The asylum had extra blankets that they wanted to donate. The pastor from Oklahoma was going to take these blankets to natives on a reservation, who lived in caves. The poor were donating to the poor.

At Vision in Action, I saw a lot of my own values at work: faith, community, hard work, preserving human dignity. Many of my coworkers at the hospital feel similarly as I do about patient care and best practices. But the system is very overwhelming, with a lot of red tape and the like. It is frustrating. Change comes slowly. In many ways, it seems, we are slaves to liability. We are under fear of litigation or scrutiny from authorities. It is hard and almost unfair to compare a large state psychiatric hospital in America with a small faith-based asylum in the deserts of Mexico. My hope for state psychiatric hospitals in the US is that they would look a little more like Vision in Action. I hope that patients are allowed to use their hands, to do good work. I hope that everyone treats each other with dignity, treating people as whole people and not diagnoses’ on a page. I hope that programming and schedules would be seen as one of many tools and not a prescription that will magically heal every brain and heart. I hope that staff, at the end of the day, will be able to utter: “I felt my feet were praying.”

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Megan Cullip works as a chaplain at a state psychiatric institution in the United States. She can be reached at megancullip@gmail.com