Mental Health: a Family Member’s Perspective

Miami's Community Newspapers
Alex Penelas, Mayor of Miami Miami-Dade County (1996-2004)

We’ve heard this repeatedly: one out of every five adults in the United States struggles with a mental health affliction of some sort. Those afflicted, however, are more than statistics: they are our friends, neighbors, co-workers, and family members.

In our family it was my older brother Pedro who suffered from mental health issues his entire adult life until his passing a year ago. Since I was a young boy, I witnessed Pedro’s struggles with substance abuse, incarceration, institutionalization and even periods of homelessness. At first his crises were intermittent but eventually presented every two years or so; stabilization took longer and longer with each episode and in some cases up to ten months.

It was painful to see my parents struggle to find help for Pedro; they knocked on the door of every crisis unit in town and in their broken English and with limited knowledge of the judicial system resorted to the Baker Act far too many times to remember. Thankfully there were also periods of stability but Pedro lived nothing that resembled a normal life; no spouse, children or meaningful employment.

As the years passed I actively assisted my parents and eventually became my brother’s primary caretaker after my mom passed and my dad became ill.

Because of these experiences I understand the struggles of so many families that are impacted by mental health affliction and thus offer the following observations:

Families of those afflicted by mental health issues are the first and undeniably the best line of support, and we must do more to assist them.  This assistance is critical especially during a crisis episode because family members often become the targets of their loved ones behavior and aggression typically blaming the family for their predicament.

Our judicial intervention process, more commonly known as the Baker Act in Florida, is painstaking and taxing on the patient but on the family as well; the end result is usually 72 hours of involuntary psychiatric care before the patient is eligible for discharge. Anyone who has gone through this understands that 72 hours isn’t enough to stabilize someone suffering a psychiatric crisis. While recent reforms have addressed many of these issues, more is needed to make this process less intimidating for the family while balancing the rights and immediate needs of the family member.

Reform is needed in the way Crisis Intervention Units operate and how they are reimbursed for their services. CIU’s do incredible and consequential work, but often times carry out their efforts unsure of the source and amount of compensation. Furthermore, benefits for crisis intervention typically cover a very short period of time (typically one week) resulting in a revolving door of admissions, discharges and readmissions which does little to address the patients’ needs and leaves struggling families with little recourse, significant frustration and in some cases the prospective of large bills.

Finally, families (and patients) would benefit from centralized mental health records. While I recognize any such records system must have the appropriate privacy safeguards, I can’t begin to describe how exhausting it is to repeat the same background, describe the same symptoms, medical history, provide a list of medications over and over to what would appear to be an endless number of psychiatrists, psychologists, nurses, social workers, or judges and police officers during each crisis. Not only is this painful for family members, but also consumes precious limited time. A centralized records system can reduce the time necessary to provide the patient with the help needed to begin the path towards recovery, not to mention relive this burden on the families. Centralized records are even more critical in cases where the family is not available or engaged in the caretaking.

Undoubtedly mental health issues are very difficult on the patient but on the families as well. We need to do more to assist these families who are the first and best line of support.

In conclusion, I want to thank the countless mental health professionals (you know who you are) who assisted my brother and our family over the past 40 plus years.  There are many unsung heroes out there at the front lines of mental health illness and I salute them and thank them for their tireless efforts.

Alex Penelas served as a two-term Mayor of Miami-Dade County from 1996 to 2004. Alex’s career in public service began in 1987 when he was elected to the City Council of Hialeah before successfully running for a County Commission seat in 1990, becoming the youngest County Commissioner in history. During his eight years as mayor, Alex focused on implementing robust solutions for early education, public transportation, and homelessness. In fact, it was exactly 25 years ago that Alex sponsored the ordinance creating the Miami Dade County Homeless Trust, a program that continues to serve our community’s homeless today. A proud father of three, Alex now lives in Miami Lakes with his wife, Lilliam and their youngest daughter, Alexandra. If you would like to reach out to Alex, feel free to do so through his personal email:

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  1. I appreciate the publication of this article, it is needed to do more to have a positive impact in the lives of the one that suffers mental health issues and their families. How about the alone homeless? That person lives by himself in the streets and nobody can help that person with his real problem, mental health. Again, thank you for talking about it.

    • Arthur, thank you for reading my column and for taking the time to leave a comment. I believe that mental health and homelessness are two issues inextricably linked to one another. In fact, when I served as County Commission Chairman of the newly formed Homeless Trust, a major component of our program was specialized outreach to the homeless suffering from mental illness. As we move forward, we need to implement more robust policies that treat mental health and homelessness as one issue- thank you for an excellent point!

  2. Unfortunately our mental health care system has major flaws and dysfunction. It tends to provide a superficial approach to care that seeks to suppress or control symptoms but fails to uncover and heal the roots of those symptoms and what led to the mental illness diagnoses. The medications used to treat symptoms often lead to further problems and people get stuck in a chronic cycle of illness and often a downward spiral that could have been avoided with a more conscious, enlightened system of healing resources. In my work in the mental health field I advocate for a more integrative, holistic care model that is trauma-informed and which considers more alternative medicine, energy medicine, mind-body (e.g. hypnotherapy, energy psychology, somatic therapies), and spiritual/metaphysical healing resources to get to the roots of mental health issues and facilitate recovery. Mental health reform requires a major paradigm shift and comprehensive reform of how we think about and address mental health issues.

    • Right on! We need our politicians — current and former leaders — to focus on getting mental health covered by insurance! For those who suffer with any type of issue needing therapy … be it a diagnosed mental health issue or just needing someone to talk to during a difficult moment in their life in order to avoid full blown depression … we need to be able to use insurance to get the help required to address that issue at hand. 10 sessions paid for by the patient and counted towards an outrageous deductible or not counted at all is not even good enough to call ridiculous! Even for a family with significant means, paying $150-350/session several times a week for months during a crisis or even once a week during maintenance is just too much of a financial burden to take on (not to mention that other people and caregivers around the afflicted person may also need therapy to help with the situation!). Every person needs access to mental health professionals at reasonable prices and when needed … again, not needing to wait months for an appointment. There are so many tragedies that could be averted if we had access to mental health at the time and price point that it is needed — suicide, mass shootings, hostage situations, school fights, etc… So, while I am glad we are having this conversation, we need more than just talk — we need immediate action.

    • Hey Jed, part of why I wrote this column was to do my part to help change the conversation about mental health. Because of the stigma that unfortunately surrounds this issue, I fear that too many are afraid to speak up and discuss how it has impacted their families and what our society could be doing to better care for those afflicted. I believe that, as you describe in your comment, holistic care is something we absolutely need to put more of an emphasis on, and I appreciate you mentioning that. Lastly, I would like to thank you for the invaluable work you do, it really does make a difference.

  3. If there is anything in which I may be assistance to you and this important cause please do not hesitate to contact me. With pleasure I will support you. Dr. Vilma Castro, LMFT (305)495-0757

  4. I feel your pain Mr. Panelas. I just lost my daughter to mental illness in May of this year. We need to keep on working to improve the lives of those affected with mental illness. Please join us.

  5. Thank you so much for that insightful article regarding mental illness and the caretaking process. It seems like nobody understands the process of wants to become a part of the solution to in sure that mental health is a dress appropriately and caretakers are given unwavering support to assist and be assisted. Until it is too late and nothing can be done to help.

    • Vanessa, the situation you describe is one that occurs all too often. We absolutely need to do more to support the caretakers and give them the resources they need to do their jobs. Thank you very much for your comment.

  6. Thank you Alex Penelas for your opinion, I m going thru the same situation you are describing, I agree with you a 100% My daughter has been in and out of hospitals her whole like. she is 49 years old. She does not take her medications, I am trying to have into involuntary medications, (injections once a month) without success. I have told the same story to all Drs. and Hopitals over and over. No one pays attention.

  7. I am strongly agreed with your opinion we are living with the same problem in my family and only 72 hrs is not enough for recovery

  8. It is the first time that I read something that makes sense. It goes to show that politicians are also humans like the rest of us. Now, since you have influence in the political arena, if something could be done, lets do it. You will be sure that a lot of people will support any solution that really matters for our own entire society . Yes, all of what you say it is true. But, solution up in the air will solve nothing. Until we confront mental health issues with solutions like the one you mentioned, until them, we will continue the same.

    • Hello Mary, mental health afflictions do not care who you are or what you’ve done- they can and do impact people from all different walks of life. By coming together and discussing the issue openly, we can work towards creating solutions that work for the individual and stop treating mental health as a one-size-fits-all issue.

  9. Excellent article. My sympathy to Mr Penelas and his family for all the grief they have suffered.

    We need much more focus on mental health. Millions of American’s are suffering from the nightmare of mental illness.

    It’s destroying lives every day. It strike at anytime in any family.

    Let’s work to alleviate this scrouge as best we all can.

  10. This article is not representative of the families nor relatives. The points as stated have many misrepresentations. Mental disability is covered by Medicaid and each and every mentally disabled person is entitled to receive social security disability. First, there is a need for Social Workers to empower disabled people to have access to their benefits. Hospitals are getting $15K for 72 hours paid by Medicaid. Additionally, hospitals harass and start collection proceedings of dubious charges against disabled people to collect on top of what Medicaid paid, often completely ruining their credit reports and credit scores. Mentally disabled people need more guarantees that their human rights, constitutional rights, and civil liberties are respected. Social security disability of $770 and Food stamps of $15 are an undignifying solution that maintains a state of vulnerability. There is a perverse system of institutional neglect and monetization of mental disability where hospitals and psychotic drug manufacturers are winning on the backs of mentally disabled people. The legislation is willing to pay 15K per 72 hours hospitalization and thousands monthly for psychotic drugs but is UNWILLING to provide the very basic of housing and nutrition. Without mentioning that these Crisis Intervention Units are run like prisons with enforcement that raises serious questions about human rights violations and a chronic habit to overmedicate and sedate mentally disabled people. The idea of addressing mental health from any point of view that does not have the disabled person at the center is a serious misjudgment and leads to dangerous solutions for the very people that already isolated, marginalized and in a state of abandonment.

  11. Excellent article. I’m a Professional Masters Level Social Worker and I have been on the front lines here in Miami Dade and Broward. Sadly, the system is broken and until an emphasis is placed on Mental Health beginning in Washington D.C . Funding for Mental Health Services and most important the Direct Staff, the aides, the Social Workers, The Mental Health Therapists we ourselves need an over abundant decent, living wages. There is no positive reinforcement working in the field of Mental Health no one cares about the client’s and they defintely do not care for the everyday worker who is providing Direct Care to the Mentally Ill. Until a spotlight is placed on salaries for the workers, and emphasis on Self Care for the workers and Professionals . Until these needs are addressed the situation will just get worse. Working in this field, one needs Mental Health Services, one self. There needs to be more paid ” Mental Health ” days for the employees; incentives; Professional Development Days etc;. I could go on and on. Thank you for listening

    • Caroline, thank you for leaving this comment but more importantly, thank you for the incredible work that you do. It is absolutely critical that we do more to support the hardworking men and women who provide care to our community’s mentally ill, without them a solution is impossible.

  12. Dear Mr. Penelas, I have known you since before 1987 and have followed your meteoric rise in the political arena. You have always had my highest regards which is now even more augmented with your sharing a personal facet of your life and the trials and tribulations of your parents. I have seen your family’s (wife’s and adorable children’s) pictures in the media. I feel like I personally know your family.
    I have been a Registered Nurse since 1996 specializing in Mental Health. I have followed mental health patients anywhere from 8 hours to over 2 decades. I cannot begin to narrate to general population the anguish and heart-rending experiences the patients and their loving families have (although, you know perfectly well what I am trying to say). Many patients and families refrain themselves from seeking mental healthcare primarily due to denial of existence of the issue (especially, Bipolar Disorder), financial burden of hospitalization(s), unaffordable and prohibitive costs of medicines, and a sliver of stigma that still exists despite MH professionals’ best efforts to dispel many myths the general population in certain ethnic groups (e.g. that mental illness is a punishment from God. Please know that God is a loving, and caring God like a mother).
    Sir, what you have described is only the tip of the iceberg of the problems that exist.
    To emulate Dr. Vilma Castro’s (LMFT) example, I would like to join your noble team to vanquish this scourge of mental illness in whatever infinitesimal way I can. I work in one of the best hospitals in the County (if not the Country) that does its lion’s share in treating patients afflicted with mental illness (regardless of being insured or otherwise). Palmetto General Hospital’s philosophy of treating patients (medical and psychiatric) as their own families is epitome of healthcare. I can unequivocally aver that it is incomparable, and unsurpassable.
    May almighty God grant us more rudders like yourself and paid employees/volunteers to treat, and stabilize, if not eradicate mental health issues like Major Depression, Bipolar Disorder, Anxiety Disorder, PTSD, Schizophrenia, Schizoaffective Disorder, and plethora of other psychological disorders. Deep in my heart, I believe that with selfless devotion and Legislative backing, this mammoth task is surmountable. God Bless.
    Ps: I recommend and encourage patients and their families to join and available themselves of the support provided by the bulwark and champions of mental health groups: NAMI (National Alliance for Mental Ilness).

    • Hey Al, thank you for reading this article and for sharing your story with me. I can only imagine what you have witnessed during your time working in the mental health field, and I want to thank you for your service to our community. You are correct in saying that this is just the tip of the iceberg, we can and must do more.

  13. I totally agree with all the comments. This is a big country, yet mental health is a mess. The access to good specialists is very limited and at a price you cannot afford. Preventive medicine on mental health is not available and when patients are in a hole the only solution is to drug them.No resources to help the families affected either. No body cares about it

  14. Thank you for your insight on mental illness. Many families are going through what you have been through. the stress and heartache are a heavy burden. I know years of medication destroys the individual. My family has gone through the same situation.

  15. OMG this was well said, people treat mental health people very badly sometimes, I have two close family members that’s struggling with mental health issues right now and the neighborhood we live in, some kind f the neighbors are horrible, they look down on my family members and even call the police on my family member if he goes outside and talks to himself loud. I have seen instances where they would provoke my family then they call the police and say my family is making noise in the neighborhood: People need to realize mental health can happen to anyone, it just take. an unexpected event to trigger it. If you have a family member going thru mental health ,continue to give them your best support. God bless ypu all,,

  16. Gracias Sr Penelas por su artículo .
    Soy mamá de tres niños dos ya adultos y un pequeño de 3 . Hace 19 años estoy en Miami . MIs sos primeros hijos hicieron la escuela y el secundario en esta ciudad y la adolescencia no es fácil en este lugar . Mamá soltera era el sustento de mi hogar y el trabajo y la rutina no fue fácil . Las cosas se me fueron de control primero fue el mayor y luego la del medio . Es fácil en las escuelas hoy en día atrévece a usar sustancias. Y lo hacen por pertenecer a un círculo . Mucha presión reciben para no estar fuera de …
    cuando las niña se comportaba muy mal tome todas las acciones necesarias. . Policía médicos terapia y no encontré ninguna respuesta. . Golpeó y golpie muchas puertas ninguna me ayudo . Quice llevarla cuando aún era menor de edad a un lugar llamado “ the bridge” me mandaron hacerle un test sicologico porque en la entrevista que tuvieron con ella menor de edad a solas ella les dijo que había intentado suicidarce y no era verdad . Me gaste $600 en un test en el hospital . Para que el sicólogo me dijera que mi hija lo que nesecitaba era una oportunidad de sus padres. !! Hoy mi hija no tiene trabajo no hace nada con su vida no termino los estudios y nadie le da una oportunidad . Sigo buscando ayuda para que ella sea un adulto sano y productivo en la vida y sigo sin encontrar ayuda. . quiciera que ningún padre pasara por esto Quiciera que no sea tan fácil el alcance de las drogas a los niños y adolescentes en su edad más difícil . Quiciera que se ayudara más a los papas de adolescentes y que Miami sea más. Seguras las escuelas. . Las hijas de mi mejor amiga van al middle school en Miami Beach y ya les ofrecieron drogas. Y todos los días hay una pelea. En la escuela. Y es normal . Si comenzamos por ayudar a los padre se hace más fácil el poder ayudar a los hijos. .
    Gracias. Por el artículo espero poder ayudar para contribuir en comenzar algo . Maday me comentó sobre este artículo soy su compañera de trabajo

  17. I agree with you Alex . After living a life long struggle with a scyphrannic mother in Dade county I can feel for all those who are facing this struggle. Thank You

  18. I am glad that you mentioned how difficult mental health issues are for a patient and their families. My wife and I are struggling to help our oldest son who is suffering from mental health issues. Thank you for the support that you give to these patients and their families, it means a lot.


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