reviews

MENTAL HEALTH PRACTICE JOURNAL FILM REVIEW
out of the shadow
Reviewer: Tony Gillam

"We have no right to information about our own mother," complains award-winning
documentary filmmaker Susan Smiley at the start of this film. It is frustration with
the mental health system which prompted Susan to turn the camera on her own
family's struggle with her mother Millie's schizophrenia.

Made in 2004, out of the shadow has been officially selected by numerous film
festivals, having its worldwide premiere at the Vancouver International Film Festival.
It has not only impressed aficionados of documentary film-making but also many
mental health professionals who have seen it. As a result, it has been taken up by
American advocacy organisations as a tool for raising awareness. It will be
broadcast on public TV stations in the States this spring and there are plans to
make a shortened educational version available to high schools to help teach
children about mental illness and how to identify it within their own families.

Susan Smiley's film is not only an outstanding documentary but a compelling,
true-life family drama. "When mom's illness takes over I become the enemy," says
Susan in a voice-over, during a scene where her mother gets increasingly furious
about people meddling in her affairs. Still, it is the family - not the professionals
- that seems to have the responsibility to find Millie somewhere to live each
time she is discharged from hospital.

Susan interviews members of her family - Tina her sister, her brother-in-law,
her cousin, and her father who divorced Millie when Susan and Tina were young.
Millie was given custody of the children and became increasingly more deluded
and paranoid (but also skilled at hiding this from other adults). The children
grew up believing there were cameras all over their house and the authorities
(including their teachers) were spying on them. Sadly, no one was aware, as Tina
recalls, that Millie was neglectful and physically violent towards them. Susan's
voice-over admits she did not want Tina to bring this up: "That was not part
of the movie I wanted to make but, as I thought about it, I decided it wasn't
right to hide it either."

The film highlights the importance of the community in protecting children.
Neighbours and family failed Susan and Tina as surely as the mental health
system has repeatedly failed Millie. While parents with mental health problems
are, of course, not necessarily neglectful or violent, the film forces us
(as citizens and professionals) to confront the uncomfortable fact that families
need our support and children will sometimes need our protection. We cannot
assume this only happens in the USA.

It is only when Tina attempts suicide that the authorities and their father
get involved, and only at this point that the family are given a diagnosis -
until then the teenage Susan didn't even know her mother had an illness. When
Millie loses her home and she herself attempts suicide the family sue the state
for guardianship to make it easier to navigate their way through the public
health system. There are notable differences with the UK health care system,
but still much for us to learn. Millie's case manager does not communicate with
the family, even though they are her legal guardians. The family is asked to
get Millie to sign consent to have an injection, and Tina deceives her mother by
pretending she is signing for accommodation rather than medication. We may be
shocked, as Susan is, that a family member is so desperate for her mother to
have medication she is prepared to trick her in this way. Like most families,
though, they believe they are acting in Millie's best interests. Care coordination
seems to be an alien concept. Millie is treated by "a long line of nameless,
faceless doctors who all have a different idea of how she should be treated."
She is given a multitude of drugs with little information and, apparently,
little treatment other than drugs. Not surprisingly, Millie is often noncompliant.

By the end of the film, Millie has managed to secure a place in a permanent
residential group home … and her first job in thirty years. She still doesn't
make a connection between consistent use of antipsychotic medication and
wellness, but is able to meet her personal goals and is no longer an outsider,
but a part of her family and her community. This provides a resolution for
Millie and for Susan too.

The film is now available on DVD accompanied by a discussion guide
(with modules on both psychosocial and psychopharmacological treatment and
how families can manage and prepare for crises). This is a beautifully-made
film and a powerful tool for education about schizophrenia. When shown to
families and carers or, indeed, service users themselves, care would need to be
taken to explain some differences between the UK and US mental health care
systems and also to clarify that parents with mental health problems can be -
and often are - very caring parents. However, the film is an invaluable discussion
point for professionals, highlighting the need to work in partnership with
families and carers, and to support parents with mental health problems and their
children. It also illustrates the importance of an integrated approach to the
treatment of schizophrenia,using pharmacological and psychosocial interventions
together to promote recovery.

The DVD is available from the website: www.outoftheshadow.com