As a therapist at a community mental health provider. this is a question that is very challenging on an ethical level. One of the biggest challenges that I face is with patients who either don’t want care, are violent/belligerent or are a combination of all of these. Often, these patients have been through the mill of services – in and out of jail/prison, chronically suicidal, and spit out by every mental health provider in a 100 mile radius.

And then they are referred to me.

These referrals come from people who are out of options, who are at their wits end as to how to provide care for these individuals. Whether it is people who are chronically addicted to some substance, have a personality disorder, or just don’t want help (which is a lot of people), I am the one who gets the call when there is no one left to call.

When I get these calls, I can confidently say that I always want to help. Is it an ego thing? A “big heart” thing? Am I perhaps too naïve? Whatever it is, I always want to add them to the caseload.

When they do get added, it is very quickly that I realize why they were referred to me, and refused services from so many other organizations in the process. They are angry, aggressive, belligerent, intoxicated, and a plethora of other things that prevents me from being able to help them, if they even want help in the first place.

When the violence, anger and belligerence starts, though, I feel at a loss. These individuals are justifiably angry in many instances. They have been abused, mistreated, refused service and generally thrown to the wayside by every societal apparatus that we have at hand. And I do not blame these apparatus’ when they do throw these people away! Many of these individuals are fundamentally broken people, and beyond the help that I, or the wonderful people that I work with can provide.

As a therapist, I often have to come to the conclusion that I am unable to help these people, and that it is only a choice on their end that will allow them to become able to accept help, when it does eventually come to them. But as a Catholic? It is extremely difficult for me to accept this. Christianity is the religion of the broken and the castaway. It is the religion for those who have been shunned by the society in which they are a part. So how do we help these people? These people, who refuse the assistance of secular society, often justifiably so. These people, who are so often simply beyond the help of secular society. These people, who deserve to be accepted by those of a religious heart?

I do not have an answer. But I had to ask the question.