Mad Mess

A sobering assessment of the systematic failures of mental health work.

The United States is in the midst of a mental health crisis that cannot be ignored. Its effects are visible in overcrowded emergency rooms, homeless encampments, and frequent police encounters responding to people with serious mental illness. And yet, the many ways we attempt to support people with mental illness—from medical care to housing support to basic hygiene—seem to never take meaningful hold. All this despite the tireless work of professionals who attempt to help people bring together the pieces of a life. The problem is not in any individual effort to ameliorate the problem; it’s the many ways these programs fail to work together. For those with serious mental illness, and those who work to ameliorate it, there is no system. There is only mess. 

In A Mad Mess, sociologist Owen Whooley uncovers the exasperating barriers, bureaucratic mismatches, and threadbare resources that have made a mess of what should be a supportive system. Set in Albuquerque, New Mexico—a city whose struggles echo communities nationwide— the book reveals the challenges mental health workers face daily, from tedious paperwork to occasional violence. Whooley interviewed mental health workers at two local mental health services organizations, the specialized behavioral health division of the Albuquerque Police Department (APD), and a psychiatric emergency department at the University of New Mexico Hospital. Despite mostly good intentions and sometimes heroic efforts, he shows why this important work so often ends in failure. 

Written with deep sympathy and unflinching honesty, A Mad Mess reveals how the lack of a cohesive mental health system obstructs critical care and places roadblocks before front-line mental health workers at every turn. Most critically, for those who suffer from severe mental illness, these setbacks are a constant reminder that the institutions charged with helping them have left them on their own.

Owen Whooley is professor of sociology at the University of New Mexico. He is the author of Knowledge in the Time of Cholera and On the Heels of Ignorance, also published by the University of Chicago Press.