The familiar expression ‘it takes a village to raise a child’ is readily accepted, especially by parents and carers. A less familiar and agreed upon idea is that it takes a village to support a person with major mental health challenges.
Geel, a small town of 35,000 people in Flemish Belgium is a natural experiment dating back to the 13th century, that attests to the wisdom of this proposition. The legend is that Dymphna, daughter of the Irish king Damon fled to Geel after her mother died and her father, made crazy with grief pursued her as a replacement. In Geel, Dymphna, well versed in dealing with those who were mentally ill, cared for others. Damon tracked his daughter to Geel and murdered her and Geel became a place of pilgrimage where the afflicted sought a nine-day religious treatment from the church. Dymphna was canonised becoming the ‘patron saint of lunatics’ and Geel overrun by those seeking her intersession. In response, local people began to offer hospitality and the foster care system that still functions today. Geel is well recognised for its unique population with Van Dale, the Dutch language dictionary, citing ‘Geel’: ‘Expression: bound to go to Geel, to come from Geel: to be mentally ill’. A lighter expression which references people of Geel is: ‘Half Geel is entirely crazy: and entire Geel is half crazy’.
Those who stayed after their treatment became boarders in the homes of locals who assimilated them into their community. These families and their descendants became mental health providers in what is now called the family care program. In 1968, 78 chronic patients, primarily diagnosed with schizophrenia and personality disorders were transferred from the nearby city of Kortenberg’s psychiatric hospital into the Geel family care program. The 10-year Geel Family Research Project which followed these people, reported that only 9 had returned to hospital at the end of this time. Marc Godemont, who worked in Geel’s mental health system believes this success is due to three key factors: Geel recognises the needs of its boarders, the community meets these needs with opportunities for work and social interaction and they become members of both a family and a community. The foster families are not trained in provision of psychiatric care, but in van Bilsen’s words provide ‘normal expectations, normal demands in an atmosphere I would like to describe as radical compassion and kindness’. The families’ role as caretaker, teacher, natural supportive parent, and behavioural model allows boarders to function in the ‘normal’ social world in spite of their illness. (van Bilsen 2016).
In 2021 Gabrielle Carey, wrote ‘The take-home message from this centuries-old tradition for our modern and much beleaguered mental health system in Australia is that no matter what change we make in the treatment of people with mental illness, it will be short-lived as long as there is no change in the social treatment from the community. A sense of belonging, of having a role, of being accepted by the broader community – what is otherwise called social health – is equally, if not more important, than medication.’
In Australia, we are increasingly aware that need is growing and resources diminishing, and it is time to consider other ways to respond. The family care program is a model that could be successfully applied to a range of difficulties and not only those that appear in psychiatric systems. It attests to the need for all of us to have a rich identity that encompasses family, work, and friends rather than stripping a person to become a diagnosis that prescribes narrow and singular solutions.
Carey, G. Australia can learn from a Belgian town where people with mental illness live with dignity in the community, The Guardian Sat 24 Apr 2021
Goldstein, JL, Godemont, MML. The legend and lessons of Geel, Belgium: a 1500-year-old legend, a 21st century model. Community Mental Health Journal 2003; 39: 441–58.
van Bilsen, H. Lessons to be learned from the oldest community psychiatric service in the world: Geel in Belgium , 2016 Aug; 40(4): 207–211.