State of Mind

How Libraries Became Refuges for People With Mental Illness

An outline of a person in profile, with the outline filled with books.
Photo illustration by Natalie Matthews-Ramo/Slate. Photo by Chanvre Québec on Unsplash and Pawel_B/iStock/Getty Images Plus.

Welcome to State of Mind, a new section from Slate and Arizona State University dedicated to exploring mental health. Follow us on Twitter.

The Argentine writer Jorge Luis Borges is often credited with saying that “Paradise is a library.” He must not have meant a downtown public library, circa 8 p.m. Such places, like most communal spheres, can be a challenge to oversee. Some people treat them like a sort of roomless hotel, sleeping in chairs and bathing in restrooms. I used to watch a man who looked like the famous woodcut of Blackbeard the Pirate ride the escalator of my three-story library up, down, up, down. For hours. Carrying a duffel bag. He never bothered anyone, so our security officers left him alone. (Can’t say the same for the lady of the evening who was meeting clients in the stairwell.)

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Then there are the questions from believers in Qanon. Election deniers. Sovereign citizens. The woman who ranted about the “news” that the World Health Organization was going to “force a vote to allow them to take over the U.S. and force a lockdown like China.” (If WHO had that kind of power, why bother with a vote?) The man who asked me how he and a few of his buddies could get into the governor’s office to “remove him” over pandemic closures. (Would that all insurrectionists did such thorough research!) Declinism is the feeling that everything is getting harder, scarier, and weirder, and a lot of people seem to have it.

Work in a library, I want to tell them, and you’ll learn what weird is.

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To be clear: I enjoy the weird. And I am proud that public libraries double as unofficial care centers. In 2015, the Washington Post quoted a librarian who estimated that about half of their regular patrons were either mentally ill or experiencing homelessness. The same article speculated that “the transition from inpatient to outpatient psychiatric treatment that began in the 1960s, including the closure of state-run psychiatric hospitals, may contribute to the prevalence of mental illness among the homeless.” In nearly every U.S. state, people with serious mental illness are more likely to be jailed than sent to a hospital.

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A library is a more welcoming environment than either of those. Undoubtedly, this is what attracts many people who suffer from mental illness. Sociologist Eric Klinenberg calls libraries “social infrastructure,” emphasizing that, in addition to books and materials, they offer welcoming spaces and human interaction. The Ferguson Municipal Public Library became a “safe haven” amid the riots after the 2014 shooting of Michael Brown, staying open when other businesses had closed, to act as a community anchor. After the 2016 shooting of five police officers, the Dallas Public Library provided on-site counselors to assist city residents.

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A number of libraries now employ social workers or mental health professionals to step in when needed. Others have partnered with mental health organizations to train librarians in crisis response. In 2017, staff at the San Diego Public Library completed the Mental Health First Aid course developed by the National Council on Behavioral Health. One of the staff, Joe Miesner, tapped into that training when he deescalated a situation with an distressed patron. “I just spent time listening to her,” Miesner told the American Psychological Association, “and eventually she gathered her belongings and walked away quietly.” Some librarians have even saved lives. Three weeks after being trained to administer the opioid antidote naloxone, Matt Pfisterer, a New York librarian, revived a patron who had overdosed.

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Academic libraries have also seen an increase in mental health needs, such as autism spectrum disorder, and have developed programs to meet them. Dawn Behrend, a librarian at Lenoir-Rhyne University who is also a licensed therapist, offers online workshops on providing service to ASD patrons. (She has another course called Assisting Patrons With Mental Disorders Across Library Settings that extends beyond the autism spectrum.)

In 2018, Robarts Library at the University of Toronto opened a family study space. Similar spaces exist at U.S. colleges. The room holds 20 people and includes work stations, toys, and child-sized furniture—perfect for student-parents who are forced to schlep their kids to campus. (I could have used one when I was a graduate student. Maybe I wouldn’t have been cashiered out of the computer lab because my 3-year-old was “banging on a keyboard.”)

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Another trend is library “meditation rooms,” which students use for prayer, yoga, scripture study, or just to catch their breath between classes. At North Carolina State University, for instance, the rooms include resources such as prayer rugs, meditation cushions and mats, a sound machine, and colored pencils and paper. One of the most creative programs is Montana State University’s Paws to De-Stress, in which the library, in partnership with Intermountain Therapy Animals, lets visitors mingle with registered therapy dogs during the weeks of final exams.

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When it comes to LGBTQ patrons, libraries have lots of opportunities. According to the National Alliance on Mental Illness, gay or bisexual adults are more than twice as likely as heterosexuals to struggle with their mental health. Transgender individuals are nearly four times as likely. In addition, 40 percent of transgender adults have attempted suicide in their lifetime, compared with less than 5percent of the general population. The numbers for transgender youths are even higher.

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The trick is in offering services to these patrons while also balancing their privacy needs. LGBTQ people have to be circumspect about how, when, and to whom they come out. They have to be, considering the discrimination—and hate crimes—they often face. Libraries should be safe spaces, which could include private rooms for reference transactions, wearing pronouns on a name badge, or circulation slips that don’t include the patron’s name (to forestall accidental dead-naming). The more LGBTQ books and other materials a library can collect, the better, though the best practice is to integrate them into the general collection rather than create a special collection that someone might be reluctant to ask for. Same with special displays for, say, Pride Month, which can be challenged by right-wing groups. There are subtler ways to advertise resources—a printed bibliography, for example.

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Sometimes, as Joe Miesner found out, the best thing we can do for a patron’s mental health is listen. Listening is an underrated librarian skill. Too often, when a patron comes to us with a question, our minds jump to the solution. The patron needs this book! They should read this article! They should search this website! Or we refer them so promptly to another organization (maybe we’re busy, or tired, or, heck, maybe we’re not OK ourselves), they may hang up and wonder, “Wait, did I just get dissed? By a librarian?”

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I am the director of the North Carolina Legislative Library, which is part of the state legislature. In the early days of the COVID-19 pandemic, a lot of state agencies were closed. My library was not. Word of this must have gotten around as our reference numbers shot up. Callers were asking about subjects—unemployment benefits, small business loans, birth certificates, job-hunting resources, filing for bankruptcy—that were not in our purview. Why? We were one of the few places to answer the phone. And listen. And try to help. I’m convinced we did help, even if we didn’t solve their immediate problem.

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We helped by being ministerial. By being focused. By being present. Listening isn’t just a librarian skill–it’s a human skill, and a slippery one. It seems facile: just let the other person talk. To do it well, however, we have to shut off our editorial side. Our stand-up-comic side. Our judge-and-jury side. In short, we have to shut off our brains and just be … what? Nothing. Just be.

It isn’t just patrons who need support. Librarians do as well. Our jobs are more stressful than it would appear. We are constantly asked to do more with less, and there is never enough time or staff—or funding. Patrons can be challenging in about a million ways. And there is the ever-present threat of closure. I once worked in the library of a law school that went out of business after losing its accreditation.

Librarians have a unique ability to help people find answers. It’s what we’ve dedicated our careers to doing. Sometimes those answers come from books, journals, the internet; sometimes they don’t. We often see people at their lowest moments. We have a duty, perhaps a calling, to reach out in tangible ways.

Mental health has become an any-port-in-a-storm situation. Librarians can provide one of those ports.

State of Mind is a partnership of Slate and Arizona State University that offers a practical look at our mental health system—and how to make it better.

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