Mental Health Care Doesn't Improve With Release To The Community
Around 1985, my troubled young cousin was staying with my retired parents; his own parents had moved to Naples, Fla, and he needed a place to go. One day, he looked my mom in the eye and said, "God is telling me I need to kill you."
That night, my folks locked their bedroom door, and then told him he had to leave. Within a year, he had gone to Florida and fatally stabbed his own mom 50 times.
The problem is that people who are disturbed do disturbed things- using whatever weapons are available- when what they need is in-patient psychiatric care. We can't do that, of course, because starting in the 1970's it was deemed inhumane to lock up patients with sanity issues. So the state hospitals were largely shut down (thanks, Geraldo Rivera) and large numbers of people were turned out on the street, the true start and primary cause of "homelessness," Mitch Snyder notwithstanding. It was the perfect "bootleggers and Baptists" scenario: Lefties wanted to eliminate in-patient commitment; conservatives wanted to eliminate the state hospitals' budget lines.
Mainstreaming is bad for all parties. People with true schizophrenic disorders are turned loose as long as they haven't done anything (yet), along with their psych meds- and these are meds that patients avoid taking because of unpleasant side effects. It is a recipe for trouble.
Add to that "scoop journalism" and we get the world we earned.
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Jul '11
Re: Mental Health Care Doesn't Improve With Release To The Community
Sadly enough, sanitariums were the way to go with forced medication regimens.
Nov '10
Re: Mental Health Care Doesn't Improve With Release To The Community
If the problem was that they weren't nice places, the solution would have been to make them nicer. At any rate, they beat living on the streets.
In medical school I knew a psych aide who had worked at one of the Pennsylvania state hospitals. He had been terribly traumatized by the closing of that place, when they basically discharged all their least place-able and most impaired people--people who had lived most of their lives in the hospital--to the streets.
This is one area where I am a believer in government spending.
Funny, we all agree here. And we're all in health care.
May '10
Re: Mental Health Care Doesn't Improve With Release To The Community
double post ack!
Edited on December 19, 2012 at 12:03amMay '10
Re: Mental Health Care Doesn't Improve With Release To The Community
I agree that the move to let people out of the hospitals has gone too far. Today, people have a "right" to be psychotic. We only put people into hospitals for being an immediate threat to themselves or others. Most people don't stay a threat in the hospital. No longer are people even stabilized.
However, public hospitals have been underfunded and the are not nice places to be. Those need to improve.
Also, most people with some sort of psychotic disorder can operate without hurting anyone else in a less restrictive environment than a hospital. The goal should be having the resources in place to support that.
Sadly, what happens is that hospitals are closed down, and the community mental health system does not get the funding needed to provide the support in the community. They never had since we started to empty out the inpatient units.
The average American simply does not care about mental illness enough to make an issue about it. That is too bad, because right now, the number one reason for disability is for mental illness. We are already spending a lot of money on this, just not in a very efficient way.
Apr '12
Re: Mental Health Care Doesn't Improve With Release To The Community
Yes, that's the crazy thing about these hideous explosions of murderous violence. The perpetrators were known to be disturbed and likely dangerous, and their relatives and acquaintances are chillingly unsurprised.
I've been instrumental in identifying mentally ill people before, basically just because my job puts me in contact kids in the stage in life when mental illness first manifests itself. For obvious reasons, I won't give details, but I will say that the first time I encountered such a person (I suspect a schizophrenic having a psychotic break), what was most striking was how completely un-subtle the symptoms were. I had absolutely no relevant experience or expertise, but one conversation was enough to say with confidence, "This person is mentally ill and should get help."
That first time, I was puzzled as to how I could be the first to notice such glaring problems. I think part of the issue might be that familiar settings and company can minimize the initial symptoms, whereas more stressful settings (like a college class) exacerbate them. But the point remains that identification isn't the hard part. Potential perpetrators of these horrific incidents are, in general, pretty easy to spot.
Edited on December 19, 2012 at 4:17amNov '10
Re: Mental Health Care Doesn't Improve With Release To The Community
Bryan G. Stephens:
However, public hospitals have been underfunded and the are not nice places to be. Those need to improve.
Also, most people with some sort of psychotic disorder can operate without hurting anyone else in a less restrictive environment than a hospital. The goal should be having the resources in place to support that.
I couldn't agree more that hospitals need to be nicer, and that they are badly, badly underfunded (where they still exist at all). I'm not so sure I agree that the goal should necessarily be to get everyone possible out of the hospital.
I did a rotation at "The Institute of Pennsylvania Hospital," an old fashioned private psych hospital. There were a few patients still there whose parents had left enough money for them to spend their lives in the hospital--and it was a pretty good life. Of course, it has closed. Why should everyone assume that whatever "community" setting those people are living in now is better than a good, stable hospital would be?
Mar '11
Re: Mental Health Care Doesn't Improve With Release To The Community
The concept of stripping mentally ill citizens of some of their freedoms for the common good is probably necessary, but I wonder if we can't come up with a few "conservative"-style intermediate solutions.
For instance, some with schizophrenia or bipolar disorder are fairly stable through strong families/communities which keep them on their medications. Perhaps we could allow these people to remain in society if a (mentally healthy) relative?
May '10
Re: Mental Health Care Doesn't Improve With Release To The Community
My point is not everyone should come out. However, if someone can live safely in the community, and have a happy, rewarding life, he or she should not be locked up forever.
There are some people that are so unstable, that some sort of 24/7 monitoring makes sense in a closed setting. I think we are way over the mark of who we have decided does not need that.
And I might add, I work with exactly these clients, and we struggle with exactly these issues right now.
Edited on December 19, 2012 at 12:35amMar '11
Re: Mental Health Care Doesn't Improve With Release To The Community
Bryan G. Stephens:
That is too bad, because right now, the number one reason for disability is for mental illness. We are already spending a lot of money on this, just not in a very efficient way.
We should probably be careful with definin mental illness if reinstitutionalization is in the cards. As I understand it (which is not very well), most of the "mental illnesses" which cost so much money and lead to so many people on disability are not the kind which make people potentially unstable and violent, but the more the modern type of "illness" that used to be considered an extension of normal human emotions.
Aug '10
Re: Mental Health Care Doesn't Improve With Release To The Community
"Mental health care does not improve with release to the community"
It does if you don't belong in an institution in the first place. I once scared myself during a bad spell as a teenager and decided that admitting myself to the local hospital's mental health ward would be the responsible thing to do. It wasn't. It was the dumbest thing I ever did.
I wasn't crazy, just really depressed. But there I was, surrounded by crazy people, being threatened with readmission against my will if I chose to leave, and getting hardly any care during the whole week they kept me there (which is understandable, considering that the staff had much bigger problems than me to deal with). It was a total waste of my time and my parents' money.
Anyhow, I would hope that if compulsory institutionalization increases, there are safeguards to decrease the likelihood of folks like Aaron Miller and Yours Truly getting stuck in a system in which they don't belong.
Jul '11
Re: Mental Health Care Doesn't Improve With Release To The Community
Mendel: The concept of stripping mentally ill citizens of some of their freedoms for the common good is probably necessary, but I wonder if we can't come up with a few "conservative"-style intermediate solutions.
For instance, some with schizophrenia or bipolar disorder are fairly stable through strong families/communities which keep them on their medications. Perhaps we could allow these people to remain in society if a (mentally healthy) relative? · 52 minutes ago
Family support is critical. Of course some families deny all medications, immunizations, and use alternative health meds. None of these families help the situation so how to discern? Mandatory blood levels of whatever poison is keeping them sane?
Jan '11
Re: Mental Health Care Doesn't Improve With Release To The Community
Mendel: The concept of stripping mentally ill citizens of some of their freedoms for the common good is probably necessary, but I wonder if we can't come up with a few "conservative"-style intermediate solutions.
For instance, some with schizophrenia or bipolar disorder are fairly stable through strong families/communities which keep them on their medications. Perhaps we could allow these people to remain in society if a (mentally healthy) relative? · 53 minutes ago
An idea, one from an inventor/physician who I believe posted here about small microchips that could monitor patient's medicine/prescription levels. I can't recall if this automatically triggered additional dosages or if there was a type of alarm. Something like this, coupled with the house arrest type bracelets might ensure that meds are being taken and where patients are located. I'm sure the technology exists that consumption of drugs, veiwing of child pornography, internet searches/violent game playing could also be monitored & reported.
Apr '12
Re: Mental Health Care Doesn't Improve With Release To The Community
Midget Faded Rattlesnake:
Anyhow, I would hope that if compulsory institutionalization increases, there are safeguards to decrease the likelihood of folks like Aaron Miller and Yours Truly getting stuck in a system in which they don't belong. · 17 minutes ago
I think, pretty clearly, that long-term forcible institutionalization should be an extreme step, and that both families and the person herself should have the opportunity to appeal. (I'm thinking some families might want to foist relatives on the system who are merely needy or hard to deal with for whatever reason.) But I think part of the point is that people who are truly and violently disturbed tend to be fairly identifiable, not easily confused with the merely ill-adjusted or depressed.
It is true that families are a tricky element, in some ways so helpful but in others so challenging. As I mentioned above, one problematic feature may be that mental illness often does become more obvious to the more-distantly-acquainted, simply because family make the person feel comfortable and thus mute the symptoms. But in the end, do most people want to be personally responsible for a dangerously disturbed relation?
Apr '12
Re: Mental Health Care Doesn't Improve With Release To The Community
WI Con
An idea, one from an inventor/physician who I believe posted here about small microchips that could monitor patient's medicine/prescription levels. I can't recall if this automatically triggered additional dosages or if there was a type of alarm. Something like this, coupled with the house arrest type bracelets might ensure that meds are being taken and where patients are located. I'm sure the technology exists that consumption of drugs, veiwing of child pornography, internet searches/violent game playing could also be monitored & reported. · 8 minutes ago
So, question: do we offer the person state-sponsored institutionalization if they and their family prefer that option? It's a pretty huge burden to put on a family member, especially considering that children tend to outlive their parents and then a sibling or aunt or cousin may get stuck with the job.
Nov '10
Re: Mental Health Care Doesn't Improve With Release To The Community
Rachel L.
So, question: do we offer the person state-sponsored institutionalization if they and their family prefer that option? It's a pretty huge burden to put on a family member, especially considering that children tend to outlive their parents and then a sibling or aunt or cousin may get stuck with the job.
I think we should. Again, I saw a really good (private) traditional psych hospital in action near the end of its days, and for decades it had offered some patients a really good life. Apparently there used to be a really decent state mental health system here in NC--no more, though. But, yes, I see no reason why we shouldn't have nice psych facilities for those who would benefit from the care.
Obviously this is a side issue from the question of who needs involuntary hospitalization.
Aug '10
Re: Mental Health Care Doesn't Improve With Release To The Community
Rachel L.
(I'm thinking some families might want to foist relatives on the system who are merely needy or hard to deal with for whatever reason.)
Golly. That sounds like pretty much every teenager, at one point or another.
Nov '10
Re: Mental Health Care Doesn't Improve With Release To The Community
Midget Faded Rattlesnake
Rachel L.
(I'm thinking some families might want to foist relatives on the system who are merely needy or hard to deal with for whatever reason.)
Golly. That sounds like pretty much every teenager, at one point or another.
And yet the young man in Connecticut was only 20 years old. So you can't just assume that a family that wants help with an adolescent is being impatient or is overreacting, or that the person is merely needy or hard to deal with--or at all, in any way, analogous to you in your adolescent experience. A lot of very severe mental illness starts in adolescence, and some of it even earlier.
May '11
Re: Mental Health Care Doesn't Improve With Release To The Community
The problem seems to me to be that true mental illness, however you define true, mental and illness, is extraordinarily hard to treat, even with all the tools we have now. Chemicals are just chemicals and although they improve the status quo for many, there are no easy answers. For me, the most depressing thing about this massacre, is that there is no easy solution. Certainly society would benefit from more enforced institutionalism of seriously disturbed individuals, just as it has benefited from a more inclusive prison system, but crime is far easier to delineate than mental illness.
Aug '10
Re: Mental Health Care Doesn't Improve With Release To The Community
Lucy Pevensie
Midget Faded Rattlesnake
Rachel L.
(I'm thinking some families might want to foist relatives on the system who are merely needy or hard to deal with for whatever reason.)
Golly. That sounds like pretty much every teenager, at one point or another.
And yet the young man in Connecticut was only 20 years old. So you can't just assume that a family that wants help with an adolescent is being impatient or is overreacting, or that the person is merely needy or hard to deal with--or at all, in any way, analogous to you in your adolescent experience. A lot of very severe mental illness starts in adolescence, and some of it even earlier.
Oh, Lucy! I was just trying to inject some levity into what is otherwise a depressingly serious conversation.
May '10
Re: Mental Health Care Doesn't Improve With Release To The Community
I agree this is no easy solution to last Friday.
However, Mental Illness is a great under treated problem in this country. Its costs are huge. 1 in 5 people will struggle with a mental illness serious enough to cause some degree of impairment in their lives. That is not to say they will be violent.
Suicide rates are going up for all age groups, and it gets worse as we get older.
We are not doing a good job even talking about mental illness and substance abuse in America, much less allocating resources.
The Largest inpatient facility in Cobb County where I live is the County Jail in terms of numbers of people treated each month.