Tuesday, June 20, 2006

The New Asylums

This is just a brief post to recommend a documentary for those who haven't seen it yet. It's a Frontline episode called The New Asylums. This is a vivid but balanced story about correctional mental health care and the needs of mentally ill inmates. You can watch it in streaming video at the Frontline web site. I will warn you that Part 2 has a scene of a very ill, out-of-control patient that could be shocking.

Here is an observation from the documentary that I could relate to:

"We release people with two weeks' worth of medication. Yet it appears that it's taking three months for people to actually get an appointment in the community to continue their services … and if they don't have the energy and/or the insight to do that, they're going to fall through the cracks and end up back in some kind of criminal activity," warns Debbie Nixon-Hughes, chief of the mental health bureau of the Ohio Department of Corrections.

Nothing will make you feel so helpless as a former patient who calls from free society to ask how he can pay for his medication. Or who says the clinic won't take him because he has no insurance. The part of the quote I disagree with is the part that says the patient is destined to fall back into criminal activity. I cringe a bit when I hear mental illness and criminality being inextricably linked and inevitable. There's nothing like worsening the stigma of our own patients.


Anonymous said...

A few months ago someone had posted that link on a forum I often visit. It was really shocking. I knew there were a lot of mentally ill inmates, but it was a very eye opening documentary. I recently found out that my aunt had done something that landed her in jail for a bit about a year ago (she stopped taking her meds). Sadly, that was the best thing for her because it was a way for her to get the psychiatric care she desperately needed. I highly recommend people watch this documentary. I'm interested in seeing everyone else's reaction.

On the Same Page said...

What I found disturbing about the "New Asylums" is the marriage of mental illness and criminality; criminal survival "behaviour" of the mentally disordered seen and punished as as "common crimes." I have mentioned here previously my own observation of what I believe to be the misinterpretation of manipulative,"difficult" behaviour in a manipulative, difficult environment, as ASPD, far beyond acknowledged prevalence. The evaluation of "paranoia," in an exceptionally dangerous, violent environment is used to determine levels of custody and contribute to "predictions" of violence. I wear an on-body alarm and a whistle, and frequently a stab-proof vest and face-shield. What, me worry? Likewise, the fact that medical care in the CA prison system has been placed in receivership would seem to suggest that treatment on "the inside" is simply better than nothing at all. I by no means wish to be disparaging, but it speaks to the extent of my frustration and heartbreak. Sometimes it takes every ounce of compassion to keep going.

On a more positive note, CA Parole sets a condition for mentally disordered parolees to attend the Parole Out-Patient system where medications are dispensed without cost. You can actually be returned to custody for absconding from treatment. Oddly enough, there is even greater latitude in the Parole medication formulary (very close to the Medicaid formulary) than on the inside. While therapy services are, at best, sporadic, patients do get their 15 minutes a month with a psychiatrist (sigh). Nevertheless, only 38% of MI offenders who attend POC recidivate.

CA also has what is referred to as Short-Doyle & Prop 63 Funding that makes mental health care and medications available to most anyone except parolees. Working in an urban clinic for the persistently mentally ill, where three-quarters of the budget was devoted to psychotropic medications, we were aided by the pharmaceutical reps who would give us enough samples to get patients started and enrolled in the manufactures' "Patients in Need Programs" which provide medications without cost. The increasing "hoops" the manufacturers make an indigent patient jump through (e.g. a copy of last years W-2; "Oh, I left it at home in the dumpster") is another matter... Yeah, get me started, ClinkShrink.

ClinkShrink said...

What, me a provocateur? I'm shocked, shocked I tell you.

It's interesting about parolees being excluded from public mental health coverage. Here in Most Righteous State the mental health budget was recently cut back by 15%, and the first people the clinics threatened to drop were the forensic patients.