Tuesday, April 30, 2013

Where Do They Go? Finding Places for the Severely -- and Dangerously -- Ill Patient

A doorway into a bedroomIn the upcoming Mother Jones article "Schizophrenic.  Killer.  My Cousin,"  Mac McClelland talks about his third cousin who suffers from schizophrenia and ultimately kills his own father. 

McClelland talks about the difficulty in getting an ill person help, changes in how resources have been allocated which make this difficult, and fears about calling the police to bring a mentally ill patient to the hospital.  McClelland writes:

"You can call the police," the deputy director of Sonoma County's National Alliance on Mental Illness (NAMI), David France, said when I asked him what options are available to a parent whose adult child appears to be having a mental breakdown. "The police can activate resources," like an emergency psych bed in a regular hospital, or transport and admission to a psychiatric hospital in a county that, unlike Sonoma, has one. But only if the police decide your child is a danger to himself or others can they arrest him with the right to hold him for three days—what in California is called a 5150, after the relevant section of state law. Otherwise you can be turned away for lack of space even if your loved one is willing to be admitted, or be left no good options if they're not. Ninety-two percent of the patients in California's state psych hospitals got there via the criminal-justice system.

But Mark didn't want to call the police. For one, he didn't think Houston was dangerous, just upset, despairing. 

McClelland goes on to write about her aunt's devastating struggle with schizophrenia and the economics of decreasing mental health care dollars and beds.  

 Ah, California. No. 1 in the amount of mental-health funding cut from 2009 to 2011, No. 7 in cuts as a percentage. Home to one of the largest jail/psych facilities in the nation, the LA County Jail. Where visitors can't believe how many bat-shit-crazy homeless we've got. Where deinstitutionalization was pioneered under Gov. Ronald Reagan with the 1967 Lanterman-Petris-Short Act, which made it vastly more difficult to commit people, and where the rate of mentally ill in the criminal-justice system doubled just one year after it took effect. Where, often, the severely mentally ill live in jail for three to six months because they're waiting for a bed to open up in a psychiatric facility. California: where, says Torrey, the psychiatrist who warns about "predictable" violence like my cousin's, "they led the way in [deinstitutionalization], and they've led the way downhill. They're certainly leading the way in consequences

One psychiatrist we know called the article 'sensationalism not journalism,' and I'll leave that judgement to you.


roblindeman said...

"You can call the police."

Five words that tell you all you need to know about our treatment of the so-called mentally ill in the US. (Also tells you all you need to know about NAMI)

Joel Hassman, MD said...

Well, look at it this way, sensationalism does get attention, sometimes bad but sometimes well intended. We seem to live in a culture that these days people have to be negatively affected in fairly dramatic ways for change to be implemented.

Yeah, it is stupid and shows incredibly poor insight and judgment for things to be done differently, but, our leadership does reflect the constituency, true?

For instance, those here in Maryland, what do you think of this new "Rain Tax"? Anne Arundel County is rejecting it, yet, the Baltimore Sun runs an op ed piece that seems to relate how terrible things are in that county's government. Really?

Deeds, not words, are what define us. Politicians tell us they want to make mental health care options better, but, they cut funding still. And I will bet that 85% of incumbents here in the State win reelection by more than 10% Fall of 2014. Change?

Nice article to post on though.

Anonymous said...

The writer says this about the state of California:

"...visitors can't believe how many bat-shit-crazy homeless we've got."

About a mentally ill woman making a presentation at NAMI:

"I remember finding her totally weak and disgusting."

Bat-shit-crazy? Totally weak and disgusting? What I find totally weak and disgusting is that Mother Jones published an article where the author uses terms such as this. Her loathing of the mentally ill is evident through her use of language.

Even the lefty press seems to think it's okay to stigmatize those labelled mentally ill. Really, it's the last bastion of socially acceptable bigotry in this society.

Anonymous said...

Anon wrote, "Her loathing of the mentally ill is evident through her use of language."

That was my thought, too. Ugh.

Anonymous said...

It sounds like the incompetence of the psychiatrist might have been a factor in this horrific tragedy and not the fact that he didn't receive care:

""His dad, Mark, who had once struggled with depression and substance abuse but was now a pillar of the recovery community, and his mom, Marilyn, tried to help, took him to a psychiatrist. Houston didn't have a drinking problem, but he mostly stopped drinking anyway. He didn't smoke pot anymore, or even cigarettes. His psychiatrist indicated possible schizoaffective disorder in his notes, but put Houston on a changing regimen of antidepressants over the next eight months. It didn't make any difference. Houston had started stealing his mom's Adderall. He said it helped him feel better. He got fired from multiple jobs. Marilyn kicked him out, and he moved in with Mark.""

Why the heck was he put on antidepressants if the psychiatrist thought he had schizophrenia? And of course, the quick med changes sure didn't help matters.

""Toward the end of Houston's devolution, he started having violent outbursts, breaking furniture; he tossed his mom across a room. Desperate now, Mark and Marilyn called the psychiatrist repeatedly and asked what to do. He told them to call the police.""

Why the heck didn't the psychiatrist reevaluate the situation as clearly something was amiss? That is disgraceful.

And of course, once again, Fuller Torrey uses as tragedy like this to suggest that everyone who is mentally ill is guilty until proven innocent essentially wanting them to lose their rights. Again, he keeps claiming the lack of access when actually, it looked like the son who committed the crime was under the care of what appears to be a very incompetent psychiatrist.

A big fat sigh!


Jemma said...

It was a bit annoying that she kept trying to bring partisan politics into it, continually blaming Reagan i 1967 for having signed the Lanterman–Petris–Short (LPS) Act (co-authored by one Republican and two Democrats) into law all the way up to blaming the Tea Party for 2012-2013 budget cuts in Ohio.

Those opposing involuntary commitment in the 60s and 70s, no matter where they fell on the political spectrum, were mostly doing it on a human rights basis. My mom was one of them. you can argue that they might have got it wrong, but not that it was some Evil Republican Plot (stretching 45 years??!!).

I'm a lifelong Democrat/Green myself, but I'm getting sick of partisan political ranting getting injected into EVERY argument.

Dinah said...

I agree.