Wednesday, March 08, 2017

Really? Can't we be nicer? Objecting to sending those in mental health crisis directly to jail.

Hi, it's been a while.  I have been ranting in other venues, and caught up a bit in the All-Trump-All-The-Time phenomena.  

So my latest thing to rant about is hospitals that send patients to jail when they don't have beds.  I don't mean people who've committed crimes, I mean people who are in crisis, who are presumed to be a danger to themselves or others.  Here are some of my thoughts:

On Psychology Today's website, I wrote "A simple solution to the bed shortage? Unfortunately, Jail"  The link to that is Here.
Over on Clinical Psychiatry News, I did a little more research on the topic and spoke with the reporter, one of the doctors, and the Rapid City Sheriff. See "Mentally Ill? Go Directly to Jail"
The link to that is HERE.

But I've learned that it's not just in Rapid City, South Dakota where it's an issue -- oh, and the sheriff there is apparently refusing to take these patients -- but other states have these issues as well.  My friend, Pete Earley the mental health advocate has been kind enough to share my outrage HERE

On Facebook, I've noted:

When we submitted our book proposal for Committed, our editor told us we had to take a stance and the message had to be something more than be kind to patients. Lately, I'm thinking that "Be kind to patients" is not such an obvious thing in our crazy world. Last week, I wrote an article about a hospital in Rapid City SD that announced their overflow psychiatry patients would be held in jail (--I researched the article after I first saw it on this FB page, so thank you to the poster). Today I read that in 6 states people in mental health crises can be (and are) held in jail when there are no hospital beds available. These are not people who have committed a crime. Why, as a society, don't we think this is unconscionable? Could you imagine going to the hospital for pneumonia, being told there were no beds so you were going to jail? Why is jail ever an alternative to health care? What is wrong with us?
 Mostly I've been surprised at how little outrage there is, though I hear the APA is now writing an action paper to oppose jailing psych patients. Will that help? Does anyone read APA action papers?  Commenters say, well, most mental health care is given in jail (and, sigh, we seem to accept that as okay), but this is different: these are not people who've committed a crime, these are patients going to an ER for help!  They haven't broken a law, they aren't under arrest.  Advocates want to increase laws to make it easier to force care, how about making it easier to access care in a humane and kind way?


Anonymous said...

Actually, the largest problem appears to be the rampant, minor microaggressions, often deliberately heaped upon a person, that have not been remedied by our society. Ignorant people then label the targeted person as mentally ill, often duping the responding law enforcement officer(s) into believing that the true criminals are innocent parties.

Back when I was growing up, and during my first twenty to twenty-five years in the work place, bullies were not tolerated. Sometimes what might be considered a bully was actually a person ignorant of the lawful, cultural norms, and would willingly comply when things were better understood. Other times, the bully, had to be threatened with ejection from school, the workplace, etc., to get them to comply.

These days, under-performing, under-achieving packs of bullies frequently target a person, and harass them, including all the way into death, for the bullies' enjoyment, and sometimes for monetary gain. In addition, lying to harm the target is just considered part of the fun -- the more involved and harmful the lie, the more entertaining it is.

What needs to happen a lot more than it currently does is for Law Enforcement to look deeply into these abuse victims, often erroneously labeled as mentally ill, and get to the truth. A LOT more work, for the first few cases, but the investment pays off in the long run, by restoring and expanding stability among the communities, and penalizing the actual criminals.

And psychiatrists, please quit over-utilizing the allied mental health care providers. Your much higher intellects (on average), combined with getting out among your fellow human beings, outside of hospitals and other skewed experiences, will go a long ways towards restoring our communities. Physicians -- please, " Do no harm." Quit pathologizing people, for the short-term convenience of others, which often includes secondary gain for family members, employers, etc. The current over utilization of the mental healthcare system, to perpetuate harm to victims, also marginalizes the victim, often for life.

The path we are on, is not sustainable. Our best and brightest have been victimized too much, including by employers of thousands of physicians via under-compensated over-work, and the victims are often no longer in the workplace. They choose to drop out of our malfunctioning society, rather than engage with such needy and greedy that over-populate too many workplaces and other venues.

We are all much poorer for tolerating the illegal behavior of needy, greedy bullies, that will NEVER be satisfied, accept for the occasional few that can have their personality disorders successfully treated.

Anonymous said...

Hmm, maybe the question that needs asked is why are so many people going to ERs and other acute care facilities allegedly needing inpatient care, when there are questionable issues confounding the initial presentation, like: substance abuse/dependency, lurking legal issues not immediately an issue but to be dealt with shortly, and the undiagnosed medical issues poorly if not neglectfully worked up that have psychological symptoms, and yet the medical facilities like ERs are not interested to pursue further?

I agree fully with your overall point, people who have committed NO crimes do not belong in correctional facilities to "house" them, but, what percentage of these people who are allegedly stuck on hold have potential legal issues pending? I don't know the number, my guess is about a third, but, then the alternative, why are 33% of people who really more likely belong in correctional facilities are instead housed on Psychiatric inpatient units?

Ah, don't you love the pendulum, getting "clocked" every time it finishes it's swing in one direction?!...

Joel Hassman, MD

Anonymous said...

2nd from this "Anonymous":

Maybe having Law Enforcement officers available in the ER would provide the level-headed guidance needed, along with an avenue into investigations of abuse. So much of the abuse, these days, is often subtle and a combination of efforts of many bullies. In addition, the bullies may be individual bullies lurking amongst employees of otherwise decent and law-abiding companies and organizations.

Right now, the physicians and staff members may only be able to offer sympathetic ears and many have not experienced the abuse that can be very frequently meted out, especially by under-performers, under-achievers and other people with unaddressed issues. I hesitate to call those issues "mental health" because it unfairly stigmatizes the vast majority of those with mental health issues, that are law abiding.

Hopefully, with this pendulum swing, our society will finally "nail it" and we will be right in the center -- all of us with reasonable burdens and sufficient resources with which to resolve them.

Anonymous said...

And for perspective, our current rate of completed suicides in the USA is roughly 40,000 per year. Of those deaths, 4000 -- 6000 lives are lost due to workplace or academic institution bullying, often with the higher performing individuals being the ones targeted. Another 10,000 lives are lost to suicide because of false allegations made against people, with foolish and/or mean people handing out "vigilante injustice" because there was zero crime in the first place, before they engaged in criminal activity.

Adding to the toll on our healthcare dollars, and our economy in general, is that ten to twenty times the number that complete suicide, attempt suicide, incurring varying levels of morbidity and disability.

Our families have been damaged and destroyed by criminals and charlatans pretending we have a healthcare crisis, when in fact, we have a crisis of too few people governing their own lives by them acting in moral, legal and ethical ways. These charlatans and criminals prefer to meddle and destroy others' lives rather than productively work on fixing themselves, or at least, minding their own business.

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Unknown said...

Wow. So glad I live in Canada. Everything in the US just seems to be going backwards. You people are devolving to the Middle Ages. It's gotten so bad that Canadian schools will no longer take their students over the border for field trips and many private citizens are afraid to cross the border into that insane country to the south of us.