Requiring Treatment for the Mentally ill (State laws)

[I have WHAT in my yard?]

Yay Chicks! :

I worked for a number of years in community mental health. So many heart breaking stories. So many desperate families. So many times that I would send a person to the hospital because they were threatening suicide with intent and plan and when the arrived at the hospital they would tell the doctor that they were not suicidal and be released. Or they would be in a paranoid psychotic state, threatening to hurt others, but at the hospital they would pull it together enough to say that they were not a danger to themselves or others. And so the doctor, who has known the patient for 5 minutes, determines they are fine and sets them loose. The mental health wards in hospitals are always full and they work to discharge as quickly as possible. The make an outpatient appointment for the patient who, of course, then does not show up for the appointment. The system is a mess. Underfunded, those that want to help are worked to the point of exhaustion and paid so little that many, with expensive masters degrees, are barely making it. And the ill person just gets caught in a loop, hospitalization (or arrest), release, sent to outpatient, doesn't show up and round and round we go. I don't know what the answer is. But I do know that the 'fee for service' system does not work. That the levels of paperwork required to get funding to help these people leaves the workers using 70% of their time doing paperwork and 30% of their time trying to help a huge caseload. These are among the most vulnerable of our society. Most of them are not violent, but that is what you see in the news and so it creates an 'us against them' atmosphere.
This is too close to my heart and I am not being particularly articulate. I left community mental health because I got burnt out and discouraged. There is a huge turnover in these agencies which leads to a lack of any consistency for those being treated.
That's all I can say right now. Not much help from me, but I appreciate the forum to discuss this.

What she said.

Our program fell apart because after I had run it for over 5 years the feds decided I was not credentialled enough to be in charge. I essentially fired myself to try to hire on a PhD. The first one lasted about two weeks. The next one lasted a year. I don't blame them. Like I ended up walking away, like Yay chicks ended up walking away.

I remember one occassion I took a vet who had had a shrapnel wound to the frontal lobe that caused frontal lobe epilepsy and made him very violent. One day he came in and said he was seeing auras (often a precursor) and that he was having intrusive thoughts of killing his wife. I took him to the VA and the doc asked him if he wanted to kill himself. He looked at the guy like he was dumb and said No. The doc then proceeded to chew ME out for bringing in a patient that was not a danger to himself and stalked off. Apparently he forgot about the whole "or others" part. I was left driving a very violent patient back home. Half way there he told me to pull over as he was getting the urge to kill me. I let him out and drove away (no cell phones in those days) I got to the office as soon as I could and called his wife and the police. It was too late. He stabbed his wife 19 times.

The doc involved got "reprimanded".

The system is badly broken. Part of the same issue of blaming people and feeling like we as a society have no obligation to help those who cannot help themselves......​

 

[welsummerchicks]

ACTUALLY I don't think we need any new buildings at all - the EXPENSIVE way is how we're doing it now. The right way costs far less overall. I didn't dream that up myself. A doctor once told me we could provide housing, meaningful activities, medication, counseling and wellness checkups for every single severely ill person in the US for a tenth of what we spend on emergency housing, jail and court actions and all the repercussions to victim's families, etc. now. He said 'how we're doing it NOW is the expensive way, the right way is the cheaper way'

!!!!????!!!

He trotted out some 'real cost figures' and convinced me!

There is no reason why most people need to be hospitalized to start medication or change medication. They need to be seen frequently but usually do not require hospitalization.

With psychosis, most people start to improve very quickly and it's obvious the medication works - their sentence structure and every thing starts to change very quickly - BUT - what you don't know is how much better they'll get, a person can continue to improve for up to 12 months with some medications...and you don't know if they will stick with the medicine or not....that's the crux of the problem right there.

Medication doesn't fix all the irrational thinking, it only handles SOME symptoms. The rest requires community support, frequent visits, and a bond of trust and confidence between the patient and his Care Team.

Some people feel depot medications that last a month on one injection, are the answer.

I say no. In fact, I haven't seen the greatest results with depot medications. But I've never felt any pill or shot is going to be the whole answer. There needs to be a relationship, and people who care.

There are people like that out there, but the rules, laws, regulations, the frustration of feeling like they try so hard and still lose so many people, like the lady above, get burned out and give up.

 

[I have WHAT in my yard?]

Our program proved very clearly that such a program could reduce costs all the way around. That doctor was right.

But, mentally ill people don't vote. And their families often don't either. NAMI can only do so much on the lobbying front when they are up against Kaiser and other firms that want people hospitalized, heavily medicated or both.

 

[thaiturkey]

It's encouraging to read so many constructive and knowledgeable posts about this desperate problem and to see that some have been willing and able to do something about it.

On the subject of drugs, I believe that Psychiatrists are far too ready to prescribe them and do no more than that. In a hospital where each day I visited someone very close to me, I begged the staff to get on with treatment for her 'chronic depression'. They love labels, don't they? The answer was that she was so heavily sedated that no treatment was possible. From what I could see, patients were drugged for weeks until their behaviour was completely passive and then they were discharged, often only to return a few weeks later worse than ever.

My friend attempted suicide twice in that place. She walked over to the hospital pharmacy and bought 72 paracetamol. She was in the ICU for a few days but suffered no physical damage and was returned to the psychiatric ward. As a result of that she was put on 24 hour observation. I asked for a meeting with her doctor and nurse and they were angry at my intervention. I was intimidated by the nurse following us around the ward and grounds when I visited. She would sit or stand near us smirking and staring at me. A couple of weeks later, still supposedly under obs., she was found in bed with more pills, bought from the same source, falling from her mouth. She'd been there for hours according to another patient. Again, she spent time in ICU and suffered no lasting physical damage.

My friend eventually asked to be discharged with medication and the consultant reluctantly agreed because, amazingly, he could not find grounds to 'section' her. She asked to stay at my home and three months or so later she gassed herself in her car in my garage while I was on a training course.

During the visits that I made to that hospital, I saw staff taunting and poking fun at patients who really could not take it. They were too drugged to react but must have taken it all in.

A past patient returned begging to be readmitted because he felt suicidal. He was refused because he made a nuisance of himself previously. I doubt whether they, as employees in a State hospital, could legally do that.

A young woman patient would go hyper some days and run around yelling. She was discharged because of her behaviour. I suppose that the drugs didn't subdue her an the system had no other methods.

I felt that some of the staff were unable to cope with the demands of what must have seemed like an impossible job. In a way I can't blame them for acting unprofessionally when they see no hope of giving proper help to people.

The legal provisions for dealing with these patients in the UK, as I have previously described, seems to provide a sound framework. The problem is that, despite all the skill available, staff resort to drugs for an easy working day for themselves.

One reason for the poor treatment of emotionally and mentally ill people is, I believe, the general uncaring attitude of the public. As is often the case with a difficult problem, it's easier to spout some facile suggestion as to a solution rather than consider properly what could be done or lend a hand.

I don't want to broaden this discussion off topic but mentally ill people are just one group in society that are dismissed as nuisances and not given proper consideration.

 

[redhen]

I think that if someone is really determined to commit suicide.. they WILL find a way.
No matter how much unwanted intervention they get..
Just my opinion...
My grandfather did it.. trust me... he knew what he was doing. He wasnt playing around... he was a WW vet and knew how to end his life and be sure about it.
In my opinion... most suicide "attempts" are a covert cry for help... they dont really want to die... they want help or something.
But when someone REALLY wants to die... they simply just do it quietly.

 

[Mattemma]

I think it is unfortunate that the funds are cut to help the mentally ill.

I recall seeing a story about a jail that is set up for sex offenders. Atleast they are not being released but this *jail* was set up like a mall. The sex offenders had a better life than many good citizens. I did look it up online to verify the place existied,because I just could not believe people would want to fund such a place. Sex offenders deserve a coffin cell not a hotel setting. It is sad that money could not be spread out a bit more for other people in need.

http://www.insideedition.com/storyp...al-sex-offender-hospital-costs-taxpayers.aspx


http://www.dmh.ca.gov/services_and_programs/state_hospitals/coalinga/default.asp

Sadly little or nothing is done until something happens.At that point what good is it when a loved one is hurt or killed? I have read the guy here in Ohio who had the 13yo tied up in his basement had mental issues,but ofcourse he was not breaking any laws.Now an entire family is missing. Sad.

 

[welsummerchicks]

Middle class Americans trying to afford psychiatric medications have a number of options, especially the pharmaceutical companies which provide medication free of charge to a large number of people.

Additionally, many doctors used to 'pass out samples' for years, to patients who could not afford medication...unfortunately there seems to have been a big crack down on that.

While some may see 'drugs' as an 'easy solution', research has shown that for many serious disorders, they are an indispensable part of treatment. Counseling and supportive environment and schizophrenia, for example. Treatment success is very good when medication is adhered to, but it is EVEN BETTER with practical, schizophrenia-relevant counseling/therapy, supportive housing and education of family members. BUT...WITHOUT medication, NOTHING is successful.

I find it very strange, as an American(with experience with American hospitals and programs), that a person would be 'sedated' by any 'antidepressant'. I do know that in the US, many patients are too embarrassed to admit they have psychotic symptoms, and with psychotic symptoms, there may actually be a need to put up with a medication that causes sedation - hopefully only briefly - til they get used to it, switch to a similar medicine that helps but does not cause sedation, or get a dose adjust from their doc.

But depression is not always so simple. It's often a part of bipolar (formerly manic depressive) disorder. The person then isn't actually 'down', their mood is 'unstable' and only LOOKS down right now, because you're seeing them in the bottom of a 'down' period. People quite often just say they have 'depression' when they actually have bipolar disorder, though in the USA, it's far more sociably acceptable to admit one has bipolar disorder than schizophrenia.

Medications which control that condition may initially be sedating, and may initially require a lot of adjustment.

Too, severe unipolar depression rarely responds to just an antidepressant, the doctor may find himself struggling with combinations of medications, and tuning each medication to get the results the patient needs. The doctor may try a number of times to try and find a combination that works for the person.

Finally, there are - and they better be very, very few or someone isn't doing their job - a very, very few patients that are so sick, have been so long without treeatment, and have such a severe illness to start with, that their treatment is a compromise between safety and sedation. In the past, sedation was accepted as a part and parcel of the older medications. With the current situation in America, sedation is far, far less acceptable, even for doctors and hospitals.

We no longer have many issues with 'control and custody' of patients and 'wanting to keep them shut up', because they aren't in the hospital long enough for that to be an issue! Further, patient's legal rights to refuse medication have been so highly emphasized in recent years in the US, that there is great, great pressure to prescribe with a very, very light hand.

SO....

First - in a few weeks, the medication may no longer be sedating, when the person is used to it.

Second, the person may need to be sedated if he is violent, self harming. Many places, there is no choice. It is so difficult to get restraints ordered except for very brief periods, that all they can do to prevent violence or self harm is prescribe a sedative.

Third, the person may ACCEPT no other medication than a sedative. Patients often refuse antipsychotic medication, but are willing to take a sedative.

Fourth, the person may be feigning sedation - it's a not uncommon tactic of suicidal people to feign a degree of sedation, so they will be more free to self-harm, the doctors and nurses may feel when sedated the person will go to bed and not harm him/herself.

Fifth, the hospital may be allowed to give a patient sedatives against their will, but no other medications. The sedatives are used in case of violence, self harm. These 'PRN' medications may be all the hospital has the power to insist the patient take.

I DO agree....a person who wants to commit suicide will be very persistent. But that's the point, many suicides are not like that at all - they're sudden impulses. I don't agree that that means that we should sit back because prevention is hopeless...and yes, I've lost loved ones to suicide, so I do think about it in a direct, not a theoretical, way.

However, research proves overwhelmingly that the vast majority of people who commit suicide are suffering from inadequately treated depression, and that most of them have many options other than offing themselves...they can't see that, because they are depressed. In other words, most people are committing suicide not because of life events that upset them, but because of depression - untreated depression.

Depression, and no I'm not talking about the 'situational blues' or 'problems of daily living', I'm talking about the disease depression which causes irrational thought and sudden impulses to self harm, depression to my way of thinking is not in and of itself a valid reason for suicide.

Depression is treatable - all mental disorders are treatable, but depression is THE MOST TREATABLE...and the most often UNTREATED or INADEQUATELY TREATED!

The simple fact is that those antidepressants which are so easily prescribed to so many people by GP's - can take months - three to six months, to improve mood, and they only work on ONE 'depression chemistry path' and not on others.

The person might start a medication, and still have MONTHS of depression ahead of him even if that medicine is going to work. And if someone doesn't tell him how long medications can take to work - he can get awful, awful discouraged. Most likely, he needs an awful lot of supervision to get safely through that waiting period...he may even go several months, be a 'non responder' to THAT med and have to go through trying ANOTHER medicine!

This isn't because 'medicines don't work' or 'doctors are stupid' - these are the built in, inherent problems with depression, because there are different chemical pathways that produce depression. And we don't have any approved, insurance-pays-for ways of determining which a depressed person has, except crossing our fingers and praying we can get our loved one through the waiting period!

We see on the outside, the behavior, the result. But what chemistry is wrong in that brain, a doctor is doing his VERY best to figure that out, but he is doing it without being able to watch that brain directly enough.

Some experts say that depression actually is a kind of chemistry mistake that cropped up as hibernation or hibernation like adjustments, developed in early humans. It's also possible that different groups of humans actually developed DIFFERENT flaws in brain chemistry as hibernation evolved. Now we are a global community, and we have perhaps even DOZENS of chemistry flaws under the hood, that cause that visible result we see, depression.

When I was working at a crisis center, we were, in following our mission statement, extremely proactive about stopping suicides of impaired people. People on drugs, mentally ill people, autistic adults, even people under severe duress such as war or natural disaster, are characterized by impulsivity - that is - their brain gets these sudden strong urges and they act on them as the only course. All options disappear and they jump at that impulse.

When a person is in intractible physical pain, and makes the decision with a clear head, to end their life, we tend to kind of understand suicide. But when an autistic adult throws himself off a bridge because 'if I hit my head hard I will become normal', or if a schizophrenic person, is happily enjoying his family and in the midst of that, leaps out a window and dies (as my friend's brother did), that is due to impaired thinking, impulsivity...not a carefully reasoned out response to hopeless situation.

We tend to still think of major mental illness as 'hopeless', 'a tragedy' and 'terrible', and so tend to 'kind of understand' a person wanting a 'relief from suffering', but as far as what knowledge and discoveries are available and could be made use of, if we find suicide as an 'understandable response' to mental illness, we are operating far in the past. Today, there are specific treatments for mental disease, and suicide need not be 'understandable'. It does not have to be a 'tragedy' or 'hopeless'. There is much in our system of laws and our economics that is extremely unhelpful and even crazy - but the diseases, the disorders themselves, there is no actual REASON they have to end in tragedy, despair, or as 'hopeless'. And therefore, no actual reason suicide really is 'understandable', except due to our fractured, inadequate system which is creating tragedy where none need to exist - that is economics, policy and law and outmoded ideas, not the nature of the disease and its treatment in and of itself.

 

[welsummerchicks]

"The doc involved got "reprimanded"."

The VA has gotten a lot more scrutiny of late, and hopefully, at some point, people actually will start sueing doctors, hospitals and agencies for lack of effective action.

Unfortunately, there is built into our legal system, a certain amount of 'they're dealing with real tough problems, budget cuts and complex diseases...it's not their fault'. There's also the FACT that these folks invariably 'follow the rules', AS the rules exist. This is a very big problem of trying to take them to task.

The trouble is that suicidal patients often make comments without editing themselves in front of nurses and volunteers, but they are able to realize that if they share that with a doctor or another person with the ability to detain them, they WILL get detained.

That's something that's not so easy. There are people that need to get on medication right when their symptoms start, and stay on it...and they refuse to do that.

That's not 'the medication's fault', the medication doesn't fix all disordered thinking, it can't fix everything.

And quite a few patients learn how to 'work the system'.

As a volunteer, I was often told things that were very much about harm to self or others. The patients would simply deny it if questioned by their doctor. In some cases these involved grave harm to others from patients with a history and convictions of violence. So I do get what you mean.

In a sense, the system of making the doctor the only person who can report danger or determine if it exists, is rather flawed.

First of all, it isn't all that simple. Disease changes over time, worsens, improves, symptoms change, even based on the time of day or situation. Even very sick people often hang on as long as their routine does not change. But change the routine and there can be a tragedy.

A man killed a worker who came to his apartment to repair his door. The worker was unannounced and the man was terrified. The man had no history of violence and was under-treated (as about half of schizophrenics and possibly even other conditions are). In the face of an unexpected situation, he could not cope.

By the way, 'compliance' with medication is very low for nearly ALL conditions that involve taking medication daily. It is actually higher than average for the more severe psychiatric disorders. But when a person doesn't take his medication and has heartburn, the consequences are a lot different from the potential results when a person has a psychiatric disorder.

And you really can't 'decide' which patients are 'important' and which ones 'will become violent' and which will not. You can follow statistics and general trends, but you really, really can't say for sure, 'this guy will never become violent, let's ignore him'.

Psychiatric disorders can also be 'under managed'. No one may notice when a patient's disease worsens and he needs a medication adjustment. He may be 'compliant' and take his medication, but be on the wrong protocol for what his disease is right now.

It's really not so terribly easy to determine who is 'dangerous' and who is 'not'. The law that uses that as a criteria for who 'needs treatment' is severely flawed and ignores the characteristics of the diseases - everyone 'needs treatment' if they have one of these diagnoses. It is really not possible to predict who will harm and who will not because of the very nature of the diseases. Circumstances change, the disease itself changes with time...and situation.

For most patients, 'violence' is beside the point.

For all psychiatric patients, treatment isn't REALLY designed for 'controlling symptoms' as much as it is about preserving independence, providing a quality of life, allowing a fuller life than the person would have without treatment, and preventing deterioration which leads to dependence, victimization and death from ordinary health problems because the person is too mentally sick to know he needs to go to a doctor.

From the patient's view, treatment is supposed to limit the impact the disease has on his life. If he harms someone, it will have a horrendous impact on his life. But if he never harms another person, and is simply allowed to deteriorate until he lives an isolated, paranoid and highly restricted life, ending in total dependent care, that has a huge effect on his life too.

 

[thaiturkey]

Welsummerchicks, thank you for that information and insight.

On the subject of paedophiles, many if not all of those people are mentally ill too. Many were themselves abused as children. The appropriate treatment for them is just as difficult to prescribe as it is for many other types of mental or emotional disorder. The question of incarceration is the same for them as it is for other violent criminals. Child abuse is huge subject and ranges from sexual abuse to the much more common physical and emotional abuse. Paedophiles are often protected by a network of silence and secrecy either to protect the reputation of the school, church or whatever other organisation is involved or because of the perpetrators own influential connections. Some paedophiles are actually weak minded and pathetic but some are brutal. In the case of the latter, probably the only reasonable course of action is to lock them up because they are not interested in a cure, counselling or any such help.

Mattemma, I notice that the establishment in your links was designed for 'forensically committed individuals'. Most, it says, are paedophiles but the facility is not exclusively for them. I suppose it's good to give them a pleasant environment but, as you point out, many others would also welcome such surroundings. How does it work? Are all convicted paedophiles labelled as people who should be 'forensically committed' or are some just seen as nasty, abusive bullies and locked up in a more traditional way?

 

[welsummerchicks]

'pedophiles are mentally ill'.

By definition of diagnosis(IDC-10 or DSMx), pedophiles are suffering from a sexual disorder, not an axis 1 disorder ('major mental illness'). Are they 'mentally ill'? It depends on how you define mentally ill.

In my experience most pedophiles are not mentally ill, a person can be very disordered without having a mental illness. It is a personality disorder or sexual disorder.

•“96% of female rape victims in 1991, younger than 12 years old, knew their attackers. 20% were victimized by their fathers or step-fathers.” (US Department of Justice)

•25% of prisoners who victimized children had prior convictions for violent crimes. (U.S. Department of Justice.)

•Between 1976 and 1994, almost 37,000 children were murdered. 66% were less than 1 years old and 58% of those from 1 to 4 years old were killed by beating with fists, or blunt “Family Members or Acquaintances commit most of the Child Murders.” (objects or by kicking. (U.S. Department of Justice.)Bureau of Criminal Justice Standards.)

•1 in 5 violent offenders serving time in a State prison reported having victimized a child.

•Inmates who victimized children were less likely than other inmates to have a prior criminal record–nearly a third of child-victimizers had never been arrested prior to the current offense, compared to less than 20% of those who victimized adults.

•Violent child-victimizers were substantially more likely than those with adult victims to have been physically or sexually abused when they were children, though the majority of violent offenders, regardless of victim age, did not have a history of such abuse.