Monday, March 23, 2009

Bad Ideas Abound, And Here's Another One

Anyone with a chronic illness often easily transforms into an activist with a cause, particularly when one has a pressing ulterior motive to see the development of more effective treatments and even daring to dream for a cure. Since I struggle with mental illness myself, I am always on the lookout for news stories like this. Shocking though this article is, I have to tell you from personal experience such things are hardly uncommon.

I've seen firsthand what happens when psychiatric patients are thrown together with addicts in an acute hospital setting. The results are frequently unpleasant. Once I saw a fight break out between two patients, one psychiatric, the other addiction, over something as silly as an argument over a dinner roll. The quality of care suffers as well, particularly when nurses and staff have to referee potential altercations when monitoring patient conditions would be time better served. Thus, dumping mentally ill patients into nursing homes peopled largely with seniors who suffer from senile dementia and Alzheimer's is another very bad idea.

In the past, it was believed that those with severe mental illness had no chance of ever living a normal life. They were therefore institutionalized for years at a time, if not for the rest of their lives. This gave rise to the sanatorium and the iconic images of gardens, well-tended lawns, and a bucolic respite from the bustling city in the quiet of the countryside. Such things do not exist anymore. With more effective treatments available from both medication and therapy, these places were shut down. Still, just shutting down an institution doesn't mean that mental illness goes away.

There are still lamentable psychiatric conditions like schizophrenia, for example, that modern medicine still cannot effectively treat with much success. A goal of being able to live a normal life for someone who is delusional or severely psychotic is not very feasible. This is what has given rise to dumping mentally ill patients in nursing homes. Without a family willing to care for them or without a knowledge of more effective treatment options worthy of pursuing, the close family of someone with severe mental illness often believes that institutionalization in a nursing home is the only option remaining.

Many state mental hospitals, as mentioned in the article, have also closed their doors as well. This is largely a result of the fact that many were often poorly-funded, badly run, under-staffed, decaying with age, and thoroughly unpleasant for all. The state of Alabama maintains Bryce Hospital in Tuscaloosa, but its barbaric conditions have been well-documented and the most it keeps a patient at any time is ninety days by court order. This creates a severe problem when patients spend three months inside, are released, have nowhere to go, live life on the streets as a homeless person, are rearrested, and then summarily sent back to Bryce. For many, this process is a revolving door that continues for years, never satisfactorily resolved.

Psychiatric beds in conventional hospitals are often in short supply, since in-patient hospitalizations for mental illness have increased with time. This creates a multitude of problems but two of them, in particular, are that patients are summarily pushed out and discharged before they are well enough; the other is that when beds do not exist at a psychiatric hospital or psychiatric unit of a conventional hospital, caretakers look for other options, nursing homes being a major one.

No system is perfect, but we could certainly be doing much better than we are. Much misinformation exists about mental illness, particularly among the undereducated and the poor.


Gail said...


Every thing you wrote is completely accurate. At my work - an in-patient treatment facility for addiction, our population is usually 50% or more with mental health diagnosis. this is a complicated and volatile mix, at best and sadly, our staff is NOT trained to meet the needs of all, effectively. The guise of all this, to keep the bes filled, is that we claim we 'manage' the mental health condition with prescribed medications we monitor which have been previously prescribed and/or clients are seen by our staff psychiatrist and medicated. This, magically, is suppose to allow the treatment of their addiction to be the focus - and it ususally never works out well. More often than not I feel like I am on 'riot control'.

In regards to the psychiatric hospitals - When most of them closed all of those abandoned people were left to fend for themselves - and they ended up homeless, in jail, in facilities like mine or dead. Tragic.

Our government has a way of dismissing certain populations that are too costly to maintain - I believe the term is "eugenics" -societal cleansing. Sad, but true. Inhumane.

My blood boils over such injustices - And I too live with a chronic illness - M S , and in many ways, I have been dismissed, as well.

Love Gail

Lisa said...

Well said, Kevin. I once worked in admissions for a private psychiatric hospital in Illinois. From the experience, I formed my opinion of the mental health system. It leaves much to be desired.

Utah Savage said...

Kevin, this is a very fine piece. But one of the this that happened under St. Ronnie along with union busting, deregulation was also the closing of all state funded mental institutions. This gave us a large homeless population, not seen since the end of the great depression. St. Ronnie was a man without a heart. Unless you were rich and attractive that is.