Do you think psychiatric care is inadequate in the US?

Nurses Activism

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In this country a scene all too common is happening over and over in this country: a deranged man enters a public facility and starts shooting everyone. Its found out later in the news that he was suffering from XYZ Mental Illness...

I wanted to start this thread after the tragic events that unfolded today in Connecticut (my condolences to all the families effected)

Now it seems like some of these events could have been stopped had someone noticed, or if the person had adequate access to mental health services

When i used to work in LA i did a lot of psychiatric transports on the ambulance (mainly 5150 holds). I've noticed a lot of these patients were given a couple meds and then thrown out on the street and forgotten till they act up again and go through the cycle again.

I personally think there should be more public education on noticing and reporting the signs of a person who is a threat to others or them selves or unable to care for them selves.

I also think there should be more funding towards mental health institutions as well.

note i am only speaking from what i have seen with my experience on the ambulance, if anyone who works at a psychiatric/mental health facility please share your thoughts as well

what do you think? is mental health/psychiatric care is inadequate in the US?

We used to call our pts the "identified patient" in a family. Often, that person was actually the healthiest member in the family because they were the ones acting out. Other family members were living in extreme environments and either scapegoating the identified patient or using any of a number of other mechanisms INSTEAD of acting out, such that they appeared "more normal" until you started taking a closer look. But actually, it's more normal to react to a negative stimulus than it is to deny it or repress it.

I appreciate that, but then why is the "identified patient" still the patient if they are the healthiest one? Wouldn't the family member who is the real culprit become the patient? I think this is part of the problem.

I am actually okay with people staying away from me if they don't like "mental illness" or it scares them. I don't want someone putting me down all the time. I am who I am. I am happy, healthy, and for everyone person who doesn't like me because of mental illness, there are about 3-5 people who do appreciate me as a person and my work ethic. Those are the people who I want to be around and work hard for and with. The other people tend to weed themselves out. Like they say, water seeps its own level.

I think a somewhat easy way to figure out if someone has a true mental illness instead of emotional moments is over a period of time, you should be able to identify maladaptive behavior/the problem and easily come up with solutions. I know when I dealt with the mental health system, no one could help me. They didn't know what to do for me because they couldn't really figure out a problem. If you can't define a problem, then a person doesn't have mental illness. Isn't that how you measure or define whether a physical issue exists or has resolved?

The mental health profession has really lost touch with what is normal vs abnormal. An example: My mom told be there is over a 1,000 ways to be diagnosed with PTSD. The new edition of the DSM will have over 10,000 ways to be diagnosed with PTSD. That means that the criteria is even looser and more people would fit that criteria. At this rate, everyone will have a mental health dx. It truly makes a serious issue into a joke.

Of course people who with no provocation take a gun and kill strangers are mentally ill or "insane".

Yet I also hate the stigma that mentally ill people are dangerous. To think that mentally ill people, insane people, people with psychiatric illness, crazy people....are a danger to society is the same as saying everyone with cancer is going to die of cancer. Of course it depends on what type of cancer.....as it depends on what type of mental illness and what family or medical support they get.

There is such a range of mental illness. People with severe mental illness are harmless and more a danger to themselves than society.

A highly functioning, intelligent, but lonely, antisocial, (or just doesn't know how to make friends), person may not easily be recognized by family, friends, or even mental health professionals as "mentally ill" and in need of an intervention.

Unfortunately none of my brilliant insight solves any problems.....hay how about making it more difficult for people to buy guns that shoot 100 bullets in 30 seconds.....what an "insane" idea!

Yes. It's why I'm becoming a PMHNP.

Closing down the state mental asylums in the eighties was a huge mistake. Yes, they needed reform, but institutionalization is preferable to having unmedicated, unstable people roaming the streets. Which is where they are now, of course.

Specializes in Med/Surg, Neuro, ICU, travel RN, Psych.

I work in Psych, on an inpatient acute care locked unit. There is a huge problem with the mental health care in this country. Yes, there is a huge stigma, but that is just the tip of the ice burg. Many states have the county hospitals being closed down. We recently lost 22 beds at my hospital due to not having a psychiatrist to cover them. We hold people in our ER for 2 days at a time, due to their not being a bed available anywhere in the county. Yet we continually admit people who really don't need "acute care". They get discharged, and are back 2 days later and readmitted. We have patients who medicare or medicaid refuse to pay for their admission, because they never should have been admitted. They are only looking for a warm bed and meals.

The wait to get in to see a psychiatrist can take months. We are constantly discharging people who don't take their medications, because insurance won't cover the medication they are on. So they are back in a month later due to being psychotic or hearing voices and it starts all over again. The formulary medications change so often for medicare and medicaid, the doctors can't keep up. The people who can't really function on their own don't want to live in the group homes and transitional housing places available, because when they can even get a bed, the staff is abusive, the environment can be dangerous.

The public and families are often so uneducated, and really don't have any idea what mental illness really is, it also provides many obstacles. Look at all the suicides of teens, and so many people say they had no clue the person was even depressed. People simply don't know what to look for.

Just to add, there are people who do heinous things, who are considered a sociopath. Which isn't really a true psychiatric disorder in itself.

I just read in an article that it was possible that Adam Lanza suffered from a personality disorder. That made me cringe because I do fear that people will associate any personality disorder (and whatever he had) with violence. I hope this doesn't happen. :(

Specializes in kids.

A huge part of the problem is that often in the teenage years, iwhen symptoms begin to manifest, they are ignored or unable to access care. In my experience teens are the most underserved population (at least where I live) ....had they been appropriately diagnosed and treated, maybe they would not struggle as they do as adults. I do not mean that all people who meet the DSM for a psychiatric illness struggle as adults, but many do, especially if they do not get treatment and/or if they "self medicate". THere are many barriers to care that prevent those intervention.

I am volunteering at a crisis center and my hope is to get a NAMI group going. I can't get all the colleges in the area because of the state line and funding from VA vs TN. But, maybe I can figure out something with those other colleges. I think I am going to maybe see if I can do some education in schools or tell the school nurse (at the VA schools) about NAMI. I think mental health issues needs to be taught in schools--all schools. Basic level in elementary, intermediate in middle and high school, and higher level in colleges. High school and college is when problems usually start to rear its ugly head.

Specializes in Adult/Ped Emergency and Trauma.

I just wanted to say wish_me_luck, I am so glad you have found your niche, you are going to change many lives! I am so glad I was blessed to witness it.

The Nursing Profession is very blessed to have your tireless drive to change things- I know you will:)

Great thread.

There was a great series PBS did that I managed find again via google that talks about how the deinsitutitonalization of U.S. psychiatric hospitals led to the correctional system becoming the replacement by default. The New Asylums | FRONTLINE | PBS

One other thought: Mental health is viewed as an essential service with healthcare reform; it must be included in coverage. I wonder how this will affect the quality of care. I hope the ACA works in favor of anyone seeking psyc. services.

I think the problems have mostly been mentioned by previous posters. The big problem that I see is that there are not enough beds for people who need them, and the problem is getting worse instead of better. Not only are more facilities not being made available, but the ones that do exist are being shut down. I'm pretty sure the reason I have a job right now is because a facility nearby got shut down so the facility I applied to has been flooded.

Another problem (in my opinion) is that drug addicts and people with mental illness are put into the same category. I realize that people with mental illness can also be addicts d/t self medicating, etc., but there are people with no real "mental illness" other than addiction. I think with addiction being such a huge problem the facilities should be separate.

It's a shame that someone who is having a true psychiatric crisis can't get a bed because Billy Bob who knows how the system works ran out of his pills and knew if he just went to the ER and said he was going to kill himself then he would be given a warm bed, food, and enough opiates to hold him over until his check came or his pills could be refilled, whichever came first. It happens every day.

I don't know what the answer is. I know that discharging people who are unstable or just barely stable on their medications is obviously not working. Some of these people can't be trusted to be in the bathroom with the door shut, but they're supposed to make it to the pharmacy to get a refill and follow up with their outpatient appointments?

Again, I don't know the answer, but there has to be a better solution. I'm sure the solution is probably expensive which is why it's still a problem in the first place.

Another problem (in my opinion) is that drug addicts and people with mental illness are put into the same category. I realize that people with mental illness can also be addicts d/t self medicating, etc., but there are people with no real "mental illness" other than addiction. I think with addiction being such a huge problem the facilities should be separate.

Substance abuse disorders are considered Axis I mental disorders in the DSM IV. I agree that substance abuse may be a coping mechanism for another underlying mental health condition. I understand your view, but I think of substance abuse as a legitimate diagnosis as any other.

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