Do you think psychiatric care is inadequate in the US?

[MusicEMT]

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?

[Ntheboat2]

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.

I'm not saying it's not a legit diagnosis. It's just such a common diagnosis that facilities are flooded with addicts, sometimes legitimately, and sometimes because they are abusing the facility because they're withdrawling and will do anything to get an opiate or a benzo. You rarely see someone with depression or any other diagnosis go into the ER and say they're going to kill themself so that they can get admitted and get their anti-depressants for a few days. You see it all the time with addicts.

If there were separate facilities for addicts there would be more room for other patients. Substance abusers aren't the only ones who abuse the facilities either because homeless people do it too. I can't say that I blame them especially when it's cold outside. Until we have more facilities for homeless people or substance abusers then they will continue to get their needs met through the already strained psychiatric facilities.

[Topaz7]

Seems you have something against addicts... I work in addictions and I can tell you nobody wakes up saying " I think I'll become a heroin addict today, completely screw up my life up and family over." It's a valid diagnosis and unfortunately people view these patients with a very negative attitude the same as they view patients with borderline pd. these people are sick, do they have behaviors that irritate people? Sure but never forget they are sick and need help too. Also the homeless you speak of... Guess what? Many of them are homeless due to substance abuse and/or other mental illness.

[Ntheboat2]

Seems you have something against addicts...

Wrong. I'm not going to debate the issue here, but if you're really interested to know how I feel about addicts then you can read my previous posts on the specific topic.

And regarding the homeless...I actually said, "I can't say I blame them.."

It was obvious to me at least that the problem is with the lack of facilities and not with the people who abuse the psychiatric facilities d/t that.

[martymoose, BSN, RN]

Yes- lack of facilities- recently had a schizo-affective, other dx's pt, and it took them almost one full month to find a facility that would take the pt.- would threaten to kill us all the time. It had looked like there was a possibility that no facility would take pt. Would pt possibly been released to the streets? Scary thought- but think how many are like that pt that aren't treated??

[Topaz7]

I didn't realize I was talking to a 5 year old "rolling eyes." You sounded and still sound like you were being discriminatory against that population. Not wasting my time going to read your previous posts just like I'm done wasting time any further with this discussion. It made you sound like a jerk in my eyes. I'm not one of the people who endlessly troll these forums, I have other things to do lol.

[Ntheboat2]

I didn't realize I was talking to a 5 year old "rolling eyes." You sounded and still sound like you were being discriminatory against that population. Not wasting my time going to read your previous posts just like I'm done wasting time any further with this discussion. It made you sound like a jerk in my eyes. I'm not one of the people who endlessly troll these forums, I have other things to do lol.

Shining example of maturity!

[canigraduate]

Back to the topic.

I really do think mental illnesses go undiagnosed, or are diagnosed only at a crisis point. My entire immediate family is ADD and only one of us was diagnosed at the onset of symptoms. My youngest brother acted out a lot at school and was diagnosed at six. My other brother and I were diagnosed in our thirties. My mother was diagnosed in her late forties. My dad, who is WAY worse than the rest of us, is in his fifties and still has no official diagnosis.

I have a cousin who is bipolar and self-reports symptoms starting in his teens, but he wasn't diagnosed until he got in a fight in his thirties. I had a couple of aunts who suffered from depression that said it started in their teens and weren't diagnosed until their thirties.

I hate that so many of my family suffered for so long.

[kennybania]

Our job at my state run facility as it was explained to me is to get patients in, get them stabilized on meds with as normal function as possible, and get them back out into society. I read a study that stated up to 80% of schizophrenic patients are non-compliant with medication self administration. It seems to me, that a total overhaul of the system isn't going to make much of a difference if the individual isn't going to even try to manage their condition once they leave. As they say, you can't help someone that doesn't want to help themselves. As for the kid in Connecticut, I'm not sure what mental illness he had but they're isn't always obvious signs that someone has a mental illness and needs to have inpatient treatment. So I definitely wouldn't blame the psychiatric community for what happened yesterday.

[Music in My Heart]

I remember a time when we did not see mental health patients roaming the streets... and/or committing these heinous mass murders.

From what I've observed, these events are not being perpetrated by the street people who, by and large, don't have access to sophisticated weaponry.

[dirtyhippiegirl, BSN, RN]

Deinstitutionalization actually began with an unfunded mandate written during the Kennedy administration to move mental health services from large institutions to community-based programs. While economics certainly played a part, in the spirit of that era, a large part of the mandate was spearheaded by patient's rights advocates, as well as some research into alternative methods of delivering mental health care (group homes and halfway houses being big during this time), as well as perhaps the medical community being a little *too* optimistic about the effectiveness of breakthrough drugs like thorazine.

While there is a fundamental issue of lack of access to mental health facilities and length of stay, access to outside resources - even for people with good, private insurance - as several psych nurses have already commented on, compliance is a *huge* issue with the severely mentally ill. For a variety of reasons. Some of the basic tenants of deinstitutionalization were that people should not be forced into treatment that they do not want. The issue is much more complicated than many of the paternalistic "they can't take care of themselves so we have to take care of them" pro-reinstitutionalization posters make it out to be. And much more difficult than merely assuming that a lack of access to proper treatment is what causes relapse, non-compliance, or un-diagnosed mental illness. When compared to the past, it could simply be argued that the mentally ill or those deemed mentally ill simply had no recourse to say no.

Also, I am definitely against systematic screening of children and adolescents for mental illness. And this is coming from someone who spent the majority of her adolescence on mixed children/teenager units. I had a nine year-old roommate whom I later learned had systematically tortured and killed all of the family pets.

[Marshall1]

Another part of the problem, in my humble opinion, is people who recognize they or someone they care for has a problem are often unable to get help because of lack of access (it takes MONTHS to see a psycharists where I live) and if you don't have insurance - forget it. The low cost/free clinic is full up, there is no private or state mental health facility within 100 miles of where I live, neither hospital in the area offers psych and the only psych unit in a hospital w/in an hour from where I live admits/treats only those 55 and older. Another issue is the cost of medication - even with insurance. It prohibitive a lot of the time and the patient assitance programs the drug companies offer don't help everyone and usually are limited to a few refills or up to a year.

Another problem is we are overly saturated with the negative - 24/7 CNN, Fox, local news, etc. The face to face interaction of generations gone by are now replaced with facebook, text messaging, emails..I'm not saying these are bad or evil things - certainly they have their place, but, people are more isolated because of them and someone who is already struggling can be pushed further.

All that being said, some people are just evil - they are born or made that way - I don't know - but mental illness is one thing being evil is another and they don't go hand in hand all the time. Some people are just mean, abusive, violent and that does not need to be excused or explained away when they do something horrible.

Our judical system has also become one - at least where I live - that's soft on crime. People are given probation or short sentences because of jail space - well, jail isn't suppose to be a trip to Disney Land. I'm not saying be abusive of course, but cutting repeat offenders breaks and excusing their behavior because their mom didn't love them enough or whatever else they say is not helping. LOTS of people grew up hard - look at Joyce Meyer - whether you like her or not is not the point here - it's her history of physical/sexual and emotional abuse for years at the hands of her father - she turn her tragedies into good.

As far as guns, stricter gun laws will do nothing - if someone wants to kill someone they can use weapons other than a gun.

I don't know what the answer is but with the health cuts coming from the gov't things can only get worse.

[Multicollinearity, BSN, RN]

Psychiatry could do better, but I don't see that as the main problem in the US. I think the US culture is inadequate, and so is the legal system that (doesn't) deal with the problem people.