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?

[tinyonern]

I have a child with Asperger's. She is doing very well, but not because of the system, but because she has worked very hard. Now that she is an adult we have to "prove" her ongoing disability to my insurance company every year to keep her coverage, even though she has been covered by them since she was born. She does work although only part time and that is also with support from a job coach. She will probably never live independently. Without insurance her meds would cost over $500/month. Why do we need to stress every year that we will miss some paperwork and she will be des-enrolled from coverage?? Her needs aren't great, and it is still a struggle!! She has a friend with schizophrenia who has very little family support. This friend frequently goes off her meds because she can't afford them, can't get them (doesn't drive and we have poor public transportation) or thinks she doesn't need them. She then ends up in the hospital. Wouldn't it be way more cost effective to have an outreach program that assists her?? I strongly suspect she will end as a suicide, of course a huge risk with her dx. There are no programs in our area to effectively help her....and she is just too needy and involved for me to (since I have MS, am dealing with severely demented family member, have another elderly family member with mild/moderate dementia who still lives alone, yada, yada...). What few programs are available keep getting their funding cut, so they basically just do crisis intervention, rather than prevention. This is obviously an area of great frustration to me!! Mental health services should be easier to obtain than a gun....

[Music in My Heart]

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

Sure, if they want to kill someone... a blade will suffice..

If they want to kill 20, 30, 50 someones, however, they'll need either explosives or guns.

And I've noticed that the regular use of explosives on the general population is limited... and that appears to correlate to very strict regulations on possession of explosives.

It takes real skill, and time, to kill with a blade or an arrow... it requires little of either to kills with an M4 and a high capacity magazine.

[Ntheboat2]

Sure, if they want to kill someone... a blade will suffice..

If they want to kill 20, 30, 50 someones, however, they'll need either explosives or guns.

And I've noticed that the regular use of explosives on the general population is limited... and that appears to correlate to very strict regulations on possession of explosives.

It takes real skill, and time, to kill with a blade or an arrow... it requires little of either to kills with an M4 and a high capacity magazine.

AMEN!

I've seen so many gun lovers (that's how I describe them bc they're in love with their guns apparently) use the story of the 22 children in China who were attacked with a knife to "prove" that banning guns won't stop "evil."

I said, ALL OF THOSE KIDS IN CHINA ARE ALIVE! Are you kidding me comparing a knife attack where all the kids are alive to a gun attack that turned into a massacre?!

I don't get it. Nobody needs a gun that shoots 100 rounds in a matter of seconds in order to "protect themselves." Ugh this makes my blood boil.

[Ntheboat2]

I think people are afraid to take their children for psychiatric evaluations if/when they do notice signs and I can't blame them. My daughter recently said some pretty disturbing things to her counselor at school and I had no choice but to take her for an exam. Still, I was terrified that they were going to take her and put her in a facility. Even if it were for one week that would've been too much to handle. She's not even ten years old...not even close.

Luckily, the person who did her initial assessment said she didn't think there were any psychiatric issues, but just a very smart and imaginitive kid who didn't realize the consequences of what she was saying. Thank goodness.

[nrsang97, BSN, RN]

Well, duh.

I think of it like this: how healthy would people be if there were only emergency rooms? No hospitals, no continuing care. That's how I think mental health is treated. It's awful.

I also think it's seriously overlooked, ignored, and undiagnosed in the general public. If I had my way, signs of mental illness and pathways to receiving treatment would be taught starting at the elementary school level, along with basic health. I still remember being taught how to brush my teeth when I was in kindergarten, so the lessons learned that young can stick with you. Why not teach kids to tell an adult if they are having symptoms?

I truly believe my brother in law would have been diagnosed so much sooner if my mother in law would have listened to the signs/what he said when he was younger. He told her he felt "The devil was after his soul" and she ignored it. She told me "You never want to believe something is wrong with your child." While that is true, she completely ignored him. He was not diagnosed until he was 32 with schizophrenia. He was hearing voices, God only knows what he was hearing from them. He ended up begging them to take him to the hospital wanting to commit suicide due to the voices. They would hear him in his room yelling at the voices just before that.

Unfortunately there is so much stigma attached to a mental health diagnosis. Trying to make an appointment is a darn nightmare too. My grandma has paranoia with her depression and trying to make an appointment in a reasonable timeframe is awful.

[Wrench Party]

Staying off the gun part of this topic...but yes, I firmly believe that psych care is inadequate from my own experience. I used to work with the homeless population in a nearby city serving meals and distributing blankets, and nearly every one of them self-identified as having a mental illness and/or substance abuse problems. If they couldn't get into shelters for the night,

they would camp out on the old state mental hospital grounds (irony, anyone?) or sleep in abandoned houses.

It was considered risky, but we ended up taking in some of the women on several occasions, because I couldn't

stand hearing their stories of prostitution or abuse that happened to them on the streets. We all know this, but without

proper treatment, the homeless get stuck in a cycle of drug abuse, violence and poverty that shadows the recurrence

of their symptoms.

I would love if adolescents in schools were screened for common psych disorders and offered support and treatment, because

many of the homeless started having their symptoms during that time. I know it's not as simple as screening for scoliosis,

but it would prevent a lot of problems down the road.

[RNperdiem, RN]

If you turned the question around to ask : Where in the world is psychiatric care adequate? I would love to know.

[guest416560]

As a NP who sees numerous patients with severe mental illness, I am all for more institutionalizing of the severely ill patients. I can prescribe all the typical, atypicals and lithium I want but if the patients don't take the medicines it doesn't help. Every week I have to send a patient to the ER because they have a breakthrough due to medication noncompliance. It is an epidemic.

In regards to guns being the problem.....I highly disagree. Anybody could go to the local hardware store, buy a sack of fertilizer, mix it with diesel fuel and make a bomb that can kill hundreds. Oklahoma city comes to mind. If an evil mind wants to kill they will. Banning assault weapons will only make the evil mind find an equally distasteful alternative.

[wish_me_luck, BSN, RN]

rnperdiem, that is a valid point. I know I have read articles in regard to UK and Australia's mental health care and they too are lacking. As a matter of fact, an in-patient stay could be quite traumatizing there.

[Guest343211]

To the originally posted question,Most probably. It's hard to make work, however, when people must take responsibility in their own mental health work and processes. And each individual, in so far as he or she can, he or she must. But often people get around this, or level for self-initiative is unclear.That's the real issue financially, and otherwise.

People that aren't on the cusp of going totally psychotic don't get enough help or really work the process for themselves in order to be their best and healthiest. They don't do it for their marriages, or even their children...and these are people that are higher functioning than many of those closer to psychoses.

Until you address the greater issue of individual reponsibility, you are spinning your wheels.

And insurance companies will look at numbers of those that showed lack of compliance and all the money repeatedly wasted on these people in programs--and they don't really do the required work to get better.

I am not making a judgment per se on it, but I will tell you what payers are looking at.

[azhiker96, BSN, RN]

One big problem is those with mental disorders usually don't see themselves as having a problem. They don't seek help and if offered will often refuse it. I know a woman who would threaten to kill her husband on a daily basis. However, since she had not yet caused harm the family could not get her treated because she refused meds. Finally she started refusing her diabetes meds and a judge then agreed that she could be forced to take treatment because she was harming herself.

In the old days non-violent people could be institutionalized indefinitely. There were abuses of the system. Then patient rights advocates got the pendulum to swing the other way and we are living with the consequences. Treatments can't work if the ill person refuses them.

[PMFB-RN, RN]

Banning assault weapons will only make the evil mind find an equally distasteful alternative.

*** Not to mention that what the media calls "assault weapons" are not fundamentaly different in function than hundreds of firearms not labled "assault weapons". What ends up happening is that certain firearms get "banned" (well not really, at no time during the last federal "assault weapons" ban were the "banned" weapons unavailable for sale at the local gun shop, same for high capasity magazines, hough he cost of them did go up) based on purely cosmetic grounds.