Do you think psychiatric care is inadequate in the US?

kcmylorn · Dec 22, 2012

Going back to what someone posted earlier- about the violence in music, in video games and on TV- the how detached society has become with facebook, twitter etc, and the way our society is, I would love to see a large scale concerted effort on all the manufactures and producers of these various products, be mandated to just stop. We brought up the subject of obesity- part of the national public health effort to address the epidemic of obesity is targeted at children with the curbing of advertisers of McD, and all the other fast food, junk food companies to not air their advertisment during the after school hours and to limit children's TV and sendetary habits to 2 hrs/day. I think a restriction on these venues would be a good start. Our society as a whole has to do a major 360- this meanness and cruelity attitude that prevails has got to stop. This- it's all about ME. This business model mind set,has got to stop. The philosophy of profits before people, has to stop. There truely is a lack of caring in our society. I remember seeing news peices of the Occupy movement in NYC and some blonde sitting on the balcony of one of the wall street brokerage buildings, laughing at the protesters, drinking champagne and toasting in mockery - she's lucky some one didn't pull a gun out and shoot her arrogant behind or a bunch of innocent people in an misdirected agitated rage over that. This is an example of how our society fuels this kind of violent behavior. ( cause and effect, every action has a reaction, all behavior is meaningful)

But it should also go hand in hand with vast improvements in our mental health care delivery- the better salaries for our mental health professionals, god knows they are in very short supply, which accounts for the long wait to get into seeing them. This I know from working outpatient family practice- these patients are on waiting lists for alot of time- 6 months, unless there is a verbaiization of suicide -then they can get into an ED and be evaluated immediately and maybe, hopefully, admitted before they do harm to themselves or someone else. But if it's a patient with a diagnosis of cancer, whose having a tough time dealing with it, and it's causing work related problems, and the patient is in danger of loosing their job and therefore their private insurance coverage.- this patient has to wait 6 months!! How long before this situation deteriorates into something more serious! This is a problem. The patient may well have insurance, but has to wait for an extended period of time to be seen/access to care!! What about the paerson who has been unemployed for months on end, no insurance- that person has to wait, untilwhen, they become suicidal or homicidal/angry enough to kill afew people out side their work place because they are working!! If this person can getr their hands on a weapon- well there's another insident. We wouldn't let chest pain or diabetic ketoacidosis go on this long.

Family practice doesn't like to and in many cases refuses to order, monitor and adjust psych meds- it's not their speciality. Peds will some times intitiate, monitor and adjust the ADD and ADHD meds but not all pediatricians will do this. Some times these kids are on more than the aderall, concerta and ritalin- some are on resperadol and other antipsychotics. We did get a phone call once from a dad whose son was threatening to set the house on fire. For that we called the police. There needs to be more dialog between the patients, thier caregivers or family and the providers. There does need to be increased education of family members every single time that patient is seen. How does disease managment and case managment fit in the total psychiatric care of patients in these outpatient psychiatric offices. We definately need more Psychiatric Nurse Practioners- we need providers that can order meds, monitor them and adjust them. I read an article that in Texas where alot of the military with PTSD or other psych issues, come back to after their time in Afghanistan, they have had to call on more Mental Health counselors for all over the country to provide care to these soldiers because there were not enough on the base or in the surrounding community.

I think we have to address the problem at it's root and I don't think a total ban on guns is the root of the problem. If some one wants an gun, they can get it legally or illegally. Once it's illegal- it is totally out of everyones hands and then we have a bigger mess and other issues. Smuggling for one. Can we really afford that?? Are we now going to bele to afford the increse in police force to stand patrol in the schools?? In my area, police have been laid off and neighboring departments have had to share officers. I am all for tougher screening for those who purchase guns, but is there any kind of education on how to use it, load it, safety in storing it, I thought there were reg ulations about keeping it locked and the keys in another pplace and storing it unloaded with the bullits in another secure place?

MusicEMT · Dec 22, 2012

Wow I didnt know this thread would blow up! Great comments keep them coming!

This is a discussion that certainly needs to be had in this country

I read an interesting article a few hours ago:

America’s Failing Mental Health System: Families Struggle to Find Quality Care | TIME.com

This really shows the alarming state of our mental health system

Quoted from the article:

" ...A recent government report showed that 7500 psychiatrists currently serve the needs of children and adolescents, while around 20,000 are needed. Reimbursement for mental health services, from both public and privates insurers, frequently falls short of providing the most-needed services, which typically involve continuous care that can extend for years.4"

"...About five million American children suffer mental illnesses — including schizophrenia, bipolar disorder, major depression and other conditions — that are severe enough to cause significant life impairment such as being unable to live safely at home or attend and benefit from school"

with the current amount of psychiatrists it equals to almost 695 child patients per one psychiatrist which is in my opinion extremely inadequate..

olddragger · Dec 22, 2012

There is one context of all this reaction that really worries me. It seems that the media and individuals are all looking to the Government to prevent such a tragedy from ever happening again? That is so wrong IMHO. We should not look for someone else to address this, we should address this ourselves. Government trying to correct such a situation will only result in inefficiency, a waste of a lot on money and possibly negative affects on many others. Nothing can control human behavior. Nothing.

What can be done that would have the most positive affect will have to be done on the local level.

Now the Government can mandate insurance companies to provide more Psychiatric services but would that really be of benefit? Think about this. In my area of the country affordable Psychiatric care can be obtained if the person or family tries hard enough.

But, many times the main problem, again IMHO, is that the person that needs psy care is not motivated to obtain it. Now how do you address that? Do you want the government to pass a law that gives hcws more lenient involuntary commitment authority?

I don't think so. So what is left? The community is all that remains. But, people now a days do not want to become involved, many do not even speak with their neighbors. I am guilty myself. There are many needs within my community that I could help with. But, I don't. I plead not enough time, money or energy. I just can kept up with my own families needs! So what is the answer? At the risk off sounding Zen like, the answer is that there is no single answer. We as a society have to accept that, do the best we can to learn from it and move on.

allnurses Guide · Dec 23, 2012

Va. Tech Gunman's Records Reveal Disorganized Mental Health System

...

The records indicate that Cho sought help at the university's Cook Counseling Center three times in November and December 2005, twice on the phone and once in person. Each time, he was assessed but not treated.

On Dec. 14, 2005, the day Cho was released from a psychiatric hospital, was declared a danger for threatening to kill himself and was ordered by a judge to receive involuntary outpatient treatment at Cook, the therapist who saw him there did not evaluate his mood. Instead, she drew an "X" through the preprinted triage form.

"Did not assess," therapist Sherry Lynch Conrad wrote. "Student has 2 previous triages in past 2 weeks. Last 2 days ago."

At the psychiatric hospital, just hours before, Cho had been given Ativan for anxiety and was assessed as having a mood disorder, the newly released records show.

"Patient very non-verbal, very quiet, sits in the chair looking down at the floor, does not blink," the records say. "No smile, no laughter, no crying."

Cho had been temporarily detained at the hospital, Carilion St. Albans in Christiansburg, after telling a roommate that he had "blades" in the room and that he might as well kill himself after a female student reported his harassing behavior to campus police in 2005. ...

Va. Tech Gunman's Records Reveal Disorganized Mental Health System

The court document -- http://www.thesmokinggun.com/file/court-found-cho-mentally-ill

martymoose, BSN, RN · Dec 27, 2012

Ok here's another example- tell me what you all think should be done......

We have a pt who is very "of size", not independent- yet. When the school shootings went on, he threatened us by saying "someday I hope I can do that to you guys ratatat".We call security, fill out report. Then a couple days ago he heard about the firefighter ambush, and said again he wished he could do the same to us. Again security called. But NO further action. no psych eval, no future plans for the psych ward. And this guy is in the hospital.

This stuff is happening right under our noses, and nothing is being done about it.

allnurses Guide · Dec 28, 2012

Ok here's another example- tell me what you all think should be done......
We have a pt who is very "of size", not independent- yet. When the school shootings went on, he threatened us by saying "someday I hope I can do that to you guys ratatat".We call security, fill out report. Then a couple days ago he heard about the firefighter ambush, and said again he wished he could do the same to us. Again security called. But NO further action. no psych eval, no future plans for the psych ward. And this guy is in the hospital.
This stuff is happening right under our noses, and nothing is being done about it.

First let management know you are seriously concerned about your safety. Notify the police and the owners of your facility. Tell them the are on notice about the threat.

Read what these nurses did -- Ventura County Medical Center will pay for police officer in emergency room Â» Ventura County Star

wish_me_luck, BSN, RN · Dec 28, 2012

Yes, this is a conversation that needs to be had. Here's my experience...again, taking risks here with licensing...I personally have a mental illness. I didn't feel quite right for a long time. But, me being fairly responsible, I wanted help. I tried getting help--told my parents, went to counseling center at college, tried voluntary counseling (mom took me out of it), been in patient three times (first: couldn't find anything physically; kind of exploratory to see if problem was psych; second: voluntary; third: involuntary/TDO--suicide attempt) and subsequent court ordered out patient treatment. I do have a dx now, but care is not ideal (love my therapist, but that's it).

I want people to know that many times people go in patient and they leave without a dx (health care providers have no idea what is wrong with them), many people go to psychiatry appts and they go exactly like mine did: went to appt and needed form filled out for HPMP. I wanted to know what my tx plan was (we still have that right, you know) and without any assessment on that visit, my pdoc told me that I didn't need medication. I added that I have a separate therapist, so he wasn't doing medication management and he wasn't doing psychotherapy. After this exchange took place, he took my form, told me I didn't need to come monthly, and got up and led me out of his office. End of appt. I paid for the appt and the claim was submitted to insurance. The claim--medication management. I was not on medication. I don't know if there is an office visit code for billing, but if not, there needs to be one. Medication management is defined as being on at least one psychotropic drug and the subsequent management (lab draws, assessment of side effects, and decrease/increase in dosage). I called the insurance about it and they didn't care. I don't care if the insurance wants to pay for something not received. Between the both of us (insurance and I) $100 was paid for that visit--5 minute visit which no medication management, no therapy, no assessment, no anything.

I, however, am highly concerned about my fellow man with mental illness that is not getting the proper treatment for their condition. Then, we blame them in the end.

Our complaints go unaddressed. We beg for help.

I will admit, there are some good health care providers. So far, I really like my therapist. She has an open office (nothing between us) and she offered to do anything that needs to be done to help me. I think some mental health care professionals try to keep their patients in therapy for the rest of their life. Those are inept professionals as therapy is meant to work through issues and help with finding alternative solutions to the negative behavior. People should be done with therapy, if they have a good therapist, in 3-5 years or so. I left a therapist (that had a CSAC credential) that would have her desk in between us, very bare/uninviting office, just licenses/certs/degrees on the wall and when I told her what my dreams/future plans were, she told me that I shouldn't go for it/wouldn't make it type thing because of the stress level and I wouldn't be able to manage effectively. That's when I left because I don't want a negative therapist, I don't want someone who tells me I won't be able to handle the stress (that is the reason I was going to her--to help me find healthy coping mechanisms).

My point is, I am sure there are patients that just are not going to function optimally/are disabled even with all the help in the world, but there's many that tried to get help and this is what we get for help. Instead of blaming patients and saying, "well we don't have enough mental health care providers"; maybe, we should say "we need to take a good long hard look at the quality of the ones that we have and the ones we are putting out."

There's also a lot of fraud within the mental health system. I think part of it is because patients don't have clarity of mind and can easily be taken advantage of, but then, since mental health with some insurances are "sensitive dx", patients don't receive explanations of benefits. That means they do not receive something that tells what the provider charged them for. Therefore, they can't say "well this didn't happen". The way the system is set up, well meaning or not, allows for easy fraud to occur. It's not only a money issue, like I said before, you don't have these people who are needing service done getting the proper care.

Sorry for being a parrot, but I want people to know what is going on with mental health care. Those are some of the problems. I don't have all of the answers, but if I can tell as many people (especially younger people) about me and my mental health issues and maybe be someone that they can go to for help or to talk or something, then it's better than being silent. Silence can be dangerous. It's that big elephant in the room that every knows about and sees and no one even acknowledges. Change doesn't occur from being silent.