What do you think can be done to improve access to mental health care?

Nurses Activism

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The problem has been getting worse for decades. I once saw a man hit by a car near a hospital. Neighbors had repeatedly called to report a man who walked naked across a four lane street for hours at night.

He had been hospitalized for two weeks and then discharged. After that when they called they were told nothing could be done.

I have no idea how he did after being taken to the ER. It seems so wrong to me that there is so liitle available to help so many sick people.

This is recent news to illustrated the problem:

Nowhere to Go: Mentally ill youth in crisis

Scott Pelley reports on severe shortcomings in the state of mental health care for young people in the U.S.

Last November 19th, Virginia State Senator Creigh Deeds was slashed and stabbed repeatedly by his own son. Gus Deeds was 24 years old and had been struggling with mental illness. He and his father had been in an emergency room just hours before the attack but didn't get the help that they needed.

The story of what went wrong with his medical care exposes a problem in the way that America handles mental health. It's a failure that came to the fore with the murders at Sandy Hook Elementary School....

... The vast majority of mental patients are not violent. But this is a story about the fraction who are a danger to themselves or others. Parents of mentally ill children in crisis often find, as Sen. Deeds did, that they have nowhere to go. Creigh Deeds bears the scars of this failure on his face, his body and his soul.Creigh Deeds: I really don't want Gus to be defined by his illness. I don't want Gus to be defined by what happened on the 19th. Gus was a great kid. He was a perfect son. It's clear the system failed. It's clear that it failed Gus. It killed Gus.

We met Creigh Deeds four weeks after the attack. He was still distraught. But he told us his story was a warning that could not wait....

... Scott Pelley: What would have saved Gus?

Creigh Deeds: If he could have been hospitalized that night, they could have gotten him medicated, and I could have worked to get Gus in some sort of long term care....

... Brian Geyser: You know, every day, we have 10 to 20 kids with psychiatric problems come into our emergency department, kids who wanna kill themselves, who've tried to kill themselves, who've tried to kill somebody else.

Brian Geyser is a nurse practitioner we met in the emergency department of Yale New Haven Hospital in Connecticut-- it's one of the best in the nation in psychiatry.

Brian Geyser: We have 52 psychiatric beds here at Yale. And right now, all 52 are full. And so the seven kids that are here in the emergency room are waiting for an open bed.

Scott Pelley: How long will they wait?

Brian Geyser: Five of them have been here three days already....

... They wanted to discharge my daughter. She needed to stay where she was safe and the insurance company would not pay and so I was told by our social worker in the hospital that if I gave my daughter up to Department of Children and Families, that then she would have insurance coverage through the state and she would be allowed to stay....

... The state of Virginia is investigating why there was no hospital bed for Gus Deeds that night. Nationwide, since 2008, states have cut $4.5 billion from mental health care funding....

http://www.cbsnews.com/news/mentally-ill-youth-in-crisis/

[h=2]My comments will be late, but it is better for late answer, then never. For all non psychiatric or hospital based fellows:

Outpatient commitment (more commonly known as Assisted Outpatient Treatment (AOT) refers to state mental health laws that create civil court procedure wherein a judge orders a person with severe mental illness to adhere to an outpatient treatment plan designed to prevent relapse and dangerous deterioration. Assisted Outpatient Commitment (AOT) allows the assisted involuntary treatment of individuals diagnosed with severe mental disorders who are living in the community and experiencing a mental illness crisis that requires intervention to prevent further deterioration that is harmful to themselves or others, rather than detained in hospital or incarcerated. The individual may be subject to rapid recall to hospital, including medication over objection, if the conditions of the plan/order are broken, and the person's mental health deteriorates. This generally means taking psychiatric medication as directed and may also include attending appointments with a mental health professional, and sometimes even not to take non-prescribed illicit drugs and not associate with certain people or in certain places deemed to have been linked to a deterioration in mental health in that individual.Criteria for outpatient commitment are established by law, which vary among nations and, in the U.S., from state to state. Some require court hearings and others require that treating psychiatrists comply with a set of requirements before compulsory treatment is instituted.

[/h][h=2]

So SMI patients can be treated in outpatient settings mandated by court.[/h][h=2]References[/h]

[h=2]External links[/h]

How to improve access? Make mental health care accessible!

I have this crazy dream of multiple mental health clinics in every town and city, with adequate staff and follow-up care in hospital or residential settings as appropriate. Of course, it's only a dream. Good care costs money, and the mentally-ill just aren't important enough--in terms of campaign contributions, votes, and lobbying.

Creigh Deeds, a Virginia state Senator, is pushing for better access to and availability of mental health beds in psychiatric facilities and wards. Of course, this is only after his son attacked him, then committed suicide, shortly after a psychiatric crisis; he was to be hospitalized, but no beds were available. It's a sad truth that people in power don't really care about mental health until one of their own is affected. Same with drug addiction.

I think the only way to improve mental health in this country is to make it a priority, and that means putting money into research (what needs to be done) and development of new psychiatric care models. Community care seems the best option--hospitalization should be reserved for crisis intervention--but communities need bodies and buildings to provide care; and those cost money--which no one in government wants to spend. Just a shame all around.

Specializes in NICU, PICU, Transport, L&D, Hospice.

I'm pretty sure that Ronald Reagan defunded the mental health system during his presidency. That is one of his legacies which lives on with a vengeance today. When considering that particular policy decision one must also include the associated homelessness, increase in violence, and poverty of the victims of such uncaring governance.

Thank you Ronnie Raygun

Specializes in Pediatrics, Emergency, Trauma.
I'm pretty sure that Ronald Reagan defunded the mental health system during his presidency. That is one of his legacies which lives on with a vengeance today. When considering that particular policy decision one must also include the associated homelessness, increase in violence, and poverty of the victims of such uncaring governance.

Thank you Ronnie Raygun

He sure did...along with his "Reagnomics" we can thank him for many issues... :whistling:

Specializes in Medsurg/ICU, Mental Health, Home Health.

I don't know what we can do, but we must do something.

There's a big part of me that thinks if JFK wasn't assassinated...maybe we'd be somewhere. He was very much for progressive mental health care. LBJ did a bit to help out but he also got us into Vietnam which churned out a whole heckuva lot of mental health issues in of itself.

My state was sued by the US Department of Justice a while back because of how we handled mental health and we're far from being the most backwards in terms of mental health.

It's a crisis, to say the least. I think we need a champion, to be honest. Mental health isn't a cause people tend to like to get behind. It doesn't have well known symbols or colors like other diseases and afflictions do. But maybe, maybe if JFK and RFK weren't gunned down...I don't know, maybe I'm just an idealist hippie child...

Specializes in Critical Care; Cardiac; Professional Development.

I am actually writing a lengthy paper for school right now (MSN program) about increasing use of jail diversion programs. Jails are now the defunct mental health system. Of course, they suck for that. Evaluation of those arrested for nonviolent, nonthreatening issues such as disorderly conduct, public intoxication, etc etc etc receive evaluation for mental health needs prior to being placed in the general jail population. Those who are found to need this care are instead diverted into community mental health programs that provide stabilization, medication, housing and employment assistance, etc. They have been quite successful so far in the communities that are using them. Not only do they increase access to mental health services, they protect a very vulnerable population from being put in the worst possible environment for dealing with their illness, save taxpayer dollars and decrease crime.

Specializes in Psych, Addictions, SOL (Student of Life).

Appropriate healthcare for the mentally ill fell apart in the late 70's when the notion that people with mental illness should be allowed to receive treatment in the least restrictive manner possible. It was also about that time that the horrible abuses of the state run mental health system became widely known. The Institutions for the mentally ill were no more than prisons where people died horrible death at the hands of Orderlies/so called nurses and Dr.'s who made the patients subjects of cruel experiments, involuntary sterilization, involuntary ECT treatment and worse. In today's world the mentally are the single most medically underserved portion of the population. They make up a huge portion of the homeless, are beaten and killed by police and face discrimination by the so-called sane folks. When a man built a simple shelter in his front yard to allow a homeless man a safe place to sleep residents on his street petitioned the city to have it torn down. it's interesting to note that the ACA does absolutely nothing to address the problem of treatment for the mentally ill. Only a small percentage of the mentally ill are dangerous but no one thinks about this poputaion until one of the dangerous ones kills someone. We have to move away from the NIMBY mindset and focus on what happens outside the psych hospital.

Hppy

I agree with hppygr8ful to a point, the "notion that people with mental illness should be allowed to receive treatment in the least restrictive manner possible" was a very appropriate idea.

I'm certain some of the terrible abuses happened, but closing all the state run mental health facilities was like throwing the baby out with the dirty bath water. And of course replacing the state institutions with small community group homes or day treatment was never funded appropriately to deal with the issue.

Irregardless bringing up these allegations just inflames the issue. We need to deal with facts, as well facts and mental illness can be ascertained?

This is totally my anecdotal observation, although my husband was a psychiatric social worker for many years. But some (many?) mentally ill people can't acknowledge they are a danger to their selves. They think they are fine, begging, being homeless, not taking their meds, using alcohol or other drugs, is fine with them.

Some mentally ill people need to be in a clean, well funded, well run, mental institution, forced to take their medications and even receive ECT (which can be effective) totally against their will for perhaps their whole life.

Specializes in Critical care, tele, Medical-Surgical.

What do you think of this article on the history of the release of mental patients from institutions?

HOW RELEASE OF MENTAL PATIENTS BEGAN

Published: October 30, 1984

HOW RELEASE OF MENTAL PATIENTS BEGAN - NYTimes.com

Mental health is seen as expensive by the insurance company because it can take many visits to get well. So, this nearly always requires a referral and isn't always easy to get due to insurance guidelines. If we let anyone go get help that needed it, there would be a lot of cost with that.

All chronic illness are expensive for insurance. As for mental chronic disorders all much more complicated, since SPECT/EEG not done in every case and maybe it could help to identify new subtypes of anxiety, depression and attention deficit disorder, categories far more specific than even the forthcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, the benchmark of the field.

I hope , one day will be the real opportunity for psychiatry to use the emerging advances in genetics, molecular biology, imaging and cognitive science to supplement, rather than replace, the symptom-driven diagnosis.

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