In our psyche rotation, we were discussing the problems w/recividism (sp?) We were told one of the major problems was that when inpatients (bipolar, schizophrenia, depression often w/dual addiction) are released, they're feeling better and take their meds as long as their 'samples' hold out, and then they often stop taking them, become acute and are readmitted. My question to those who work in this field, is when does personal responsibility come in to play? My feeling is, we expect diabetics to test their blood sugars and be compliant w/their meds, in short to take responsibility for teatment of their disease...some of my fellow classmates, feel that they are ill, and shouldn't be held responsible for following through with their treatment plan and perhaps should have their hand held throughout the continuem of care. So, when do you say "we've done all that we can, now it's up to you? Here are phone numbers, resources for meds, shelters and food..."? I realize as a nation we need to take care of those who don't have the ability to care for themselves, but yet we also say we have the right and freedom to chose...and some of these folks chose to live on the street, or not take their meds...when does our responsibility end and the patients start? In AA and Alanon, isn't this called enabling? Or is my complete ignorance in the Psyche field showing through?
Oct 1, '04
I think in part some of the explaination comes from the fact that society today views being a user of illegal drugs or alcohol as having less stigma than mental illness. By mental illness I am not speaking simply of depression, or personality disorder type DX. but the biggies such as Bipolar, Schiz & Schizoaffective. This is sad but true. I feel in part that some of the patients we see in & out so frequently self medicate with illegal drugs & alcohol rather than take their psych meds b/c they actually feel this is more like being "normal."
Now then on the opposite side of that you have the mallingers who are in my opinion misdiagnosed. In truth the are actually addicts with personality disorders of which no amount of medication shall make any difference. They constantly are non-compliant with OPT & meds, go back out on a snort using whatever drugs they use, then come back for admission claiming depression with suicidal ideation. They have been through countless rehabs but the behavior persists & as long as they claim to be suicidal or made some lame gesture such as scrathing their wrist they know they will get admitted. I mean any psych nurse worth her salt knows the truely & severly mentally ill when she/he see it.
The majority of the dual diagnosis patients I see at our hospital are not truely Schiz or Bipolar. They are in fact simply addicts who refuse to grow up & take responsibility for the actions & face the consequences of such. I do believe the greatest diservice we do to this particular group of patients is to not tell them the truth, ie: you are of course depressed after losing your job, wife, children, family, friends, home & using several hundered $$ of crack cocaine. Shall we now look at the fact that had you not been sitting with that stem in you mouth in some God forsaken crack house you may still have all those things you have lost. Does you choice to use not have a direct impact into the losses in your life. If you deal with your addiction problem maybe you will not have this depression b/c your life situation will improve? Instead we tell them oh you are depressed & suicidal, here take this Prozac or Zoloft or Effexor, or whatever, it will make you feel better. We never really deal with the root of the problem. Behavior mod is really the only way to deal with addiction. The person themselves must wish to change. They must be allowed to fall flat on their face hard to come to the realization that they need to change. The enabeling we do does not help them it only serves to keep them using & stay sick.
Now some may say this sounds a bit harsh but, allow me to say I have been clean since 1989. No one picked me up, they allowed me to fall & fall hard. I then made the decision I had a prob & sought help in dealing. The help I sought was not in Psych or even health care, although detox sometimes requires hospitalization for safety. The help I sought was from others who had fought the same battle & won. I went solely & still go solely to 12 Step Program & have maintained abstinence since 1989. It was no easy but it does work if you really want it. There are many who will help for nothing in return, just because you have asked for the help. All these in & out SIMD & polysub abuse Dx. are only playing the system & playing a game.
Only my opinion & thanks for listening. Good question by the way. Really cool that you even thought to ask it.
Last edit by TitaniaSidhe on Oct 1, '04
Oct 6, '04
There are alot of factors why people are noncompliant in maintaining their health. Denial remains a big problem. Why a Schiz or Bipolar goes off meds may be quite similar to a diabetic who does the same thing or a person with pneumonia stops taking his/her antibiotic because now feels better. Axis I diagnosed folks may be quite different than Axis II diagnosed folks in their rationale. Substance use complicates it more so, considering that 80% of antisocial PD's abuse substances, 50% of Schiz and Bipolar do, as well as 30% of depressed and anxious folks. Another factor is COST, COST, COST, such as "Do I buy this medication or do I pay rent or buy food?" Many truely sick Axis I folks can't afford the new meds, especially the atypicals. Another factor is general poor management skills. Now really, who enjoys balancing a checkbook? Balancing meds, appointments, supports, meals, etc can be quite difficult for folks who remain symptomatic. Another factor may be the amount of meds the patient has to take on a daily basis. Sometimes, you simply forget taking the medication. Another factor may be that we are kicking out of the hospital folks sooner and sicker and less educated than before. Another factor is if that person has a competent case manager in the community who actually does case management. Not all case managers are the same, nor all community mental health centers...sort of like nursing homes (not all nursing homes are alike). Another factor is that the person's family members may be just as ill as the patient, and may even encourage noncompliance. Some folks don't like the stigma which still remains and choose not to be one. And true, some patients may chose to remain ill because the hospital provides three hots and a cot. There are many reasons and no real good answers with our current system. Maybe a paradigm shift is in order. Do other folks have any ideas?
Last edit by Thunderwolf on Oct 12, '04