The Nightmare Part Two

In the previous article I focused on the events in the old mental health system, a system of containment of those who were different. The article ended with the advent of the "drug culture". In the 1980's we decided to have a war on drugs. This war has been lost but the effects of it will last for generations to come. We equated drug use with mental illness and have treated both by incarceration. This article is a call to action to find better ways of dealing with both psychiatric illness and drug addiction. Nurses Announcements Archive Article

The Nightmare Part Two

Currently we have jails to provide a majority of mental health services. In other words you may have to get into the penal system in order to get any mental health care. Is this really mental health care? Do we find skilled treatment savvy individuals? Yes, some are. Many of these individuals are recovering addicts who work with those addicts who wish a shorter sentence or real help to stop using. Guards are not psychiatric workers. Their training is in control, not assisting an individual to develop better mental health and better coping skills. Those with mental health problems will most likely be given a drug to make sure they are manageable. If someone is drugged enough there is no way to commit suicide, one of the black marks on any prison guard shift.

How is mental illness identified? Schools are given the job of identifying youngsters who are out of the Bell-shaped curve for behavior. Parents are encouraged by doctors and schools to medicate active children with diseases known only by initials. I know there are children who need assistance but we seem to have allowed the drug companies to determine when enough bad behavior is enough. Parents are pushed to have their children fit into molds of the community norm. If in an area where soccer is loved the child who is not into soccer is considered awkward,asocial, and strange. If it is an area where dance by a male is frowned upon expect bullying to take place.

Conforming seems to be the goal of all I have discussed. Isolate those who do not conform and find ways to hide them or make them conform. So far, we do not have a mental health system to deal with the brain illnesses that we now know are partially, at least,responsible for mental illness. Those who suffer continue to be treated as outcasts, viewed with disdain, and in many cases the continuation of bullying is the norm.

We treat mental illness differently that other illnesses. The excuse given is that it is too expensive to include in insurance. Without insurance it is very difficult to get real care. Psychiatrists are at a premium. There are not enough and the ones that exist,in general, only want big money clients either through self pay or partial self pay with insurance. So, one result is that people with mental illness, especially chronic mental illness, cannot get comprehensive care.

And we are shocked when it bleeds into the rest of the country. Now it is a national nightmare. We need changes in our view of mental illness and quickly. There are other voices being heard: Real voices not hallucinations. Do not let these voices become quiet. Do not let them become silenced by those who are afraid. Speak up to those who count the pennies it costs to care for mental illness properly rather than the millions it costs to keep non-violent mentally ill people in jails. Let no child be diagnosed by those who are not trained while the individuals who are trained are let go in school districts as "too expensive"

I was asked what my nightmare was. My nightmare is that we continue down this path of conformity with the exceptional child being singled out as odd. That we continue our current thinking that teachers, nurses and psychologists are not worthy of living wages while we putguards in schools. As we continue our quest for conformity somehow we have lost the wisdom given down to us that to move forward one must go beyond thinking like every one else. The person must have a basic education that encourages creative thinking and action.

My nightmare is that we used to warehouse people for not fitting in to a prescribed manner of behavior. We did this because we did not have the education, knowledge, skills and experience to find other ways of dealing with those who have mental health issues or those who did not fit in well for other reasons such as delayed developmental skill acquisition.

How is our current system any better? We now call the warehouses "jails" rather than"Bedlam" or "insane asylums". We keep no-violent people with violent offenders. We jail people for longer times than any other developed country. We create a whole cadre of people incapable of living in the "outside" world. We have created a "nanny state" for these people who lose valuable skills. They cannot cook for themselves. They have no idea of real costs in the outside world. We stigmatize those who have been jailed so future employment is more difficult. We create a system that is self perpetuating by making sure those who are jailed cannot make it in the outside world.

My nightmare is that people will not heed the call to get better mental health assessments in schools. They will continue to rely upon the penal system to house those they find unacceptable rather than look at the person and find answers to keep that person out of a system that continues to punish those with mental illness.

As each person with mental illness slips through the cracks in our current systems we are in danger of the minute percent of violent mentally ill people not diagnosed. Not diagnosed because we have removed those people who might have seen the early sign posts: the experienced teachers,the nurses, the psychologists in schools. We have consolidated schools to try to save money and instead pump more money into jails.

This is a call to those who find mental illness hard to understand. Open your mind and your heart. People with mental illnesses don't choose it anymore than a little person chooses to be small. It is genes and environment and we are just learning the rest of what mental illness really is. It is a call to those who have not noticed how expensive it is to continue to fund and build more jails to care for the mentally ill. It is a call to those who have looked down on those who have been in jail and decide they do not deserve a chance.

In short, my nightmare is that we all have become so institutionalized so as not to see how we are pushed into a conformity that will be the end of our ability to move forward as a nation.

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TopazLover

About TopazLover, BSN, RN

TopazLover is a retired nurse who now has a second career as an office manager. Her background as a nurse helps daily dealing with a criminal defense lawyer's office. As a widow she has led many grief groups and provides support for those in turmoil.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

Thank you for another informative article on mental health issues, aknottedyarn. This is timely in the aftermath of the recent massacre in Newtown due to a psychologically disturbed perpetrator.

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Specializes in psychiatric.

Thanks for another thought provoking insight into mental health. I just left an ICU job to go into Psych and I hope to be able to have a positive impact upon these people and specifically children and teens. We are fortunate to have a mental health clinic in one of the schools nearby which has made a great in-roads in being able to help these at risk kids before they progress too far. It is a positive sign that the people who can make a difference are seeking out ways to reach as many as possible, at least in my area

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Thank you for taking the time to write this second half or your article, aknottedyarn. I wish I had something positive to add, but I'm left with nothing but questions. Questions like "Is it even possible to solve this problem?" I mean as you've said yourself, the cost per pt is immense, and while it would be great if that didn't matter, the fact is it does, and not wanting that to be so will not change it. Another question would be "Do we actually possess the knowledge necessary to even diagnose a true mental disorder that isn't obvious?" I ask this second question because these days, if anyone is sent to a mental health professional (for whatever the reason may be) They are almost sure to end up with a diagnosis and a prescription, even if they just had a bad day and are otherwise "normal." And what is "Normal," really? Have we even defined that?

I had an aunt who had temporary custody of me once (for a brief 5 month period while I was 11 years old) and, because a psychiatrist had helped her once upon a time, she had me see one too (and "Yes," for no other reason than because she really loved her psychiatrist. It's amazing what people want as long as it's not coming out of their own pocket, huh?). Long story short I was given 5 months of follow ups (and why not? Medicaid was paying for it. Not that that had anything to do with the Psychiatrist setting these appointments up, for as we all know medical professionals are, if nothing else ethical :rolleyes: By the way, I'm sure most actually are ethical, but the point I'm trying to make is it is hard for most people, even a medical professional, to not milk a cash cow, necessarily or not.) and a prescription for Paxil.

Another example. My nephew was diagnosed with ADHD and was given a prescription of Ritalin some time back. Now, let me be the first to admit that I am in no way whatsoever implying that I'm qualified to diagnose anyone with anything. But at the same time, I know my nephew, and to me he is just a normal boy who is acting up because his mother is a bad parent and lets him. She doesn't discipline him. She doesn't do anything with him other than live with him. She is just "there. That's it. Just...there." So of course he had a disciplinary problem. Apparently this automatically = ADHD... And his mother doesn't have a problem with the diagnosis. Well, at first she did, but once she found out that her son now qualifies for SSI, she "Accepted" it. FTR, she blows that check within a week of receiving it every month on herself.

I'm also unaware of any kids that I know personally who are on medicaid NOT getting recommendations for follow up appts and a prescription for something after seeing a mental health professional. I will admit that it is possible that every one of them (us) did in fact need those follow ups and prescriptions, but I just have a hard time actually believing it. I mean, every one of them (us)! you have to admit that that is a little odd...

In truth, it may very well not be about the money though. I mean, what happens if the mental health professional did say that they thought that the child was fine, but for whatever reason actually did misdiagnose them? Yep...LITIGATION! Which is a shame. It really is. Perhaps the place to start to fix our mental health crisis would be to do something about that? I've said in other threads that the fact that it is so lucrative to sue a medical professional (and so ridiculously easy to do, at that. Even if it is frivolous, many provider's insurance companies settle out of court to avoid larger court expenses and negative publicity. This paint bulls eyes on medical professional's backs. With $ signs centered on the bulls eye. I believe if this would stop, cost and expenses would go down tremendously. It would be a really good start to fixing things, I think. But what do I know? )

Please don't be offended by any of this, aknottedyarn, ok? I am not in any way insulting your profession. In fact it is the NURS 243 (Mental Health Nursing) section of my program that I am most looking forward to attending. While I still have a long way to go before I make such decisions, as it stands now it is the mental health field of nursing that I am likely to try to get into upon graduation. It's just that the peoblem you are addressing is gigantic! And I just don't have any definitive answers to fixing it.

Jaime

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Hey... I just proofread that thing, and I think it comes off as me talking "at" you and not "to" you. I just want to clarify that I mean it as talking "To" you :) it is just too long for me to edit as I'm a slow typer lol.

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pricharillaismissed, Thank you for your great examples. It is frustrating to discuss the mental health - mental illness continuum as we have so much to learn.

My points just included how we have "moved the deck chairs on the Titanic" by shifting those who do not fit well from Bedlam to prison. Our outcomes do not seem to justify the costs in money or human dignity.

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Prich, you mentioned something about diagnosing true mental illness. I think that right there is a huge part of it. I am not in denial about my diagnosis, but I take a glimpse around me and I have to ask myself if I am the mentally ill one. Part of the problem is the fact that quite frankly, the DSM has become a joke. It used to describe only certain ways to be considered mentally ill. Now, we are including even more ways to be diagnosed with mental illness. Like I said before, the old DSM had roughly 1,000 or so different ways to be diagnosed with PTSD. The new one has 10,000. All they have done is loosen the criteria to be able to fit more people. Then, we try and say more people are mentally ill now. No, more people are not mentally ill now, we have loosened the criteria to where it fits more people.

Plus, we have the internet now. We have a lot of people/patients/family members that have become arm chair psychiatrists by reading the internet and such. It's like "I/my spouse/child/etc. has xyz disorder" "Oh, you were diagnosed?" "Oh no, I/my spouse/child/etc. fits the criteria/ has the signs and symptoms". Then, they spread this stuff around to others.

I will use BPD as an example. Google BPD and you will come up with some of the nastiest comments regarding us from family/friends. I wager that there's more to these stories than the family/friends are sharing. Also, many of these stories are cases of "suspected BPD". Not diagnosed cases. People often forget that in order to be diagnosed with something, you have to meet like 5 of 9 criteria and it has to go on for at least 6 months or more. I think family/friends should have to give concrete examples of events that have occurred that would suggest such a disorder. I think all of the exchanges leading up to said event need to be considered and discussed. I think psych professionals sometimes jump the gun and diagnose something before they know all the facts.

Anyone know if there's been studies regarding the number of psych diagnoses before the presence of the internet and after the internet?

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This is a great article, thank you for posting it. The issues are explained so clearly and yet these issues are far too often overlooked by the general public. I am disgusted how the deaths of those poor children have given way to a war on firearms. Americans need to come together to solve the problems at hand, not create a political battleground.

There is not much research (especially in the states) on the effects of mental illness on society and it really irks me. Suicide is the third leading cause of death among high school and college students, yet it is still a hushed issue. Any other leading cause of death is bombarded by researchers and evidenced based practice and QI projects all searching for ways to save people. Yet, suicide, which affects (arguably) the most important age group is just an issue that gets pushed back and forth between the schools and the medical professionals.

- Holly

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Now, we are including even more ways to be diagnosed with mental illness. Like I said before, the old DSM had roughly 1,000 or so different ways to be diagnosed with PTSD. The new one has 10,000. All they have done is loosen the criteria to be able to fit more people. Then, we try and say more people are mentally ill now. No, more people are not mentally ill now, we have loosened the criteria to where it fits more people.

I think psych professionals sometimes jump the gun and diagnose something before they know all the facts.

Anyone know if there's been studies regarding the number of psych diagnoses before the presence of the internet and after the internet?

I agree with your post in its entirety, but the above is the part that really sticks out. That, coupled with the OPs (EXCERPTED) quote "How is mental illness identified? Schools are given the job of identifying youngsters who are out of the Bell-shaped curve for behavior. Parents are encouraged by doctors and schools to medicate active children with diseases known only by initials. I know there are children who need assistance but we seem to have allowed the drug companies to determine when enough bad behavior is enough. Parents are pushed to have their children fit into molds of the community norm. If in an area where soccer is loved the child who is not into soccer is considered awkward,asocial, and strange. If it is an area where dance by a male is frowned upon expect bullying to take place." The bolded (by me) portion is particularly scary, reason being that if none of us ever fell a bit outside the Bell curve, we would stagnate as a people. Here's what I mean.

Look at the Leaders of our scientific community. The ones who's ideas advanced us as a whole. Much of their behavior is/was considered strange by the masses, yet their ways of thinking changed the world. Einstein and Newton come to mind (I mean this as a compliment, by the way. I wish I had a third of either one of their intelligence). Einstein was considered a bit of an eccentric, and Newton was an asocial *** with a temper. He was even known for disappearing for hours into his study hall, while entertaining a house full of guest because a thought hit him and it encompassed him to a point where he had to write it all down. He was said to have even FORGOTTEN that he had guest on occasion .

Now today, if either one of them were to sit in front of a Mental health professional of today (Assuming they were unknowns :) ), I would say there would be a better than 50/50 shot that they would walk out of there with a prescription for something, as those 2 were clearly outside of the curve. This is why this problem must be really thought out.

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I have been working in behavoral medicine on and off since 1967. There are many treatments and philosophies and the fact is that some people do need to be locked up for indefinite periods of time because they are a true danger to themselves or others. Once they leave institutions it is very dificult to get them to continue theere medicines because they feel better not taking them. It may be hundreds of years before we solve this problem or maybe sooner but it is necessary to keep some people locked up no matter what.

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Billybob, I agree completely. There are people who need to be confined for their own good as well as the rest of society. Our mental health system is broken, IMHO. We have poor criteria for who is a danger to themselves or others and our health care system pushes people out before they are stable. This forces more hospitalizations because there is incomplete basic eduction about the disease process, the meds involved and the return to the "real world". In the real world things have gone down hill due to the perosn' inability to keep a job, take care of financial obligations, work with a family, etc. We bring 'em in, med and bed 'em down, have a couple of individual sessions, do group with people who are in no way ready for group interactions, stablize meds, discharge. Repeat. We have little follow up and almost no assistance for those things a social worker may assist with during in pt. treatment.

We have difficulty getting diabetics to follow instructions and that disease is accepted an insurance covers almost all treatment. How do we expect people to accept their diagnosis of mental illness when the rest of the population does nto accept people who have a diagnsis. The stigma is really bad.

I believe we can help many more to avoid long term need for hospitalization if we are able to work with the person a bit longer. We still have "30 day" programs for addicts and insurance covers much of this. Why do we have such a poor chance of getting even 3 weeks of in pt. intensive treatment?

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