Horror Stories: Rethinking Nursing School

[Tegridy]

subee said:

I live across the street from a state hospital that was closed in the '60's and is now condos, restaurants, businesses, etc.  There are still a few buildings left to renovate and I wish one would have been preserved for those who couldn't function independently but needed minimal supervision.  They had their own farm and those that were higher functioning were free to leave and were just part of the town, as they should be.  Now they sleep in the nearby woods.

For sure, that's the type of place I was sort of insinuating toward. Beats being homeless for sure and its one thing I wouldn't mind paying a bit more in taxes to support, compared to most of the stuff we waste money on.

[hppygr8ful, ASN, RN, EMT-I]

10 hours ago, Tegridy said:

Hence why I said may not have been. id assume the ways the old inpatient psych facilities were ran it wouldn't cost so much. Im thinking more as giant facilities where they are housed fed, given their depo shots. Probably better than being homeless. Im all for freedom but where the line is drawn for being able to make self-decisions may not make freedom the best option for those who cannot function at all in society. 

By the first bolded statement you have to understand that many psychiatric patients were often locked away with the keys thrown away. There was no judicial review. Patients were subjected to forced medication, unproven experimental treatments, involuntary sterilization, lobotomies, shock treatment and more. Many were victims of violence and sexual assaults and that was just the staff doing it, let alone their fellow patients. Lets then talk about substandard hygiene, food and medical/dental care. So old in-patient psych facilities were sure great places.

But the general public didn't have to see them so they could assume they were well cared for. 

I don't have time to list all the references but it's all easily searchable. 

This information regards the State of California other states may vary but remember that state psychiatric facilities must provide 24 hour care 365 days a year. This includes non-licensed/non-medical staff, licensed staff, and non-licensed medical staff. The criteria required to commit a person is stringent and requires judicial review at several steps along the way. A person has to first be conserved which takes 60 to 90 days, then they wait for a long term bed to be available. the average wait for conserved patients where I work is over a year. Once placed they get an annual judicial review with a state appointed attorney if they cannot afford one. They must see a psychiatrist a minimum of once a month and a general medical provider not less than every three months but unlimited if the patients has conditions that require regular medical care and the list goes on and on.

I actually underestimated the annual cost. The per person annual cost in 2017-18 was $310,000.00 most of which is funded through tax payor contributions. 

I have been assaulted in acute medical hospitals by people who did not have a mental health diagnosis. After I went to work in Psych I was assaulted 1 time in 20 years and that was entirely my fault. 

I am extremely passionate about the rights of persons with mental illness (Most of whom are not violent and don't deserve to be treated as if they are). The whole system needs reform. No easy answers.

Off my high horse now.   

Hppy

[kbrn2002, ADN, RN]

FiremedicMike said:

Not to be contrary just for the sake of arguing, but that website says 4 years plus 3 years. 

I personally feel 3 years of doctorate level work after obtaining a bachelors in a "STEM" program with at least a 3.0 GPA is a significantly more difficult path than a BSN

It can be done faster. My son finished the bachelor portion in 3 years by taking the maximum allowed course load and completed the DPT 2 years following the Bachelors. So it was 5 years for him.  He was pretty motivated to get done as fast as possible since he attended a spendy private catholic university as that was the only campus in our area offering the degree. Even getting done about 2 years earlier than the norm his student loans were over $140,000 and that was after significant scholarships. He worked as a personal trainer during school so his hours remained very flexible. 

Of course not everybody is able or willing to fast track a degree but it is possible.

[hppygr8ful, ASN, RN, EMT-I]

FiremedicMike said:

Not to be contrary just for the sake of arguing, but that website says 4 years plus 3 years. 

I personally feel 3 years of doctorate level work after obtaining a bachelors in a "STEM" program with at least a 3.0 GPA is a significantly more difficult path than a BSN

Actually it says 4+3 for an MD and around four a DPT

"The good news is that DPT students have a much shorter course of study than medical students pursuing their MD (which is four years for the degree, plus three to seven in a residency). A DPT typically can be earned in less than three years, including several terms of clinical practice."

[FiremedicMike, RN, EMT-P]

hppygr8ful said:

Actually it says 4+3 for an MD and around four a DPT

"The good news is that DPT students have a much shorter course of study than medical students pursuing their MD (which is four years for the degree, plus three to seven in a residency). A DPT typically can be earned in less than three years, including several terms of clinical practice."

That paragraph does exist, but that's 3 years to complete the DPT.  In order to get into that 3 year DPT program, you need to have already completed a bachelor's in a STEM major, per that article.

[subee, MSN, CRNA]

13 hours ago, hppygr8ful said:

By the first bolded statement you have to understand that many psychiatric patients were often locked away with the keys thrown away. There was no judicial review. Patients were subjected to forced medication, unproven experimental treatments, involuntary sterilization, lobotomies, shock treatment and more. Many were victims of violence and sexual assaults and that was just the staff doing it, let alone their fellow patients. Lets then talk about substandard hygiene, food and medical/dental care. So old in-patient psych facilities were sure great places.

But the general public didn't have to see them so they could assume they were well cared for. 

I don't have time to list all the references but it's all easily searchable. 

This information regards the State of California other states may vary but remember that state psychiatric facilities must provide 24 hour care 365 days a year. This includes non-licensed/non-medical staff, licensed staff, and non-licensed medical staff. The criteria required to commit a person is stringent and requires judicial review at several steps along the way. A person has to first be conserved which takes 60 to 90 days, then they wait for a long term bed to be available. the average wait for conserved patients where I work is over a year. Once placed they get an annual judicial review with a state appointed attorney if they cannot afford one. They must see a psychiatrist a minimum of once a month and a general medical provider not less than every three months but unlimited if the patients has conditions that require regular medical care and the list goes on and on.

I actually underestimated the annual cost. The per person annual cost in 2017-18 was $310,000.00 most of which is funded through tax payor contributions. 

I have been assaulted in acute medical hospitals by people who did not have a mental health diagnosis. After I went to work in Psych I was assaulted 1 time in 20 years and that was entirely my fault. 

I am extremely passionate about the rights of persons with mental illness (Most of whom are not violent and don't deserve to be treated as if they are). The whole system needs reform. No easy answers.

Off my high horse now.   

Hppy

This wasn't the patient group that I was talking about and I doubt Tegrity was talking about either.   I was talking about the patient population that was already permitted to move freely in and out of the institution.  I know that is a quaint idea these days and would undoubtedly cost more than having them sleep in a public park as they do now.  I do volunteer at the homeless shelter which offers great services (for evenings and nights only) but can't fit in everybody on a really cold night.  Comparing what it costs to jail them, leaving low-acuity psych facilities open seems like a bargain.

[Tegridy]

hppygr8ful said:

By the first bolded statement you have to understand that many psychiatric patients were often locked away with the keys thrown away. There was no judicial review. Patients were subjected to forced medication, unproven experimental treatments, involuntary sterilization, lobotomies, shock treatment and more. Many were victims of violence and sexual assaults and that was just the staff doing it, let alone their fellow patients. Lets then talk about substandard hygiene, food and medical/dental care. So old in-patient psych facilities were sure great places.

But the general public didn't have to see them so they could assume they were well cared for. 

I don't have time to list all the references but it's all easily searchable. 

This information regards the State of California other states may vary but remember that state psychiatric facilities must provide 24 hour care 365 days a year. This includes non-licensed/non-medical staff, licensed staff, and non-licensed medical staff. The criteria required to commit a person is stringent and requires judicial review at several steps along the way. A person has to first be conserved which takes 60 to 90 days, then they wait for a long term bed to be available. the average wait for conserved patients where I work is over a year. Once placed they get an annual judicial review with a state appointed attorney if they cannot afford one. They must see a psychiatrist a minimum of once a month and a general medical provider not less than every three months but unlimited if the patients has conditions that require regular medical care and the list goes on and on.

I actually underestimated the annual cost. The per person annual cost in 2017-18 was $310,000.00 most of which is funded through tax payor contributions. 

I have been assaulted in acute medical hospitals by people who did not have a mental health diagnosis. After I went to work in Psych I was assaulted 1 time in 20 years and that was entirely my fault. 

I am extremely passionate about the rights of persons with mental illness (Most of whom are not violent and don't deserve to be treated as if they are). The whole system needs reform. No easy answers.

Off my high horse now.   

There were probably good facilities also such as the one previously mentioned, which is what we are alluding to, not the shutter island type you described, obviously we aren't condoning that..... It also probably costs more to have many of these patients in and out of the hospital sometimes we have patients on our service waiting months collecting hospital bills of well over 300k during the stay. But at least we can agree the entire system needs some sort of reform.

I think many of the low acuity psych patients would gladly be in a long term care type facility, at least the ones attempting to get some sort of treatment which seems to fall short due to a lack of beds.