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Laura Hears Voices

Nurses Article   (955 Views | 3 Replies | 923 Words)
by Nurse Beth Nurse Beth, MSN (Columnist) Writer Innovator Expert Nurse

Nurse Beth has 30 years experience as a MSN and specializes in Med Surg, Tele, ICU, Ortho.

18 Followers; 102 Articles; 234,560 Profile Views; 2,051 Posts

How Can Nurses Help Reach The Vulnerable Psychiatric Population?

Psychiatric services often do not reach some of our most vulnerable population- the mentally ill. Inpatient beds are limited and coverage is inadequate. The results can be heartbreaking.

Laura Hears Voices

Laura’s Story

Laura (name changed) was a 27 yr old successful make-up artist in Los Angeles. She was in demand on movie sets and worked for several well-known clients when she was diagnosed with schizoaffective disorder. In the years leading to her complete mental break and suicide attempt, there had been some signs- she was obsessed with numerology and even moved apartments twice in order to live in places with a more favorable number address.

Later she would confess to her mother she heard voices since high school. One night the voices told her to get rid of all her jewelry, as it was evil, and she threw her great-grandmother’s 1.5-carat mine-cut vintage diamond ring set with emeralds and sapphires into the middle of the street, never to be found.

The night she had her break, she drove herself to an outpatient crisis center. Despite being disorganized, paranoid and anxious, she was discharged. An hour later, she threw herself in front of a police car to get attention and help. She was hospitalized with several injuries and when her mother went to her apartment to pick up some of her things, she found a 50 lb open bag of dog food in the living room for her 2 large Great Pyrenees dogs to eat out of. The kitchen sink and countertops were strewn with mail, dirty dishes, and articles of clothing. There were wads of uncashed checks from clients.

Most disturbing to her mother was the small bedroom closet. On the floor was a pile of blankets indented in the middle. It looked like a small nest. She’d been sleeping on the floor in her closet to feel safe at night.

After her hospitalization, Laura was an outpatient in the “mental health system”. She was lucky in that she qualified for Medicare and Medicaid. 

Laura and her family quickly learned some hard realities about the mental health system. Laura was in and out of the hospital several times the first 2 years for medication adjustments but learned that she had to say she was actively suicidal in order to get admitted and receive treatment because of the shortage of behavioral health beds. If she simply checked into a crisis center and said the voices were threatening her and she was terrified, or hadn’t slept in 3 days, she would be told she had to wait 3-6 weeks to see her psychiatrist and released, often without seeing a doctor.  Laura also learned that her psychiatrist would change every few months because county doctors were doing their residencies and quickly moved on.

Luckily for Laura, her family educated themselves about mental illness and supported her completely. Her mother accompanied her to doctor visits and often wondered what happened to young adults in the system who had no one to advocate for them. Then she looked out of the window of her car and wondered if Laura would be one of the homeless people wandering around downtown, without her family.  Many adults with mental health issues live on the streets, estranged from family. The mental health system has few resources to help them.

The Numbers

Recently in the news, Henry (name changed), a 15 yr old boy with autism, waited 15 days in the emergency department of Baltimore Washington Medical Center after having a crisis at school. The shortage of behavioral health services and the increase in the need for services have created a mental health crisis.

Elias Shaya, MD, a director at Medstar Health's Behavioral Health Services in Maryland, and  past president of the Maryland Psychiatric Society says "The trend is nationwide and it is a crisis nationwide," 

According to a 2017 government report, persons with mental disorders or substance abuse disorders, or both (dual diagnosis), presenting to the ED and requiring admission have increased more than 30% from 2006-2014. 

Millions of people are affected by mental illness every year. Up to 19% of all adults will experience some form of mental illness and the prevalence is much higher in minority groups such as those who report as mixed/multiracials and lesbian, gay, and bisexual adults (National Alliance for Mental Illness (NAMI).

Nationwide Behavioral Bed Shortage

There is a national psychiatric bed shortage. According to a widely-cited report, currently, there are approximately 11.7 beds per 100,000 people. While there is no universal agreement on the number of recommended beds per capita, the most commonly cited target is about 50 beds per 100,000.

Over 5 of those 11.7 beds are occupied by patients who are being investigated for a crime. Jails and prisons have become de facto mental health facilities since mental health facilities were shut down in the 1980s with the 1980’s deinstitutionalization of the mentally ill social initiative. 

Lack of Insurance Parity

There’s also a lack of parity in insurance coverage for mental illness coverage. Mental health insurance parity means that insurance should provide equal benefits for mental health and substance abuse disorders as for medical disorders.

What is the solution to this growing problem? Is it time to look at what other countries are doing to help their mentally ill? At the very least, we can help to raise awareness about the lack of parity. Each of us can do our part to combat stigmatism.

What are your thoughts, and how can we do more?

Nurse Beth is an Educator, Writer, Blogger, and Subject Matter Expert who blogs about nursing career advice at nursecode.com.

18 Followers; 102 Articles; 234,560 Profile Views; 2,051 Posts

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Davey Do has 41 years experience and specializes in Psych, CD, HH, Admin, LTC, OR, ER, Med Surge.

15 Followers; 1 Article; 6,441 Posts; 80,390 Profile Views

Great article, Nurse Beth! It is disheartening to realize that individuals who are truly ill cannot be served.

Laura's apartment sounds something like that of a patient about my age, when the Assertive Community Treatment (ACT) program began in the mid 90's.  He saved all of his urine in bottles because "I don't want my spermies to get mixed with other spermies in the Mississippi!"

Back to individuals not being able to receive services: Wrongway Regional regularly ran around 100 psych patients in the early 'aughts. The census as of late has been hovering around half of that.

Wrongway has gone through great lengths to keep the psych patient population up. From marketing to LTC facilities to regularly admitting recidivistic patients to admitting patients who don't truly meet criteria.

Different areas, different circumstances, I guess.

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I occasionally floated to our locked psych facility.  My husband has a LCSW and worked in psych facilities, adult day treatment, etc.  Psychiatric illness is heartbreaking in so many ways.

I would love to be told I am wrong.  But my inaccurate, anecdotal, impression is  many seriously ill psych patients do not believe or understand that they are ill.  Do not want to take any medications for their mental illness for various reasons.  Our society, in it's misguided attempt to not take away any civil liberties, does not believe placing seriously mentally ill patients in a locked facility is the way to go.  So we let the seriously mentally ill roam the streets, pop in and out of ER's, be in psych facilities for 2 - 3 days, then back to their "freedom" to live on the streets.

Laura and her family were "lucky" in that Laura accepted their care and the care of the doctors.  I have heard of families that beg their mentally ill loved one to stay with them, take their meds, begged police or mental health workers to help their loved one, to no avail.  They cannot understand they are ill and won't accept help.  Money, health care, was never mentioned as a reason their loved one couldn't get help.

It can't be that hard to have a well run, well regulated, frequently inspected, locked facility for long term psychiatric patients.  Physically and mentally stabilize them on their meds.  Slowly transition them to supervised half-way housing when they are able.  

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Nurse Beth has 30 years experience as a MSN and specializes in Med Surg, Tele, ICU, Ortho.

18 Followers; 102 Articles; 2,051 Posts; 234,560 Profile Views

On 1/30/2020 at 7:11 AM, Davey Do said:

Great article, Nurse Beth! It is disheartening to realize that individuals who are truly ill cannot be served.

Laura's apartment sounds something like that of a patient about my age, when the Assertive Community Treatment (ACT) program began in the mid 90's.  He saved all of his urine in bottles because "I don't want my spermies to get mixed with other spermies in the Mississippi!"

 

Thank you, Davey Do! I'm honored you like my article:)

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