Nurses (and any other healthcare professionals) with mental illness, please read

[wish_me_luck, BSN, RN]

Hello,

I have my own personal opinions of the mental health care system, but I want to know a few things from others. There are phenomenal mental health providers out there (Meriwhen and many others that post in the psych forum and those few who are not on AN), but there's a lot lacking in this realm of care. I want to know the following from other providers, both with mental illness and not (nurses, physicians, CNAs, etc.) and if you have any loved ones with mental illness:

1) What do you find lacking in the mental health system? What things do you find are in place now that could be a hindrance? What kind of bad experiences have you had?

2) What do you think would make things better? What would be your ideal system?

3) What do find positive that is being done (i.e. the good in the mental health system)?

4) If you could have any legislation changed or passed to the benefit, what would you want?

I guess I am trying to get other opinions on defining the problems (specific, not like vague poor care, poor education, etc, but what specifically). I have my opinions, but it could just be my experience, so I want to see if others experience the same, so maybe there can be some change somewhere. Please share. If you want to know my opinion, read below, but the above are the real questions.

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My personal experience: Inpatient: Depended on facility, it was both good and bad. The bad facility was old/dimly lit, same activity day after day, snacks/beverages only accessible at certain times, couldn't go outside, and a psychiatrist that told me there was nothing wrong with me. Which, that sounds nice and all, but when you emotionally feel like crap, something is not right. It was always "well, I don't see a problem"--last I checked, the problem was whatever the patient thought the problem was. So, I leave, without being any better than when I went in. However, there were definitely bills coming in from it. I, however, liked not having a roommate at that facility. The good facilities care wise--they had more color (i.e. light greenish/blue, the soothing shade of blue/green), better lit, had more activity variety, one was more open as far as space in the common area, the patient rooms had two closet spaces--one was open to the patient, the other was locked for personal belongings that could not be given to the patient (nice because the belongings were with the patient at all times, helps with paranoia), and the dining area was accessible at all times for food and drinks. The bad--couldn't go outside (I am a chick that loves to be outdoors) and again, went for evaluation with psychiatrist and she had trouble figuring out what was wrong. Left without dx (went in because of a suicide attempt--admitting dx Major Depression, but that went by the wayside after eval.). They wanted to keep me longer to try and figure it out (I was TDO--72 hrs), but I wanted to go home and go back to class/clinical, so I didn't fail. So, I had to get out patient per court order. Outpatient: The bad-- I had a care coordinator that did nothing for me at all, yet I had to pay her. I had a therapist at one time that her office was plain with only a desk, chairs (not comfy ones, just plain chairs) and her degrees on the wall. The desk separated her and I. I felt like I was doing a business deal or something--not therapy. Not very inviting at all. She always asked me about the past and the same incidents over and over. Didn't get anywhere and never any suggestions. It was obvious that she didn't look at her notes from the previous visit. My pdocs-- I went to a community service board, so turn over with pdocs was fairly high. I had one, he retired, then got the second one and he was leaving to start his own practice. I would have been on my third doc in a matter of about 6 months. So, for some continuance in care (especially since he was the one who wrote my BON letter when I had to send one with my application), I followed him to his practice. HPMP made my contract going to a pdoc every month. Well, after 3-4 visits of going monthly and him deciding that I didn't need meds and we weren't doing anything in the appt, I called my case manager and told her that I was literally going to appts in order to get my form for HPMP filled out. My contract is now as needed pdoc visits. The best tx I have received outpatient is from my current therapist--she is kind and actually tried to help me work through what I view my current issues are, her office is more open. Her desk is against the wall and she has a couch, instead of chairs for her clients. The space in-between is open, no desk in-between or anything else. She told me that she would do what she needed to do to help me--whether it be going to other appts with me (like to the pdoc, so everyone is on the same page, so to speak) and there are times that if she doesn't have a patient after me, then we go over a little. We are going to do some DBT soon. I did make sure to tell her that she is about the only one who has actually helped me. I think providers need to know when they do something right.

The Boards: Everyone already knows my deal. Overall, I think there's still discrimination. My personal health info is made public. I was initially denied my pharmacy tech license. Now get this, my pdoc told me to go at the BOP with the ADA thing. I agree that it would be good to approach it from that angle, but I think I was floored because the reason I was denied the license was because of what he wrote. The letter for the basis of the denial came from the same person who told me to site ADA. I didn't go there threatening ADA or anything. You catch more flies with honey than vinegar. So, that's overturned. Now, I am dealing with TN (hoping for another victory).

Things that would make it better. Better services--I want someone who has that drive to help the mentally ill get back into a productive life and who will advocate for them when they need something or when there is an injustice. I want more job services that are geared toward getting the mentally ill working and more independent housing. I think as far as jobs, they should have like part time work in the beginning until they really get a feel for the job and they get over the 'new job' stress. Then, if they want, they can move to full time. I think they should have whatever job they are capable to handle--be it nursing or something like retail. I don't think the only jobs they should hold are janitor jobs or minimum wage jobs. I think that they actually should have jobs (if they are functioning well enough) in the mental health realm, if they want, because I think they are more likely to have the drive to advocate and the understanding and compassion to deal with their peers. I want facilities that are more cheery, more activities, access to food/drinks at all times, private rooms, I think pet therapy would be nice, more outside privileges, and therapeutic staff. Better education--I think mental health education should be taught in schools. I think there should be more available info. I think what is said about mental health topics should be based in fact, not opinion. Better advocacy and legislation-- I think there should be a crack down in discrimination against mental illness, including dealing with the Boards (if anything, they should know better). I think personal info in regards to the Boards should be private unless there is evidential facts that would support that it would be in the best interest to the public to disclose the personal info (for example, someone saying they are homicidal or something). Mental illness in itself is not a reason for someone to lose their privacy rights (HIPAA). That operates under the assumption that they are automatically a danger, which criminalizes mental illness. It's hard to break a stigma with healthcare professionals acting this way. What makes it worse is the fact that if they have a dx, then they are most likely treated. The goal of treatment is to get someone back to functioning normally or at the optimum level that they can achieve.

The positives--there are mental health advocacy organizations that exist. There are some good providers. I think most, if not everyone, realizes that there needs to be improvement in mental health services. That's the first step--admitting there's a problem. Then, you have to define the problem. You have to plan or come up with a solution (figure out where you want to be and how to get there). Then, you do it. And evaluate to see where problems still exist.

Legislation--Change the laws to where our info is private and protected. I don't care to disclose to the Boards, but I don't think it should automatically be disclosed to the public. Only in an event where the public needs to know to protect their safety.

Okay, what do you all want?

[VivaLasViejas, ASN, RN]

I have been very fortunate in my dealings with the mental health system thus far. As badly as I feared entering it, my introduction to the world of psychiatry has been gentle and not intimidating at all, thanks to an excellent doctor and good insurance.

Of course, I've never been hospitalized so I have no frame of reference for that experience. I do hope never to need inpatient care, but if I should need it, I trust my doctor to make that decision. Trust is a HUGE deal in mental health; I think it's safe to say that most patients with MI have issues with it, and it's all too easy to shatter such a delicate thing. I feel for those who have had bad experiences with their psychiatrists or therapists and who have had nightmarish hospital admissions......when one's illness is out of control, it's terrifying enough without adding heedless caregivers or a forbidding environment to the mix.

If there's one thing I wish for, it would be to see the stigma of mental illness disappear in my lifetime. Again, I've been lucky not to have suffered much in the way of discrimination, even though I don't make a big secret out of my MI and honestly don't care if my diagnosis intimidates some people. I am not just my disorder; I am a flesh-and-blood human being like everyone else, and I have just as much right to pursue my dreams and live a full life as "normal" folks do.

OK, off my soapbox now. This is a good topic; hope you get some thoughtful replies.

[ThePrincessBride, MSN, RN, NP]

I won't be too specific about my mental illness or treatment, but I find that the mental health system is lacking. My professors didn't take my anxiety and illness seriously and were inflexible in their teaching habits and failed me after putting me in a situation that I was doomed to fail in from the very start. It is hard, and I find nursing to be very unwelcoming for people like me. But I've chosen this field, so it is what it is.

That being said, I do think that nurses in general need to become more educated about mental health and illnesses. I feel that most people, even medical professionals outside of psychiatry/pscyhology, do not have a firm grasp of mental illness. We are stereotyped as "crazy", "uncontrollable" and "psychotic" when for the vast majority of us, it certainly isn't the case. Nursing schools and clinical instructors, as a whole, have no idea what people like me go through and the unnecessary anxiety they put on us by being over the top drill sergents when it is uncalled for.

I would like for psychiatrists and psychologists/therapists to stop charging outrageous amounts per session. I would like for psychiatrists to STOP jumping towards medication as a treatment plan without considering alternative methods (not all people respond well to meds and not everyone wants to be drugged into a zombie). Medication may treat the symptoms, but it does not cure the disease. Rather, it masks it, and I find that to be very counterproductive.

I would like legislation to make it so that people like me cannot be discriminated against and that we get the necessary accomodations like those with ADD and ADHD,which are arguably less serious than an anxiety disorder.

Overall, I haven't found much help with my illness and I am currently untreated without meds. So far, I haven't killed myself or anyone else, so I guess everything's okay.

[teeniebert, LPN]

Here's a change I'd like to see--if a person in an inpatient mental health facility asks for regular coffee with their breakfast tray, GIVE THEM REGULAR ******* COFFEE. Don't change it to decaf and then pretend you don't know the difference. And don't even try that 'caffeine is a drug, you can't have it with X medication' lecture. The smokers don't get their cigarettes taken away cold turkey, the alcoholics are at least supervised and given meds/tx to help them through withdrawal, why are caffeine users expected to quit and 'just deal with' the debilitating headaches and fatigue that follow?

(Been there, done that, got hollered at for going to my room and pulling the covers over my head to block the light and noise instead of going to Group...)

[wooh, BSN, RN]

I think until the world puts mental health problems on par with physical health problems, we're not going to get the changes we need. Which is a shame. The world still sees mental health problems as a "failing." You should be able to snap out of it! I'm lucky that an antidepressant is all that I need. Because with the crappy coverage my health plan has for mental health treatment, I'd be broke and/or untreated if needed actual therapy (which I could probably benefit from, but I make do without) and/or if I needed inpatient treatment or more specialized care to get the right balance of medications.

[VivaLasViejas, ASN, RN]

I don't know how I got so lucky with my current insurance. It's pretty bare-bones, but the MH coverage is outstanding---unlimited visits and only a $50 co-pay. I've been in that office so many times this year that I've literally saved several thousand dollars. I can't get weight-loss surgery done with this insurance, but at least I can see my pdoc whenever I need to. Could be worse!

[dirtyhippiegirl, BSN, RN]

I just realized the other day that four out of the five acute inpatient units that I spent time on as an adolescent are now closed. Both of the residential hospitals are still open and have actually expanded in the last decade. I thought that was kind of interesting.

[BeOne77]

I'd like to see more open and educated nurses especially in the BON that are less discriminating and more understanding to those who either have, have yet to have or know someone who has mental illness.