What do you think can be done to improve access to mental health care?

[herring_RN, ASN, BSN]

The problem has been getting worse for decades. I once saw a man hit by a car near a hospital. Neighbors had repeatedly called to report a man who walked naked across a four lane street for hours at night.

He had been hospitalized for two weeks and then discharged. After that when they called they were told nothing could be done.

I have no idea how he did after being taken to the ER. It seems so wrong to me that there is so liitle available to help so many sick people.

This is recent news to illustrated the problem:

Nowhere to Go: Mentally ill youth in crisis

Scott Pelley reports on severe shortcomings in the state of mental health care for young people in the U.S.

Last November 19th, Virginia State Senator Creigh Deeds was slashed and stabbed repeatedly by his own son. Gus Deeds was 24 years old and had been struggling with mental illness. He and his father had been in an emergency room just hours before the attack but didn't get the help that they needed.

The story of what went wrong with his medical care exposes a problem in the way that America handles mental health. It's a failure that came to the fore with the murders at Sandy Hook Elementary School....

... The vast majority of mental patients are not violent. But this is a story about the fraction who are a danger to themselves or others. Parents of mentally ill children in crisis often find, as Sen. Deeds did, that they have nowhere to go. Creigh Deeds bears the scars of this failure on his face, his body and his soul.Creigh Deeds: I really don't want Gus to be defined by his illness. I don't want Gus to be defined by what happened on the 19th. Gus was a great kid. He was a perfect son. It's clear the system failed. It's clear that it failed Gus. It killed Gus.

We met Creigh Deeds four weeks after the attack. He was still distraught. But he told us his story was a warning that could not wait....

... Scott Pelley: What would have saved Gus?

Creigh Deeds: If he could have been hospitalized that night, they could have gotten him medicated, and I could have worked to get Gus in some sort of long term care....

... Brian Geyser: You know, every day, we have 10 to 20 kids with psychiatric problems come into our emergency department, kids who wanna kill themselves, who've tried to kill themselves, who've tried to kill somebody else.

Brian Geyser is a nurse practitioner we met in the emergency department of Yale New Haven Hospital in Connecticut-- it's one of the best in the nation in psychiatry.

Brian Geyser: We have 52 psychiatric beds here at Yale. And right now, all 52 are full. And so the seven kids that are here in the emergency room are waiting for an open bed.

Scott Pelley: How long will they wait?

Brian Geyser: Five of them have been here three days already....

... They wanted to discharge my daughter. She needed to stay where she was safe and the insurance company would not pay and so I was told by our social worker in the hospital that if I gave my daughter up to Department of Children and Families, that then she would have insurance coverage through the state and she would be allowed to stay....

... The state of Virginia is investigating why there was no hospital bed for Gus Deeds that night. Nationwide, since 2008, states have cut $4.5 billion from mental health care funding....

http://www.cbsnews.com/news/mentally-ill-youth-in-crisis/

[Kyrshamarks, BSN, RN]

Unfortuantely this is case of you reap what you sow. In the 1970's there was the big push to deinstitutionalize mental patients and put them back in the community. The psych hospitals closed. Now there is nowhere for these people to go and get treatment they need because of the policies of the 70's.

[That Guy, BSN, RN, EMT-B]

I saw that 60 minutes report, it was really sad and showed just how terrible our mental health care is in this country. I think the problem relies a lot on funding. We see countless come in to the ER wanting help, but they cant get it, or its for too short of times and they cant get better in 3 days. Sad sad state of affairs.

[Carrie RN]

Because it isn't a money maker in the hospital, and a hospital can't keep them forever. Most communities have nowhere for people to go. The programs are all full.

[imintrouble, BSN, RN]

We either find placement directly from the ER, or admit them to the floor until placement can be found. It's inadequate care all the way around.

We're not psych nurses, and we have no psychiatric services here. The best we can do do is "babysit" until we find a psych facility to take them. It stretches the resources of our hospital, as these pts almost always require 1-1 staffing.

There is only one way to improve access to mental health care. More money. Where are we supposed to get it?

[Krzysztof]

There is only one way to improve access to mental health care. More money. Where are we supposed to get it?

Well, I've got a whole list of chronic diseases r/t habits of personal choice that I'd be willing to defund in order to free up some cash for mental illness. It's terribly un-PC, however. I'd never be elected.

[RNGriffin]

I believe MRDD patients deserve to be in a community setting, and not in an institution. However, I believe states need to adopt the special home/group home model. So many fail, by trying to staff individual apartments with DSP(s) and an on call nurse. There definitely is a large market for MRDD community integration.

While in college, I helped a company develop an organization where we contracted with the state, purchased a couple of town homes, and housed up to 4 individuals per home/apartment. Worked beautifully, as the clients became familiar with their community & home environment and were able to develop a consistent routine.

Once you change the routine of anyone ( psych diagnosis or not) you are going to be faced with adverse outcomes. If there were more models built with the mindset of assisted living for psych patients, there would be more compliance.

[LadyFree28, BSN, LPN, RN]

I believe MRDD patients deserve to be in a community setting and not in an institution. However, I believe states need to adopt the special home/group home model. So many fail, by trying to staff individual apartments with DSP(s) and an on call nurse. There definitely is a large market for MRDD community integration. While in college, I helped a company develop an organization where we contracted with the state, purchased a couple of town homes, and housed up to 4 individuals per home/apartment. Worked beautifully, as the clients became familiar with their community & home environment and were able to develop a consistent routine. Once you change the routine of anyone ( psych diagnosis or not) you are going to be faced with adverse outcomes. If there were more models built with the mindset of assisted living for psych patients, there would be more compliance.[/quote']

If this could be duplicated, it would be an effective possibility, however there may be a push in communities re: the stigma, but still a start.

[BlueDevil,DNP, DNP, RN]

I have a pt that has several severe mental health diagnoses. She has long been dangerous to herself and others. She is constantly in and out of behavioral health units and jails/prison, and then back in our office again. I don't treat her psych disorders, but do treat asthma and a few sundry medical conditions. I have to deal with her psych issues, as does the rest of the community.

A few months ago she had to be removed from our office for making threats (off her meds, obviously). We were surprised to see her back a few weeks later, having been "stabilized" in the BH unit at the Univ hospital for about 10 days and released. She was off her meds, again, and in the front office making threats, again. She left of her own accord but then assaulted another patient in the parking lot. She was arrested. There were other warrants out for her and she had prior convictions, so she went to county lock up for a few months. Then she was back and we went through the same scenarios all over again. Until she killed her mother. I think they will keep her a little while this time. The saddest part- her mother was the one caring for her 6 children (fathers unknown). What happens to them now?

[nekozuki, LPN]

A neighbor of mine suffers from bipolar disorder, and her manic states are the stuff of local legend. Last week, she knocked on my door at 11pm and asked to use the phone. My roommate let her in, and she started screaming and gesticulating wildly, convinced the police were trying to steal her identity and kill her, among other delusions. Because she refused to leave, we had to call the cops and leave the house to allow them to enter and coax her out.

The cops didn't bother with the Baker Act, and didn't even consider taking her to the local psych facility. Because she wasn't actively trying to self-harm, they walked her home and left her there. The woman needed to be hospitalized and put back on meds, but instead she was left to wander the streets in forty degree weather. She has a daughter with downs syndrome, and constantly threatens to take to the streets with her if the family tries to intervene. Ugh, this world is such a screwed up place.

[Sam J.]

I'm a a road trip for months, been all over CA and was (I thought) shocked at the numbers of mentally ill homeless people 'all' over that state (even sleeping under trees on the grounds of the capital in Sacramento), and the worst disgrace, I thought, was S.F. There, on every corner in many areas of town (funny, how the 'financial district' is kept clear) the mentally ill lay in their own waste, in broad daylight, everywhere, and eat garbage out of the trash, and are simply walked over and ignored. But for the most part, they were calm, and unobtrusive, else they were 'hauled away' to places unknown.

Now that I'm in Reno, I realize what 'shocking' is- not only is it freezing cold here, and not only are there mentally ill people wandering around everywhere- many of them are in full-blown psychotic states, and a real danger to themselves, and others. I've never in my life been afraid to walk down a street in broad daylight, but here I have been accosted several times. In a casino, one women spit on and attacked a waitress, and then a guard, and what happened? They pushed her out the door into the night. Not even a call to the police. Turns out, the state of Nevada has been giving its mentally ill souls $1500 and a one way bus ticket to California, with the advice that they 'seek help' once they arrive there in the land of Milk and Honey.

The short answer? Few people in this country care, unless it concerns them on a personal level, like many things. And it's always the same old tired question- WHERE will the money come from? Sad.

[michaeljr]

Deinstitutionalization was an enormous loss to this country. The practices were...less than ideal for quite some time. A reestablishment of it would be a great improvement. The stigma and complete ignorance surrounding mental health/diagnosis/disorders and varying degrees/etc in this country is absolutely astounding. Everything is painted with a broad brush, and people are scared to come forward because people In general are largely ignorant to the actual illness. Bipolar, for instance, is as broadly brushed as depression, yet a person with bipolar II (regarded by the educated as a mild mood disorder) is lumped in by the masses with the likes of violent bipolar I patients, thus chasing people that otherwise could receive help to the hills for fear of being looked at as though they were Adam Lanza.

Ignorance is the biggest enemy of all, and we perpetuate it daily by not corrected the root problem.