Thursday, December 5, 2013

Mental Health Treatment in this country needs serious help

A couple weeks ago, one of our (Virginia) state senators, Creigh Deeds,  was brutally stabbed in house after an argument with his son, who then killed himself.  What made the story more tragic is that he had tried to get his son help the day before.  The court had mandated a hold for evaluation, only the hospital sent him home instead.  They claimed there were no beds for him anywhere.  It is a very rural area.  Only, now several facilities have claimed they had beds but no one contacted them.  Well, an investigation will hopefully sort that all out.

What I want to actually talk about is how broken the system is.  When there are tragedies where the mentally ill kill someone (Sandy Hook, Boulder, The Navy Yard and on and on), society looks for answers and asks how it could happen.  The thing is, it's easy.

I am going to use Virginia as an example, because all states have their own systems and they are similar.  Additionally, I am going to chose just one illness - Schizophrenia to use in my examples because it affects (according to NIMH) about 1% of the population (That's one in one hundred people - a LOT) and that makes the math easier for me.  But there are so many other chronic illnesses out there as well - Bipolar and Depression being two other major ones.

So using the numbers:

In Virginia there are 5,309 beds in state psychiatric facilities based on a 2011 report.  In 2012, the population estimate for Virginia was 8,185,867.   So 1% of that population would be an estimate of 81,859 people suffering from schizophrenia.  Now most people with schizophrenia are stabilized on medications and living relatively 'normal' lives.  But that said, a large number are not.  Either they refuse to take their medications, are undiagnosed (particularly in the late teens/early twenties, most common onset period), or the meds just don't work well.  5,309 beds for 81,859 people PLUS those suffering from all sorts of other mental illnesses who might need those beds.  Not good numbers.

So, I am going to take it further and just discuss Northern Virginia.  The state facility serving the Northern Virginia is called Northern Virginia Mental Health Institute.  It has 123 beds.  It is for acute care not long-term care.  I worked there for 6 months a lifetime ago as a psychiatric technician.  Burnt out quickly and bad.

Anyway, it serves the Counties and Cities of Fairfax 1.1 million, Loudon 337 thousand, Arlington 221 thousand, Alexandria 146 thousand, Falls Church 13 thousand, and Prince William 430 thousand.  These numbers are also from 2012.  The grand total is 2.2 Million and only 123 beds. 

Of course that doesn't include private facilities or half-way houses or whatnot.  But even so.  There are not many places to care for those who are really mentally ill.  And those who do, have an incredibly high turnover.  Where when someone really bad comes in, pick the one best off and they leave to make room.  Treat Them and Street Them is a reality.  stabilize their meds and get them out with aftercare setup, but you cant make them follow through with aftercare.

After a tragedy we ask didn't anyone see the signs?  Or why couldn't it have been prevented?  Great questions.  I would propose a couple answers.  People probably saw the signs, may have even intervened or tried to, but there isn't a lot that they can do legally if the person doesn't want help.

In most states a court can order an involuntary evaluation hold for 24-72 hours, at which time, if the person is NOT considered a danger to self or others, they can just walk away or get voluntary treatment.  But if they are paranoid, they might not think anything is wrong with them or that the treatment itself is a threat to them.  Or they may be good at hiding their real thoughts (esp. if they have been in the system before) and delusions.  And they will lie.  They don't want to be locked up.

In the past, committals were easier (maybe too easy) but after deinstitutionalization in the 80s, the mentally ill were rarely kept against their will over time.  Whether people like it or not, they have rights including the right to refuse treatment.  Unless they are a danger.  But how easy is that to prove legally BEFORE they do something awful?  It's not.  And the fact is, it is a SMALL number that actually are dangerous.  And though some seek help, many don't.  And even if they do seek help, is the system really equipped to help them?

And then there is money.  A lot of insurance has very little coverage for mental illness, or caps on time allowed in a facility or under treatment.  And the nature of the illness also means, they may not be able to hold down a job that provides insurance.  So then who pays?  The state?  Mental Illness is not one of the high funding categories.  And building more facilities?  Nobody wants them in their neighborhood?  Do you? 

And where is that tenuous line between societal vs. individual rights?  We have a right to be safe from those who are dangerous.  Yes.  But do we have the right to lock them up and medicate them against their will?  These are questions we need to have MAJOR discussions about as communities and as a country.

I do not believe the mental health system can prevent these kind of tragedies without some huge changes. 

I believe the biggest obstacle to improving the system though is this society's attitude towards mental illness.  People DON'T want to talk about it or educate themselves about it.  They would rather look away, until it affects them personally.  And then, like poor Gus Deeds, it is too late.


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