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Source: (consider it)
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Thread: Mental health care in the US
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Josephine
Orthodox Belle
# 3899
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Posted
While we're talking about mass killings, it wouldn't hurt to talk about mental health care, or the lack thereof.
As one mother of a mentally ill teenager explains, it is exceedingly difficult to get mental health care in this country. Insurance might cover 6 outpatient visits a year, or it might not cover mental health care at all. And if it does cover it, of course, you have to have a job to get the insurance. And if you are seriously mentally ill, or your child is, you might not be able to hold a job.
I can't find the link now, but I saw a story that noted that the frequency of mass shootings has gone up since 1982. It's worth noting, perhaps, that we started shuttering psychiatric hospitals in 1981. They were deemed to be both expensive and inhumane. Let's release the patients to their communities, and care for them in community-based outpatient clinics and with community support. That was the theory. The reality was that the community-based clinics and other forms of community support didn't exist and don't exist. But neither do the hospitals any more.
I know people who have called the police and paramedics to take their child to the emergency room, because the child was in a violent rage, and the child were sedated and sent home because there were no hospital beds available. I have a co-worker who had to insist that his daughter press charges against his son for a violent assault, so that his son could be imprisoned, because that was the only way that his son could receive psychiatric services.
Yes, assault rifles and high-capacity magazines are a serious problem. But so is the lack of mental health care. What are we going to do about this part of the problem?
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I've written a book! Catherine's Pascha: A celebration of Easter in the Orthodox Church. It's a lovely book for children. Take a look!
Posts: 10273 | From: Pacific Northwest, USA | Registered: Jan 2003
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Belle Ringer
Shipmate
# 13379
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Posted
quote:
Originally posted by Josephine:
it is exceedingly difficult to get mental health care in this country. Insurance might cover 6 outpatient visits a year,
I kinda think there's a not wanting to admit to the reality of mental illness, which is part pf why a lot end up in prison.
But also, your health insurance probably doesn't cover more than 12 appointments with a physical therapist, and that may be a lifetime limit. 12 visits doesn't begin to cover the long road back from a stroke or automobile accident. Health insurance in USA is about profit for the insurance companies, that means limiting the number of treatments. For long term needs, they want to dump you on the government. Mental illness is a long term need.
Posts: 5830 | From: Texas | Registered: Jan 2008
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cliffdweller
Shipmate
# 13338
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Posted
I had a student this semester who was very much like Michael in the story. Similar diagnosis (or lack thereof) and symptoms, although thankfully, somewhat less severe. I, too, tried to get help, but fought a thicket of red tape and restrictions, even w/o the barriers of health insurance-- which, as the article notes, is the most pressing concern. I though of him this week. I thought of and prayed for Adam Lanza's surviving family. And now I will think and pray for Michael and his family.
And today I will preach: Come, Lord Jesus come.
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"Here is the world. Beautiful and terrible things will happen. Don't be afraid." -Frederick Buechner
Posts: 11242 | From: a small canyon overlooking the city | Registered: Jan 2008
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Olaf
Shipmate
# 11804
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Posted
I'm afraid schools are awful at assisting students who are lonely, afraid, sad, and victimized. It's not lack of heart, but rather lack of money. Schools need so many more social workers, guidance counselors, and mentors. These are the people--upon the advice of teacher, parents, fellow students, and students themselves--who should be identifying students who need mental health care and referring them for further assistance.
In many schools, the faculty is admonished not to even suggest to a student's parents that the student might need medical assistance, whether it be for an attending issue, an auditory issue, autism, a mental illness, or anything else. It might open the school up to financial liability for care, something no school can afford nowadays.
I lament the loss of the true middle school concept, wherein all students are assigned into small groups led by a mentor (teacher or other staff member) and given a small amount of time each day to check in. Most important were those discussions that simply help adolescents cope with adolescence. When the whole testing crunch began in the early 2000s, that character-building time was the first thing to go.
Posts: 8953 | From: Ad Midwestem | Registered: Sep 2006
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Porridge
Shipmate
# 15405
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Posted
The agency I work for serves adults (many of them in their 20s) with a combination of mental illness and developmental disabilities (mostly cognitive impairments.
Some live on their own; some live with their families.
Psychiatric hospitals were originally founded in the U.S. chiefly in response to the inhumane treatment many MI children and adults received in their own households (beaten, starved, chained up in attics or barns, etc.). There was little understanding of MI then (and I'm hesitant to say there's a lot more now, though there's some).
"Asylums," as they were called back then, were meant to remove these folks from abusive environments and provide humane, caring treatment for these patients. Fast forward 100-150 years. The asylums filled to overflowing, often because families wished to offload the significant burden of caring for someone very, very difficult to care for. However, asylums also filled with cast-off adolescents or young adults someone's new spouse wanted nothing to do with. (I've met such cases; one was a woman who'd lived in my state's facility for more than 60 years, with no evidence there was ever anything wrong with her beyond a little mild adolescent rebellion.)
As the institutions overfilled and funding began to pose problems, care (such as it was, and it was sometimes barbaric) deteriorated. Soon it was the institution's turn (as opposed to the original family care) to be charged with abuse, neglect, and inhumanity. The institutions were largely emptied; many have now been converted to short-term, acute care centers.
The problem is that family life with a person who has MMI like schizophrenia or bipolar disorder requires significantly more than "understanding." When your adult son, who may be several inches taller and many pounds heavier than you, abruptly takes on board the belief that you are the devil incarnate and you are out to harm him (and everything he is seeing / hearing only confirms him in this belief because the disease process profoundly distorts his perceptions of your voice, your words, your actions, and your appearance), you are in danger even if he has no access to any kind of weapon. He may well beat you bloody in his delusional efforts to protect himself from you.
If he has access to weapons you're keeping in the house, God help you.
There are not enough beds. There is not enough treatment. There are too few genuinely competent shrinks, and we know too little about these illnesses.
And many of the meds a person can take to combat the worst of the symptoms have devastating effects on physical health.
Because insurance barely covers treatment for depression, the common cold of the MI world, there's little profit in developing newer, more effective, and less damaging meds for MMI.
Frankly, I wonder if the rate of mental illness in the U.S. is higher than elsewhere in the world. I am fairly closely acquainted with about a dozen middle-aged women, every single one of whom has been prescribed some kind of anti-depressant.
I wonder if we, the citizens of the U.S., are simply driving ourselves crazy. Two weeks ago, one of my staff was assaulted by one of our clients. He was not seriously hurt, and in reviewing the incident, it's clear that the staffer played a small role (and yes, he had training, and yes, he should have known better) in instigating this violence. But he was also tired, having put in 15 extra hours covering for another male staffer who was out on leave, because certain clients can only have male staff, and I only have two men working for me. This week just past, he gave in his notice, and I can't blame him.
The other factor in this assault is that state government has cut my budget and therefore also the service hours my clients receive twice in the past year. This particular client had been receiving services every day for two hours -- 14 hours a week. Now he is receiving 6 hours a week -- two hours on Monday, Wednesday, and Friday. The staffer was assaulted on a Monday.
Frankly, I am seriously considering chucking in the towel myself. I feel in danger throughout at least half of any working day; the emergencies are now constant; and it's only a matter of time until somebody at my agency -- maybe one of my staff or me, because we have all the "nut" cases -- gets killed.
[ 16. December 2012, 18:14: Message edited by: Porridge ]
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Spiggott: Everything I've ever told you is a lie, including that.
Moon: Including what?
Spiggott: That everything I've ever told you is a lie.
Moon: That's not true!
Posts: 3925 | From: Upper right corner | Registered: Jan 2010
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Doublethink.
Ship's Foolwise Unperson
# 1984
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Posted
I work with adults with serious mental illness in the UK, and the stories I hear of US care scare me. Beyond the resource issue, my understanding is that the ability to pick up someone behaving erratically and assess them for emergency psychiatric care - without a crime having being committed - is next to non-existent. Is this in fact true ?
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All political thinking for years past has been vitiated in the same way. People can foresee the future only when it coincides with their own wishes, and the most grossly obvious facts can be ignored when they are unwelcome. George Orwell
Posts: 19219 | From: Erehwon | Registered: Aug 2005
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Porridge
Shipmate
# 15405
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Posted
quote:
Originally posted by Doublethink:
I work with adults with serious mental illness in the UK, and the stories I hear of US care scare me. Beyond the resource issue, my understanding is that the ability to pick up someone behaving erratically and assess them for emergency psychiatric care - without a crime having being committed - is next to non-existent. Is this in fact true ?
It varies by state, Doublethink. In my own state and many others, an individual cannot be involuntarily committed (which would have to happen before s/he could be psychiatrically assessed) unless s/he is actively endangering self or others -- which generally means committing or attempting to commit a crime.
Even when involuntarily committed, patients can refuse meds and refuse other treatment. And they often do. Staff can restrain people who are violent, but there are usually strict rules (again, these vary by state) about how long people can be kept in restraints, what kinds of restraints can be used, and how often restrained individuals must be checked on to ensure their safety -- sometimes very difficult to adhere to when short-staffed, as is often the case.
My staff and I (and in my state, all MH workers in hospital setting) all receive training in dealing with violent clients with non-violent interventions. But frankly, these are of little use unless regularly practiced and trainees are always "on the jump" for potential violence.
We're human; we get to know our clients (or think we do), and get accustomed to their sometimes strange ways. And we relax. Or we get worn down, as my staffer did, and we lapse into lowered vigilance.
The police will sometimes pick up someone who's behaving strangely, but usually only to see if they're drunk (illegal in public where I live). Once they establish it's not booze or some other intoxicant, they'll often try to contact a family member (if any) to come collect their kin.
Provided, of course, they have the time to do this.
[ 16. December 2012, 20:38: Message edited by: Porridge ]
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Spiggott: Everything I've ever told you is a lie, including that.
Moon: Including what?
Spiggott: That everything I've ever told you is a lie.
Moon: That's not true!
Posts: 3925 | From: Upper right corner | Registered: Jan 2010
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Doublethink.
Ship's Foolwise Unperson
# 1984
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Posted
That is tragic.
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All political thinking for years past has been vitiated in the same way. People can foresee the future only when it coincides with their own wishes, and the most grossly obvious facts can be ignored when they are unwelcome. George Orwell
Posts: 19219 | From: Erehwon | Registered: Aug 2005
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cliffdweller
Shipmate
# 13338
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Posted
What Porridge describes is definitely the case in Calif., and a leading driver of our high rate of homelessness. This morning one of our shelter residents came to our worship service, then stayed and asked me to pray with him afterwards. It quickly became clear he was more psychotic than most of our clients, quite agitated and anxious, and clearly had broken with reality. I asked one of our therapists to come join me in the conversation, even though I was fairly certain there was nothing she could do. And that was indeed the case. Very, very sad.
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"Here is the world. Beautiful and terrible things will happen. Don't be afraid." -Frederick Buechner
Posts: 11242 | From: a small canyon overlooking the city | Registered: Jan 2008
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no prophet's flag is set so...
Proceed to see sea
# 15560
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Posted
Not in the USA. But what I've seen in Canada: gov'ts are relying less on taxation to provide public services, and sponsors (corporations) are keeping more and more of their money. The sensible replacement for gov't funding is to have the private companies fill in the gaps. So they do. But what they want it their name on a building, like a hospital, a cancer centre, or a building housing a program with cachet, like children, breast health etc.
This all means that what were community programs don't get funded anymore. Who wants to sponsor a street program for homeless mentally ill people? Not very attractive people and not an attractive program for a company to associate its name with.
Unless you're at the stage of committing a crime, you generally don't get any coverage or attention, even in the publically funded system in Canada any more. 30-40 years ago, when gov'ts funded programs and sponsors didn't fund buildings, there were such services. This is a situation where gov'ts do a much better job than any private enterprise.
I suspect the situation in the USA is parallel to a degree, though a friend who worked in mental health in Missouri for a while and then moved backafter another friend of his who worked in mental health in another state was shot by a patient. He also told me about the difficulties with patients showing up for appointments with firearms. Preventative and community based care is underfunded everywhere for mental health as far as I can tell.
[ 16. December 2012, 21:09: Message edited by: no prophet ]
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Out of this nettle, danger, we pluck this flower, safety.
\_(ツ)_/
Posts: 11498 | From: Treaty 6 territory in the nonexistant Province of Buffalo, Canada ↄ⃝' | Registered: Mar 2010
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Porridge
Shipmate
# 15405
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Posted
It's dangerous.
About 6 years ago, one of my clients was living with a woman in a local flea-bag hotel. This client had a mobility impairment -- very hard for him to get around, even with Canadian crutches.
Staff would show up for his service appointment, knock, and this woman would answer and claim Client wasn't there, or didn't want his services.
Staff would call. Woman would answer the phone & claim Client wasn't there, or he didn't want to come to the phone.
Long story short: when we finally re-established contact, with help from local police, he was in a filthy, feces-bedecked bed, seriously dehydrated and half starved.
The woman had Alzheimer's. Physically, fit as a fiddle. She was going in and out daily, fetching groceries for herself, fixing herself cereal and coffee, but completely forgetting that he needed food and drink too.
I had them both transported to the hospital, where he was admitted (at some point he'd fallen and broken his arm) for rehydration, feeding, and surgery.
She was examined and released.
I went back to the apartment with her and, while there, unplugged the stove. All I could think of was her forgetting she'd put on the coffee and burning down the entire building with all its poverty-stricken, disabled, addicted, and otherwise downtrodden inmates with it.
She had family in the area, in total denial.
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Spiggott: Everything I've ever told you is a lie, including that.
Moon: Including what?
Spiggott: That everything I've ever told you is a lie.
Moon: That's not true!
Posts: 3925 | From: Upper right corner | Registered: Jan 2010
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Doublethink.
Ship's Foolwise Unperson
# 1984
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Posted
Lest anyone is interested, here is the explanation one of our leading peer led charities gives of our mental health act: MHA site.
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All political thinking for years past has been vitiated in the same way. People can foresee the future only when it coincides with their own wishes, and the most grossly obvious facts can be ignored when they are unwelcome. George Orwell
Posts: 19219 | From: Erehwon | Registered: Aug 2005
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cliffdweller
Shipmate
# 13338
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Posted
quote:
Originally posted by Porridge:
It's dangerous.
About 6 years ago, one of my clients was living with a woman in a local flea-bag hotel. This client had a mobility impairment -- very hard for him to get around, even with Canadian crutches.
Staff would show up for his service appointment, knock, and this woman would answer and claim Client wasn't there, or didn't want his services.
Staff would call. Woman would answer the phone & claim Client wasn't there, or he didn't want to come to the phone.
Long story short: when we finally re-established contact, with help from local police, he was in a filthy, feces-bedecked bed, seriously dehydrated and half starved.
The woman had Alzheimer's. Physically, fit as a fiddle. She was going in and out daily, fetching groceries for herself, fixing herself cereal and coffee, but completely forgetting that he needed food and drink too.
I had them both transported to the hospital, where he was admitted (at some point he'd fallen and broken his arm) for rehydration, feeding, and surgery.
She was examined and released.
I went back to the apartment with her and, while there, unplugged the stove. All I could think of was her forgetting she'd put on the coffee and burning down the entire building with all its poverty-stricken, disabled, addicted, and otherwise downtrodden inmates with it.
She had family in the area, in total denial.
Or unable to do anything about it.
We were in the same place with my MIL's Alzheimer's when my FIL became ill. He had a stroke one night and fell, unconscious, to the bathroom floor. She couldn't remember what you were supposed to do in that circumstance, so she got him a pillow.
The difference was... they were in Canada. Some government (I'm guessing a provincial health care agency, but I wasn't the direct contact) stepped in to remove her from the home and bring in a health care aid for FIL. Coming from Calif., where I work tangentally in the field, I was astonished that they could remove her from her home w/o her consent, even though she clearly couldn't care for herself or FIL. The social worker was initially defensive, thinking I was being critical, til I assure her I was grateful for their assistance in solving such a desperate situation, that in the US we'd be struggling to deal with on our own. MIL was admitted involuntarily to a very nice, locked facility where she received loving care. Short of a cure, it was the best place for her-- and the best way to care of FIL. But would never have happened south of the border.
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"Here is the world. Beautiful and terrible things will happen. Don't be afraid." -Frederick Buechner
Posts: 11242 | From: a small canyon overlooking the city | Registered: Jan 2008
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Porridge
Shipmate
# 15405
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Posted
Well, here's the nut that holds the wheel (and in the U.S., keeps it from turning):
quote:
If your AMHP is making the application, they must consult your nearest relative. If the AMHP is applying to detain you under section 2, your nearest relative can give their view, but even if they object to the section 2, they cannot stop the section from going ahead.
1. In the U.S. an AMHP-equivalent can apply for a patient to be involuntarily admitted (I tried this two weeks ago when my staffer got assaulted, on the grounds that Client was clearly a danger to others). There is one, count 'em, 1, acute care psych facility in the state. It was full. It's been full virtually since it opened about 10 years ago, and will continue to be full, as there are too few beds in it to start with.
Client was put on a waiting list. ETA for an admittal: around 6 weeks. Will he be slugging my staffers 6 weeks from now? Probably not. The "danger to self or others" thingie has to be happening or to have happened within 72 hours of application.
2. This client has family still tangentially involved (he has slugged them, too). Stepdad's unemployed, mom pulls down just enough for them to hang onto their house, but they're on food stamps. Her insurance doesn't cover Client; he gets Medicaid, which will cover him (if & when admitted), but which will also come after mom & stepdad when costs exceed what Medicaid will pay (which they will).
Family will HAVE to stop the hospitalization, because they can barely keep the lights on and the furnace stoked. They certainly can't afford to have Client running up bills in acute care.
Can I get a job in the UK?
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Spiggott: Everything I've ever told you is a lie, including that.
Moon: Including what?
Spiggott: That everything I've ever told you is a lie.
Moon: That's not true!
Posts: 3925 | From: Upper right corner | Registered: Jan 2010
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Porridge
Shipmate
# 15405
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Posted
And this sort of thing just makes me ill.
He makes it sound so simple. What planet is he living on? Your loved one isn't sleeping? Get professional help! Your loved isn't eating? Get professional help!
I'm guessing he charges around $450 an hour, meds not included.
I'm also guessing his family isn't running like demented mice from one part-time-job to another, with no benefits, trying to scrabble together enough money to pay the rent, with barely enough time to say hello to each other, much less figure out who's losing it.
You want to help, Dr. Asshole? Get on down here and sit with my assaultive client and figure out what meds to switch him to now. He's already been on 9 different ones, and that's just this year.
Wanna bet his caseload consists exclusively of the Worried Well?
[ 16. December 2012, 22:43: Message edited by: Porridge ]
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Spiggott: Everything I've ever told you is a lie, including that.
Moon: Including what?
Spiggott: That everything I've ever told you is a lie.
Moon: That's not true!
Posts: 3925 | From: Upper right corner | Registered: Jan 2010
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cliffdweller
Shipmate
# 13338
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Posted
Plus he ignores that fact (surely known to a Calif. psychiatrist) that it's virtually impossible to hospitalize a mentally ill relative w/o their consent unless they have attempted either suicide or homicide.
Reports from relatives of the shooter here seem to suggest that the family was well aware that he was mentally ill. Whether or not he was receiving any care, and why or why not, remains to be seen.
Yep, "worried well"-- or perhaps, "affluenza".
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"Here is the world. Beautiful and terrible things will happen. Don't be afraid." -Frederick Buechner
Posts: 11242 | From: a small canyon overlooking the city | Registered: Jan 2008
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Doublethink.
Ship's Foolwise Unperson
# 1984
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Posted
quote:
Originally posted by Porridge:
Well, here's the nut that holds the wheel (and in the U.S., keeps it from turning):
quote:
If your AMHP is making the application, they must consult your nearest relative. If the AMHP is applying to detain you under section 2, your nearest relative can give their view, but even if they object to the section 2, they cannot stop the section from going ahead.
1. In the U.S. an AMHP-equivalent can apply for a patient to be involuntarily admitted (I tried this two weeks ago when my staffer got assaulted, on the grounds that Client was clearly a danger to others). There is one, count 'em, 1, acute care psych facility in the state. It was full. It's been full virtually since it opened about 10 years ago, and will continue to be full, as there are too few beds in it to start with.
Client was put on a waiting list. ETA for an admittal: around 6 weeks. Will he be slugging my staffers 6 weeks from now? Probably not. The "danger to self or others" thingie has to be happening or to have happened within 72 hours of application.
2. This client has family still tangentially involved (he has slugged them, too). Stepdad's unemployed, mom pulls down just enough for them to hang onto their house, but they're on food stamps. Her insurance doesn't cover Client; he gets Medicaid, which will cover him (if & when admitted), but which will also come after mom & stepdad when costs exceed what Medicaid will pay (which they will).
Family will HAVE to stop the hospitalization, because they can barely keep the lights on and the furnace stoked. They certainly can't afford to have Client running up bills in acute care.
Can I get a job in the UK?
Jesus wept.
In the UK the amp has to find a bed if the patient is sectioned - that means going out of county if necessary.
My trust area has approx 1 million population, 6 adult psych wards (assessment, treatment & rehab two each), 1 specialist adult eating disorder unit, 1 specialist low secure unit, 1 specialist child unit, 1 specialist adolescent unit - I think 4 older adults units and a specialist service for the ministry of defence. When people who have been sectioned are discharged the council has a statutory duty to manage their aftercare, which can include funded care pacakages and supported housing.
This provision is a substantial reduction owing to recent cuts. And we are in the bottom 5% of rate of funding per head.
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All political thinking for years past has been vitiated in the same way. People can foresee the future only when it coincides with their own wishes, and the most grossly obvious facts can be ignored when they are unwelcome. George Orwell
Posts: 19219 | From: Erehwon | Registered: Aug 2005
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Doublethink.
Ship's Foolwise Unperson
# 1984
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Posted
(And two learning disability wards.)
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All political thinking for years past has been vitiated in the same way. People can foresee the future only when it coincides with their own wishes, and the most grossly obvious facts can be ignored when they are unwelcome. George Orwell
Posts: 19219 | From: Erehwon | Registered: Aug 2005
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Lamb Chopped
Ship's kebab
# 5528
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Posted
All of the above is true. I have tried on many occasions to hospitalize a violent paranoid schizophrenic with his family's desperate help, only to run into a) no insurance b) no willingness from authorities to tangle with him c) no one willing to keep him past the obviously violent period, in spite of the obvious fact that putting him back on the streets would immediately re-evoke paranoia and violence, d) stupid-ass rules like "patients may not smoke ANYWHERE" (which led directly to him signing himself out so he could have a cig in the parking lot. Oh, and go home and assault family again, being totally off his head). In one case the only way we got him hospitalized for a couple days was for him to assault my husband in full view of the emergency room staff, who had been denying him admission up to that point. Fuck this shit.
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Er, this is what I've been up to (book).
Oh, that you would rend the heavens and come down!
Posts: 20059 | From: off in left field somewhere | Registered: Feb 2004
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Doublethink.
Ship's Foolwise Unperson
# 1984
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Posted
And obviously, health care free at the point of use is really what you need to make this work. It is hard enough to try to build relationships with people who don't think they are ill in the first place, without bankrupting them and trying to get them to use half their income on depot medication they don't think they need.
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All political thinking for years past has been vitiated in the same way. People can foresee the future only when it coincides with their own wishes, and the most grossly obvious facts can be ignored when they are unwelcome. George Orwell
Posts: 19219 | From: Erehwon | Registered: Aug 2005
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Sober Preacher's Kid
Presbymethegationalist
# 12699
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Posted
quote:
Originally posted by cliffdweller:
quote:
Originally posted by Porridge:
It's dangerous.
About 6 years ago, one of my clients was living with a woman in a local flea-bag hotel. This client had a mobility impairment -- very hard for him to get around, even with Canadian crutches.
Staff would show up for his service appointment, knock, and this woman would answer and claim Client wasn't there, or didn't want his services.
Staff would call. Woman would answer the phone & claim Client wasn't there, or he didn't want to come to the phone.
Long story short: when we finally re-established contact, with help from local police, he was in a filthy, feces-bedecked bed, seriously dehydrated and half starved.
The woman had Alzheimer's. Physically, fit as a fiddle. She was going in and out daily, fetching groceries for herself, fixing herself cereal and coffee, but completely forgetting that he needed food and drink too.
I had them both transported to the hospital, where he was admitted (at some point he'd fallen and broken his arm) for rehydration, feeding, and surgery.
She was examined and released.
I went back to the apartment with her and, while there, unplugged the stove. All I could think of was her forgetting she'd put on the coffee and burning down the entire building with all its poverty-stricken, disabled, addicted, and otherwise downtrodden inmates with it.
She had family in the area, in total denial.
Or unable to do anything about it.
We were in the same place with my MIL's Alzheimer's when my FIL became ill. He had a stroke one night and fell, unconscious, to the bathroom floor. She couldn't remember what you were supposed to do in that circumstance, so she got him a pillow.
The difference was... they were in Canada. Some government (I'm guessing a provincial health care agency, but I wasn't the direct contact) stepped in to remove her from the home and bring in a health care aid for FIL. Coming from Calif., where I work tangentally in the field, I was astonished that they could remove her from her home w/o her consent, even though she clearly couldn't care for herself or FIL. The social worker was initially defensive, thinking I was being critical, til I assure her I was grateful for their assistance in solving such a desperate situation, that in the US we'd be struggling to deal with on our own. MIL was admitted involuntarily to a very nice, locked facility where she received loving care. Short of a cure, it was the best place for her-- and the best way to care of FIL. But would never have happened south of the border.
That would be the provincial Ministry of Health, by whatever name it goes by. They won't let a diagnosed Alzheimer's patient live alone; that's a walking lawsuit. Your relative was likely committed to a Long-Term Care Facility. They can be nice, but they're one of the ugly ducklings of the health care system up here. They don't fall under the Canada Health Act so coverage varies provincially and the wait lists can be long. Your MIL got in because she had nobody to care for her.
Here in Ontario the province has recently made providing more LTC beds in lieu of acute care beds a priority. An LTC patient filling up an acute care bed is an expensive waste.
The local LTC facility here in town is locked from the inside to prevent the Alzheimer's patients (at least half the residents) from wandering. That little measure prevents a bill of thousands to the police.
Drugs are the other Ugly Duckling, ridiculously spotty provincial coverage and surely not comprehensive. Dear Britain, would you please lend us the NHS?
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NDP Federal Convention Ottawa 2018: A random assortment of Prots and Trots.
Posts: 7646 | From: Peterborough, Upper Canada | Registered: Jun 2007
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Porridge
Shipmate
# 15405
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Posted
quote:
Originally posted by Doublethink:
Jesus wept.
In the UK the amp has to find a bed if the patient is sectioned - that means going out of county if necessary.
My trust area has approx 1 million population, 6 adult psych wards (assessment, treatment & rehab two each), 1 specialist adult eating disorder unit, 1 specialist low secure unit, 1 specialist child unit, 1 specialist adolescent unit - I think 4 older adults units and a specialist service for the ministry of defence.
My state has a little more than 1 million population. We have one public child-psych unit with about 40 beds (last I knew, though there are rumors about shutting it down even though it's always full and has a waitlist), 1 public adult acute-care facility with 120 beds. These are intended for short-term stays only. That's it for public psych beds.
The state has several not-for-profit hospitals, and those have varying numbers of private psych-unit beds (in my city of around 50,000, 6 beds), but you need private insurance with mental health coverage to get a bed there. Mental health coverage on private insurance is like hen's teeth, mostly because it costs the moon.
There's a private psych unit in a for-profit hospital on the other side of the state, but it's outrageously expensive.
We have 12 totally overwhelmed by underfunding community mental health units, 1 in each MH division of the state. These offer outpatient care only, and they're where MMI inpatients get referred to on discharge. There's a statutory duty for follow-up, but that's a mess. Here's why:
Since all public inpatient care is located in one spot -- the state capital -- that's where you get hospitalized. On discharge, if you live in the North Country, there's no transportation to get home unless a family member is picking you up for the 4-hour drive north. No family? SOL. There's no public transport to get there. Got discharged on weekend? You can't call the North Country Community Mental Health Center for help; they're closed.
Unsurprisingly, the Comm. MH centers often "lose" their follow-up and aftercare patients.
In my experience, follow-up is sketchy at best; aftercare generally consists of "case management" plus one Medicaid-funded shrink visit per month. (I know you must know how abruptly med needs can change -- and that's especially true when people have been hospitalized for maybe 4 days and have been "stabilized" but the new drugs have barely kicked in.)
MH case management consists of getting added to caseloads of 200 or more (I have 52 on my caseload currently, and I'm run ragged -- but I'm contracted through the DD system, not the MH system). These guys are lucky if they can occasionally locate a roominghouse for a few of their clients to live in.
quote:
Originally posted by Doublethink:
When people who have been sectioned are discharged the council has a statutory duty to manage their aftercare, which can include funded care pacakages and supported housing.
This provision is a substantial reduction owing to recent cuts. And we are in the bottom 5% of rate of funding per head.
Jesus: still weeping.
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Spiggott: Everything I've ever told you is a lie, including that.
Moon: Including what?
Spiggott: That everything I've ever told you is a lie.
Moon: That's not true!
Posts: 3925 | From: Upper right corner | Registered: Jan 2010
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Doublethink.
Ship's Foolwise Unperson
# 1984
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Posted
I think you actually have about the same number of beds as us - though maybe organised differently. I don't know the details of private provision in our area. We do have fairly extensive community services.
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All political thinking for years past has been vitiated in the same way. People can foresee the future only when it coincides with their own wishes, and the most grossly obvious facts can be ignored when they are unwelcome. George Orwell
Posts: 19219 | From: Erehwon | Registered: Aug 2005
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Doublethink.
Ship's Foolwise Unperson
# 1984
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Posted
In community we try to run caseloads of 25ish.
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All political thinking for years past has been vitiated in the same way. People can foresee the future only when it coincides with their own wishes, and the most grossly obvious facts can be ignored when they are unwelcome. George Orwell
Posts: 19219 | From: Erehwon | Registered: Aug 2005
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Porridge
Shipmate
# 15405
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Posted
God. 25ish?
If I had 25 people on my caseload, I would probably actually be able to spend at least an hour with each of them twice every month, and therefore have a better handle on what was going on with them. I might even be able to forestall an emergency or two.
I don't know a single MH caseworker with under 200 cases. I know one with 275. I keep getting "offers" from the MH side to come sign up with them (the pay's a little better), but no thanks. I like to be able to remember my clients' names and a few particulars at least.
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Spiggott: Everything I've ever told you is a lie, including that.
Moon: Including what?
Spiggott: That everything I've ever told you is a lie.
Moon: That's not true!
Posts: 3925 | From: Upper right corner | Registered: Jan 2010
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Squirrel
Shipmate
# 3040
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Posted
I'm a social worker in New York, and the situation is pretty poor here as well. However, we do have one law that helps- it mandates health insurance companies to cover certain serious mental illnesses, including schizophrenia, bipolar disorder and borderline personality disorder.
The problem is that many, if not most of, the people who are potentially dangerous are not covered under employer-provided health insurance. They're too disturbed to work, or stay in serious relationships with somebody who does. Many get Medicaid, the government program for poor folks, but to apply for and receive this benefit takes a fair amount of work that, frankly, the most seriously ill people cannot handle.
Then of course there are all those rules out there to "protect" the seriously mentally ill against involuntary care, which mean that those who need the treatment the most don't get it. The model of "community" mental health, in which such people live independently, or in supervised housing, and go for regular therapy and medication, is a shameful farce.
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"The moral is to the physical as three is to one."
- Napoleon
"Five to one."
- George S. Patton
Posts: 1014 | From: Gotham City - Brain of the Great Satan | Registered: Jul 2002
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Sober Preacher's Kid
Presbymethegationalist
# 12699
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Posted
Private insurance of health is a failure for conceptual reasons. Health Insurance classically viewed health problems as catastrophic, you got very sick for a little while then either died or got better. Accidents where you die or break something major are the starting point.
It was also tied, muddily, to the concept of disability insurance, which covers of loss of earning power while sick. Many of the contractual concepts are the same.
Insurance for health expenses, catastrophic coverage and loss of earnings are all separate concepts and are best insured separately.
People who can't earn a living because of mental health issues either never get health coverage under a private model or can't keep it. They absolutely must have universal, comprehensive coverage to have any hope of controlling their illness.
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NDP Federal Convention Ottawa 2018: A random assortment of Prots and Trots.
Posts: 7646 | From: Peterborough, Upper Canada | Registered: Jun 2007
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LutheranChik
Shipmate
# 9826
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Posted
I was guardian for an aunt who had a whole constellation of mental health problems...it was an absolute nightmare trying to persuade the local Probate Court to have her involuntarily hospitalized, even though she had injured herself severely through physical self-neglect. In many states in the US the burden of proof needed to hospitalize a mentally ill individual even for an initial assessment is ridiculous. After finally getting my aunt in the hospital for treatment of her injuries and to do a preliminary assessment of her mental state, I then had to go to court again to argue for guardianship and her continued hospitalization. Keep in mind that, after I was successful doing this (which wasn't at all a certainty), it took a full two years of hospitalization, medication and therapy for my aunt to return, if not to perfect mental health, to a place where she was no longer having psychotic episodes, exhibiting oppositional behavior, hoarding and her other symptoms, and where she was comfortable and content in her care facility.
She, by the way, had no insurance. We had to do what's called a spend-down of her assets to qualify her for Medicaid, the American healthcare program for the poor...very tricky; the bean-counters at DHS tend to treat family members like de facto thieves trying to bilk the system, and every cent of monetary assets (even the proverbial family change jar) and significant item of personal property has to be accounted for AND proven not to have been disposed of deliberately in order to qualify for benefits. (The allotted time for potential Medicaid recipients to have transferred property to family/others -- as gifts or whatever -- has gone from two to three and now I think to four years in Michigan; every state has leeway to tweak the rules one way or the other.) It was a very confusing process even for educated and reasonably sane family members to try and navigate, and it was also humiliating...it seemed like the system was designed to make applicants and their loved ones grovel before the state as some sort of moral prerequisite for services. (Mitigating factor: Our local aging services agency, for which I worked at the time, had an employee whose job was to help families apply for Medicaid, Medicare and other health services; a lady who was very non-judgmental, supportive and empathetic with families while being steel-tough and persistent with balky/clueless bureaucrats. She and the agency social workers were a big help.)
Anyway...the mental health system in the US is badly broken, and no one seems very interested in fixing it. And most Americans have no idea that western Europeans find our healthcare system in general and mental healthcare in particular to be inhumane and ridiculous.
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Simul iustus et peccator
http://www.lutheranchiklworddiary.blogspot.com
Posts: 6462 | From: rural Michigan, USA | Registered: Jul 2005
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Squirrel
Shipmate
# 3040
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Posted
Oh, yes, those Medicaid regulations! They treat people looking for health care like they're a bunch of welfare cheats.
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"The moral is to the physical as three is to one."
- Napoleon
"Five to one."
- George S. Patton
Posts: 1014 | From: Gotham City - Brain of the Great Satan | Registered: Jul 2002
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cliffdweller
Shipmate
# 13338
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Posted
quote:
Originally posted by Sober Preacher's Kid:
That would be the provincial Ministry of Health, by whatever name it goes by. They won't let a diagnosed Alzheimer's patient live alone; that's a walking lawsuit. Your relative was likely committed to a Long-Term Care Facility. They can be nice, but they're one of the ugly ducklings of the health care system up here. They don't fall under the Canada Health Act so coverage varies provincially and the wait lists can be long. Your MIL got in because she had nobody to care for her.
Here in Ontario the province has recently made providing more LTC beds in lieu of acute care beds a priority. An LTC patient filling up an acute care bed is an expensive waste.
The local LTC facility here in town is locked from the inside to prevent the Alzheimer's patients (at least half the residents) from wandering. That little measure prevents a bill of thousands to the police.
Drugs are the other Ugly Duckling, ridiculously spotty provincial coverage and surely not comprehensive. Dear Britain, would you please lend us the NHS?
Yes, precisely. And no matter how spotty it may be, it is better than what we have south of the border, where families are entirely on their own in such circumstances-- not just to pay for such care, but also to convince their relative to enter such a facility. Simply can't make such an involuntary placement here except under the most extreme of circumstances.
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"Here is the world. Beautiful and terrible things will happen. Don't be afraid." -Frederick Buechner
Posts: 11242 | From: a small canyon overlooking the city | Registered: Jan 2008
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Try
Shipmate
# 4951
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Posted
quote:
Originally posted by LutheranChik:
She, by the way, had no insurance. We had to do what's called a spend-down of her assets to qualify her for Medicaid, the American healthcare program for the poor...very tricky; the bean-counters at DHS tend to treat family members like de facto thieves trying to bilk the system, and every cent of monetary assets (even the proverbial family change jar) and significant item of personal property has to be accounted for AND proven not to have been disposed of deliberately in order to qualify for benefits. (The allotted time for potential Medicaid recipients to have transferred property to family/others -- as gifts or whatever -- has gone from two to three and now I think to four years in Michigan; every state has leeway to tweak the rules one way or the other.) It was a very confusing process even for educated and reasonably sane family members to try and navigate, and it was also humiliating...it seemed like the system was designed to make applicants and their loved ones grovel before the state as some sort of moral prerequisite for services. (Mitigating factor: Our local aging services agency, for which I worked at the time, had an employee whose job was to help families apply for Medicaid, Medicare and other health services; a lady who was very non-judgmental, supportive and empathetic with families while being steel-tough and persistent with balky/clueless bureaucrats. She and the agency social workers were a big help.)
You're lucky that Michigan was willing to put her on Medicare. I tried to apply for Medicare for myself, because my own mental issues are apparently too severe for me to keep down a full time job. Apparently in Ohio a single adult without children can only get medicare if they either receive or have applied for SSI/disability. I have no desire to go on disability- that would mean giving up on ever working more then part time. And I am not visibly disabled, and don't want to be a parasite. Fortunately, the county that I live in has established a system of reimbursements for doctors and psychiatrists who treat the uninsured. But if I lived one county over I would be SOL.
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“I’m so glad to be a translator in the 20th century. They only burn Bibles now, not the translators!” - the Rev. Dr. Bruce M. Metzger
Posts: 852 | From: Beautiful Ohio, in dreams again I see... | Registered: Sep 2003
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bib
Shipmate
# 13074
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Posted
Lack of mental health care is a problem world wide. In my city there are no psychiatrists in private practice, no private mental health facilities and the only place to get treatment is at the public hospital which only has a 30 bed facility for those needing admission. Problem is a lot of the admissions are people with drug induced psychosis whome the police bring to the hospital. It is inappropriate admit other patients with mental illness such as post natal depression when the ward is full of druggies, but there is nothing else available.
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"My Lord, my Life, my Way, my End, accept the praise I bring"
Posts: 1307 | From: Australia | Registered: Oct 2007
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Timothy the Obscure
Mostly Friendly
# 292
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Posted
I work in a state psychiatric hospital, in which about 80% of the patients are forensic, meaning they have been found "guilty except for insanity" (WTF does that mean in English?) of some crime. Some have done truly horrific things, and some have a history of it. Others have had one disastrous episode in an otherwise productive and peaceful life (some have done things that were scary and illegal, but actually harmed no one). Some actively sought help in the days leading up to their offense, and were turned away because there were no public resources and they couldn't afford private ones. So they are stuck in a hospital for years (and let's be clear--people don't recover in psychiatric hospitals, at best they stabilize, and if they stay too long they are likely to get worse) because there are no adequate treatment resources in the community (a few months ago there were three open group home beds in the state--at any given moment we probably have at least 30 patients who don't require a hospital level of care). It gets harder every day to convince myself that I'm doing more good than harm.
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When you think of the long and gloomy history of man, you will find more hideous crimes have been committed in the name of obedience than have ever been committed in the name of rebellion.
- C. P. Snow
Posts: 6114 | From: PDX | Registered: May 2001
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Doublethink.
Ship's Foolwise Unperson
# 1984
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Posted
One in four people has a mental health problem at some point in their life. Why do they vote for this ?
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All political thinking for years past has been vitiated in the same way. People can foresee the future only when it coincides with their own wishes, and the most grossly obvious facts can be ignored when they are unwelcome. George Orwell
Posts: 19219 | From: Erehwon | Registered: Aug 2005
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Boogie
Boogie on down!
# 13538
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Posted
I wonder if the lack of national health care comes from the same root as lack of national gun control - a fear of 'control' and removal of 'freedoms'? I also wonder where this fear is coming from (stirred up by big money interests in keeping the status quo?)
Living in a country which has both I must say that I feel neither controlled nor lacking in freedom by these two things.
But, unless the people really want them, they most certainly won't get them. The only way it will happen is from the ground up. The vested interests of the firearms and insurance industries are not going to give up these enormous money spinning concerns easily imo.
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Garden. Room. Walk
Posts: 13030 | From: Boogie Wonderland | Registered: Mar 2008
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Boogie
Boogie on down!
# 13538
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Posted
quote:
Originally posted by LutheranChik:
And most Americans have no idea that western Europeans find our healthcare system in general and mental healthcare in particular to be inhumane and ridiculous.
When I look at your health care arrangements it reminds me, more than anything, of the pet insurance I have for my dog.
![[Frown]](frown.gif) ![[Votive]](graemlins/votive.gif)
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Garden. Room. Walk
Posts: 13030 | From: Boogie Wonderland | Registered: Mar 2008
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Anna B
Shipmate
# 1439
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Posted
quote:
Originally posted by Doublethink:
One in four people has a mental health problem at some point in their life. Why do they vote for this ?
This question puts me in mind of several responses, none of them particularly charitable or patriotic. What can I say. It's 6 AM in Connecticut; soon I must send my son to school. Please continue to remember us in prayer.
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Bad Christian (TM)
Posts: 3069 | From: near a lot of fish | Registered: Oct 2001
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Porridge
Shipmate
# 15405
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Posted
quote:
Originally posted by Timothy the Obscure:
I work in a state psychiatric hospital, in which about 80% of the patients are forensic, meaning they have been found "guilty except for insanity" (WTF does that mean in English?) of some crime. Some have done truly horrific things, and some have a history of it. Others have had one disastrous episode in an otherwise productive and peaceful life (some have done things that were scary and illegal, but actually harmed no one). Some actively sought help in the days leading up to their offense, and were turned away because there were no public resources and they couldn't afford private ones. So they are stuck in a hospital for years (and let's be clear--people don't recover in psychiatric hospitals, at best they stabilize, and if they stay too long they are likely to get worse) because there are no adequate treatment resources in the community (a few months ago there were three open group home beds in the state--at any given moment we probably have at least 30 patients who don't require a hospital level of care). It gets harder every day to convince myself that I'm doing more good than harm.
This.
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Spiggott: Everything I've ever told you is a lie, including that.
Moon: Including what?
Spiggott: That everything I've ever told you is a lie.
Moon: That's not true!
Posts: 3925 | From: Upper right corner | Registered: Jan 2010
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Josephine
Orthodox Belle
# 3899
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Posted
quote:
Originally posted by Doublethink:
One in four people has a mental health problem at some point in their life. Why do they vote for this ?
There are, in this country, many people, a majority perhaps, who believe in "the rugged individual." They believe that people ought to take care of their own, that your family should take care of you, and if your family can't, then your church should. Family and church will know you, understand your needs, be able to distinguish between the person who genuinely needs help and the malingerer. A bunch of strangers in an office in another part of the state, or another part of the country, can't possibly know that.
There are also many people in this country, perhaps a majority, who believe that most people are so lazy, and so lacking in initiative or drive or any other worthwhile characteristics, that if you give them any help at all, they will prefer to take that help and will quit doing anything to help themselves.
I think these two beliefs are, for many people, part of the American Civil Religion -- the religion that requires politicians to wear flag lapel pins and to end speeches with "God bless America," the religion that requires political parties to mention God in their platform and government entities to begin meetings with prayers, the religion that requires school children to pledge allegiance to the flag, the religion that says God withdrew his protection from public schools when teachers were no longer allowed to lead their students in prayer.
A lot of people believe that American Civil Religion is the same as Christianity, but it is not. And I think that the lack of adequate healthcare in the US, and the lack of adequate gun control, are both outworkings of the dogmas of the American Civil Religion.
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I've written a book! Catherine's Pascha: A celebration of Easter in the Orthodox Church. It's a lovely book for children. Take a look!
Posts: 10273 | From: Pacific Northwest, USA | Registered: Jan 2003
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cliffdweller
Shipmate
# 13338
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Posted
quote:
Originally posted by Anna B:
This question puts me in mind of several responses, none of them particularly charitable or patriotic. What can I say. It's 6 AM in Connecticut; soon I must send my son to school. Please continue to remember us in prayer.
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"Here is the world. Beautiful and terrible things will happen. Don't be afraid." -Frederick Buechner
Posts: 11242 | From: a small canyon overlooking the city | Registered: Jan 2008
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Twilight
Puddleglum's sister
# 2832
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Posted
quote:
Originally posted by Boogie:
I wonder if the lack of national health care comes from the same root as lack of national gun control - a fear of 'control' and removal of 'freedoms'?
That's just what I was thinking today when I heard someone on the radio bring up the old fear that involuntary commitment of mentally ill people (who are out of control and either non-compliant with or not responsive to medications) would impair their freedom.
That attitude denies medical care to an entire group of people who are too ill to make decisions for themselves. Yet, we don't worry about nursing homes that keep the elderly dementia patients locked inside so they won't walk barefoot into the snow.
At times like this when half the population is expressing fear that they're going to lose the freedom to own assault weapons and the other half is afraid some psychiatric hospital is going to take away an ill person's freedom to kill himself, I'm beginning to hate the "f" word.
Reading this thread is traumatic in itself. There aren't enough
![[Overused]](graemlins/notworthy.gif) smilies for those of you who work in this dangerous, messed up field. All I can say is thank you.
Posts: 6817 | Registered: May 2002
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Cara
Shipmate
# 16966
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Posted
What Twilight said.
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Pondering.
Posts: 898 | Registered: Feb 2012
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roybart
Shipmate
# 17357
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Posted
What Twilight AND Cara said.
Regarding the matter of the under-funded and poorly-designed U.S. approach to mental health -- I was interested to read in today's NY Times a point made by Robert A. Levy, chairman of the libertarian conservative Cato Institute, "and one of the organizers behind a Supreme Court case that enshrined a Second Amendment individual right to own guns." quote:
I'm skeptical about the efficacy of gun regulations imposed across the board -- almost exclusively on persons who are not part of the problem. To reduce the risk of multivictim violence, we would be better advised to focus on early detection and treatment of mental illness. An early detection regime might indeed be the basis for selective gun access restrictions that even the N.R.A. would support.
My first reaction was one of disgust. Here we have the head of a a right-wing think tank noted for its ideological opposition to non-military, non-police government programs. He appears to be advocating what would turn out to be a huge, inevitably costly new government venture to identify (hard to do), label (ditto), and (apparently) actually FUND TREATMENT FOR mental illness of the sort (whatever that is) that might lead to the commission of "multivictim violence." Apparently anything is better than re-thinking their rigid ideological aversion to gun regulation.
My second thought was different. Maybe this bizarre idea -- assuming it is offered in good faith and with the intention of making this policy work well -- might be our only hope of bringing a wide range of U.S. conservatives on board to actually accomplish something.
We've had plenty of hand-wringing and prayer meetings after previous massacres, with little or no practical results. (1) Is it possible that this suggestion from the Cato Institute is the best the U.S. can hope to achieve in practical terms? (2) Might it actually work?
[ 17. December 2012, 19:42: Message edited by: roybart ]
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"The consolations of the imaginary are not imaginary consolations."
-- Roger Scruton
Posts: 547 | From: here | Registered: Sep 2012
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Timothy the Obscure
Mostly Friendly
# 292
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Posted
It would be great if we could get conservative organizations like the Cato Institute behind an effort to improve mental health care--but the vast majority of people with mental illnesses are not part of the gun violence problem, and most of the people committing violent crimes with guns are not mentally ill. This is just a smokescreen, an attempt to divert attention to a different problem and away from the gun issue.
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When you think of the long and gloomy history of man, you will find more hideous crimes have been committed in the name of obedience than have ever been committed in the name of rebellion.
- C. P. Snow
Posts: 6114 | From: PDX | Registered: May 2001
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Porridge
Shipmate
# 15405
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Posted
I think better treatment and more funding for the MI among us is a great idea. I think taking semi-assault weapons out of the hands of non-police and non-military is a great idea.
There's a few wrinkles to be worked out, though. If someone, anyone, walks into a gun store and asks to purchase a weapon, they have to fill out a form. On that form it asks, "Have you ever been institutionalized for mental illness?" with a couple little tick-boxes for YES or NO.
How many mentally-ill folks with voices in their heads commanding BUYAGUNBUYAGUNBUYAGUN SHOOTEVERYBODYSHOOTEVERYBODY DOITNOWDOITNOW are likely to check off YES?
And guess what? When they check off NO, the gun store owner has absolutely NO way to check. If you call the local looney bin and ask, "Joe Blow was just here buying himself an AK-47 with 3,000 rounds of ammunition. He hasn't been a guest of yours at any point, has he?" they will say, "Sorry, we cannot give you that information under HIPPA regulations."
HIPPA protects the privacy of patients from snoops like purveyors of guns trying to do their duty as responsible arms-dealers.
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Spiggott: Everything I've ever told you is a lie, including that.
Moon: Including what?
Spiggott: That everything I've ever told you is a lie.
Moon: That's not true!
Posts: 3925 | From: Upper right corner | Registered: Jan 2010
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cliffdweller
Shipmate
# 13338
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Posted
quote:
Originally posted by Timothy the Obscure:
It would be great if we could get conservative organizations like the Cato Institute behind an effort to improve mental health care--but the vast majority of people with mental illnesses are not part of the gun violence problem, and most of the people committing violent crimes with guns are not mentally ill. This is just a smokescreen, an attempt to divert attention to a different problem and away from the gun issue.
Yes. My cynical response is it's a shell game. Talk about gun control and they'll cry "no! it's about mental health!". Talk about mental health care and they'll cry "no! It's about violence!".
The fact is, it's about both. It is a complex, multi-faceted problem with multiple causes, and requires a complex, multi-faceted response. We need better mental health care-- more accessibility, more funding, better early intervention. But even in a perfect world with all that, identifying the small percentage of those who will become violent is going to be challenging. So we also need to reduce access to deadly weapons, and reduce the overall number of weapons floating around the country.
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"Here is the world. Beautiful and terrible things will happen. Don't be afraid." -Frederick Buechner
Posts: 11242 | From: a small canyon overlooking the city | Registered: Jan 2008
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ken
Ship's Roundhead
# 2460
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Posted
quote:
Originally posted by Porridge:
If someone, anyone, walks into a gun store and asks to purchase a weapon, they have to fill out a form. On that form it asks, "Have you ever been institutionalized for mental illness?" with a couple little tick-boxes for YES or NO.
How many mentally-ill folks with voices in their heads commanding BUYAGUNBUYAGUNBUYAGUN SHOOTEVERYBODYSHOOTEVERYBODY DOITNOWDOITNOW are likely to check off YES?
A Great American Tradition. When I flew in to Houston about 20 years ago or more, well before 9/11, I had to fill in a form that asked me, among other things, if I intended to attempt the violent overthrow of the government of the United States of America. Yes or No? Not too hard to guess the right answer to that one.
I have no idea why they ask such things.
quote:
Originally posted by Timothy the Obscure:
It would be great if we could get conservative organizations like the Cato Institute behind an effort to improve mental health care...
Well yes, but its never going to happen. Serious mental health care doesn't fit in with some common right-wing world views.
One of the common conservative self-delusions is that people get what they deserve, or what they work for. Rich people are rich and healthy because they worked hard, or because they were specially skilled or clever or entrepreneurial. Poor people, and welfare recipients, are poor because they are lazy, or incompetent, or addicted, or incapable of work in some way. Political commentators push the notion every day: makers and takers, workers and shirkers, the deserving versus the undeserving poor, and all that other fantasy. And the same thinking gets extended from wealth to health to quite other things like love and beauty. (I know its a weird topsy-turvy world - no sane person could believe it if they thought about it seriously for a moment - but somehow they fall for it. Maybe being a far-right conservative requires being both misanthropic and gullible)
Anyway, that mind set is reinforced by the presence of visibly incompetent mentally ill people on the margins of society. They can't make it because they aren't capable of proper work. But as for me, I can make it to the top, because I am better than them. I will make it to the top, because I deserve it. I am not like them, I am better than them!
If it was possible for society to get itself together and help the mentally ill so that by providing a little bit of support they were able to live normally and work and maybe even prosper and contribute as much to the economy as the able-minded and able-bodied - if that were possible than then the scam would be blown. The lie would no longer work. So conservative political organisations have no self-interest in promoting a workable social approach to mental health - even ones like the Cato Institute, whose members almost certainly don't believe the workers v. shirkers lie in any intellectual sense, they are far too clever for that (and yes maybe even too well-meaning, you don't have to be a nasty person to be right-wing)
Same goes for the homeless, for addicts, for prisoners, for alcoholics, for the uneducated, for the stupid, the criminal, even the physically disabled - even people you would think conservatives would approve of such as disabled war veterans. Their very existence serves conservative interests.
They are frightening, they scare people, and that works for conservatives because they need people beyond the boundaries of society so that they can show how important it is to defend those boundaries. We don't want scum like that in our street. Their fate is frightening, it scares others into conformity. They are a kind of living proof that winners are winners and losers are losers because they are being rewarded for the work they do, and that those who can't or won't work will fail, and those who can and do work will prosper. As long as you are obeying the rules, they are visible evidence that you are better than them, and that you do get what you deserve and that you can live the dream. And they scare people into working hard and not rocking the boat, because they are visible evidence of what happens to you if you don't.
"I must work hard and earn as much as possible, and be polite to my boss, and do what I'm told, and get a mortgage, and never go on strike, and never ever join a trade union (or if I have to be very sure never to be active in it), and always remember how good it is that I am Argentinan Australian American Brazilian British Chinese Canadian Egyptian French German Indonesian Iranian Indian Italian Iraqi Japanese Kenyan Malay Mexican Nigerian Pakistani Polish Russian Tunisian Thai Turkish or whatever because we are the BEST, and drive a big car, and discipline my kids so they will grow up to be a good citizen like me dress like everyone else, and go to the same church my neighbours do (or no church at all if my neighbours don't), and have nothing to do with those scum who live over there and, keep my front yard tidy, and listen to the same kind of music as everyone else, and live in a nice tidy house, and love my country (but hate the government, unless there is a war on), and marry someone the same colour as me, and never do drugs, and not get too carried away with religion or politics or art or science or literature or anything else that distracts me from my job, and get promoted, and if I get to be a boss treat my employees as badly as my bosses treat me now because its for their own good, and they deserve it obey my bosses orders, and rise up the company ladder, and generally conform to society, and not make a fuss, and not rock the boat, and above all else never, EVER, risk getting fired from my job because if I lose my job and I lose my house I will be Just Like Them and I know I am better than them and I've worked hard for everything I've got and its my turn now and I DESERVE it."
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Ken
L’amor che move il sole e l’altre stelle.
Posts: 39579 | From: London | Registered: Mar 2002
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sabine
Shipmate
# 3861
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Posted
When I was practicing social work (and I know this had not changed) the issue that drove doctors, therapists, and social workers mad was the fact that insurance companies can refuse to cover certain medications that may be absolutely needed to keep a person stable and able to live a productive life without being in a hospital.
Sorry, it's not in our formulary. . . or worse sorry, we don't think you should prescribe this certain medication, please try another. . .
I didn't have prescribing priviledges, but my SIL does, I dated someone who did, and worked with others who did. They were all frustrated at being told how to practice medicine by insurance companies.
sabine
[ 19. December 2012, 16:09: Message edited by: sabine ]
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"Hunger looks like the man that hunger is killing." Eduardo Galeano
Posts: 5887 | From: the US Heartland | Registered: Dec 2002
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cliffdweller
Shipmate
# 13338
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Posted
Yes. The most galling thing about the right-wing rhetoric about government "death panels" is that we already have death panels-- but they're made up of not of govt bureaucrats, but with corporate bureaucrats-- bean counters with degrees in accounting and spreadsheets, not medicine.
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"Here is the world. Beautiful and terrible things will happen. Don't be afraid." -Frederick Buechner
Posts: 11242 | From: a small canyon overlooking the city | Registered: Jan 2008
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