In an article published by the Treatment Advocacy Center, The Shortage of Public Hospital Beds for Mentally Ill Persons, the authors (D. J. Jaffe and E. Fuller Torrey) present the idea that we have far too few hospital beds in this country, and because of that there has been a dramatic shift towards the diversion of people labeled with mental illness into prisons and homelessness. Their answer to this issue is that we should radically increase the amount of hospital beds and we should also dramatically increase our reliance on outpatient treatment in the form of mandated involuntary medication programs. As many people know here, the TAC has been highly influential politically and the authors of this paper have been instrumental in getting laws passed that mandate the outpatient use of psychiatric drugs for people who have been civilly committed.
As I have written before here, I think it is simply unethical and frankly unconstitutional to mandate that any population be forced to take neuroleptic drugs — drugs that are known to damage health and shorten lives. Furthermore, numerous studies have shown that long-term use of neuroleptics augments the long-term potential for psychosis and elongates the length of the “illness.” Forcing people into a state of permanent sedation may work as a form of social control, but ultimately harms large groups of people while positing the false belief that these drugs correct an illness.
But in this post I mainly want to address the issue of hospital beds. Since the 1960’s there has been a shift towards deinstitutionalization and an increasing reduction in hospital beds in favor of community programs for helping people in emotional distress. In 1955 there were over half a million hospital beds available to the public. Now there is about a tenth that amount at just over 52,000. This has happened while the population has nearly doubled. Essentially, we have gone from about 340 beds per 100,000 people to about 17 beds per 100,000, a massive reduction in available psychiatric beds.
Deinstitutionalization has happened for a number of reasons. On a simple political level, conservatives supported the process as a way of saving money and liberals and libertarians supported the process as a way of promoting civil liberties and greater agency for people labeled with a mental illness.
Because of this enormous drop in available beds, the number of people civilly committed and kept under the guardianship of the state due to “presenting a danger to self or others” has dropped dramatically. In essence, the commitment process has started to phase out except for a very small group of people. This is almost entirely due to financial considerations. States do not want to pay for the high cost of housing patients, so hospital stays have become increasingly short. Many leave the next day and most leave within a few days.
In essence, the hospitals are radically reducing beds due to not being adequately funded by State and Federal coffers. With this massive reduction in beds, there have been wide side effects. Many more people are “boarding” in emergency departments and sometimes stay there for days in small cubicles with few distractions outside of television and asking for a tranquilizer from a medical nurse on the floor. This has become a crisis in some states. In Washington, a judge recently ruled that this is no longer legal and that mental health patients are required to be given a psychiatric bed, or be discharged.
We are also seeing a wholesale shift towards prison management of people with mental health concerns. In Canada, 60% of female inmates are now treated with psych drugs. The New York Times recently outlined the horrific abuses taking place within prison settings to “manage” people labeled with a mental illness. From the Times article, Winerip and Schwirtz write
”The growing numbers of mentally unstable inmates, with issues like depression, schizophrenia and bipolar disorder, are a major factor in the violence. Rikers now has about as many people with mental illnesses — roughly 4,000 of the 11,000 inmates — as all 24 psychiatric hospitals in New York State combined. They make up nearly 40 percent of the jail population, up from about 20 percent eight years ago.”
Knowing all that, should we take Torrey and Jaffe’s advice to dramatically ramp up the amount of hospital beds nationwide? On a basic level this question is a non-starter because it won’t happen even if there was a desire for this. There is simply not enough money to pay for this very expensive form of care. Most of the hospitals in Portland, where I live, lose money in their psychiatric units. In most cases, they retain these units as a way of diverting the “mentally ill” population out of their emergency departments to make way for better paying patients with physical health problems.
Even if there were a new pot of money to pay for a gigantic increase in beds, I would argue that this is a very poor way of managing crisis. Right now, hospital units are run primarily by highly paid psychiatrists and nurses. The main overwhelming focus is on medication “stabilization.” This is an extremely costly system. Instead I would support shifting monies to creating crisis care centers that are run almost entirely by peers and therapists with a small group of doctors and nurses as adjuncts. This would not only create a much cheaper model of care, it would also emphasize what is truly needed, humane care directed towards listening, attending to needs, comfort measures, and receiving a space to experience deep distress and extreme states that is safe and caring. Peer respite centers such as Second Story are already on the front lines of providing this type of care.
So yes, I would agree with Torrey and Jaffe that we need more crisis care beds. But what kind of beds are we talking about? The kind where someone is simply started on powerful psychotropics and then sent out the door? Or one that truly addresses the needs of an individual, one based on human contact and not one solely based on “medication management” and “rapid stabilization.”
Until we move away from a primarily psychiatric model of attending to those in crisis, we will be forever caught in an extremely costly and at times harmful way of helping people in distress. Do we need more beds? Sure, but not the kind that the Treatment Advocacy Center wants.
Make more hospital beds, take more from peoples lives, make more profits from drugging. Why not give people free housing instead so they can have their own roof over their heads and find new places to live easily and be more independent without need for a hospital bed. And give em outpatient stuff on their terms.
Warning: people seek profit by mandating psychiatric care. What a shocker that the industry pushes for and conducts these studies to make it happen and information against them such as alternatives is always ignored.
http://www.obamasweapon.com
I definitely agree that housing is key to this process. Ultimately a lot of the issues surrounding crisis care has to do with economic injustice, classism and a lack of adequate housing. At the same time, there will always be a need for respite for those in crisis. I think we can look to peer respite centers as models of the type of care that we should offer more of…and I believe we should divert much of the money we spend on really expensive medical model “care” towards scaled back facilities that are for more centered on giving people a place to ride out extreme emotional distress without a drug based approach.
Thanks for post, Jonathan. I think the emphasis on “beds” may be misplaced – whether in hospitals or in your preferred crisis residential settings. Mobile, supportive staff/peers going to people’s homes, similar to Open Dialogue, avoids much of the high costs of running facilities, keeps people in familiar places & routines (family, pets) and the intensity of support can be titrated. This seems far less disruptive & can potentially strengthen natural supports.
Of course, it does depend on a person having adequate housing. As you know, hospitals get used for housing/food quite a bit.
Fair enough- I think a lot can be accomplished without needing crisis beds at all. In many ways this is why deinstitutionalization happened. We decided to try and help people in distress in the community where they lived. However, this led to an industry of assigning people as disabled with 700 dollar checks to pay for substandard housing and crappy food.
And by radically cutting crisis beds from 340 per 100,000 to 17 per 100,000, we have left little room for crisis facilities when people are in extreme states. For people who are homeless, or are in dangerous situations, or who want round the clock support we need a better model of care. My argument is that we may need beds…but they need to be significantly different from the type of beds we have now.
I think you’re both correct. There is need for places of comfort and care when one is distressed and in need of kindness while working towards recovery, especially from injustice – and occasionally that’s not in one’s own home or one doesn’t even have a home. The current “medical model” of defaming people to their families by declaring one’s real life concerns to be a “chemical imbalance” and “credible fictional story,” stigmatizing, and massively tranquilizing people really does the opposite of helping one heal from real life traumatic experiences, not to mention the psychotropic drugs are very toxic and can cause a lot of health problems.
And I know my health insurance company was defrauded out of tens of thousands of dollars for inappropriate, unneeded and harmful “treatment,” and my family was defrauded out of over $100,000 in health care premiums, for this type of absurd medical “care,” thus there are definitely people profiting off of this “medical model.”
I think the Open Dialog approach to helping families or individuals work together to heal their real life interpersonal issues really is a very logical and much more long run financially practical way of dealing with most distressed individuals.
Well, there’s a value in taking a person out of his/her life circumstances for a short time (especially if these circumstances have caused the problems in the first place: like abusive spouse or parent or bullying or bad working environment). So I am not completely against some for of institution for people to go to and get “time off” their lives and someone helpful to listen and consult with.
Another reason the big hospitals closed was that people were outraged by the horrible conditions in them. Someone who writes here (Mark Ragins?) commented that nobody cares about the horrible conditions in prisons. The money to fund an improvement in conditions is absolutely there, it’s just being sucked up and wasted by a for profit system.
Outrage at horrible hospital conditions definitely helped lead to deinstitutionalization. This was especially the case in the 60’s and 70’s. But I would say that financial concerns have really been the main cause for the deep cuts in beds in the last 10-20 years.
In essence the medical model system of managing mental health crisis is dying not due to social justice concerns, but because it is too damn expensive.
We can create models of respite care that are far cheaper and far more humane. I think this would also help a number of people avoid the extreme peril of jail and prison based mental health “care.”
I beg to disagree with both you and E. Fuller Torrey, D. J. Jaffee, et al. What we don’t need are more beds! What we need is more tolerance.
As someone I met once said, “If you give them more beds, they will fill them.”
Over and over again, if that bears repeating, let me repeat it. “If you give them more beds they will fill them.”
http://en.wikipedia.org/wiki/History_of_psychiatric_institutions
That was the 19 th century, and there’s a lesson to be learned in this that we still aren’t learning.
You don’t need to double the number of patients you have because the population doubled. In fact, you don’t need to double the number of patients you have because the population didn’t double. You don’t need to double, triple, qua-triple, etc., the number of patients you’ve got.
I used to live in Virginia. They are adding beds in Virginia. They are building “crisis stabilization units”. The same things is happening in California. The patients in these facilities are in all likelihood heavily drugged. They are not ex-patient/patient run, and they are not going to be. Yes, we could use “crisis respite centers”, and “crisis respite centers” that are ex-patient/patient run, but on any large scale that is still potential rather than reality. The reality is these “crisis stabilization units”. What we don’t need is more beds because that’s where they’d be going in the main.
If the criminal justice system is using petty offenses and frivolous laws to lock up people with problems, that’s another issue altogether. It’s a problem that shouldn’t be. People go to jail and prison because they break the law, people don’t go to jail and prison because they are “sick”. I’m not saying we couldn’t use a little jail diversion for some folks. I am saying that jail and prison are not the primary problem here, and walking into a trap set by the Treatment Advocacy Center is not a great thing to do either.
We still need less beds. What we don’t need is more beds. Reinstitutionalization, and outpatient commitment may be the TAC’s thing. Don’t let it be your’s.
“If you give them more beds, they will fill them.” This is, in fact, true. A doctor I had the misfortune of being shipped to, Dr. V R Kuchipudi, has now been arrested by the FBI for having many, many well insured patients medically unnecessarily shipped to him from all over the Chicagoland area, “snowing,” patients, then performing unneeded tracheotomies on them – all just for profit.
http://chicagoist.com/2013/04/16/chicago_hospital_owner_doctors_arre.php
What we need is for the psychiatric industry to stop creating “life long, incurable, genetic mental illnesses,” with their drugs, not more hospital beds.
“That was the 19 th century, and there’s a lesson to be learned in this that we still aren’t learning. ”
Interesting that it correlated with industrialisation and horrific social condition for workers and disappearance of natural family and community relationships. Much like in the neoliberal era we live now.
I strongly agree with most of what you say, Jon. That your background has included working in an inpatient psychiatric setting gives you more credence in my eyes. Some people’s comments, whether in favor of increased or decreased psychiatric hospital beds, seem naive and make me wonder whether they’ve ever really experienced or witnessed the extreme mental states that lead to civil commitments. Don’t get me wrong, I’m not justifying such commitments, and especially not the ill-conceived “treatments” forced on people in such extreme states. But I’m convinced that any really effective alternative (such as the “Open Dialogue” treatment model in the Lapland province of Finland) has to be very well thought out, carefully staffed and implemented.
I’m totally on board with your vision of a very different type of crisis care, staffed primarily by peers and therapists; a place that would provide as you say “a space to experience deep distress and extreme states that is safe and caring”. And I further agree that increasing existing hospital beds is both untenable in terms of cost and ultimately leads to great harm to those it purports to help.
However, I have to ask you to be very real and honest about this: Based on your experience, both in the inpatient psychiatric unit and in your current practice at “Hearthside Healing”, do you believe the primarily peer-staffed facilities you’re aware of would really be equipped to appropriately help people in the most distressing mental states (e.g., psychotic mania)? What about the issue of locked wards? Do you think this is ever warranted, and if not, what is the alternative? How would you address safety for residents and staff? You probably know that people in the “Torrey/Jaffe” camp have plenty of concerns and “scare stories” from people who disparage alternative programs as grossly inadequate (of course, we’re well aware of the very real “scare stories” that abound in the current “gulag psychepelago” system!)
Part of the maddening dilemma, as i see it, is fueled by the pernicious circular reasoning of conventional psychiatry. Since the existing “standard of care” dictates that these extreme states be “treated” aggressively with medication, there is no allowance for non-drug interventions. Therefore, aside from the few drug naive distressed people who might find their way to such a progressive, primarily peer-staffed facility, many of those who come in will be in the throes of prescription drug withdrawal (perhaps mixed with effects of street drugs), or will need to have careful adjustment (hopefully tapering and eventual discontinuance) of the drugs they’ve been put on. And, of course, there’s the issue of very little funding and public support of such alternatives.
Oi vay! But I like your spirit and ideas, and we have to keep plugging away!
Really good questions Russerford…and well worth examining carefully. I think it’s important to acknowledge that there is a population that comes to hospitals that have a history of violence, predatory behavior and ways of acting that are intensely intrusive and frankly scary to many people.
I think it’s even more important with this group that it is stafford primarily be non-medical staff. There is no need to pay a nurse 100,oo0 a year to work with someone in an extreme state. It would be much smarter to have well trained peers and therapists who understand how to listen well, support a path of recovery, provide comfort, and help de-escalate any one who becomes threatening or abusive . I absolutely think that we could develop primarily non-medical units for a wide variety of people.
In terms of violence…In the hospital I work in, the use of restraints is rare…perhaps once every other month due to someone being very violent. This…or even less..should be the norm. And this is in a place that takes perhaps the most highly acute patients in Oregon with long histories of assaultive and violent behavior.
I also understand that many people in distress are already taking medication and will likely need continued medication. Units can have adjunct doctors and a limited amount of nurses to provide those drugs. But the emphasis should be on Recovery…not rapid medical stabilization.
Oh…I saw I didn’t address your question of locked wards. This is a pretty broad topic and probably one deserving its own thread but let me start with a story.
Recently I have been working with a number of suicidal people and we have discussed the possibility of hospitalization and I gave them a clear understanding of what to expect. They would likely be placed on a hold (have to stay in a locked unit) due to being “a danger to self” and would likely stay no more than 3-4 days. They would receive prn benzos for anxiety and sleeplessness and the doctor would prescribe one or two drugs to take daily.
And..that’s about it. A social worker would make a cursory plan for following up with a provider. These folks would not be taking these drugs so that part was useless. The only thing that a locked unit could provide was the ability to keep them safe for a few days by not letting them hurt themselves. For the folks I worked with, they felt secure enough to not want to go through hospitalization.
But, I do know folks who are natural minded, and who hate psychiatry, who have chosen periodic hospitalization and its locked units. I have also known people who are in such an extreme state that they have become intrusive to the point of scaring people, or violent towards their family, etc. I support a limited amount of locked units for these cases.
What I do not support is a doctor ever having the right to force a prescription of psych drugs on a person. This only happens when someone is civilly committed and it should be abolished. There is far too much power in the hands of doctors who should not have the right to require someone to take drugs that damages health and shortens lives over the long term.
This is a very interesting and important discussion. Torry has been around for a long long time and i remember reading his early works and thinking that he had some valid points. The de-institutionalization movement was supported by Dr. Sidney Wolfe in the beginning with the Developmentally Disabled. There is a long intermixing of the Developmentally Disabled and Mental Health movements that really hasn’t been discussed in any coherent in depth way. Back in the old days there initially was a thread of commitment for both populations into state institutions regardless of the exact nature of the problem.Back in high school I had a summer job microfilming old state commitment papers. They made for fascinating and scary reading. Anyone could be committed as long as a medical doctor or person of authority was used as a reference for the probate hearing. Many people were committed and shortly after we saw the death certificate in the file. As a graduate student in Social Work my field placement too k place in a state institution for the Developmentally Disabled. In that state it was still common to have Mental Health patients intermixed with the Developmentally Disabled. One poor man had been fighting for years to get out. There were cottages that we were not allowed entry to. Eventually that place was closed down as thankfully so many others across the nation.
As a person with altered mental states I was able to describe the oncoming mental assault well. However I did not have a supportive husband and my mother was unable to access appropriate help. I was very aware of the trouble with medication and the whole terribly invasive ER and then awful route of substandard hospital treatment.
There was not then nor now an option that would help me deal with my altered mental state in any safe or helpful way. It would have to have been or now be totally private pay.My family was totally unaware of the peer movement and Soteria House approaches. And these were graduate degreed professionals some active in the Community Mental Health working community.
My best guess is that altered mental states have a continuous flow and path and that depending on the person’s intellectual, economic status , and state of self awareness a critical point of awareness map, as done in substance abuse recovery work, can be drawn and used most effectively.
Until there is an established and ongoing face to face dialogue between those of us who have experienced altered mental states and Mental Health professionals all of this discussion is moot. I am thinking of Saul Alinsky here. A meeting where all are gathered in rooms and environments where power is not regulated only to the medical docs and administrations.
Trauma and environmental concerns need to be elevated to the extreme . We all must acknowledge that except for the 1% we are all living under duress. Rodney King’s question of – ” Can’t we all just get along” is oh so important and so very relevant today.
Hey- great reply- and yes- I think there needs to be a lot more dialogue between “those of us who have experienced altered mental states and Mental Health professionals.” And yes, the power balance needs to be shifted away from MDs when it comes to these key issues.
What amazes me is that we only have 10 percent of the amount of people in hospitals since 1955. We have outsourced some of this to outpatient “treatment” programs in the form of periodic neuroleptic shots, but by and large we have shifted to a model of spotty meetings with prescribers and crappy housing if you are lucky. Hospitals are generally a place of churning people in and out as rapidly as possible.
In many ways, the anti-psychiatry movement is winning the battle of radically reducing commitments and eliminating the hospital model simply due to the financial burden and costs of caring for people in crisis. The problem is that people still go through severe crisis without adequate respite.
I am increasingly seeing “circles of support”, where friends, family and loved ones will do round the clock care for someone in crisis. The problem is that this only works for folks with a strong social network.
Thanks for your good words.
“But, I do know folks who are natural minded, and who hate psychiatry, who have chosen periodic hospitalization and its locked units.”
That’s different. If I have a friend or family member who happens to experience psychosis and he/she tells me: “listen, when I have an episode and become dangerous for myself you should restrain me” it’s OK to restrain that person. In fact that would be a good thing. But that is consensual and different from forced psychiatry.
I really appreciate your responses, Jon. Since I’m checking back into this discussion a week later, you may not see this comment. But here goes anyway…
I’ll give a specific scenario that is somewhat different from those you’ve mentioned, and is of very real concern to me. I’m certainly not raising this as a “set up”, as it is an actual quandary that I’ve been faced with. In this scenario, you have an adult family member who is neither suicidal or homicidal, but dangerously delusional. For example (and this is not the actual situation in my personal experience), the loved one is convinced she is a covert agent of the CIA and must meet at midnight at a certain location–one that is known to be a hangout of drug addicts, prostitutes and violent criminals. She cannot be reasoned or talked out of this and, in fact, becomes angry and accusatory toward those who try to impede this “mission”. You want with all your heart to avoid the psychiatric unit at the local hospital, which was so demeaning and injurious to her in a previous episode.
Okay, now let’s suppose we are fortunate enough to have Hearthside Healing, or Parachute NYC (about which I’ve heard good things), or one of the new Soteria Houses nearby. That would be wonderful, and a huge improvement in my local area (even though it is awash in all of the conventional mental health facilities and resources).
But…in this delusional state, my family member will probably be no more likely to check into such a place as she would be to check into the local hospital’s psych ward.
Some of you might say, “Well, she’s an adult. It’s her choice. Let her go and try to carry out her ‘mission'”. To me, loving her and knowing how irrational she is at the moment, that would be grossly negligent. There is the very real possibility that she would put herself in the hands of some very bad actors and end up greatly harmed, dead or missing.
On the other hand, to facilitate her return to the hospital would be to put her back into the hands of those who have unchecked power to harm her body, mind and spirit.
This is what prompted me to ask the questions I did in my initial comment above. And your responses were obviously well thought out and somewhat helpful. But I still struggle to see how it would work in the kind of situation I’ve described.
I’d be interested in any and all input on this.
Thanks.
You mean mental health workers, psychiatrists, and police, of course.
We really have to do something about those mental health workers and their “long histories of assaultive and violent behavior”. When that violence is a matter of the chemical warfare and confinement used against people on the fringes of things, it’s killing them.
Get your doctors to stop prescribing powerful neuroleptics and harmful anti-convulsants, and they’d be saving lives all the way around, as well as preventing chronicity where that chronicity is actually a matter of altered chemistry and dependence.
I agree that I would like to see a radical reduction in the use of “medications” that tend to lead to further chronicity. The problem is that many people coming into hospitals have already long been taking psych drugs. Simply stopping prescribing the drugs cold turkey is inhumane at that point.
I would go to the root of the problem and address how we work with people in first states of psychosis. If we don’t jump to a drug based model of initially treating psychosis, we would radically reduce the potential for long term illness and the need for chronic hospitalization.
Frank, you are so right about violent and assaultive behavior by “professionals!” In addition to the inherent violence you mention in being arrested and locked up, and often held down and forced to take drugs against one’s will, which is clearly a violent and intrusive violation of a person’s integrity and body, I see way too frequently that a patient “assaulted” a staff person, and then read the incident report, and it’s clear that the staff person assaulted the patient and the patient was not allowed to defend him/herself. I’ve seen kids have criminal charges filed because they fought back when a staff person put hands on them unnecessarily after an escalation of a power struggle started by the staff person. There are institutionalized excuses for staff assault that are almost universally accepted in residential settings, and clients are almost always blamed when any kind of violence occurs, even if the staff initiate it.
There are plenty of instances of violent and predatory behavior by staff. I’m not saying this is the norm, but it’s easy to get away with, and there are sociopathic types who go into this work just so they can exert that kind of arbitrary power over helpless victims. Another reason why enforced treatment has got to go!
—- Steve
Well, the assault often starts with putting the person in the hospital. “For the person’s own good”, of course.
Second that final thought, Steve McCrea.
Btw, anyone who is brought to the hospital against his/her will, threatened and assaulted with drugs and restraints is totally justified in defending him/herself with whatever violence he/she chooses. If someone punches me on a street I have a right to defend myself. Psychiatric coercion is state sponsored violence and if you get hit by a guy whom your imprisoning and assaulting it’s your fault and stop moaning.
“there is a population that comes to hospitals that have a history of violence, predatory behavior and ways of acting that are intensely intrusive and frankly scary to many people”
Then they belong to prisons and not in hospitals. Another thing is people who are intellectually disabled and are also included into the mix. But the easiest thing is to just lock everyone up and drug them into unconsciousness. I think we’d be better off with no psych hospitals at all.
More beds?
Quick, someone book that nice hotel in the Bahamas for a week, we will need to have a conference to discuss what color sheets we are going to buy.
And all that added responsibility, 15% pay rises all round. Bring my copy of Wheels magazine, i’m in the market for a new car.
So for 5 million a politician gets to open the new dvd player for the ward.
Some time later….
“The traditionalists won, we went with white sheets. Like my tan? Goes well with the leather interior of my new Beemer. Gee the mentally ill are costing the government a lot these days”
Laughing too hard to reply.
😀
This is the very same E. Fuller Torrey who has declared that schizophrenia is most probably caused by a virus picked up from cats!! The problem is not a shortage of hospital beds, and it is not a problem of “mentally unstable” persons alone. What we are seeing is yet one more effect of the mass destruction caused by neoliberal economic policies that have only served to further the gulf between the haves and the have-nots, that have further dismantled the social contract while blaming the victims of this vicious system, thus leaving large swaths of the populace impoverished, ignored, without protection and without hope. This is NOT a medical problem to be solved by pouring more money into psychiatry and will certainly not be solved by the likes of Fuller Torrey. It is a social problem and will only be solved by rethinking the question of how we wish to live together on this planet.
I tend to agree. But Torrey has proven to be one of the most politically influential mental health “experts” in the country. His organization…the Treatment Advocacy Center has developed a lot of the language for onerous Outpatient Treatment programs. If he, Jaffe and others, are calling for a massive ramp up in psych beds, there needs to be a fair bit of rebuttal.
There seems to be quite a bit of evidence that the toxoplasmosis virus, which is carried by cats, can infect people’s brains. It is a known to cause mental retardation in fetuses, why could it not possibly be a cause of schizophrenia? Unless you know for sure what causes schizophrenia, please do not be so dismissive of the research looking for the cause of this devastating disease. The only way we will ever find a cure is if the public supports research into the cause or causes of this terrible disease. I have watched someone I love come done with this disease. It really is a disease and not just a “social problem”.
there is quite a lot of research into the causes of, “schizophrenia.” The research shows psychological trauma, especially at an early age, in people who get this diagnosis. Other factors are racism, homophobia and poverty.
“T. gondii infections occur throughout the world, although infection rates differ significantly by country.[56] For women of childbearing age, a survey of 99 studies within 44 countries found the areas of highest prevalence are within Latin America (about 50–80%), parts of Eastern and Central Europe (about 20–60%), the Middle East (about 30-50%), parts of Southeast Asia (about 20–60%), and parts of Africa (about 20–55%).”
From Wikipedia. Quite a lot of underdiagnosed schizophrenics out there… Btw, some viruses do cause psychosis (HIV being the most prominent) but then the treatment is to suppress the virus and not pump someone full of psych drugs.
I am sorry about your loved one, madincanada. But I’m pretty sure that the majority of the increase in the number of “bipolar” patients, from approximately .05% of the population historically, to 7% of children and 4.4% of American adults is a massive misdiagnosis problem, and a societal injustice problem. I agree with you, Eugene.
And I suppose it’s possible my black cat at home caused the brief “schizoaffective symptoms” I suffered from right after being drugged with 17 different drugs, in willy nilly drug combinations of at least seven drugs at a time, over a ten day period. But I’m pretty certain it was the “snowing” that caused the “schizoaffective symptoms,” not the black cat.
My daughter just convinced me to get an orange cat, he’s much nicer than our black cat. And my medical records now list most the drugs (my current doctor got too embarrassed to finish the list on my first appointment with him) that made me “bipolar” with “schizoaffective symptoms” listed as drugs I have bad reactions to. Plus, I took my name off the organ donor list. So hopefully I won’t run into that problem again.
I’d like to live in a society where it’s considered of paramount importance all people show mutual respect towards all others, and profiting off making people “mentally ill” for life, completely with drugs, is no longer considered “appropriate medical care.”
We would not need more hospital beds if we did this:
“The main difference is that a holistic therapist spends quite a bit of time focused on health and well being. That means looking at diet, lifestyle habits, herbal and vitamin supplements, sleep, rest and exercise patterns as cornerstones of good mental health. At the core of the practice Jon emphasizes nourishment. A well nourished body helps regulate emotions, diminishes anxiety and depression, strengthens cognitive function and improves an overall state of well being.”
Well Said.
Well lived.
Off to make some good cheap food and sleep.
After a few golden hours spent weeding my garden and enjoying sunlight.
Health isn’t that complicated.
Thank you for being here.
I’ll be returning to cleaning houses soon.
You don’t need much money to live simply.
Even the most broken of us can do that.
If given half a chance.
Beautiful! Hope you enjoy some good food, sleep and time with your garden and sunlight…
Beautifully said, schizoeffective. “Show me a garden that’s bursting into life,” lyrics from “Chasing Cars” was inspiration for a lot of gardening when this “motoring'” “sister Christian” was on her journey back from an iatrogenic hell, too. Gardening and spending time even driving around our beautiful countryside listening to music are wonderful and overlooked tools in healing, I agree.
I think the question is answered by reading the article in the “In The News” section of MIA today, showing that there is a dose-dependent relationship between increasing psychiatric care and increasing suicide rates. Sounds like the only reason to pay for more psychiatric beds is if we want more people to kill themselves!
—- Steve
Hey Steve. I agree that I don’t want anymore psychiatric beds. But I do feel that we need more respite beds along the lines of Second Story and other peer based recovery centers. Torrey has really galvanized popular opinion towards supporting Outpatient Treatment. My worry is that he and others may galvanize a new movement towards increasing status quo psychiatric beds. We need a different type of respite bed for people in crisis.
Deinstitutionalization has led to a massive emptying out of hospitals. But we are now left with prisons becoming the defacto holding grounds for people labeled with mental illness and they are being treated horrifically.
We need more safe options for people in crisis outside of hospitals and prisons.
I agree that respite beds with a non-psychiatric focus would be essential if we’re to undermine and replace the current paradigm. People do need help in crisis situations, and we already have models (Soteria, Open Dialog, and many more) that show how that can be done with para-professionals and without force. The big question to me is how to deal with the politics? Such efforts are almost always opposed by the establishment as cutting into their slice of the economic pie. Where are the forces to oppose this politically-motivated defunding/coopting effort? Do you think the psychiatric system would ever embrace such alternatives to the point of diverting funds in that direction on a permanent basis? Maybe I’m being cynical, but I can’t see that happening without a major revolt from both “consumers” and “providers.”
—- Steve
Yah good questions- and I think this gets to Ted’s comment too. Right now, all States are looking for solid ways to cut costs. I think this is the essential argument to pitch- The medical model of crisis care is too expensive to sustain. We can save states money if we divert people into much less costly avenues of care. This means facilities primarily staffed by peers and therapists with back up medical support for those needing to stay/return to meds.
Here in Portland, I have been getting wind of a massive new project that will likely happen and Steve- and other Portlanders- you may be interested in this. A number of the hospitals, including OHSU, the Legacy system and Adventist, are considering partnering to take over the old State hospital (Portland Oregon State Hospital- P.O.S.H) and move all their hospital beds into one facility. They are doing this because all these hospitals are losing money and desperately want to outsource their beds to a different facility.
Now more than ever, we need to martial discussions aimed at our political representatives to make the case that we need much cheaper, more humane and and more effective models of crisis care. I plan to be talking to a number of representatives and hospital administrators in Portland to pitch the idea of ramping up diversion centers that are based on Recovery, not rapid medical stabilization. This will save the State and City money and will be much more caring for those who want alternatives. Win win.
I agree with just about everything the author of this article says. I think almost all the readers of MIA would also agree.
I know I have said this a lot lately, but I think we need to figure out a way to reach the public and create the political will to do away with all the damaging psychiatric interventions and replace them with helpful practices like Soteria Houses, Open Dialogue, etc.
We know now what needs to be done, now we have to figure out how to get it done. More activism is badly needed.
Five-year Study Re-affirms that Housing Stabilizes People
June 28, 2014
A five-year study involving 497 homeless people with mental health or addictions problems in Vancouver found that, when provided free apartments, most people “stabilized their lives and coexisted peacefully with their neighbours,”
Read more http://www.madinamerica.com/2014/06/five-year-study-re-affirms-housing-stabilizes-people/
“Zoning laws throughout this country are designed to keep out poor people and homeless people by making it illegal to build small, affordable, eco-friendly houses.”
LAKEWOOD, NJ — An impoverished man learned the true nature of government as he watched tearfully as bureaucrats demolished his home in the woods. He was bothering no one except the government.
This was the reality that was presented to “Sam,” a 70-year-old homeless man living in the forest in Lakewood Township, New Jersey. Sam was a part of “Tent City,” a homeless encampment where between 80-120 individuals have stayed at any given time over the past decade, on so-called public land in Lakewood. These individuals were making the best of their situation by erecting tents and shelters in the woods instead of sleeping on park benches and relying on welfare housing and government subsidies.
Read more http://www.policestateusa.com/2014/tent-city-nj/
Sam in the above post needs a hospital bed.
Jonathan:
I think we need more beds, period. Yesterday, I left my office because of a grinding headache and vertigo. Since our office does not have a cot to lie down on, I took two ibuprofen and went outside to lie down in my friend’s car, parked outside in the an inner city parking lot. I slept and several hours went by yet I was still weak with debilitating pain and vertigo. the sun started to bake me inside this tin can and my muscles became cramped from the small space afforded by the front driver’s seat. I twisted and turned and became more miserable with each passing minute but I was not well enough to look for my elevator key and stagger up to my third floor office, plus there was no where to lie down in my office anyway.
Still weak and dizzy, I staggered around, oblivious to how I must have appeared, a middle aged disheveled, odd looking woman; onlookers may have thought I was drunk or stoned. I desperately looked for a patch of grass outside to spread out my body and lie down. Each step was like climbing the last Hillary Steps of Mt. Everest. My mind could still think clearly and one of my thoughts was this is what the homeless experience when they are sick. For the first time, I really was walking in the shoes of someone who is ill from iatrogenic harm with a history of institutionalization, someone whose family members have mandated, ‘our way or the highway. Take your meds, or you can’t live here anymore! If you are in this predicament, here are no legal places to lie down!
I work in a concrete jungle with very few parks. What parks exist are highly regulated. It has become illegal for the homeless to lie down in parks and stretch out on park benches!
We live in an era not unlike the time that the parable of the Good Samaritan was told by Jesus. We walk right by people who are sick every day and do nothing. We talk about creating sanctuaries but we aren’t organizing to overcome the zoning restrictions, and the bureaucratic and funding barriers.
Imagine coming off a toxic cocktail of neuroleptic medications and being homeless with nowhere to go. Imagine experiencing brain zaps, confusion, delerium, sore muscles, nausea, weakness, thirst, hunger, akathesia, terror that someone will see you or report you and hurt you by having you arrested or forcing you to return to the hospital where you have been forcibly restrained, medicated with Haldol, Thorazine, etc.
I called a good friend who used her GPS to tell me where the nearest park was located. I was too weak to walk the eight blocks so she came and picked me up and took me to a clinic where I was examined for stroke, heart attack, etc because this was so unprecedented for me. They then released me with a bill and a diagnosis ‘migraine’ after which my friend took me to her house, put me in bed and fed me soup and medicine. The next morning, I felt much better and went to work.
I am very grateful to be plugged into a caring loving network of friends and peers, people with lived experience or whose children have been harmed by psychiatry. I am fortunate. What about those who aren’t yet plugged into our community?
At this writing, I am still weak from this mysterious episode. I am still perplexed by it and somewhat embarrassed. But I am grateful for the reminder that, as a part of our demands as a movement, we must fight for the right of homeless people to simply lie down, even in public places. It’s absolutely inhospitable and cruel to think that people who are ill should only be allowed to lie down in institutions and jails. People need safe places to lie down outdoors without having to submit themselves to zillions of regulations, and an intake interview at a day shelter, homeless shelter, hospital clinic, etc. I would suggest that we start creating small ‘oasis’ (plural?) throughout cities–small landscaped areas with shade from the sun and rain, well lit and landscaped, not big parks, just strips of grass, designated for use by anyone who needs to lie down temporarily to take a nap. They don’t need to be much larger than a bus stop and we could designate the upkeep, graffiti, landscaping, etc. to churches and civic organizations. We could pass out flyers to homeless people about the location of each oasis.
So while we are talking about hospital beds, let’s not forget, that sometimes people end up in jail for simply wanting to lie down. How about asking for more beds, period?
First of all- man- that sounds harrowing madmom. I’m glad you came out of it without any serious medical issue and had a good circle of support to help feed, support and take care of you until you got better.
I am hearing that story again and again from people going through mental health crises. A circle of support is created to offer nurturance and help a person through the worst part of an acute crisis. But like you I think of the mass groups of homeless and disenfranchised that don’t have those options and that don’t have adequate respite, don’t have a place to turn to. And like you say, they can’t even rest on the damn grass to take a nap and recuperate. They may be dealing with coming on and off of psych drugs that are making them more confused, more addled, more confused by neurological tics and tweaks brought on by the very medicine that is supposed to “heal” them.
Some come to the hospital and stay a couple nights, only to be discharged quickly with meds they are likely to stop soon, with worsening effects. Some become angry, lash out, end up picked up by cops, taken to jail.
I like your idea of just creating oases where people can rest, heal, find shelter and safety in a public area. Sometimes, people just want to…lay down.
A day in the life…..
Within a week madmom you would adapt fairly well to the situation. Get to know where the prive security beats people up to move them on, and those little cracks in the wall that are available.
Bit of advice in case you find yourself in the situation again. The large waiting times in hospitals, and public buildings provide great cover for a snooze. If yor reasonably dressed you can sleep all day in a library for example.
Councils will never provide any places for homeless, they would flood in from miles around. Detroits lookin good though lol.
Actually this reminded me of Health Dept policy here.
A person can not be released from hospital unless they have ‘suitable’ accomodation. The effect of this policy is that patients are placed under extreme pressure to obtain accomodation when even the social workers are throwing their hands in the air because there simply isn’t any available.
In many cases patients are encouraged to lie, just to escape the pressure being put on them in some very subtle ways. Out the revolving door, and back in within a month.
Madmom
Your symptoms remind me of when I had Lyme disease several years ago, and it was not a fun experience; a bad headache is just one of the symptoms. I live in New England (Ma.) and we have a lot of ticks that carry this disease. Untreated Lyme disease can become a long term problem if not treated with antibiotics when the symptoms first appear. If you had a Lyme titer blood test today it might come back negative because not enough antibodies would have been mobilized yet to show up in the test. In a few weeks this test would be more accurate. Just a thought that you might consider on the medical side of things.
Short answer: no.
Long answer: hell no.
Duane
The longer answer:
“We are also seeing a wholesale shift towards prison management of people with mental health concerns. In Canada, 60% of female inmates are now treated with psych drugs.”
Well, the number of people on psych drugs is not a way to measure how many of them have a “mental illness” (even if you agree with the term in general). People are being drugged for a simple reason – it allows the staff to tranquilise them and makes the whole thing run smoothly. The whole mess is a combination of ridiculous policies of war on drugs, cut backs in social services, cutting taxes for the rich creating massive social problems, overmedicalisation of pretty much everyone (which then also leads to illicit drug addiction) etc. etc. Changing one type of prison into another is not an answer. There are too many people in prisons who should never be there and there are too many people locked up involuntarily in psych wards and there should be none.