Tuesday, February 19, 2013

second class citizens

Don't even get me started on the gun debate.  Grrrrr... The thing that irritates me the most is talking about the mentally ill.  Doing a background check, one aspect would be to check about whether you have any mental health problems.  Intervening with people who are mentally ill before they can get to the point of shooting people.  It is obvious that the people who talk about this have no clue about psychiatric care in this country.

1) Clue #1: There are not enough psychiatrists.  Especially those who are willing to work in hospitals.

2) Clue #2: There are privacy laws called HIPPA which prohibit sharing any kind of information about patients. Think about this: It is hard enough to go and get help, do you think people will go if they know their name will be shared with others?  Who will determine who is on the list?  The whole thing is a preposterous idea.

3) Clue #3: The mental health care system in this country is abysmal.  Those who seek care for their mental health are second class citizens.  Their care, for example counselling, has to be pre-approved by insurance companies and is limited.

There are a very limited amount of mental health beds.  Apparently caring for the mentally ill is not profitable.  Here is a fairly frequent scenario when you come into an ER, using my ER as an example.

It is typically at least a 4 hour visit.  It takes that long to decide what to do with you. I see you.  The doctor sees you. Then a mental health person comes to see you and talk at length about your problem and they are the ones who decide whether you need to be admitted. The majority of people do because they are usually suicidal. There are typically two of these people for a 35 bed emergency room.  There can be 5-6 patients in the ER for mental health at one time.  Their evaluations take time.  You may wait to see them for a while.

Once they see you, they have to call the psychiatrist and discuss you with them to decide whether you should be admitted. Once they decide to admit you, they have to call your insurance company to get approval. This gives you a clue how we view mental health right here.  Does the doctor have to call your insurance company  to get approval to treat your for a heart attack?

So you are approved for admission.  Let the bed shennanigans begin.  Maybe it will be your lucky day and there will be a bed.  You may have to wait a few hours for someone to be discharged. There may not be any beds at all,  Then they will look for a bed in the rest of the city at another hospital.  You will be transferred there.  No beds in the city? They will look statewide.  You could be transferred 50-400 miles away.  I have seen people transferred to a bordering state. There may be no beds anywhere.

In that case, you will spend your time waiting in the ER.  I have people have to wait 24 hours to get a bed. They lay on an ER cart, with nothing to do.  Many of them escalate during this time.  I have people need to be restrained, sedated because they get out of control in this situation.  Who can blame them?

This is how the mentally ill are treated in this country. Perhaps the politicians who tout all the shit about mental health treatment would like to come and go through this process?


Mark p.s.2 said...

you wrote ") Clue #1: There are not enough psychiatrists."
Psychiatry is not working and you want more of it? More psychiatry? You have to be kidding me.
The percentage of mentally ill keeps increasing every year.

*1903 based on U.S. mental illness hospitalizations. 1 in 500

*1955 based on U.S. mental illness hospitalizations. 1 in 300

*1987 based on U.S. Social Security Administration payments for the mentally ill. 1 in 75

*2003 based on U.S. Social Security Administration payments for the mentally ill. 1 in 50

*2005 (2008?) National Institute of Mental Health. 1 in 17

Mark p.s.2 said...

Cross-sectional analysis by the University of Maryland and Johns
Antipsychotics for Poor Kids Soar, Mostly for Behavior Problems

Hopkins University of 456,315 youths enrolled in Medicaid between 1997 and 2006 finds that the use of antipsychotics skyrocketed up to 12x, “and reflects”, according to the authors, “increased medication use for behavioral problems.” The results appeared in Psychiatric Services this month.