The failure of the mental health system - A personal summary

Good evening friend. So It's been a while but I decided after much time in my new position I needed to summarize a little essay of my own. For thew few who remember me, I have completed my Masters in Clinical Psychology and am licensed here in my home state. Currently I work as a Crisis Clinician II. My job is to go to the emergency rooms (we have two) and determine the severity and quality of people in crisis and basically decide whether or not someone gets admitted to a psychiatric unit or is released and offered resources on the outside.

I know this simple little explanation of my position probably makes me sound like the devil incarnate, I can assure it is a necessary evil. I have the utmost respect for medical doctors and nurses but feel they do not have enough specialized training in emergency and routine mental health care. This is of course not to suggest a fault on their part, rather to point out that they are indeed medically trained and not expected to diagnose and determine mental health crises like I and my colleagues were trained to do. Really it's tantamount to me trying to diagnose a medical illness by reading tests. I wouldn't have the slightest clue

So...with that said. I have a VERY serious problem with mental health treatment and disposition in this country.

To put it bluntly, in my personal and professional opinion, our mental health system is broken. Whether or not is broken beyond repair is another discussion but it is indeed broken.

I figured I could approach this in two ways. I can detail and list out what is wrong with our system or I can share some stories that describe in picture how our system is failing.

Let's begin with a VERY important statement...

Despite my left-leaning ways, I am not blaming this on either political system

This is not meant to be an attack on the right, the left or the middle. Rather I wanted to discuss how we could fix this

So let me share with you a story.

Last week we had a woman bring her daughter in. She wanted her daughter hospitalized because she thought she was manic and mentally ill (her words). I interviewed this girl and found no real mental illness to speak of but her mother insisted that she be hospitalized (which I will spoil the ending for you...I didn't hospitalize her) but she fought and fought and eventually I set her daughter up with a counselor and her suggested family therapy as well.

Another story involves a gentleman who I see typically at least once or twice a week. He enters the ER, tells me he is suicidal and begs to be hospitalized. This man is very behavioral (meaning he has behavioral issues and is shelter seeking as opposed to being mentally ill). Shelter seeking basically means a patient who just wants to be hospitalized so they don't have to care for themselves. Arguments could be made about why this attention-seeking behavior exists, but again...another discussion for that.

So these two little blurbs may seem innocuous at first but consider the few issues we have here.

In story one we have a mother who has the legal power (in most cases) to basically hospitalize a child when in truth the mother is pouring extreme negativity on that child. The frightening disconnect between this woman and her daughter was mighty indeed. Through interviewing all involved it was discovered that mom was "tired of her daughter" and wanted the mental health system to take her off her hands for a bit.

In story two, we have a chronic abuser of the mental health system who wants only to be taken care of and has no interest in accepting responsibility for his issues.

So where does this and other stories leave the lowly clinician? It leaves us frustrated and bound by sometimes vague legalities.

Generally speaking there are two ways to hospitalize someone

1. They go voluntarily in which case we do a light amount of paperwork and life is good

2. We as clinicians strip the patient of their legal rights and hospitalize them involuntarily.

In option one and two, one of four things MUST be present to hospitalize

1. They have to be an imminent danger to themselves (suicidal)
2. They have to be an imminent danger to others and MUST have a specific target (homicidal)
3. They have to be in a psychotic episode so that they are unaware of their surroundings (psychotic)
4. They have to be a danger to their vegetative and life-sustaining needs, meaning they are so mentally ill they cannot wash, use the bathroom, eat or sleep properly (non-self-sustaining)

So when we need to hospitalize, the client is taken to the ward and treated and reasonably speaking usually improve with medication

Now here is where it gets ugly fast

Upon leaving, the patient rarely has any responsible party to assure they are taking their medication or following up with treatment and even when they do follow up, our insurance system seems to believe all therapy comes in a neat little tidy and SMALL cognitive package. What do I mean by that? Most insurance companies will listen to my diagnosis and look at a chart to determine how many sessions a client will be covered for. If by the end of those sessions they aren't completely healed, well then they are often SOL. You'd think the package of coverage would be lengthy but it is often very brief; sometimes on the order of 10 sessions.

As a therapist, I am a trauma/anxiety specialist. Anyone with any knowledge of therapy knows that it is very few and far between that a patient can come fully to terms with complex trauma and serious issues in ten sessions.

Our hands are tied so we have to make a decision. We act ethically and try to cram treatment of a lifetime of woe and illness into ten sessions, or we act unethically, lie and misdiagnose someone severely, thus ruining many things for their future. Stigma sucks...

I personally in internship and practice have acted in both manners and I will tell you now that each action makes me ill to my stomach.

The "best" part of all of it...all these issues are being made more frightening by the rampant closing of state hospitals and mental health treatment facilities

So I guess I'd love to open up discussion...have you any experience in this realm? What they heck can we possibly do to fix these problems?

Again, I'd really like to keep partisan values and politics out of this

Thanks for reading

I've felt for awhile that "mental health" care in general, is an over all failure.

I am sure it falls to a number of reasons as to why, One I have always thought a cause was the general attitude toward "mental health" in general.

Often times, those who need help, do not seek it.

For much the reasons you listed in the OP, Why deal with a system that would treat someone who is ILL in such a way in the first place?

Mental health is no different than getting treated for a broken arm, yet their is a host of "stigmas" involved, both societal and institutional in the care itself.

Imagine if you broke an arm, and you got label as fragile for the rest of your life, or ostracized for seeking care, or even worse yet, turned away when you sought it...

Whats the answer? I don't know, but it probably starts with Addressing that stigma in general.

Beyond that, their are larger issues involved in healthcare to being with, let alone individual specialties.

I don't know about fixing it, but I have a feeling a majority of mental case just need a swift kick in the ass.

I'm sure there are many legitimate cases, but the way welfare pays people and parents excuse bad behavior i think it is being milked.

The stories you mentioned, the mother needs locked up and the guy needs to get a job. I mean a real job.

tinner07
the guy needs to get a job. I mean a real job.

I know some of my colleagues might say I am not compassionate, but I don't disagree with this assessment. I believe there needs to be some point where a patient needs to take responsibility. Problem is I can't decide if it is some failing on his personal level or a systemic level. Is it because he needs to 'grow up' or has the system raised him to be a victim?

No clue here personally

I thank you both kindly for your reponses

benrl
I've felt for awhile that "mental health" care in general, is an over all failure.

I am sure it falls to a number of reasons as to why, One I have always thought a cause was the general attitude toward "mental health" in general.

Often times, those who need help, do not seek it.

For much the reasons you listed in the OP, Why deal with a system that would treat someone who is ILL in such a way in the first place?

Mental health is no different than getting treated for a broken arm, yet their is a host of "stigmas" involved, both societal and institutional in the care itself.

Imagine if you broke an arm, and you got label as fragile for the rest of your life, or ostracized for seeking care, or even worse yet, turned away when you sought it...

Whats the answer? I don't know, but it probably starts with Addressing that stigma in general.

Beyond that, their are larger issues involved in healthcare to being with, let alone individual specialties.

Yes yes...the stigma is extremely ugly and gets uglier every day

We as a society have this irrational fear of someone who suffers mental illness. We hear the word schizophrenia and this nasty little worm enters our minds and makes us think of violence and terror

Even on a small scale, as you mentioned, we treat mental illness from a distance and act as if it is always a failing on the part of the sufferer

KyoZero

Last week we had a woman bring her daughter in. She wanted her daughter hospitalized because she thought she was manic and mentally ill (her words). I interviewed this girl and found no real mental illness to speak of but her mother insisted that she be hospitalized (which I will spoil the ending for you...I didn't hospitalize her) but she fought and fought and eventually I set her daughter up with a counselor and her suggested family therapy as well.

In story one we have a mother who has the legal power (in most cases) to basically hospitalize a child when in truth the mother is pouring extreme negativity on that child. The frightening disconnect between this woman and her daughter was mighty indeed. Through interviewing all involved it was discovered that mom was "tired of her daughter" and wanted the mental health system to take her off her hands for a bit.

That's how parents create potential customers and lifetime customers to yours ,your boss would like it.

You are dead right, its broken and facilities are shutting down to make it more broken. Mental health should be treated as important, or really more important, than physical health. This is the reason so many veterans can't find the help they need...

I joined the same field with the idea that I would help people. But I pretty quickly became disillusioned counselling people and finding that most often they just wanted someone to nod and legitimize their feelings or attention for their negative behaviour... and people tended to not take my advice and they continue ill behaviour. It becomes frustrating.

A friend of mine became a doctor for the same reason and found the same things. She would treat drug addicts in the hospital and they would be released, and back the next day. The systems #ed man, people are #ed. We all want to take the easy way out of dealing with problems.

reply to post by Ridhya


I have been there on soooooo many occasions. Med seekers and shelter seekers are probably a good 30% of my clients by the look at my stats

I mean I am no perfect being. I am not saying I know the minds and inner thoughts of every patient of mine but when patients find out I want to discharge them and straight up ask me "what should I say to get Xanax?" then yeah I get a little dubious

it's a rough field...but I live with it because every once in a while you can see you changed someone's life

candlestick


That's how parents create potential customers and lifetime customers to yours ,your boss would like it.

I'd love to tell you that you are full of you know what...but the reality in me forces me to agree with this post. Sometimes these actions create precisely what we try to battle against

I was a CNA at a psychiatric hospital until the state cut the funding and it was shut down. That last month I worked there they were kicking the patients out as fast as they could and the ones they couldn't we drove to a lager hospital 3 hours away.

I can confirm what you have said. Like many other things in this country, it needs a huge overhaul.

I was very passionate about my job, but I will never go back. People ask me why all the time, you just helped remind me why.

reply to post by benrl


Mental health is nearly the same as predicting the weather. Only every single person being treated is an entire world of their own. you can see when it's raining or when it's sunny, but you can't base your prediction on the last person you saw or the way people are in general.

it's never going to work with so many wrong approaches. all trying to be right, bottle necking at the fundamental issue. It's unique to us all. no one solution, no one pill..

the DSM-TR is a good example of trying to have a name for everything. You just confuse it all.. is it this or that, or this with that, or that without this...

what you end up with is a diagnosis based on partial understanding. but it doesnt work.

treatment often fails or simply keeps things as they are...

calstorm
I was a CNA at a psychiatric hospital until the state cut the funding and it was shut down. That last month I worked there they were kicking the patients out as fast as they could and the ones they couldn't we drove to a lager hospital 3 hours away.

They must paid not enough money.

reply to post by candlestick


Actually it was the best paying job I ever had. The pay was significantly higher than your typical CNA job. Plus I could put in all the overtime I liked so I was averaging about 20-30 hours a week of double time pay. It was bureaucracy that was the problem.

Society has a long way to go in regard to treatment of mental illnesses .. its not limited to one country its worldwide the mentally ill are often shunned , treated poorly if theyre lucky they may get treatment for their condition ..
The way its viewed and treated needs a serious overhaul and modernizing ..

calstorm
reply to post by candlestick

 

Actually it was the best paying job I ever had. The pay was significantly higher than your typical CNA job. Plus I could put in all the overtime I liked so I was averaging about 20-30 hours a week of double time pay. It was bureaucracy that was the problem.

No no no no...I said those people who visited the "hospital" didn't paid enough money to the "hospital"...

1 in 68 with ASDs
25% or better of the general population on SSRIs
(all the school shooters have pretty much been on SSRIs)

so after suffering through a not so rare reaction to medical drugs aggravating my medically caused ASD, instead of doing something about the medical drug;
I was referred to a mental health councilor

I actually had this mental health councilor say:
" I realize you have a problem with capitalism, but would you consider taking cyprolex?"
I had to xplain to her that here in kanukistan we have SOCIALIST healthcare...
so no matter what the result - good bad or indifferent - you get paid
If i don't work or don't do a perfect job - I don't get paid
I'm the capitalist and YOU are not.
and that was just the beginning...

so how does one get mental health care from someone who is so "that was just the tip of the iceberg" delusional?

I have been in and out of the mental health community as the result of a math deficiency. They STILL can't tell me why.
I would say WHAT mental health system.

I found the mental health system pretty much a dangerous place to peoples sanity.......
The fact is....once inflicted with a diagnosis.....that's what you remain to the workers.....
|Not a person...just a case of PTSD or some other convenient handle.....
If you are say talking to anyone who works there even kidding around on a casual basis...they use anything you may say in your record taking it out of context and over analyzing it to death.....but they do write the weirdest # down....
Sometimes I think the clinicians are buggier than their charges.....they seem to be institutionalised shelter seekers themselves....
as a general rule...id say there really isn't a mental health system at all....just a shelter for clinicians mostly......and a warehouse for the worst cases.....

I have been dealing with the Mental Health system for decades. I have severe, chronic, unipolar depression and anxiety. Naturally, the panacea of every MH professional is pills, pills, and more pills. I have looked into more permanent solutions, like ECT, because I do not want to "manage" my symptoms with a lifetime of meds, I'd rather look for more long term solutions. Yet my docs won't give me referrals for ECT, they would rather just switch my meds, or increase dosages, despite the fact that antidepressants stop working after a period of time, and carry unwanted side effects. Sure, ECT has risks, but compared to other risks of the meds they give me, I'm willing to take that shot for a better chance at actually improving my condition.

Another thing I noticed, is that so many people fit into your first category of the woman pushing her daughter on you. Basically, I have seen and experienced this mentality. We live in such an unfriendly, anti-social, self absorbed society, and many people suffer from loneliness and neglect. When they try to reach out to friends or family, when having a rough time, friends ands family often refuse them, shunt them aside, tell them to go talk to a shrink. Everyone is too busy for "your" problems, go get a therapist. Which is what they end up doing. I'm willing to bet many of your patients fall into this category. People who normally, would not have a mental illness, but is just going through a rough patch in life, and like any human being, needs nothing more than a little bit of support and kindness from those closest to them. However, those closest to them are too self centered, their faces buried in their smartphones, their concerns usually some petty drama that seems more important than being a friend of family member. And thus, the person in need ends up in a shrink's office, looking for help. Not because they are crazy or mentally ill, but because friends and family don't feel like doing their job. And then they end up becoming mentally ill, because the constant isolation, rejection, and shallowness of their relationships takes its toll on their well being.

The mental health system is screwed, not just from the guys working in it, but from the society that fosters a climate for mental disturbances to thrive.

I am not a healthcare practitioner, but both of my parents are (mother was a clinical psychologist and psychotherapist, father psychoanalyst), and of course all of their entourage were in the same business.

My mother used to work in a state psychiatric facility, and I used to go with her often. Now, she is passed away, my father has remarried, and his wife was working in a facility for mentally ill criminals- murderers and such who are extremely ill.
She now has a job in which she does the same type of thing you do, but travels around to prisons, evaluating the state of prisoners and whether of not they should be let out. She's dealing with people like Manson- her job is actually super dangerous.

I have slowly gained the view that this whole business is something that is so difficult to place into any firm framework. It can be very effective, or can be a waste of years of payments. So much seems to depend upon the sort of chemistry you have between the therapist and the patient! Someone can make great leaps and bounds with one therapist and get nowhere with another.

My stepmother has a gift- that is how she got where she is. It is a weird intuitive sense, which seems to stem from her compassion for all living things- even murderers. She is able to sort of "mind meld" with them, stepping into their internal worlds, and yet also step back out unscathed.
She senses when to stay away, and when she can hold the hand of a dangerous schizophrenic. She has had conflicts with the staff in the facility she used to work at because she would trust her intuition rather than the rules. But after a long period of time, they could only admit she was always right.

There is a big difference between the type of situations she is dealing with, and the kinds you described.
The parents that just want to get rid of the troublesome teen were a huge problem, my mother used to tell me when she worked for a while in a private psych hosp. Sometimes it was just that the parents found out a kid tried some weed once, and they wanted them locked up. Sometimes it was perfectly good kids, just with screwed up parents. They were there, with the insurance paying big bucks, for years.

She found that scandalous, but sometimes said the kids were better off being protected from the idiotic parents, who were also forced to come in for therapy with them- which they wouldn't do otherwise.

This whole business sometimes seems to me close to magic- we have tried to capture emotional healing with a structure that can capture it and tools that can be learned and shared by all, and it just doesn't seem possible. Now the trend has gone to making it all about drugs in that attempt.

I don't know how to fit this into the kind of world we have today. It made more sense when you'd be considered the village witch or Shaman, and your living necessities were provided by the collective in return for your services.