From the terrible story of Virginia State Senator Creigh Deeds and his son Gus, who apparently stabbed his dad and then took his own life with a gun yesterday:
On Monday, state mental health officials unsuccessfully sought to find a bed in a hospital psychiatric ward for Gus Deeds, who had undergone an evaluation, according to Mary Ann Bergeron, the executive director of the Virginia Association of Community Services Boards.
None could be found and he returned home, even though a magistrate had issued an order of involuntary commitment. “In that particular rural area of the state, it is not unusual to have contacted anywhere from seven to 15 hospitals” looking for an available bed, Ms. Bergeron said.
The lack of psychiatric beds is not solely a rural thing. I know someone who works at the large urban teaching hospital here, and this person tells me that the psych ward is almost always full, and there are long waiting lists for most mental health services. Psychiatric services are generally money losers for hospitals so there’s no incentive to have the kind of capacity they have for, say, hip replacments or cardiac catheterization. Yet, as we apparently saw at the Deeds house yesterday, untreated, serious mental illness is just as deadly as a heart attack.
To switch topics just a bit: consider all those low coverage policies that people are losing because the policies don’t meet Obamacare minimum requirements. I’m sure Richard knows the technical term for the mental health coverage those plans have. I just call it “shitty”. Mental health coverage under Obamacare-approved policies is a big step up from what most of the working poor are used to getting in their low-premium, low-coverage policies.
Sebelius issued some new mental health regs not too long ago. I’m not sure how it ties in with Obamacare, since the new rules were apparently required by TARP(?!) legislation.
The stench of Reaganism rears its ugly head. And again and again.
Wait…peeps are losing mental health coverage because of O-care? Your last paragraph is wicked confusing.
Never mind the working poor, the ACA mental health coverage is a big step up for anybody dependent on insurance for mental health care.
@Punchy: Your last paragraph is wicked confusing.
Either it’s already been fixed, or you should read it a bit more carefully. The policies being lost, left behind, contain the crappy, pre-ACA, mental health services. Or am I missing something?
@JWR: My read.
Even more deadly, I would say, considering that those suffering from a heart attack don’t generally attack those around them.
Insurance coverage is great, but it doesn’t really solve the capacity problem.
dpm (dread pirate mistermix)
I re-worded the last paragraph. Another way of saying it is that those Wal-Mart and McDonald’s “medical coverage” policies have shitty or nonexistent mental health coverage.
Some states already have in place the means to transfer patients to private facilities, if there are no beds in local hospitals. McDonnell knew that space was limited in rural VA but didn’t feel the need to expand care. His prayers for the Deeds family ring hollow to me.
Good for the President and Sebelius for expanding mental health care.
dpm (dread pirate mistermix)
This is true – but part of the reason that mental health care is unprofitable is because hospitals provide it to patients who are uninsured and will never pay a bill. If more patients have insurance, hospitals might add services because they’ll be reimbursed.
No. People’s policies are being canceled under Obamacare because they don’t cover a ton of stuff. It’s the policies being canceled whose mental health coverage dpm is describing as “shitty”- though I suspect that “nonexistent” is probably more accurate- and the policies under Obamacare that have coverage much better than the working poor have come to expect.
A post over at the RBC: A Forum on Mental Illness, Public Health and Public Safety
I suppose it is too much to ask that the L.A. County Jail would no longer be “the nation’s largest mental hospital:” as a result of the ACA.
@C.V. Danes: This is another version of the argument conservatives were making about the ACA in general: “All those poor people suddenly flooding the health care market will make it even harder to see a doctor. We already have a shortage of primary care physicians.”
We have here a tragic case of someone who was deemed ill enough to hospitalize yet winds up in possession of a gun. The gun was available, a hospital bed was not.
maximiliano furtive, formerly known as dr. bloor
@dpm (dread pirate mistermix): It’s been a while since I’ve been on a hospital staff, but at least back in the late 90’s outpatient mental health services were money holes not because of lack of volume, but because of lousy reimbursement rates.
During my last couple years on staff, the hospital actually lost money every time I saw someone. They only did outpatient services because insurers wouldn’t give you their inpatient business (which was still a money maker then) without a “full spectrum” of care.
Too bad many people still view mental illness as a matter of will power and admitting to mental illness is just a sign of a lack of moral fiber.
Until mental illness gets the same destigmatization as cancer a lot of the issues surrounding mental illness will not change.
It depends, if you are in a state that accepted the Medicaid expansion or not. A lot of the poor, with mental illness issues are in the Medicaid system and have to decide to not work and stay on Medicaid and get treatment or take a risk about a relapse and get a job and lose Medicaid.
From reading the article, I thought they tried to transfer him to private facilities, but there were none within the range of an ambulance ride that had an open bed.
Capacity is a great problem when it comes to mental health. Hospitals cut back on beds not only because of the payment problems. The mental health field now trends to drugs as the preferred treatment over hospitalization or out-patient care with face time with a doctor/therapist accompanied by drugs.
I have a close friend who is a trained psych nurse. In CA, psych services have been cut back in hospital after hospital. That in turn means a cut-back in nursing staffs. In Queens, about 2 months ago, a private psych hospital closed when it couldn’t be sold.
@dpm (dread pirate mistermix):
One can only hope, because there is certainly a critical need for it.
Mental illness does not always lend itself to an out-patient solution, so it is running against the current trend of quick fix, practically DIY, care.
We won’t know how much early & often intervention will work until we actually do it, but it’s my experience that there’s so little good care that people get ignored or dumped on family until it gets really, really bad.
Like, perhaps, this instance.
Except that they are using it as a argument to deny expanding coverage. I am merely stating that we need to also expand capacity, because merely providing insurance will not solve the problem if you still have to wait weeks for treatment.
@gene108: Not sure where but maybe the Richmond Times, a private facility stated that they had rooms. The facility is two hours away though, and they were not notified of the need.
I can say from experience that this is not just a rural thing. One night a couple months ago a good friend called me in tears, saying she had to take her sister to the ER because of her mental illness, and she was so tired she couldn’t face it again without help.
So I changed out of my PJs and jumped in the car. Spent 12 hours, from 8pm until 8am, sitting in the ER with my friend and her sister. That was a long 12 hours. This was a real eye opener for me. I was shocked and appalled as I saw the game of “hot potato” playing out, with the life of a real live person hanging in the balance. Just because she is on medicaid.
I live in Champaign-Urbana, a college town, not some rural area. One of the two major hospitals closed down all of their psychiatric services, just so they wouldn’t have to take the unwashed mentally ill. We took her there to the ER anyway because that is where she had the surgery (medical) and the anesthetic is what threw her into what they call a medically induced psychosis.
It took 3 hours to be seen, but we finally got her a bed in the ER, and THEN the process began. The psychiatric screening came pretty quickly, and they determined that she was a threat to herself and others.
Then it was 8 more hours of waiting overnight in the ER while a very dedicated man called dozens of facilities, trying to get them to take her in. Finally, at dawn, he got the other major hospital to take her. It took 12 hours, but the nightmare was finally over.
Oh, did I say over? Turns out the other hospital wouldn’t admit her to their psych ward – even though she was a danger to herself and others! They admitted her to a medical ward because of the surgery she had a few days prior. Even with a psych ward and the “danger to herself and others” evaluation, they didn’t even assign a psychiatrist to oversee her care. Because if they had done either of those two things they would be stuck with her.
I guess I lead a pretty sheltered life because until that night I truly didn’t understand how medicaid patients can get treated like crap, like they are not even human beings. And a mentally ill medicaid patient? Apparently your life is worth nothing.
If we hadn’t caught a break – and the dedicated man told us it was a near miracle that the other hospital even took her – it could be my friend who is dead.
Best medical care in the world. Right.
Edit: sorry to have gone on so long, no one will probably even make it through, but I guess I needed to get it out, so it’s not a total waste of time.
One year ago my uninsured 45-year-old brother came to me for help getting a bed in an alcohol detox center. There are six beds in the state for the uninsured and we couldn’t find one. He died last month of liver failure.
I’ve seen it repeatedly. Outpatient treatment is so substandard for so many of the mentally ill because their illness leads them to be resistant to intervention. At the same time, as a society, we have an unfortunate tendency to coddle those who demonstrate antisocial behavior on a routine basis, and deem that the antisocials have a right to be that way.
Kind of like how we do with gun fetishists.
Where to draw the line between eccentricity and mental illness justifying the stripping of privacy and agency is something which can’t easily be done surgically – it takes a chainsaw-like approach.
@Botsplainer: My sister-in-law bounces in and out of inpatient mental care. It’s not that hard to draw the line in practical application. Besides, most of the very mentally ill are living out their own form of hell so they welcome any help (most are on medicaid because almost all are incapable of holding down a job due to the illness). If they refuse it is usually pretty evident that they are in the middle of an acute episode. The image of the quirky genius being treated against their will is rather overrepresented in popular culture. Most of the time if a person is asking for help it’s because they need it, and if they’re refusing the reason won’t usually make a lot of sense to the person hearing it.
I would also like to point out how it is the same problem in a VERY wealthy area of Texas (rich suburbs of Dallas). My teenage daughter suffers from depression that she is struggling with. She was in inpatient care a few months ago and I got a bed in the closest facility because she happened to arrive as they were releasing another patient. Yesterday we had to take her to a facility 20 miles in the opposite direction and also got the last bed there.
It is not a matter of money as we could afford whatever facility had an open bed. The problem is there were no beds to be found.
Obviously a terrible tragedy with lots of layers, but to focus on one for a moment: why was there a gun in the house?
Can’t get kid into psyche facility, at least get rid of the guns.
I got through it and am horrified. Had no idea that went on. Barbaric. Also incredibly stupid and short-sighted.
@Gopher2b: Or perhaps lock them up? The gun I mean, not the kid.
Your story, coming right after WaterGirl’s, is heartbreaking and eye-opening. What a terrible way to run a society. My condolences for an awful loss.
maximiliano furtive, formerly known as dr. bloor
What is this magical “chainsaw” you speak of, and how do you imagine it will be any more effective in keeping criminals in jails, the mentally ill in treatment, and eccentrics living happily in the community?
@WaterGIrl: Treatment for mental illness has been shrinking for years, thanks to St. Ronny, as JWR mentioned at comment 2 . Tipper Gore highlighted the problem when Gore was running against that other person. You are a good friend.
@maximiliano furtive, formerly known as dr. bloor:
Well, first we go to the homes of people posting sociopathic nonsense on the internet….
@WaterGIrl: I read through it too. Here’s hoping that your friend’s sister’s problem resolves soon.
@Mark H: another hard story. This thread will generate a lot of them, I’m afraid. My condolences to you and your family.
@lee: Hang in there! As a parent, it has to be difficult trying to create a normal environment when the world is spinning out of control.
@WaterGIrl: Thanks for a great account. I hope things work out for your friend and her sister. A tragic story of the worst of sixties and seventies conservativism and liberalism, a true bi-partisan horror story was the closure of inpatient facilities across the country. Liberals thought they were warehouses which kept the poor and ill in a drug induce torpor (“One Flew Over the Cookoo Nest”) and Conservatives just did not want to spend money. The bi-partisan solution was “out patient” treatment and “living in the community.” This might have worked except 1) Conservatives still did not want spend money and unless one of their own kin got sick did not care and 2) sadly, liberals did not make a big fight about this, certainly not a sustained fight, as these services are among the first cut when States have budget problems (usually associated with recessions. Also, because upper class and middle class people don’t like living next to group homes caring for mentally ill persons, the group homes got dumped in the neighborhoods with weakest political clout. And apparently, no one thought people in rural areas ever get mentally ill (apparently they were no readers of “Wisconsin Death Trip” or paid much attention to “Jane Eyre.”)
maximiliano furtive, formerly known as dr. bloor
Just out of curiosity, to take this a little further, how are you with forced medication?
@maximiliano furtive, formerly known as dr. bloor: To treat those who are a danger to themselves/others? I’m all for it.
Back when Reagan was governor of California he stripped the funding for psych hospitals and most those patients were kicked out into the streets. Many of them ended up in prisons because they were, well, mental patients. They didn’t interact/act appropriately for what society demands. Sadly that was taken nation wide.
Republicans…..they just love to fuck with others. Just don’t ask them to fuck with their own. They won’t.
Villago Delenda Est
Just this. Over and over and over again.
Villago Delenda Est
Well, this is what happens when you let MBAs out of their cages and unleash them on hospitals. The financial bottom line is the only thing that matters…there are no other values whatsoever that are considered.
Villago Delenda Est
As long as a cash register cha-chings at Smith and Wesson, all is good.
Another Holocene Human
@dpm (dread pirate mistermix): I know someone with a mood disorder who worked at Walmart to get healthcare. It was shitty, not non-existent.
They then destroyed any goodwill they had by firing him for an anxiety attack after tossing him into a “masculine” dept he’d never worked in before and knew nothing about.
Fuck the Waltons.
Another Holocene Human
I’m paying big money to see a PhD psych student now. I learned a ton in a few hours–basic emotional intelligence stuff I hadn’t learned and hadn’t been able to figure out from self-help books. I mean, this gal went to school for this shit. Plus, it really helps to have someone to talk to.
I can’t say every experience with therapy has gone this well and frankly I was skeptical of going to a psychologist instead of a psychiatrist but, damn…
Wouldn’t have learned that shit from taking a pill.
@WereBear: This is a big issue here–the Boston Globe ran a heartbreaking series (I think) on just how few beds there were for tweens and teens in crisis–the kinds of kids where intervention is critically needed, the families can’t handle it, and some kind of supervision is absolutely necessary. Sometimes you can’t just drug someone and send them home. But there aren’t enough beds. Right here in a state which, on the whole, has a lot of capacity for health care in the form of doctors, nurses, and hospitals.
Another Holocene Human
If I wanted to spend even more money–like, buy a nice used car kind of money–they could do a two day eval to get me a diagnosis on the ADD and/or ASD, but I still haven’t figured out if that would personally benefit me. I think I’d rather spend the money on more and better democrats, if I have it.
No, the technical term for mental health coverage in med-mal plans is “amazingly fucking shitty and borderline criminal in its fraudulent claims” and that is the polite term.
Was very sorry to hear about this tragedy. RIP Gus and praying for Mr. Deeds’ quick recovery. Hopefully McAuliffe can make some changes for the better to the healthcare system in VA.
@WaterGIrl: Thank you so much for writing about this. I know it was read, and it was important that it be read. We must tell these stories whenever we can, wherever we can.
@Gopher2b: Lets not jump to conclusions. Maybe the kid bought and hid the gun. Is there any evidence that the gun was a family gun? Isn’t this bad enough without attacking Deeds for being the gun owner without knowing if that is true? The kid knifed the father–he could just as easily have knifed him and killed himself without the gun.For once the gun isn’t exactly the issue.
Another Holocene Human
@Sherparick: You don’t know what you’re talking about. 60’s institutions included “homes” or “schools” for people with “mental retardation”. Have you ever noticed that you see people with cerebral palsy free-living in the community now? Well back in the 60s they were walled away and considered useless. Often, they lost the ability to walk or care for themselves. I saw a movie about some of the survivors of such institutions. They live in assisted living now. They have assisted living for people with Down’s Syndrome, while others live with their families. There are programs for them to have jobs and have something of a normal life instead of being immured in a prison. Kids with autism are treated much more aggressively from infancy and many of them gain enough skills to be able live independently.
The institution that RFK and Geraldo got shut down in NYS was not for the mentally ill–it was for disabled children who were treated worse than animals. Thank GOD we don’t do that any more.
@WaterGIrl: I am glad your friend’s sister was able to get help. Stories like that always remind me of Juan Gonzalez who attacked passengers on the Staten Island Ferry with a sword in 1986 a couple days after he was released from psychiatric care without getting the help he needed. He ended up being committed to Bronx Psychiatric Center where my father worked and my dad talked about what a decent (and remorseful) person Mr Gonzalez was after he had been diagnosed and put on proper medication.
(EDIT: In addition to all the well deserved scorn heaped on Reagan for cutting mental health services, Gov Pataki of NY is worthy of his share after the budget cuts he pushed through in the 90’s)
@Villago Delenda Est:
It is not MBA’s that did this. It was the medical profession.
Twenty years ago when SSRI’s hit the market and you had medications people could tolerate on high doses without as many side effects, the profession went more heavily to medication over therapy.
It has swung back to a more blended approach of medication and therapy, but the services the seriously ill need are not there because we choose not to fund it, so it goes back to medications and hope the patient keeps on their meds.
Another Holocene Human
In fact, remember that family whose child suffered a birth injury and not only had cerebral palsy but a profound cognitive deficit as well in HOT COFFEE? Remember they were caring for him at home? Turn back the clock 50 years and there would have been intense pressure for them to send him away to an institution, never to be seen again.
Thank goodness our attitudes have changed.
Mental illness (depression, schizophrenia, bipolar) != cognitive, social, and learning disabilities, or physical disabilities that impair hearing, eyesight, and speech
And I agree with others above–there is something very, very wrong when a suicidal person cannot get a bed in a facility.
A lot of people still view mental illness as a lack of will power or some sort moral failing, because so-and-so in the same situation did not mope around.
Until that changes, the money needed to fund the mental health system will not follow.
Very sorry for everyone who has had to deal with mental health issues, with themselves or family. One of my closest friends had significant mental illness before she killed herself and watching her family deal with it, as I did too, was eye-opening. Sometimes the best family, friends and other support and all the money in the world can’t save someone.
Since this thread is discussing mental illness, the new frontier in mental health may be in the gut.
How Bacteria Affect Mental Health
Another Holocene Human
@Gene108: And the public demanded it!
Prozac sells best in Utah, where there are lots of people utterly unwilling to change their circumstances who must put on a happy face… in other parts of the country, the culture lets people avoid personal circumstances that upset them.
And the overmedication of kids has been driven by schools and parents, not medical professionals. They pushed my brother into taking inappropriate medication because they were frustrated by his behavior, but there is no pill for “dramatic personality with too much energy” as they found out the hard way. (Ritalin caused him to have violent, uncontrollable rages and he confessed that he felt like he was losing his mind. I couldn’t sleep because I thought he was going to attack me with a butcher knife until they finally stopped the medication.)
A young friend of mine had Concerta all but crammed down her throat by an abusive parent who thought that this ADHD medication would magically change all of her ASD symptoms overnight AND make her trauma from the even more abusive parent whose whom the state had removed her from just disappear.
The kid needs treatment for PTSD. There’s a therapy for that, EMDR, but no pill that I know of.
Another Holocene Human
@Violet: well, my anecdata of one would back that up–somebody I know went through IBS so bad he ended up in the hospital AND had a massive mood disorder
but I always attributed the mood disorder to accumulated trauma from living with an unmedicated bipolar parents who said and did inappropriate and scary stuff on a daily basis
Also: The Future of Psychiatry May Be in Your Stomach:
There’s a lot more at both links. It’s a really interesting direction for investigation.
I know my gut affects my mood. I had a terrible time this summer for about a week while on antibiotics. I’m sure they upset the serotonin balance in my gut. I’ve had other less-bad similar responses to stopping supplements. I doubt I’m an isolated case.
Another Holocene Human
@aimai: I don’t care for all the political comments that were made, but the reality is that mental illness + easy access to guns = more completed suicides
It’s the big public health problem in the US–and one of the top killers of young men–that doesn’t get talked about
But even with gun control, rural people like the Deeds might still have access to firearms unless you went to a British system where rifles have to be kept at the shooting club (yeah… don’t think Americans will go for that). So again we get back to what a lot of people including Obama have been saying for the last year–it’s a multipronged approach and one of those prongs has to be intervening more effectively with mental illness.
@Another Holocene Human: There’s no reason it couldn’t have been both. The person could have inherited a bad gut from his or her parents, and the toxic environment exacerbated the situation.
I think it’s an exciting direction for research. Skin health ins another area directly affected by the gut. Having a health gut can clear up skin problems. In fact, there’s speculation that within the decade dermatologists will partner with gastroenterologists to fix the gut prior to starting medications. Not for wounds and things like that, but chronic conditions–eczema, rosacea, acne, etc.
Another Holocene Human
@Violet: I also think this aspect is being really overplayed in some circles, but maybe it’s just the blogs I read.
There is no denying, however, that bacteria set up camp in your gut and start sending signals to your body, even to your brain if they’re clever enough… stuff like “eat more of that stuff we like… you know you want to… ignore that full stomach… ignore the full feelings… nomnomnom”
@Another Holocene Human: Overplayed? How’s that?
I guess I’m on the other side of it. I think our understanding of gut bacteria, and bacteria in the human body in general, is in its infancy. Understanding the relationship between that bacteria and the rest of us has barely begun.
Another Holocene Human
@Violet: I am definitely someone with a gut/acne issue. It’s triggered by gluten. There’s really no evidence that I suffer from celiac disease, but I do have uncomfortable symptoms so I’ve had to become more and more strict… like not buying certain brands of tortillas because apparently they weren’t made in a corn-only facility and I am breaking out like a mofo.
I’m on the spectrum and we’re supposed to have leaky guts. That could be–or maybe not–why those classic 70s trials with feeding kids food coloring showed a big behavioral problem with the “hyperactive” (now I’m told that ADD and ASD are often confused) kids but not with the non-hyperactive kids. (They did a clever study design where the color of the substance was hidden and they fed kids sugar preparations, sugar-free sweeteners, colored, and uncolored. It pretty much killed the notion that sugar alone “makes” kids hyper–which I guess caused some parents to conveniently forget it IS implicated in tooth decay and more dangerously, periodontal disease. It also for some reason let the artificial colors off the hook b/c only “weird” kids were affected by them and the industry claimed the doses were too high, as if kids only have the odd colored candy and weren’t eating and drinking artificially colored crap all day long, which they do. It also led to woo diets for kids with ADHD that included not eating colorful vegetables because vegetable pigments are totes the same thing as Yellow #5 and Red 40 Lake. Anthocyanin is an antioxidant you pig ignorant mothafuckas!! And damn the stupid parents who go for this bullshit!!)
Another Holocene Human
There are studies on different kinds of breakfasts and what happens to children’s hormone levels until lunch, and if your kid eats something sugary (or starchy) with no fiber or fat to slow the release they WILL have a blood sugar spike and crash. Once blood sugar crashes those hormones kick in–norepinephrin and so on. That is associated with cranky behavior. (Not to mention the hormones are associated with putting on visceral fat and developing type II diabetes, but anyway.)
I’ve seen many parents call their children’s tired, overtired, cranky, hungry, hungry-cranky, dizzy, confused acting out as “hyper”. It’s not. Their blood sugar went wacky and they lack an adult’s self control or insight.
Another Holocene Human
@Violet: The “diet uber alles” notion. Sorry, it’s not all diet, we have big brains, they have competed and won resources away from our guts (compare to the lowland gorilla for a moment now), and the mental tools we have and mental habits have huge impacts on our moods as well.
I know this very well; I’ve struggled with mood disorders for years and digestive disorders. I’ve been very happy with very bad digestion and I’ve been very unhappy eating spinach and sweet potatoes and pastured butter. There’s nothing like a cascade of blaming yourself and oughts and recriminations to make you feel super bad and hopeless and I really don’t think gut bacteria come into it much.
We might find out that bad bacteria cause mood instability in some people and so on. We do know that they send shit into your bloodstream and try to manipulate you. Yeah, I have no doubt of that. I’m just saying that there are some parts of the blogosphere where diet is considered the one true answer to all of life’s questions (parts that have a certain number of credential medical and research professionals… after all, contrarianism can lead to new breakthroughs) and that’s a very distorted view. It solves certain problems; it does not solve all problems.
@Another Holocene Human: I agree with you that diet isn’t everything. I think it’s a piece of the puzzle–for some it’s probably a bigger piece than for others. There are definitely genetic variations. Probably environmental variations and all sorts of other variations too. Any time someone claims any one thing is the cure-all for some issue, I’m skeptical. It may work for them, but it likely won’t work for everyone.
I do think doctors don’t know much about diet and nutrition. They aren’t taught it in medical schools and most don’t make much of an effort to learn about it. I guess that’s why I see it as cutting edge. Doctors seem to agree that some foods aren’t good for people (at least in large amounts), but looking at diet and gut health as a key issue in treating someone–that’s just way out there in voodoo land for most doctors at the moment, imho. YMMV on that.
So I don’t think there’s been a lot of research into this direction and I think it’s exciting that it is beginning. Maybe some people will get helped with some relatively simple treatments. That would be awesome!
You may have randomly picked spinach and sweet potatoes, but both are high in oxalates, which some people have problems with. If those particularly caused you a problem, it might be an avenue to investigate. Or you might randomly have picked two healthy foods when making your example. Just kind of jumped out at me.
@Another Holocene Human: I’ve got the gluten-sensitivity as well. If I eat it, or if I eat too many grains or too much sugar, I can see it on my face.
The medication I took earlier this summer was to treat SIBO (small intestine bacterial overgrowth). I went for testing because I had rosacea and I was definitely positive. The medication messed with my mood really bad–I was borderline suicidal, but in a weird way–I’d only be that way if I had a negative thought and it would be transient. At first it lasted longer and as time went on, it was less frequent and lasted less time. It was definitely associated with the medication, as that sort of thinking is not me.
The antibiotic worked for my rosacea, but I still have some acne pimples that come and go depending on what I eat or if I’m stressed. I think the redness of the rosacea had one cause (SIBO) and the pimples have another trigger. It’s been interesting to experiment on myself, but challenging too. Re-building my gut flora has been interesting as well.
To comment on the original event:
Quick overview of mental health care in VA: I’m a mental health professional at one of the Community Services Boards in Virginia; here, Community Service Boards (CSBs) are quasi-public, non-profit orgs that handle most of the mental health services for the poor, disadvantaged, and disabled. These services typically include outpatient therapy, services and programs for the intellectually disabled, social skill development, Wounded Warrior programs, child and family therapy services, in-school help for children with emotional/behavioral issues, employment services for mental health consumers, residential programs, emergency crisis services, and life skill training. Most CSBs’ funding comes through Medicaid billing, with some grants sprinkled here and there. We also receive some funding from the municipalities we serve (Almost every county and city in the state has its own CSB; some CSBs serve multiple counties/cities in their catchment area). Besides us, there are some private companies that provide some of the less intensive services (mostly outpatient therapy, intellectual disability services, and life skill training), but these private companies are a fraction of the populations that CSBs serve. Most CSBs offer NO inpatient programs, and the ones that do are both voluntary and focused on minor stabilization, nowhere near the levels of crises seen by most psychiatric wards in hospitals. Virginia has mental health facilities for long-term care, but none are designated for crisis stabilization.
That said, the inability to find a bed is amazingly common, as there are very few places that have psychiatric facilities: a few hospitals, and some private, inpatient facilities. The state has been maxed out with its short-term capacity for some time, and this mirrors the level of services in the CSBs: We’re all maxed out. To make matters worse, a lot of programs are having their billable rates slashed drastically.
To prevent these tragedies, VA needs:
-more short-term, inpatient facilities.
-more qualified staff, especially on the licensed level.
-more funding for its public.
This is the ignored result of our legislature refusing the federal expansion of Medicaid in our state, coupled with the nominal funding received by CSBs from a lot of the municipalities. I’m hoping that a this results in legislature that increases funding to our CSBs, along with the state actually creating crisis stabilization facilities in high-need (i.e. poor and rural areas, which is 80% of the state) locations.
In the past 24 hours, most responses from other mental health professionals I’ve interacted with have all had the same reaction to this event: a mixture of outrage (“He was RELEASED??!”) and frustration (“same thing happened with one of my people last week/month”). Until mental health stops being treated as the red-headed stepchild of healthcare, this will continue to be our reaction, and we’ll continue to be able to do little to change this.
the fake fake al
When my son was diagnosed with sz, I installed locks on all the doors and started hiding the knives. The father should not have had any guns in the house as a safety precaution for him and his family. The home is a best therapeutic location for those with mental illness, but you have to understand the dangers and take steps to be safe.
@dpm (dread pirate mistermix):
By the time you need inpatient care, things are really bad. The ideal approach is enough effective primary mental health services including therapy services and medications management, to AVOID hospitalizations.
Another related issue is the local jail population — many of whom are repeat failures from both lack of primary intervention and emergency intervention. They never get treatment and just cycle in and out. Communities seem willing to invest in prisons but not in treatment facilities that would decrease their populations significantly.
Last but not least is the need for deep family and population involvement in grassroots meetings and support of families such as the National Alliance for Mental Illness (NAMI), which has many local chapters with support and education for families as well as helping people to organize to advocate. They helped me when a close family member was acutely ill and they gave me resources and information to manage and make things much much better.
Most of all, we have to all leave shame behind and start talking openly about our reality. From there we can begin to make change that is deeper and more meaningful than having insurance coverage alone.
This story made me so sad – it’s hard enough to read in print, but on the news last night they showed photos of the father and son together earlier in the year, and it was heartbreaking to see how they obviously loved one another. The son is a year younger than my son. It is just too easy to put yourself in the other parent’s place.
@CzarChasm: I’m just curious – if a family has money, is it any better for them? The Deeds family, one presumes, would have had resources to pay for private care. Are those services also affected by the same budget guts and shortages that affect the services you’re describing in Virginia?
I’m not trying to be unsympathetic, but I’m wondering if a family with more money has an equally difficult time. Surely the son, as an adult, would receive treatment based on his own income and eligibility, but if parents could afford to pay for anything, are there services available? Or is it difficult even with money?
“More money” is relative. This study shows that a hospitalization of someone with schizophrenia costs about $8,500 for 11 days. That’s almost $800 per day. Even rich people would start to have trouble with those kinds of costs pretty quickly.
As I said above, I suspect that the hospitals saying they had open beds were not covered by Deeds’ insurance, which is probably why they weren’t called.
@Svensker: Agree on all counts.
@JPL: Very kind of you to say that!
As the seemingly endless night went on and on, I kept thinking if it’s this hard for me, imagine what a nightmare it is seeing this happen to your sister.
I can remember worrying at the time that it would take us 20 years to recover from Reagan. Who knew I was such an optimist?
A good question: Most families with more financial resources can find some sort of private practice to provide for the person with mental illness, but that is no guarantee of stability, especially if the person does not want to take their medications for whatever reason (To head some of y’all off at the pass: yes, not all people with mental illness need medication; in yesterday’s events, however, there seemed to be some need for meds at some stage).
One challenge with treatment and recovery is encouraging the person with mental illness to change certain behaviors or thought patterns that trigger a mental health crisis in the person. The needed change can stem from multiple stressors: Family/home life, peer relations, substance abuse, bad medication management, work environment (think about the recent issue with Jonathan Martin and the Miami Dolphins), etc. Unless that person makes active changes to remove that stressor, the likelihood of a mental health crisis occurring is high.
When the crisis occurs, the next challenge is what resources are immediately available to the person: Peer/family support that recognize the danger signs of the person having a crisis, the person’s own insight (“Something’s not right, I should seek help”), and/or observations of any mental health providers that make contact with the person during this period. If none of this occurs, the crisis escalates to a point where something bad is very likely to occur to the person or someone around them.
Both stages above have a higher rate of success if the person is not isolating himself from others, which seems to happen often when mental illness flares up, and socioeconomic status doesn’t seem to influence this desire to self-isolate.
When the person is at a point where hospitalization is needed, economic status doesn’t play a factor in this state: Both public and private facilities are used for this purpose of crisis stabilization. From the reports so far, it looks like that hospital stay wasn’t possible, hence the ranty comment I posted.
The “hospital stay” usually comes after a long and bumpy road around outpatient treatment. Psychiatry has changed a lot — now mostly drug prescription and very little psychotherapy — which is usually a separate practitioner who may or may not communicate well with the psychiatrist.
The meds have their own story and many have very uncomfortable and sometimes deadly side effects — which leads to some of the non-compliance issues and relapses or exacerbations of symptoms.
There were a good representation of well to do along with middle income and those with less means in our VA support group. Wealth does nothing to mitigate the drug side effects or inability to connect with good psychotherapy. The other issue is that adult “children” don’t have to let you in to their treatment approach or lack of it. HIPAA, good for most everyone actually makes it difficult for family to keep up with what their loved one is doing in treatment — their compliance, side effects or what the therapist/psychiatrist is noting — very important if the therapist is starting to see some red flags — do they even know how to contact family or other loved ones?
There is a lot to this and as I said upstring, lets start talking plainly about it ..
This is a big issue. Many times the patients don’t like how they feel on the medications, plus they feel “fine” mentally when they’re taking them, so they don’t think they need them and stop. It’s my understanding it’s a particular issue with schizophrenia patients, but I think it’s an issue with other types of mental illness as well.
Absolutely but you are right that schizophrenics/schizoaffective and also bi-polar have particular problems with side effects or perceptions of not feeling like they want to…they start fooling around with their doses or skipping doses.
Hospitalization is no guarantee of effective treatment either. They don’t keep you long once “stabilized” and you are discharged pretty quick out into whatever support network you do or don’t have. Typically within 72 hours and while stable while treated as an inpatient, if they start skipping their drugs, boom — back to the downward spiral.
Again, hospitalization represents failure of outpatient treatment. We have to fix THAT most of all.
@Another Holocene Human: My personal experience with EMDR is that it works amazingly well. I was a skeptic when I tried it, but wow. Now, not everything works for everyone, but… Personally, given the choice between that and medication, I’ll take the therapy — hands down.
@Julie: I had a therapist do EMDR in her office with me. I had no idea what it was and am not sure it worked much for me. It did make my head feel like it was buzzing, though. I’d walk out of there feeling kind of dizzy.
@Elie: Not to mention that people can’t necessarily afford their medications and skipping doses or cutting pills in half is a way to cope with that. Hopefully the new health insurance law can help in that regard somewhat. We’ll see.
@Violet: My therapist had me do a ton of prep before we tried it, so maybe that makes a difference? That said, I know that everyone is different and responds differently. It worked wonders for me, and like I said, I was a skeptic going into the treatment.
@Julie: Mine told me what it was and asked if I wanted to try it. I was uncertain, so did some research on my own and decided what the hell. I used these clicker things–one in each hand. I think there are other ways to do it–something with eyes, and also I think headphones. It’s been awhile, but I think she also had me do something with a crystal on a chain moving back and forth to include the eye component, but that was only once.
The main problem was, she was super controlling and somewhat judgmental. If you were a minute late, she’d cancel the session and charge you anyway. It was a right pain to deal with her. I think ultimately I didn’t trust her and that’s part of why it didn’t work all that well.
She did help me with some stuff, and gave me a referral to another doctor for a family member that has proved invaluable, so I’m grateful to her, even if I don’t think she was the right person for me to see. The EMDR was interesting, though. I’m a believer in that kind of thing. I just don’t think it and her and me were the right fit.
pseudonymous in nc
I’m pretty familiar with mental health crisis work in rural(ish) areas similar to that part of VA. It’s not just that beds are scarce, but there’s also a huge taboo against seeking help, and involuntary commitment may prevent harm but also sends shockwaves through the family. It’s a really tough one.
Most states’ attitudes seem to be that they can justify spending money on mental health within the prison system — the largest facilities in the US are in prisons — but not for severely mentally ill people who haven’t committed a crime. Community mental health gets jerked about in an attempt to save money, but that’s just externalising the costs.
That honestly fits with procedure. You call the nearest facility, then the next nearest, and so on, until you get to a point where involuntary commitment is going to involve an infeasible or impractical amount of travel. I don’t say that callously: you don’t get to call a MedEvac chopper for a mental health crisis, and if there were stories of people being cuffed and/or sedated then driven across the state to find a bed, that would raise other headlines.
My hubby is doing pretty well right now on Lithium and sertraline (which he is working with his doc to scale down). A lot of folks don’t realize that anti-depressants can actually trigger mania in bi-polar persons and should be used with caution. He was on them for years and getting worse and worse in terms of manic episodes. Lithium isn’t perfect but it stabilizes things a good bit and with talk therapy and regular exercise and sleep (yes SLEEP is key), he is as good as he has been in a long long time. We have been through it — believe me.
@Violet: Oh yeah. That doesn’t sound like a good fit at all. The key to stuff like EMDR is trust. I was with my therapist for two years before we ever tried it.