Once upon a time there were places known as insane asylums. These were not pleasant places, by and large, but they were places where the “insane” (or mentally ill, as we now say) could live and receive some level of support. Insane asylums made a lot of sense because we didn’t have a lot of treatment to offer those who were too “insane” to live in the general population.
Fast-forward to the 1960s. By this time we understood mental illness a lot better and had developed antipsychotics and lithium that effectively treated many of the types of “insanity” that would have previously forced institutionalization. A movement of de-institutionalization spread wherein mental health services were moved into the community for people to access while living with the general population.
And while this sounds like a good and humane idea; I’m pretty sure we’ve gone too far with it.
De-Institutionalization of the Mentally Ill
The thing about de-institutionalization – which was a good idea – is that it left fewer places for people with serious mental illnesses to go. And this wouldn’t have been such a huge problem except for the fact that many of the community mental health services that were meant to replace institutions got closed due to lack of funding. So then a person with a serious mental illness, trying to living in the community, couldn’t get mental health services and wouldn’t have a place to go if they found they needed full-time support.
“Managed Care” of Mental Illness
And now things have gotten even worse for the general population as most people’s insurance frowns upon people getting admitted to a hospital on the grounds of a mental illness and when they do, they are covered for a few days only. Not nearly enough time to stabilize, let alone put skills in place to manage, a mental illness. And those who do have psychiatrist visits have generally seen those visits dwindle to 15 minute “med-checks” every few months – not nearly enough to manage a severe mental illness.
Case in point is suicide attempts. Frequently people who attempt suicide are not admitted to the hospital and those that are admitted may only be there a day or two. I find this outrageous and pretty much criminal on the part of the doctors (although I can understand their hands are tied financially in many cases).
Where Do People with Severe Mental Illness End Up?
And so we have a massive homeless population with mental illnesses and massive prison populations with mental illnesses. We’re talking one-third of the homeless population – 250,000 people – and half the prison population has a diagnosable mental illness and they are the fastest growing segment of the prison population.
So, people with a mental illness today get to live on the street or in a prison instead of in an asylum. How humane of us.
Re-Institutionalization of People with a Mental Illness
My question is, isn’t there a better way to handle severe mental illness than putting people behind bars or on the street where eventually they also end up behind bars? I think there is. And the answer is re-institutionalization. No, I’m not suggesting we round up people with a mental illness and put them somewhere but I am suggesting that we need safe spaces for people to go who need full-time support. Not everyone is equipped to live in the community – particularly not without a concerted effort on treatment first. And once a person has stabilized in a facility they can be moved to places that still offer support but also independence. We do this for people with addictions – sober living facilities – so where are the facilities for people with schizophrenia or bipolar disorder?
And before you reach for your pocketbook and complain about the money, consider this – Florida has determined it will need to build 10 more prisons in the next 10 years to house the increasing number of inmates. All I’m asking is that we spend even some of that money building facilities actually designed to help people rather than punish them.
Why do I feel like I’m living in 1939 Berlin here?
Alright. I am interested, particularly as my son died of a fentanyl overdose on 3 20 2020 in Merced, Ca 15 days after his 19th birthday. He was a first year student at UC Merced. We did not even know that he had been using percocet/oxycodone/rockocet to which he had gotten addicted the previous summer. Had rather lost track of him as the father of my brother and me died on 4 14 19 and we were dealing with the estate and my brother was working as a lecturer or professor too. Kevin’s mother and maternal grandmother were schizophrenic. He had oppositional defiant disorder (not diagnosed), conduct disorder that went into sociopathy (not diagnosed), anxiety (diagnosed), depression (remarked upon by a teacher) and may have been bipolar. We knew he used mj/thc, elavil, and alcohol but did not know that he had used coke, molly, lean, xanax, percocet/oxycodone/rockocet, nic puff bars, and adderal.
So how are the street schizophrenics etc to be dealt with. The homeless tend to be some combination of criminals, crazies, veterans, the improvident, the incompetent, the retarded, and the extremely lazy, and of course the drug-addicted. These are basically people who should not have liberty and privacy because they can’t handle it, can’t or w on’t take care of themselves, are a threat to themselves and others, and are a nuisancesome unsightly drag on society. A good way to deal with them would be to stuff them into cheap unused motels (which could be built for the purpose) and have them contained and supervised there. Others could be in therapeutic communities indefinitely. Where would the money come from? Could split up the country according to faction, and loot the road, prison, and military budgets, raise taxes on those making more than a million a year or having more than 100 million in assets and raise sales taxes a bit.
Most women nowadays that i have noticed unfortunately have a lot of very severe mental problems.
Good luck with that.
Well i know that very severely mentally retarded people shouldn’t be driving a car at all since they always are speeding at a very high rate and tailgating as well.
Mentally ill people are usually very extremely dangerous.
The very scary thing nowadays is that the great majority of them are women today, and very extremely dangerous as well.
Long ago the east side of my town had a large mental institution. In many ways it must have been a horrible place. My own father, who was institutionalize there a few times, called it a “snake pit.” On the other hand, our family was much safer and more able to function when he was there during those times. He was very dangerous during those times and threatened to kill many people, including us.
These days, even a very short stay for a patient can leave the family hopelessly in debt for years.
When I was young, many long term patients were allowed to leave the hospital during the days and even work for pay if they were able. They always had a place to sleep and eat.
Now there are many homeless people here. The homeless shelters can be dangerous places. Some of the homeless sleep in our parks and use the bushes for their bathrooms. I have friends who avoid our local library because of one schizophrenic man who flies into sudden rages there in the library.
One young homeless man stalked my daughter and walked into our home unannounced and very threatening. The jails are full of people like him, illnesses untreated and alcoholism unabated.
There are definitely some people who need institutionalize for the safety of themselves and everyone else. There are others who need care simply because they do not have the mental strength to handle life on their own, much like the homeless man who kept saying, “Anybody got a dollar?” My coworker growled that the man should get a job. In my heart, I knew that poor man was mentally incapable of that level of functionality.
This past week in Denver, you have the police taking blankets off of the homeless on the streets *because they care* and it is to encourage the homeless to go away and get out of the cold. It makes me wonder if those homeless aren’t the sensible ones and the police the mentally ill.
John R. Burgreen III
Boulder Bridges @ Ready to Work Homelessness
4747 Table Mesa Dr, Boulder, CO 80305
Yes, mentally ill people should be institutionalized if they are unable to function within society, or are a threat (meaning any form of violence) to themselves or to others- and that would include Sociopaths, Psychopaths and Narcissists.
Although the field of psychology have labeled them ‘behavioral disorders’ with more and more research indicating brain damage in the pre-frontal cortex of these 3 groups, added to the amount of physical, financial and emotional damage they inflict, the option of long term institutionalization should be available- for their own safety, those of their families and society.
There should be no forced pyschiatry anywhere in the world. We know from the refugee experience in Australia and other research that long-term incarceration in unpleasant conditions is bad for people’s mental health yet that is what we do to people with mental illnesses. I have heard from someone who was put in seclusion once that it ‘made him crazier’. If there was effective early intervention instead of violence masquerading as treatment, people with mental illnesses would all be back on their feet within 2-3 years (see research coming out of the Nordic countries which corroborates this – effective early intervention seems likely to consist of intensive talking therapy). I think that incarcerating even one person with mental illness (short or long term) necessitates mental health legislation that can be used against anyone with a mental illness. It is imperative that all adult human beings be allowed a respectful degree of legal autonomy. Present mental health legislation worldwide both supposes that people with mental illnesses are less capable and punishes them for is, under the guise of ‘help’. Doubtless many people working for the mental health systems of the world think they are helping people with mental illnesses, but, of course, removing an adult’s rights does nothing of the sort.
I have been doing a lot of research on this very topic and have planned a few posts on this because I am from
Chicago and Cook County Jail on 26th and California is the LARGEST mental health facility in the US. Yes. The JAIL is not just the biggest in the city or state, but the COUNTRY! having also been hospitalized a few times for my bipolar, I was fortunate to have about 10-15 days covered by my insurance, but in the psych facilities AND in the IOP’s, I saw people in the door and then out after only a few days and not much better off than they were when they walked in. It’s terrible. If we had a tumor in our brain or had suffered a severe head injury, THAT would be covered by the insurance, but chemical imbalances in our brain aren’t? If we have diabetes because our body is having troubles leveling insulin, that is covered, but brain chemical leveling issues are not. It just kills me that this is how it is, and we are so much more advanced medically, you would think that this area of medicine would be as well.
Hi Natasha,
I Came across this blog because I am at a point with my illness where I am desperate for some type of institutional care. I was diagnosed at 18 with bipolar disorder and in the last 5 years since then, my symptoms have only worsened. I have been on and off medications for different reasons, many people told me I didn’t need them and I wanted so badly to believe them because of how afraid I was that I stopped taking them a couple of times. Now, after my worst episode of psychosis, I am staying with family that doesn’t want me here- I have no id and no way to leave the house for therapy or for medication. I am desperate for someone to help me figure this situation out, I am terrified of becoming manic/psychotic again- It seems I am on a definite path to homelessness.
Wet Brain is another way of describing a condition called Wernicke-Korsakoff Syndrome. Tyis is a type of dementia that people going through end stage alcoholism might have to deal with. It is caused by a deficiency in Vitamin B1(Thiamine). If wet brain is allowed to progress too far, it will not be possible to recover from it. Untreated Woernicke-Korsakoff Syndrome always leads to death. The person was left after collapsing to be on her own. She had a mother who never worked stated “my husband told me not to waste my inheritence on my children…” and so she didn’t but dropped by after her own blood lost weight…didn’t have anything proper to wear to a shower…and to show her sick daughter her new vehicle.. Thus after four years the daughter who took her own father to cancer treatments because the mother would not and did not…then took her aunt to medical who passed after the father…then her spouse..my brother passed.. had no support… Worse than that: the daughter growing up had an eatting-digestive problem. Never taken to a professional physician: yet the father was an educator. So put this in perspective: one can see how deterioration and over caring led to her own demise while the two sisters and their spouses ignored her…including her out of state brother and certainly her selfish mother who never worked a day in her life. So many people are in facilities because they took responsibility while other indifferent, greedy, unnurtured, unloving 2 leggeds couldn’t care less.
I am a mental health clinician working in Liberia, trained by Medecins du Monde, the Peter C. Alderman Foundation and the Carter Center Post-Basic mental health program. I the issue about institutionalization and re-institutionalization has been one of debates for a long time in both my practice and training. Of course to every coin there is a right and left side. I support both based on the condition or circumstance at that point in time. We cannot have our patients being homeless, loitering the streets whereas we could have some for of institutions to keep them for a while when they are in their crisis period. If our government could support such ideas of constructing a half way home for some patients who will definitely not return home and employ nurses and other support staff to maintain that area could be one major achievement.. These half way homes will be there for patients whose families will not accept them home any longer. They could provide food and once a patient saw that every morning he went to a particular place and was offered food and water, he would want to come back everyday and found a place to sleep. With this, the nurses there will provide the medications they need. This will be expensive but will help to get these people out of the street at least
Another idea is the integration of mental health care into primary health care services. The results are great. I have seen this work well. Our government could support mental health through providing training for community leaders, community health volunteers, families and even the community nurses to identify, assess and refer through the referral pathway using the ladder (primary, secondary and Tertiary levels ) The reason is that the bulk of the people with metal health issues that can get treated and prevent a more serious problems are the ones in the communities who fear to be labeled as “mental patient” or using the services of ” mental health”. They are not the ones with the most obvious (like the psychoses) conditions which everyone term as being mentally ill. They are the ones with the hidden mental conditions (like depression, anxiety and even epilepsy even though this is not a mental health condition , it is neurological) They need to be help and integration of our services into primary health acre will do a lot for us.
this is outrageous, I swear. People like you are a shame to the profession of journalism. The institutions are horrible places, and are killing and controlling people. When a person is in one, they live by their rules, if they can get out they might even need a lawyer to do it. If it’s true Reagan released people from these places even it were to go to homelessness, he was a good guy to do that in my view, as a homeless person in many ways you have more freedoms at times, and can go where you want and don’t have to spend most of your time indoors. Mental illness is a farce somewhat, created from psychiatry and behavioral modification and is based on reality to an extent, but anything goes with a diagnosis, it is merely used to discredit and drug. Now homeless people and people in prison are also really at great risk, but even so I can’t get behind this- at all. I’m very offended by this propaganda you’re spreading, I already know people who have been holed up against their will for long periods of time and they could not get out easily at all, and many of them were not insane. Traumatic, and cruel. I hope your website gets taken down, but honestly, I’m not going to do a thing about it. I just wanted to say this because this is outrageous and no one wants to be in a place like that, hardly anyone who knows what they’re really about. The movie “One flew over the Cuckoo’s Nest” is not really that far off in a way, and even the scenes on the TV show “melrose place” with institutions, while dramatic and over the top and fear producing, had some basis on reality. Get out of here please. Get off the internet please and find something better to do with your time. -my alter
Long ago and not so far away.. there were mental hospitals. Many were filled with those who were deemed mentally ill.
Some of those people were not actually mentally ill, but, were deemed as such via family – court system – unwed mother who didn’t want to give up the child, developmentally delayed but not entirely dysfunctional, etc.
In other words; not all who were within the locked up asylums were actually mentally ill and the treatment given to those in those hospitals was not always entirely humane.
They were buildings to house people that society really didn’t want to deal with and families didn’t want to burdened with and you could be mildly ill or severely ill. Differing levels of mental illness was found in those asylums and it is asylums for which we are talking of when speaking of “institutions.”
Would I want to see that happen again? Absolutely not.
That said; having worked within a community MH system for a while now.. I can tell you that the system is quite broken. For those with money; you can buy whatever and whomever you’d like as often as you’d like to have them or it. As crude as that may read; it is true.
You have money and want to see a therapist 3 times a week… go ahead. You want to see the psychiatrist twice a month.. rock on. Want to join a group, 5 days a week… plant yourself right there sug.. let me get you a cup of coffee.
You have not much money but really good insurance… well, you may not get to just see and go when you’d like but you do have some freedom as to what and when and who. You just may be a bit more restricted as to how much, less you want to pay out of pocket and see if the insurance will reimburse you by filing yourself.
You have No money and NO insurance… pretty much, forget it.
You are at the mercy of whatever non-profit or governmental funding agency has a bed or a door that is open and there aren’t that many open.. not even that many that have lights burning in the doorways. Staff is grossly underpaid, agencies understaffed, plethora of patients, little to no access to quality programs that will take indigent poverty uninsured folks… and well, prison will get you 3 hots and a cot and maybe a trip to the prison psychiatrist.
Money, it makes the mental health system go round.
If you got it; you get it and if you don’t have it.. you get lost between the ever widening gaps.
Your points are well made. I am a physician in a community hospital ER and I see the revolving door effect of our current system all the time. My take is slightly different than yours in that I think there are facilities existing that can treat the seriously ill. Not a lot of them, but when such a patient turns up here, our psychiatry staff do have a place to send them to. The problem is that the vast majority of people with that degree of mental illness have no interest in going to such a place, nor do they even acknowledge that they have a mental illness. Their insight is extremely poor, which is itself a manifestation of their illness. Nonetheless, when the hospital petitions the probate court to commit these patients to a state hospital, the petitions are routinely denied. This I think is the real crux of the problem. The seriously mentally ill cannot be made to accept treatment except in the most extreme cases when there is an imminent threat to themselves or others. We not only need more facilities, both residential and community based, but we also need a legal system that will back this up. It is much easier to be incarcerated for a “crime” committed under the influence of psychosis than it is to be mandated to accept treatment.
What are the criteria for a successful petition to commit someone to a state hospital? You say petitions are ‘routinely denied’. On what legal grounds?
Suppose someone begins posting in social media or elsewhere that “All the XXX’s need to die — they’re trying to take over the world/our country”. In other
words, his statemetns are not direct incitement — “Go kill an XXX right now, here’s the address of one!” — but clear statements of the generat desirability of
committing mass murder on a certain group. Would this be enough to get the person committed? Suppose they bought an AR15 and a dozen magazines and
300 rounds of ammunition and began going to a shooting range to practice rapid magazine changes? I’m just curious about how the law would handle such
a case (understanding that it may vary from state to state).
Ok. Yes, the legal structure needs to be changed. Also funding and organizational structures need to be developed. Funds could be taken from road-building, prisons, the military, public administration, and from insurance to cover treatment directly.
My sister has just been Institutionalised.
Yes I agree those who are mentally ill need help: More effort must be made to inform family members when it does happen. Why say this?
I’ve just found out my sister has been Institutionalised…and the hospital didn’t even bother to tell us!
here in dayton,ohio there is really no where for them to seek any help.at the apartment building i live at we have a woman who is extremely violent.the landlords know of her illness however,they refuse to address the situation.basically they told us if we don’t like it,put in your 30 day notice and leave.now mind you,she has attacked people,ran off with the neighbors children,brandished a knife and made several threats against the other tenants.she finally went to jail after calling the cops for about two months straight.the thing is,we know she needs help,but her going to the hospital for 72 hours isn’t helping her.the sad thing is why are the other tenants including myself being treated like we have no rights,being told we should move or just deal with it.
What a well-written encapsulation of the debacle that is de-institutionalization. What began as a noble and humane idea has become callous and cruel. I agree with you about re-institutionalization. No, we don’t have to go back to the “dungeon days” as one of my forensic psychiatrist friends refers to them. We’re a country full of great minds — we can figure this out if we’ll just put our resources in the right place. It’s imperative. Do you feel safe going into a movie theatre or sending your kids to school? No-one does, and it’s because there’s no way to predict who among the mentally ill will become violent, because past violence (or lack of it) is no reliable indicator of future violence. Nearly all of the mass murders committed by severely mentally ill (untreated) people in the last three decades could have been prevented. How shameful we allow this continue. I recently wrote a book about another preventable tragedy where inadequately treated schizophrenia led to the most awful outcome. Thank you for this timely and important post. http://amzn.to/1hnlnB5 — Janice Holly Booth, Author, A Voice out of Nowhere, #1 Amazon best-seller in schizophrenia
Here is a quote from the Olmstead decision, which is largely used as the decision that upheld a person’s right to be treated in the least restrictive setting possible. Reading the decision, it is clear that intent was that it also upheld the medical necessity for some form of institutionalization for those who truly need it.
“the ADA is not reasonably read to impel States to phase out institutions, placing patients in need of close care at risk. Cf. post, at 2—3 (Kennedy, J., concurring in judgment). Nor is it the ADA’s mission to drive States to move institutionalized patients into an inappropriate setting, such as a homeless shelter, a placement the State proposed, then retracted, for E. W. See supra, at 8. Some individuals, like L. C. and E. W. in prior years, may need institutional care from time to time “to stabilize acute psychiatric symptoms.” App. 98 (affidavit of Dr. Richard L. Elliott); see 138 F.3d, at 903 (“[T]here may be times [when] a patient can be treated in the community, and others whe[n] an institutional placement is necessary.”); Reply Brief 19 (placement in a community-based treatment program does not mean the State will no longer need to retain hospital accommodations for the person so placed). For other individuals, no placement outside the institution may ever be appropriate. See Brief for American Psychiatric Association et al. as Amici Curiae 22—23 (“Some individuals, whether mentally retarded or mentally ill, are not prepared at particular times–perhaps in the short run, perhaps in the long run–for the risks and exposure of the less protective environment of community settings”; for these persons, “institutional settings are needed and must remain available.”); Brief for Voice of the Retarded et al. as Amici Curiae 11 (“Each disabled person is entitled to treatment in the most integrated setting possible for that person–
recognizing that, on a case-by-case basis, that setting may be in an institution.”); Youngberg v. Romeo, 457 U.S. 307, 327 (1982) (Blackmun, J., concurring) (“For many mentally retarded people, the difference between the capacity to do things for themselves within an institution and total dependence on the institution for all of their needs is as much liberty as they ever will know.”).”
I am with you all the way. Our current mental health “system” offers the least support to those who need it the most – people with serious mental illness (schizophrenia, bipolar disorder, some kinds of PTSD). Many of them require months of treatment just to get their symptoms “stabilized” and during that time they are unable to function on a day to day basis. New drugs in the 50s really didn’t change that. The need for long-term support while stabilizing remains the same. And it’s a hard truth that many people will not be stabilized at all because the medications don’t work for them. When I was 11 I was hospitalized for 16 months. That was the best treatment experience and outcome I’ve ever had . Yes, we need “institutions,” we just need to establish ones that do not feature any of the abuses and neglect, and minimal treatment, that many of the old ones did. Brave article. Thanks.
I honestly find this to be very ridiculous. Mental health as practiced today is riddled with enormous problems. Until these professions start to face those problems I don’t see how it is wise to rely on them for anything, but the most extreme cases. Take all the school shooting and other events we are seeing for example. Many declare this is evidence of a need for mental health care. Yet when you look at almost any of these cases, they are almost all people that are in this system. This is denied again and again and again. I happen to follow groups that track these cases and fight for a release of medical records. You find the same stories again and again. Here is the thing, psychiatry has 0 objective medical tests that they rely on for diagnosis. Psychiatry then attempts to correct imbalances that they never establish the existence of to begin with. When you look at the profession of mental health you find that as a field they have done virtually nothing to actually understand biology’s role in behavior. Instead they are fixated on a small number of substances, ignoring the vast majority of everything that makes people who and what they are. The irony of these substances is that many of them are closely related to one street drug or another. If mental health actually worked with biology in a real way they would in fact base their treatments off of medical evidence, rather then the current methods they use. The result is that they make a mess of the inner workings of their patients and cause events like suicides and massacres. Virtually no attempt is made to really work with facts or the actual truth. The result of this behavior is that thousands of our soldiers have died to suicide and homicidal behavior while on anti depressants and other mental health drugs.
” I happen to follow groups that track these cases and fight for a release of medical records.”
Can you provide links to these groups?
As a residential treatment counselor, all I can say is this: there is a severe lack of care coordination, people are shuffled through the system without the consideration of necessary level of care, programs are seriously understaffed, etc.
Considering what residential treatment counselors must do, we are underpaid. Not only do we have to provide emotional support to people in need, but we get verbally and sometimes physically abused by clients. The working conditions are terrible when the programs are not equipped to respond well in crisis situations (e.g. lack of staffing, no safety exit routes, poor staff-patient ratio).
Some clients DO commit crimes and use mental diagnosis as an excuse. I am sorry, but this is the fact. Violent behaviors are seldom taken seriously by the justice system and people get easy treatment if it is determined they have a diagnosis. There is no patient accountability.
While some people are so severely ill that they engage in unsafe behaviors, there are some who are fully aware of what they are doing. Yet, nothing is being done about it.
Most everything in this country is for profit. Healthcare is no different. The reason the mentally ill population is not being taken care of is because most of them do not carry health insurance, and treatment can be costly even with insurance. Ironically, most of them can only receive any treatment while incarcerated, when if they were just treated in the first place they would likely not have committed the crimes that got them incarcerated
My son has been in the system for 17 years on the streets homeless and jailed for illegal camping . Missed opportunities for long term help I’m told to let him hit bottom my question is hasn’t he hit bottom ? Where is the help they need. And when something happens I here where we’re the parents…Trying with no help We are there we are always there.
When I was growing up in this town, there was a large mental hospital in our town with many residents. Some of them were put there simply because their families did not want them; many of those people may not have even been mentally ill. Others were so ill that they needed to remain there the rest of their lives. My father had bipolar episodes and had to be confined at times because, unfortunately, he became dangerous. Had there not been such a facility, our family might not have survived — and I mean that very literally. Our family could never have afforded the very temporary treatment facilities of these days and Daddy would have killed us if he had not been in a locked facility at times. He did kill 11 of my aunt’s dogs with an ax, so the threat was very real.
As a young person I often saw patients walking around town. They had a place to return to at night and meals to eat. Some of them even worked.
I wonder what happened to these people and many others when the hospital was closed. When I worked in a downtown office building in the City, I often saw people, obviously mentally ill, wandering the downtown area, talking to people that weren’t there. Some hardly seemed to have the ability to cross the street safely. I believe that there are many, many homeless people who do not have the mental ability to take care of themselves and it would be a godsend if they at least had a facility where they could sleep and eat meals.
I also wish that every person caught with drugs could spend at least 6 months or more in a lock-up facility, depending on how bad his habit is.
I think the prisons would be greatly relieved of a gigantic burden, in any case.
Thank you Ms Tracy for your thoughts which are very valid. These mental issues , and Im talking about the real bad cases, are very sad and something has to be done. Commiting them to a prison is basically killing them, which is unfair and cruel, but leaving them on the free without supervisión its Also cruel and unfair for the rest of the community. And like in all instances, the mayority wins. The risk for the community is too high a price to pay, too many Lifes at risk for not taking proper action of the “one” individual. You can’t eliminate someone just because his head is un reparable, you provide a safe enviroment for him (her) and for the community around them.
Great piece! I was wondering why there weren’t places for people with extreme mental issues to go other than jail or the streets. It must be horrible to live with someone whom you fear. It’s especially unfair to other siblings. I hope we can bring places like this back BUT they need to be safe, calming, loving environments.
How about people who are mentally ill and stable??? I suffered from these manic episodes for years and I take medication, eat healthy, exercise and use skills to keep my condition at bay and I work and go to school and I feel like this is unfair because some of us function better than others and only have issues when acute.
With that said, I look at plenty of folks and think the same thing… it may be hypocritical but some people are worse off than others. Is this in general or to some people???
You are a candidate for out-patient or day-treatment if you can afford it. Bipolars tend to get along better than schizophrenics. They are rarely homeless as shzizophrenics and junkies often are.
interesting article. i know exactly what you mean, a (voluntary) rehabilitation center for MI. maybe im wrong, but aren’t there rehab like centers other than psych wards/hospitals for mental illness? like lamistad in florida. theyre residential, expensive, but there are some places that aren’t just for long term (you can stay 30 days, 60, 90,etc) i think you should check out lamistad.com. does that seem like the type of place that youre looking for to be more accessible to people?
This makes quote makes sence:
” We do this for people with addictions – sober living facilities – so where are the facilities for people with schizophrenia or bipolar disorder? ”
Many of us “mentaly ill” people have learned to follow the addictions recovery crowd for support, in fact most people in recovery have psychiatric labels or qualify for them. Some people call A.A and N.A cults, where us “crazy people” get together and solve our own problems. It works.
Rehab for addiction is nice. Lovey-dovey comradery, fluffy pillows, pools, beaches and campfires… gives a person hope, tools, support…
I have also been behind the locked doors of inpatient psychiatry and a chemical lobotamy doesn’t help anything, the locked door is only there for peole who don’t want a locked mind and might leave.
I don’t know what happened elsewhere, but I think one of the cruellest things the British Government ever did was to turf legions of long-term mentally ill out of the institutions that had cared for them so long out into “communities” that didn’t care for them at all. In fact not too long ago, if somebody spotted a person behaving outlandishly in public it was the thing to say “he/she’s in community care”… in other words going mad in the community and not being cared for at all!
Personally the idea of having to be in hospital has never really bothered me; it’s the process of going INTO hospital that put me off going. The way you’re kept waiting for hours in Emergency Reception because no member of staff can be bothered to see to you. (I get the impression they think that if they can keep them waiting long enough, a lot of prospective patients will give up on the idea of being mentally ill and just go home). And it’s the fact that in some hospitals there isn’t even a smoking area. Little things like that that put me off. But being in hospital is at the very least an interesting experience and you meet interesting people in there. I think there should be more places available in institutions. There are several times when I really should have been in hospital but just didn’t go because of stupid practical issues. I’ve decided that if I ever do go severely mentally ill again I’m NOT looking after myself through more psychosis. It’s too exhausting. I’m just going into hospital and I don’t care…
Hi Gledwood,
I agree, turfing long-term stay people is rarely a solution to anything. All it does is add to the homeless population.
And I also agree that going into the hospital is horrible. The only thing I can suggest is that you take someone with you (and maybe a book) for moral support. I’ve been to the hospital and the friends that went with me made it bearable. There is no need to work yourself up even more and be alone.
(And the no smoking area thing is weird. But maybe quitting is an added benefit?)
– Natasha Tracy
Insanity they say is the doing the same thing repeatedly and expecting different results. Yet the laws are as such that it is what they are basically doing. Getting help is one thing yet it actually being helpful is another. Some need long term structure and help beyond what the hospitals can provide. With some(probably many) states cutting funding for mental issues it seems it won’t help those who really need it. How do we as a society make a difference when so much works against you?
Hi Debra,
You’ve said it very well. My personal way of looking at it is to try to help people one person at a time and to just do the best we can with the system that is there. Now, that isn’t the best strategy for changing things, but it’s what is workable for me.
– Natasha Tracy
I’ve often wondered and asked why there are no “rehab” style places for people with mental illnesses. Places where people can stay 30/60/90 day to stabilize and learn coping skills. At my worst, I would have loved to be in a place like that. I did manage to stay inpatient for 30 days once, but I had unbelievably great private insurance at the time. If I had any other coverage, I would have been kicked out after a week, only to return again in a day or two.
We have a couple of assisted living communities here in Illinois, where patients that need full time care, but don’t require hospitalization, are monitored closely and receive mental health services. They are also encouraged to work outside the home when they are stable enough. Unfortunately there are no where near enough of them. Not sure if other states do this, but Illinois warehouses some of it’s mentally ill in nursing homes, with the elderly, where they receive little or no treatment.
Even if the funds were available to build more assisted living communities, they’d face the uphill battle that’s been taking place in the northwest suburbs of Chicago for years now. There is a proposal to build such a facility, but it’s being met with a “not in my backyard” mentality from the surrounding homes, businesses and community activists that believe every mentally ill person is a deranged, mass murderer. Everyone agrees the need is there, but no one is willing to have it built near them.
Something has to change. People need medical attention, not prison or homelessness. Florida and other states should build less prisons and more psychiatric facilities.
In my opinion..
I, personally, would rather go to a “outpatient” partial-hospitalization long-term than a long-term inpatient hospitalization. Merely because it’s cheaper on me, overall, and I can go home at night – be in my own “space” so to speak.
That is, if I didn’t get fired from my job that would pay for, or help pay for, the cost and would pay my home and living expenses as well.
If I had a place of which I could check myself in and check myself out… that was partial… I’d go so much quicker when feeling suicidal or “out of sorts”.
Unfortunately… there are no places around where I reside. There is either the community resources, the private money for profit agencies, or the inpatient that has very few beds available. Sure the MH parity law says that mental must be on par with medical in the ways of insurance paying for mental and offering benefits for it.. the same as medical (because many insurers simply didn’t tag it to benefits or made it so outrageously consumer “unfriendly”)… but that doesn’t mean it’s on the same par as a medical illness.
If you have a medical illness… you will still only be in the hospital for however long it is required to stabilize you enough to send you home OR your insurance/money runs out… because they too (medical) have too few beds to just keep everyone.
Mental is a chronic and never ending issue. More people than not, their illnesses are life long forever and always in need. There is no “short term” regimen to cure or fix, as in most medical issues and with most medical issues… medication works and/or improves the illness with documented medical tests and scans.. something mental can still not supply.
So, for insurance companies and hospitals/facilities to offer long term inpatient residential treatment (as back in the good old days)… is a money draining pit overall. The prisons offer long-term residential treatment that supplies minimum mental health treatment, but treatment nonetheless. The “rest homes” are mixed with those who are non-mentally ill and mentally ill due to gov’t cutbacks… and they offer long-term residential treatment that supplies even more minimum mental health treatment, but treatment nonetheless (except those without MI must live with those who are, and have little choice but to in many cases and vice a versa).
So… what is the option? Community services that are running on bare bone financial resources, or private “out of pocket” agencies who pitch those who won’t pay, or the inpatient facilities that have very few beds available to long term low functioning mentally ill patients who absorb the services on a long chronic term basis.
In an ideal world.. we’d have the “facilities” and homes where folks can come and go for 6 weeks to 6 months at a time… get the stabilization and follow up care they really need… and the engaging medical help that is needed on a more consistent basis.
We don’t have that… no one will afford it, no one can afford it, and no one will supply it… to those of us with mental illness.
If we could ban together, as a strong lobbying force, and really hit the policy makers… as the “medical” world does… and have the NATIONAL fundraisers as the “medical” world does… then we’d have a chance…. but, we, as a population… won’t.
There is too much stigma still associated and in many cases, the medical world is prejudiced against those with mental illness.
Hi Tabby,
I agree, it’s hard to stand with one voice and I agree, there still is stigma, even within the medical community against mental illness, but I would argue we _can_ afford it and can barely afford not to. If we can afford to house prisoners, we can afford to house people with a mental illness. In fact, we could easily make in an option to jail for non-violent offenders. My guess is that many people could get stabilized, if we treated them, and continued to offer treatment, and they would get out of the jail system completely.
The problem is that when a person with a mental illness is _in_ jail, they actually have access to care, but as soon as they leave, they don’t, so it become a revolving door. And no one can convince me that _half_ of the prison population should have a mental illness, statistically speaking. My guess is that many of these crimes are nonviolent, and drug-related and could be handled through treatment and rehab. The prison is just the wrong place to put these people.
And like I said, if Florida can afford to built _10_ prisons then they can afford to build at least one treatment facility to place people that would have been in prison anyway.
– Natasha Tracy
I just came across your website. The question you ask is one I struggle with frequently, as I am a mental health professional who does crisis work. In the US there are few mid-range options for people experiencing psychiatric crisis. It’s either 72 hour hospitalization, which does little to stabilize individuals and is primarily a med-change; or long-term institutionalization once the person has committed a crime or become exceptionally dangerous to the community. There needs to be a middle ground…residential settings where individuals can stay for weeks up to a year, dependent on their need. People need time to stabilize on their medications and they need support and education on techniques for managing symptoms. Going to the therapist/case managers office a couple times a month is like putting a band aid on an artery that’s bleeding out.
Hi Tamera,
First off, let me just say thank-you. I think people who work with the mentally ill in crisis are amazing and you deserve a round of applause. Thank-you for doing such hard work.
Secondly, I’m really sickened by the 72-hour psych hold. It drives me crazy (if you will). I don’t know what it expected to be done in 72 hours and then when released, as you said, a social worker a couple of times a month just doesn’t cut it. I feel like we are setting people up to fail. Like we’re setting them up to end up in prison (which, judging by the numbers, is exactly what happens).
I have no answers, of course, only questions. Thanks for chiming in.
– Natasha Tracy
I suffer from PTSD because of the three 72-hour holds I’ve experienced! Once released, I have always been in worse shape than when I was admitted. My self injury, the main reason for my hospitalization, worsens incalculably in the weeks following my release.
It isn’t that the unit I was admitted was awful or the staff incompetent. It’s just that crisis stabilization units are nothing more than managed chaos. The goal of the overburdened staff is to process patients in, house them, and process them out. The rules they utilize to achieve this do not take the best interests of the individual patient into account, which can result in traumatizing patients.
You learn brutally fast you want out. Your goal shifts nearly instantaneously from stabilization to release. You shut down. You joke with the staff. You help the little old woman with dementia so the staff is bothered. You reach out to fellow patients to show you care and you’re social. You eat all your meals. You don’t make too many requests, but one or two to show you’re engaged (can I have another towel or soap, can I have some paper to draw/write). You utilize whatever dumb things they offer to keep you occupied (a magazine, the TV, games, puzzles). Everything is calculated. Everything is about getting out.
While in, you are locked up. You are not in control. What happens to you is not your call. You are at the mercy of the system and the psychiatrist, who visits you 10 minutes each day.
I like the idea of a partial hospitalization, if it puts me back in control. I like the idea of a place to go to feel safe when I want to self injure -and then leave when I feel more stable; a place I can go where people understand I’m not feeling well and understand the gravity of mental illness; a place to go to perhaps talk a few minutes with someone and have help resetting my thoughts or making a doable goal… something to steer me back toward health.
It would be nice. But, I suppose I’m just dreaming. I suffer alone or I suffer in the hospital, which causes me to suffer worse when I’m alone again!
But looking on the bright side. I’m thankful for disability because I can not work. And, I’m thankful I’m not locked away in an insane asylum for decades or for life. So, it could be worse.
rl
Hi rl,
I’m sorry you’ve had to go through three 72-hour psych holds and I’m sorry you’ve found them so awful. I understand what you’re saying about the “managed chaos” and I understand what you’re saying about “gaming” the system (basically) to get released. I’m so sorry. It sounds awful.
I agree that partial hospital hospitalization is a good option for people who don’t need intense monitoring. That have those programs in places where you go to the hospital during the day but home at night. It’s certainly more economically feasible as well. All I can say is, perhaps seek out these programs and others like them. I know it can be hard when you’re on disability, but maybe contact NAMI or another local group to see if they have any information on them.
Try to know that you don’t have to suffer forever. You can get better and move past some of these feelings.
– Natasha Tracy
Wow. Your comment really struck a nerve for me as it sounds really close to my experiences as well.
“You learn brutally fast you want out. Your goal shifts nearly instantaneously from stabilization to release.”
especially rang true. I was also admitted for self injury even though I told the ER nurse multiple times that it was a coping thing for me and not suicidal. I too quickly learned that I was unlikely to get the help I needed at the place they sent me. I was the youngest person there for most of my 5 day stay and was just so lost and confused and scared. Luckily my rommate clued me in on the things expected of us patients. And the 10 minute visits with the phychatrist definitely didn’t help. I hated my doctor from day one. He was dismissive of my feelings and threaten me with a longer stay if I continued to refuse him medication. I found that the nurses there during the day were the people who helped me the most. They were the ones who sat up with me late and night and listened while I cried, who held my hand and reassured me during my multiple panic attacks. They were the ones that gave me hope that there are people out there who did want to help me get better. Not just prescibe meds and shuffle me out the door.
I too would love a medium ground between crisis centers/ER and just home. Because of how much I hated my stay I think if I ever did get to a crisis point again I’d be a little more wary about seeking help at the ER. Having a place to go & stay for a week or more to learn coping skills, to get back to interacting with people again, to taking care of myself would be a great idea. I think many would take advantage of it. I certainly would. Many days I struggle, but it’s not enough that I consider myself in a crisis. During those periods it would be nice to have somewhere to go and have medical care nearby and someone to help monitor medication ect until I got back on my feet.
Couldn’t agree with you more Natasha. I have regular contact with people with mental illnesses around the world and right now I am most appalled to hear repeatedly of the inadequate care available to people in the UK, but I know full well that right aound the globe people are suffering because of community care. And that doesn’t even start to address the problem of countries where there is no care.
I totally agree with you, and your post just makes so much sense. To me, it shouldn’t be any different than when people have serious physical illnesses and need to be in the hospital. That is where they need to be and that option is available to them. Mental illness should be treated the same way. If you are too ill to be in the community, there should be a place for you to go so that you can hopefully get back on track and re-enter the community when you are well (or at least, improved). And, in the long run, it would save society money, which unfortunately is the bottom line for a lot of people.
Hi Janet,
It’s a matter of treating mental illness on par with any other illness. Psychiatrists have been fighting for that for pretty much ever and I believe there is some legislation that mandates equal treatment (I would say that’s to force insurance companies to cover certain things). But just because, legally, it’s the same doesn’t mean that the same resources are available and it doesn’t mean that funding is the same. Illnesses get funded at different rates no matter what and mental illness just doesn’t rank as high on the list as I would like.
And you’re right, it comes down to dollars and cents which is why my argument mentions money. I hate to think of healthcare that way but it’s the way we have to think about it if we want solutions to be put in place. Thankfully, I do think there is an economic article to put forth as well as a health one.
– Natasha Tracy
I have been diagnosed as bipolar for about four years now and have been hospitalized twice. I try to take my medication, but I don’t think it’s working. I live in a place that has few if any low cost treatment. Most of the help has been eliminated by state or local government. I have been to counselors and am taking medication, I do not think they are really helping. But the most hurtful thing that happens is my brother and some of the people I know have described me as crazy. Yes, that is the word they use. I have thought about suicide many times. I have stopped talking to people when I find out that is what they call me. It is very painful and I guess I have succumed to their beliefs that, indeed I am crazy and always will be. It has caused me to lose any interst in anything and I have started to withdraw into myself. Now, I just want to be alone, so to avoid any judgement and pain. I have enough pain on my own. I don’t need anyone to exacerbate that. I just do not know what to do anymore. Why does everyone who has mental illness need to be called “crazy” by those who do not understand or refuse or deny mental illness. I just give up.
Hi Shannon,
I’m sorry you’re having a tough time and people around you aren’t treating you with the respect you deserve. I know how hard that is. I know how it is to be judged by others because of a mental illness. I know it isn’t fair and I know it isn’t your fault.
That being said, I don’t mind being called “crazy.” It’s mostly the motivation behind it that matters. Sometimes people are saying it because they don’t know it hurts. And sometimes people are saying it to be hurtful, but there is a difference. Of course, you have every right to tell them not to use that word as you find it offensive.
Have you ever heard that, “what other people think of me is none of my business?” Well, it isn’t. Believe me. There are people who _hate_ me for my diagnosis and what I write. But it’s none of my business. What they think of me is their business. And they can hate me. And it’s OK.
There are people in life who will never judge you for your illness or for anything else for that matter. There are people who will stick by you. These might be family or friends, but they are out there. And for those who don’t, it might be painful, but those are people you don’t need anyway. And keep in mind it can take a long time for others to accept a loved one’s diagnosis and things can be rocky until they do. It doesn’t mean they are lost forever.
What I’m saying is, don’t give up. Yes, you are different than others – but that’s OK! It’s OK to be different. It’s OK to have a different kind of brain. It’s OK to need medication. It’s OK to go to therapy. You’re just you. Muddling through, like everyone else. You are just as loveable, just as worthy and just as human as every other person on the planet. Don’t like the destructive thoughts of _others_ determine how you feel about yourself. That’s just giving them power over you, which they do not deserve to have.
– Natasha Tracy
Maureen, all my life living in the shadows of my older sister who was out there and refused to take meds. If I take this then I must admit to my self I am really crazy.that was back in the early 60’s before we all went crazy for kicks after that nonsense we became normal however those left behind were the finest and most couragist who truly believed in rights for all…time to take care of our poor the war on poverty was off and running, student rights to be and say and organize any club they want on campus, free speech movement 1965 sign up to stop the draft senseless killing of our young right to get in the rice fields somewhere no body knew existed until 1964 so why not the right to vote at 18 women blew off all they were taught as their duty to do…clerical nurse college just to earn their mrs. degree..work next to the boys yet paid less because the man is expected to earn a living unless you were a single mother breaking out of an abuse ridden mr. wrong these men and women were movers shakers with just enough of crazy to get it done…and by the way my sister was not crazy just a pain in the neck I mean the queen of mean Helms would have to lay down and get out…no just different…oh yes my second biggest fear was being seen as different..well I was locked in a 1960’s catholic school with nuns still wraped up in some real strange hats….every day I faced mother superior wearing some kind of hat only seen on tv..the flying nun or in one of those insane places where boredom trumps carzy so lets see who can make the most bizzar head wear just in case dr.s and staff start thinking they are not doing a job with too little pay except dr ho ho over paid and under needed. and so it goes. ask Phyllis Dillard..made her stage life making lots of money looking as if she just came out of shock treatment…and people loved her. filled her venue just being herself…yes after my sister passed away I remember how she could whip up out of her head that only the likes of Marlyn could pull off….IQ at tops 164 and way ahead of her time creating a home out of a cave…not too bad..and she made a little $$ charging people for the life time thrill of spending the night in her little way to cool cave land….then it happened to me about your age I discovered I did not come from the family we watched on TV my family was a mess and just in case you worry about what people without a life think of you…try going to school every day trying to act like those normal girls after the night before an older brother and friends raping a little girl about 10….it’s as if they knew…I was so used to leaving my body during the molestation bouts that I blocked it so far down my little fragil mind and body that of course being different was how to act out before I really did blow it…of course sitting at my desk eating lunch while wishing I could be like Noreen with every thing pressed clean and not a hair out of place her twin brother tom was also in our class…and not knowing how or why a full stream of yellow water let the dam running wild not stopping until every kid stopped eating as the were being fire drill style as their shoes sloshed in that really strange girls body…I just stood up and let go of another qt of tears slobber style uncontrolled pain screaming crying soon to let lose of an unsightly glob of snot from my nose…I do remember so clearly the look on miss noreen’s face as she was the closest and first to get a load of what it really means to be the different not so cute over grown girl in her 4th grade experience…..let me tell you this I ran into her around my early 20’s when I grew up and into a body I thought tops hair long and the cats meow with an attitude too big for girls like me…she lost her job never finished college as was in the plan husban left he for someone more different yeah right and crying on my very big shoulders with her over sized mumu wishing she would meet me to tell me I was one of the few friends she truly trusted…she was my frind and all that time I was too locked im my closed up world thinking even as the kootie kid I was the center of their universe…and she was in pain trying to be what her parents wanted her to be….as we hugged and both got it…the TV family was not real and while we all hid our dirty little disfunctions mothers who drank all night from a day locked up like the crazy people had to go…unable to escape or get well until one night she did escape druk walking so easy down the middle of her steet bottle in one hand forgetting to finish the function of how to dress like a lady hat of course on a sloppy slope down her back touching her lace bra on down to the ops forgot to put on hanging out crying for help in unrelenting waves of depression with her drug of choice until she died before she could see her kids grauduate,,,and her brother tom died homeless alone under the I st bridge because he did not have the hope or will to live….yes…they are only projecting onto you their fears that the world will know….and people who try so hard to be normal are unable to…different is the spark you and others refuse to let go of….people who think they are truly free are scared to death of us who are fee enough not to become the stafford in crowd or stafford wives….freedom is given to us by God himself….he gave us free will…to embrace those who are at the bottem…you will become someone who will make great changes in the lives of people we didn’t do for but was just being another woman who understands their story…as for the other girls…along came the late sxties I went to public high school and they set the world on fire. and on killing or wonding a body that dosen’t even belong to you…we are created by God and in his image not ours…think getting your only out tearing and abusing Gods child…you would never dream of doing that to someone’s child…especially when sent down his son to take on the battered children our sins before now and forever…come on sweetie we are not that crazy to think we can mess with Gods little lambs…I did learn something that the church made real clear that death or murder of self will send you straight into hell super speed…well if there is hell….just enough religion to not even go there….be cause you can’t undo your own death just in case you discover, “holy sh..t” those bitchy nuns were right…not only is there a hell but just in case you have any second thoughts…it’s hotter then he…and the fires burn you forever….and ever…and the devil may actually be some of the real crazy people running our goverment….give me and yourself that little tid bit….especially during an especially 108degree day…because like how we changed our very earth with abuse…..we may be much to fast to skip the pits as our hell will be of our own greed power and you think your different…take a look of that around…we have not learned a think as we regress from a much fought battle to end apartied in our very own country…I remember,,,it was not stopped until the whole world was watchinh 1964….Think about it bring back the KKK unequal school for some and sub standard for those of color who will always remind they were not illegals try to get to america…they were ripped from a life they could hang with by strange thin skinned white men stinking of hate….chained…and positioned like the hens we fight to give a little wiggle room…worse…if some die get sick like mad cows they must be removed or they will infect the product…thrown over like dead fish…into an abiss…so don’t kid your self our little proud country was really crazy…because we look into the eyes of the oppressed never forgetting they were human beings bought and sold to the highest bidder…sane people in a growing civilized new world would have to be insane or worse without the souls god gave all to nurture and grow…men without souls or a conscious and there are many who run our goverments fuel fear bringing us back with a war on women unforgiving people who belive in a right to life while living in texas taking into their own hands conditions to the right to life…some should be given the right to the same death roll that their loving Jesus himself was given…that was the death penaty the very one the call on to save them…but how can these people be saved while their to busy for the worlds record of how many people to inject today…and what is different and wack a doodle crazy is this….hate in this country has infected us so much that the truth is most white people are showing their true deep seated racism…they will even dump the encomony and all of us because….there is a black man in the white house…hiw about that…good luck lady and put on a freak flag and fly away because you can you belong to the rest of us different folks…well this will be most likely my last chance to crash Natsha’s world…after she comes to the diganostic evulation of my illness is a wishful thought enough to save her fans from a women not crazy but is different just the same…a woman with balls to post ramblings of a
from an old hippi who is sane but dropped too much acid…not true..tried it 3 times and the third didn’t count because I never got of…I was too bored sitting with wowed friends at the dark side of the moon gig that everyone thought Pink Floyd can never go wrong…well the did slow never ending songs with trite special effects…like the ever so passed it’s time…when an airplane on a string flys on a string from one end of the cow palace passing over our heads to the other end….whoww..over sized model plane on strings they were too lazy to hide…to be lost under some shower curtain….well that’s that…they are still going and here I sit thinking I’m too cool for acid…..now I’m crazy and getting really good and tired with typos all over…but hay I do belive I can get some sleep because I have bored myself enough to spend a good nights sleep withdrawing..I’ll put that off till the rain clears my weary old head.. Natasha I think you are out of my league…or possibly not up to my over inflated ego taking simpts at you…I love what your doing…far more than I’m getting back on track…you do help and I belive you truly want to help all of us dazed and confused mostly women…give hugs and a cup of tea….but really Miss Tracy your getting a little full of yourself and could lay off the st Natasha….I really fell off my cloud when I came out of my St. Janis first 10yrs of AA then sponser of the yr telling women kind words of bullshit…that it’s OK just keep comming back some left some played the in and out burger queens…and some just allow me to hold them with out getting real…like my sponser did…get off your ass even if your feel like your just lost your ass..put it in a bag and haul it to a meeting no excuses hope its close and womens group and sit your butt in the bag on your lap and stay put…make sure you smoke as much of what you have in the pack…not the time to quit…..your have to a big road to truge just to live another day….this is life and death my friend….once you pass through the doors of AA the jig is up…normal people like my husband well not reall normal but those who just passed on this physical mental and spritual cancer in which there is no curer for except stop doing what most people really have a hard time understanding so they just say we are weak have no will power and we should have not been drinking in the first place so are very coveted time one one day ….we live five yers or 20 is just stupid don’t start if byou can’t handle drinking…go on find another sport likr fishing…and like mots people wake up on their best day in weeks to greet the day with…I know what i’ll do…i’ll go to an aa meeting and become an acolholis…sounds fun….so please lrt off on the mental illness stuff when all we can do is line the rich with off shore hold outs while cramming down dregs to those who truly need it at the expense od too many people wanting that fast food fix if they have profit motivated insurance ceo’s working with drug companys wit profit only because they anwser to no one but the god of profit only in a place called wall street… and as the hope for finding a drug that will save lives of all people that has been thrown over the low bottem feeders who could discover a way to cure cancer…it’s abuut time…dosen’t sell why not help all those middle age boomers do keep on doing what is set up as the natural passing through life when as intended passed on to the young that can’t get it down…as a way to insure the human population does not die off and those men living way past the age they should not only getting it up but living…when we are to pass the flame to those who were ment to to their task keeping the population thriving…oh what a dea;…cancer dropped off at some trash toxic waist mess because they found some fountain of youth to wallow in for money over all…yes money spent by over their prime pepsi generation…who will pray to the golden god if it promises one more erect…. that might last too long with side effects that cannot stop the lust in men who lust for gold with some women 30yrs younger…that’s crazy and dangerous for a culture trying to live in love not in swimming upstream like fish were programed to do not humans…just go fissing…profits keep their greedy minds happy while real people who are may not be ment ill just a bad day go unattended..unloved and alone….so see ya Lady Natasha I respet you but will nener get to know you to like…You are one person that would be a match for sparing over coffee…..
We need alternatives to asylums. Loving, caring places.
Here are a few ideas
http://www.soterianetwork.org.uk/index.php
Soteria
http://www.mindfreedom.org/kb/mental-health-alternatives/finland-open-dialogue
Open Dialogue
http://www.iraresoul.com/dvd.html
Watch clips
http://www.asylumonline.net/resources/alternative-sources-of-support/
Asylum magazine links
I am commenting anonymously because my husband is a laywer who represents mentally ill patients and don’t want to tread too close to any ethical regulations…anyway, based on stories he’s told me of patients who have nowhere to go, but can’t really take care of themselves, I actually proposed the exact same thing to him-voluntary commitment facilites, similar to a nursing home, for people who are struggling with mental illness and can’t take care of themselves properly, yet don’t belong in jail or the hospital either. They would have doctors and nurses available regularly, and could even have fun stuff to do like nursing homes, like fitness classes and art classes and community service projects (for fun and warm-fuzzy-feelings, not forced). They could be allowed to work outside their living facility, but they’d have somewhere safe to come home to, where any strange symptoms would be noticed and no one would let them accidentally run out of medication. I think most mentally ill people wouldn’t choose to enter such a facility, but if done affordably, many would, and it could be a great blessing to some of them. Anyway, great discussion to get going.
Hi AnonymousMom,
No problem being anonymous, many of my commenters are, it’s a sensitive subject.
I suspect most people wouldn’t “choose” to live there as a long-term solution but I think many would or could go there as part of an overall treatment plan. What I hate seeing is people with serious mental illness just getting dumped on the street after a 2-day hospital stay. It’s just asking for a suicide or some act of violence out of desperation.
– Natasha Tracy
Dear Natasha.
I am in the Uk which you would think has a better system than the US.However that great Conservative heroine(like the drug addictive and totally harmful and distorts reality) Margaret Thatcher had a plan in the eighties called “care in the Community” in which all the people who were institutionalized were basically thrown out with no support and the sucide rate went through the roof.Now we have private places that cost ten times as much(while paying staff minimum wage to look after violent and abusive patients,hospitals that are shortstay(unless you are an addict in which case you get unlimited treatment) and community mental health teams that cannot be bothered or just mock their patients(yes i have factual evidence of this from my own experience).
I know you are correct as all the evidence,studies.observation back you up.Yes the system needed changes but improving not eliminating.One of the things that did work in institutions was the doing chores thing.Gave a sense of routine and hell even a sense of achievement.That was stopped and private contractors paid min wage because it was beneath the dignity of the patients.In MHO giving people a routine helps with mental stability but that is only a personal view.
Hi Patrick,
In my opinion, giving people things to do inside an institution is critically important, not just for routine but also because it gives people a sense of purpose, self-worth and achievement. It is not “demeaning” to clean floors – we all do it at home – it’s proof that you can accomplish a task and people with a mental illness need this as many of them feel like they are worthless and “can’t do anything right.” It’s obviously people who don’t understand the ill who would make poor decisions like that.
– Natasha Tracy
Dear Natashe,
Yes.yes,yes totally agree with your response.One of my issues with the system is that people who don’t understand MI are the ones making critical decisions and being backed up by those motivated by greed or ego who do have a better understanding.
It never made sense to me even in the depths of a complete physical and mental break down that sitting around with nothing to do but think about your problems was in anyway beneficial or that as you say doing normal jobs was undignified.Separating what is normal from what is not to me is a key identifier when action needs to be taken.
Mind you one of my first ever jobs was mucking out stables so maybe i am baised lol
Hi Patrick,
Well, my first job was working at Subway and that place _wasn’t_normal_at_all ;)
– Natasha
In NC, where I am, there are “community” programs called ACTT or Assertive Community Treatment Teams for those who have severe and serious mental illness (Schizophrenia, Bipolar, etc..). Many of the patients (not all but many of them) in those programs live within “group homes” with trained caregivers/caretakers and meet with the ACTT team, each day as well as meet with the designated psychiatrist each day or as needed.
The case workers also go out into the community to meet the patients, take them to their other appointments (medical, etc..), are often “payees” who handle many of the patients rent – electric – groceries, etc.. for those who do not live within the group homes, etc…
There are also IDDT teams for those with Dual Diagnosis Disorders.. same set up but addresses the substance abuse issue as well.
If a patient needs IP.. the designated psychiatrists handle the admitting and/or transferring. When the patient is discharged, they return to the daily team coverage. There are also RNs who handle psychotropic injections, do routine blood work/labs, etc…
Yet.. not everyone is eligible or qualified to be on the teams… and if you have commercial insurance, the insurance will not pay for the service, so it’s “out of pocket” and it’s horrendously expensive. The teams are generally for those who have no insurance or receive Medicaid because Medicaid pays for the service and there are not that many teams available.
Even if there were… “facilities” for those with Bipolar, for example… to go and stay for however long OR even for outpatient hospitalization (which there are none in my area)… for many, it would not be financially obtainable… because either it would be so priced out of the ability for most OR it would be, like the community agencies, and be on the verge of closing every year due to reimbursement issues.
There are facilities for cancer treatment, alzheimer’s, drug and alcohol treatment… there are even facilities for eating disorders, here in NC for example… but, there are no facilities … for Bipolar, etc.
Hi Tabby,
Those programs do sound good for the people who qualify. I’ve found there is a problem where the poorest of the poor (on medicaid) may have access to certain services while the working poor can’t afford the out-of-pocket services and don’t qualify for the medicaid-paid for services. These people are stuck in the awful middle where they can’t seem to access anything.
And I just don’t buy these “awfully expensive” arguments. If we can afford to house people in jail, we can afford to house people with a mental illness so they don’t end up in jail.
– Natasha Tracy
Its so hard for families of a person with severe mental illness. My son has SMI. He has been in and out of the state hospital and several high priced mental drug rehab facilities, only to keep getting sicker, and sicker. He is now sitting in jail because he caused $6000. property damage. I do not know what we can do at this point, It seems that nothing is really helped him for any length of time. I would challenge any Dr. to find a way to help him, but it seems there are no answers for this young man. So very sad for him and our famiy. He is my youngest son, very sick.
No need to reinstitutionalize. We can make greater use of Assisted Outpatient Treatment Laws like Kendra’s Law in NY, Laura’s Law in California, Gregory’s Law in NY. It is less expensive, less restrictive and more humane than inpatient commitment. AOT allows judges to order people likely to otherwise be institutionalized to stay in treatment as a condition of living in the community, and more importantly it allows judges to involuntarily commit the mental health system to provide it.
Learn more at
http://mentalillnesspolicy.org
http://kendras-law.org
http://lauras-law.org
Hi DJ JaffeJ,
I appreciate Laura’s Law, as you know: https://natashatracy.com/mental-illness-issues/lauras-law-forced-treatment-saved-lives/
But I don’t think it is useful in all cases. There are simply many cases where people need more care than the community can provide. People need places where they can _live_ for a time. Like with addiction centers – those people need to _live_ somewhere for a time to get their lives on track and the community setting just isn’t enough.
– Natasha Tracy
DJ, if AOT is present, where are people going to go? To institutions, of course. It’s a skewed form of logic (which AOT proponents use regularly) to imply that AOT will keep people out of hospitals and living in the community. Especially when the majority of the rhetoric slams the door on alternatives to institutions and/or drugs as the ONLY options.
I am from a different country so things are (arguably) a little more towards the type of thing you are advocating.
While in hospital I made friends with a young man diagnosed with paranoid schizophrenia. He does not think he is sick and does not want to be in treatment. However, for the last 8 years, since adolescence, he has been under an ‘involuntary treatment order’ for his own safety. He is certainly unable to look after himself. He has his own little self-contained unit in a purpose built facility in the community, with round the clock nursing and case management. The facility is not locked, but he is only allowed out when he has some ‘leave’, which he has to clear with the nurses first, and then only if he has been upholding his end of the deal and doing his chores. Within fifteen minutes the staff will notice if he is missing, and will notify the police.
He spits out his medication on the quiet and has managed to convince a couple of the regular nurses not to give his medication at all. He has escaped twice; once, he flew three hours to another city by pawning his musical instruments. His dream was to live on the streets, and make a living busking. After a few months he was desperate for help so he went to a community centre, who promptly flew him back home.
According to my values, he is much better off in his supported accomodation. But according to him, he wants to be free. Free to be himself, free of medication, and of supervision. And of late I have noticed a deterioration in him, both physically and mentally, and he seems to be losing hope. I’m starting to think that institutionalisation might be worse than a life on the streets, for some people, no matter the quality of care. But at least there should be the option for care, or for freedom, as the person chooses.
Hi Sarah,
Thanks for sharing that story, I think it’s illustrative of a real problem with people who can’t take care of themselves – they idolize a life that would be even worse. I think this is due to a lack of insight. Most of us realize that “making a living busking” isn’t that reasonable and that most homeless people end up eating out of garbage cans and not living some sort of romanticised lifestyle. In the case of the person you were talking about, if he doesn’t think he is sick he’s suffering from anosognosia – which is a clinical lack of insight into a person’s disease. Unfortunately, people with severe mental illness, like schizophrenia, often suffer from it.
I appreciate the desire to be free – certainly. But I think the goal is to put the treatment and skills in place so that person can experience more freedom – hopefully in a less restrictive living facility at some point. That would be my wish for him.
– Natasha Tracy
Freedom is an indulgence which is good for many and terrible for a few individuals including this one. He could not handle it and would just end up going down the tubes. Perhaps he would do better, as suggested, in a less restrictive therapeutic community but not in the general population either.
Hello Natasha, I have been reading your blog for a few weeks now and I really appreciate that you are doing it. I have recommended your blog to friends of mine who have bipolar disorder. I have depression. I agree with you regarding the need for places where people who are seriously mentally ill can go to recover and get the skills they need. You might be interested, if you are not already aware of, a project being undertaken here in Canada regarding homelessness and the mentally ill: http://athome.nfb.ca/#/athome
Hi Maureen,
Nice to meet a new reader and one that recommends me – my favourite :)
Thanks for the link to the project, I always like to be aware of such things.
– Natasha Tracy