The WORST of both worlds: The Mental Healthcare System

Okay, so it's approximately 1am on a lovely November Sunday morning. I just arrived home from babysitting. Sleeping would be great right about now. However, I am about to devote the next I-don't-know-how-long to a ramble about the mental healthcare system, and how really, there is not much right about it.

I'll start off by saying that we've hit this spot where we've started seeing people as individuals. FABULOUS! But, now that we are seeing each person as an individual, we are recognizing that we may not be able to give them the proper care. HOWEVER, that's not stopping us (now...the use of "us" and "them" are going to be switched off interchangeably throughout this blog and that's just the nature of it being all about the best of both worlds...or the worst) from referring them elsewhere or denying services. When questioned about WHY we're serving the individual in a particular manner, though, we'll just say that it's all we can do because they don't really fit the mold of people whom we serve, so we're giving them the most individualized approach that we can.

I don't even know where to start. Okay. Let's start in the emergency room of a medical hospital with no psychiatric unit. A patient comes in, looking to be medically cleared to be sent to a psychiatric hospital with no medical unit, after an overdose. The hospital does not actively work with psychiatric patients and there is no psychiatrist on staff, however they cannot turn this patient away, as she needs immediate medical care. The team comes up with a protocol. Lock up all her things. Take off her pants. Berate her for crying. Don't answer any questions because she's crazy. Treat her differently from every other patient ever seen in the ER. Treat her differently than she has been treated every time she has been in the ER medically. Don't allow her to use the bathroom. Don't allow her to read a book. She brought her baby blanket because she knew it would comfort her but she's not allowed to touch anything that isn't provided to her by the hospital. Call her psychiatrist at 3am, and then hand her the phone, confusing both the psychiatrist and the patient. Threaten to restrain her when she tries to get out of bed to use the bathroom. Don't remove the IV from her hand, threaten to restrain her if she tries to pull it out, even though there is nothing dripping through the IV, and when there was, it was only an anti-nausea medication.

Let's take a look at Door #2, the hospital which, after hearing about this incident, the patient above swore that she would never go to. A patient is transported by the police, due to suicidal ideation, to the psychiatric unit of a local hospital. She is not allowed to pack anything to bring with her. "We don't know what you might bring." She invites the officers to stay in the room with her while she packs clean underwear and a pair of pajamas. The officers refuse, and bring her out to the car. Upon entry to the hospital, she is told that she must be strip searched, however, there are no female staff on duty at this time. This particular patient has a trauma history, but a patient without a trauma history would probably be disturbed by this as well, and rightfully so. The patient is told that she will be given a 1:1 if she will not agree to a strip search. "This means that a man will be watching you go to the bathroom, etc." The next morning, she is told that if she does not comply to the strip search, it will be forced upon her.

Taking a step away from horrible experiences at psychiatric hospitals, just for a few minutes, let's take a look at a young woman with various learning and psychiatric disabilities, who attends a special school. She attends the school due to trouble learning and managing her social anxiety and impulses at a public school. Like every student in the school, she has an individualized education plan, and a special calming plan that she brought with her from her last hospitalization. However, the staff at the school find it to be too much trouble to deal with her calming plan, because it involves taking 30 seconds out of their day to grant her the permission to leave the classroom, or it "burdens" the crisis staff if they need to talk to the student, although it appears to this outside observer that they are just doing their job. The student's needs were consistently unmet, and one day the difficulties in school led her to a suicide attempt. When hospitalized after that suicide attempt, the student explained to her social worker, "It's a school for kids like me. But they don't know what to do with me. I came in showing them how to work with me, and it's like they don't get it." The majority of the students at the school have behavioral problems, and start fights, or have developmental disabilities that prevent them from being able to succeed academically in a mainstream classroom.

Or take a look inside a community mental health agency. In the day program, most of the clients struggle with psychotic disorders. Although many of the clients are in fair remission, they do often exhibit symptoms of psychosis. This is tolerated pretty well. However, when clients show symptoms of anxiety and depression, it is looked at as the client's irreverence. One gentleman gets very anxious during his groups and tends to speak out, asking whatever random question comes to his mind. He is often very harshly redirected, which tends to hurt his feelings. Another woman struggles with severe anxiety and depression, with no history of psychosis whatsoever. She is brushed off to the side when she's just coasting by, but as soon as she starts to struggle, she explains that staff accuse her of being lazy or stubborn. This continues digging a deeper hole of low-self esteem than she already started with. Her depression and anxiety show little improvement, and while she may not be responding well to medications, this observer tends to believe that her environmental situation may be perpetuating the anxious and depressive symptoms.

Back to the psychiatric unit. Most patients who are admitted to the female psychiatric unit of a particular prestigious hospital struggle with mood disorders - either bipolar disorder or depression. Some also have psychotic symptoms, but few struggle with mostly anxiety. At one recent time, two patients on the unit were treated for anxiety disorders. When either patient cried - as a healthy way of expressing discomfort, instead of keeping it inside and allowing it to mull, like many anxious patients do - it was ignored, dismissed as manipulative, or seen as a symptom of mood dysregulation. When both patients spoke with intake staff about the unit, staff informed them that anxiety disorders are very well-served on the unit. However, the milieu staff did not help to redirect the patients. All they were looking to do was make sure that no individuals hurt themselves or anyone else. Both patients did report leaving the hospital in somewhat of a better situation than they entered - mostly because neither wanted to ever have to be in the situation where they would have to go back there again. Those death-like anxieties were nothing in comparison to the threat of another hospitalization.

And this doesn't even touch on the insurance aspect of mental healthcare. This only covers people who are currently being treated, whether against their will or voluntarily. It demonstrates that hospitals and agencies have a mold that they are set to serve, and while they will happily accept people outside of their mold (if only for financial reasons), they will not modify any of their protocol to better serve those patients.

That's not to say that some agencies, hospitals, and professionals do not genuinely care. However, my psychiatrist said it best when she said that most healthcare follows an impersonal insurance-based model, and even when insurance isn't being considered an issue, the fact is that the model of treatment has been based around it, that it's just a best-fit model. There are people out there, like my psychiatrist and my therapist, who do not work their treatments around this best-fit insurance model. All I can say is, thank God.

This was written over the course of about half an hour, way past my bedtime, so I apologize if it's poorly written or repetitive. I'm not really even writing it to inform anyone else. That will be done at a time of day when I am far more coherent. This was more for my own benefit, of getting my own experiences and the experiences of those who mean a lot to me, out there, out of my head and onto the internet.

Because sometimes broadcasting my thoughts allows me to feel temporarily free from them.