Treatment of mental illness

[blue-mangos.livejournal.com]

In 2009 a schizophrenic Toronto man who had stopped taking his medication pushed 3 teenage boys into the path of an incoming subway. Thanks to the quick actions of the driver and the smart thinking of the boys, all survived. In 1999 Kendra Webdale of New York City was not as lucky. In 2010 Stephanie Moulton a group home worker, was killed by a resident days after his mother expressed concern he had stopped taking his medications. Last week a Minneapolis man tried to strangle a woman after seeking help at a hospital, warning them that he wanted to kill someone. His pleas for help were ignored. I could cite multiple examples of these type of cases, all over the world. It should be noted though that although these cases are shocking and receive great attention, the majority of violence perpetrated by mentally ill people is against family members. They also do not commit violent crimes in any greater numbers than the general population.

Psychiatric treatment has changed considerably over the years, reacting to new knowledge, medications and public opinion. Mentally ill people were once imprisoned, or locked away and abandoned in public buildings. In the late 1700s lunatic asylums began to be built. Patients were given very little actual treatment, instead were simply restrained using straitjackets and handcuffs. Starting in the 1900s a push for 'moral therapy practices' began. These treatments included electroshock therapy, insulin comas, hydrotherapy and lobotomies. By the 1950s, although many of these practices were still in use there had begun a shift towards psychoanalytic therapy and new medications to treat mental illness were introduced.

In the 1960s the anti-psychiatry movement gained ground, leading to deinstitutionalisation where patients were released into the general population. The idea was to replace the hospital with community based homes and support. Unfortunately these support systems were never fully developed and patients often fell through the cracks, ending up homeless or in jail. Very little has changed in that regard today. In our times help for mentally ill individuals is nowhere near as comprehensive as it should be. Involuntary commitment lasts 72 hours before they are discharged and even those seeking voluntary commitment are often turned away due to lack of space and resources. Patients are often left to manage their diseases with very little assistance or supervision. Which can lead to tragic consequences for the public, their families and the patients themselves.

While I sympathize greatly with those suffering from mental illness, the threat to the public from those suffering from violent hallucinations should not be ignored. Nor should the need of those desperately seeking help and finding no relief. 30-35% of the general homeless population suffer from a mental illness. In women that number jumps to 75%. 55% of male prisoners have a diagnosed mental illness, while women prisoners again have a higher rate of 73%. Looking at these numbers one can say that we have in fact gone backwards in our treatment of the mentally ill, again locking them up and avoiding dealing with the issue. I'm not sure where the line is between personal freedom and public safety but I am not convinced we have found it yet.

Comments

[airiefairie.livejournal.com]

This reminds me of a documentary I recently watched, Can We Get Married (http://documentaryheaven.com/can-we-get-married/). It is about a couple in Devon, UK, who both have Down's syndrome and who encounter all sorts of complications as society bars them from enjoying the most basic of civil rights one could imagine - the right to get married with the person you love. Not sure if this is directly related to your post, but a powerful story indeed.

It is not much different...

[sophia-sadek.livejournal.com]

... from the stories of gay couples who are prevented from marrying.

[johnny9fingers.livejournal.com]

This issue needs exploring.

Alas, even from the margins, I find I have not enough time here to state my opinions fully.

And I must add: we do need clarity and expert opinion on this matter.

One of the reforms...

[sophia-sadek.livejournal.com]

The most significant remark you make is, "They also do not commit violent crimes in any greater numbers than the general population." People with mental problems are often treated with a broad brush by the general population. The unkempt man who mumbles vicious thoughts out loud is often treated as if he were the kind of person who would push an old lady in front of a speeding train.

Mental health professionals no longer refer to mental problems a diseases. This is the kind of terminology that was retired along with the characterization of homosexuality as a mental "illness." As a result of thoughtful research, the term "mental disorder" has taken the place of the concept of disease. What you miss in your remarks are the people who experience mental degradation not by anything that is wrong with them, but because of what is wrong with the general population. Sometimes a disorder is a natural reaction to a vicious environment that sees itself as perfectly virtuous.

[meus-ovatio.livejournal.com]

There's a lot of issues with the whole idea of diagnosing prison populations in the first place. There's still not enough standardization to be able to confidently assess "mental illness", especially in the context of women's justice, where women are diagnosed with mental illness simply for violating gender norms, rather than having an actual mental illness. Women receive great attention and over-diagnosis for "mental illness". Where as the same type of male is just "being male", a woman who is "being male" is diagnosed with some kind of disorder.

In my non-expert opinion, the percentages listed for mental illness are just too statistically deviant for any population to be taken seriously. "Mental illness" is becoming a term for breaking the law, or some behavioral issues... and the concept is becoming meaningless.

[gunslnger.livejournal.com]

It's also used to refer to political opponents or people who disagree with you.

[meus-ovatio.livejournal.com]

Really? You serious?

[mintogrubb.livejournal.com]

I think he is - in Soviet Russia , you got incarcerated for criticising the government. I mean , if you didn't believe in Communism - you had to be insane ... didn't you ?

[meus-ovatio.livejournal.com]

I mean, "Wow, you mean people use things in a derogatory manner and insult people?"

The same technique...

[sophia-sadek.livejournal.com]

... is used in the American education system. When a child chronically misbehaves, she is put through a process that can eventually lead to "medical" treatment.

Re: The same technique...

[lilenth.livejournal.com]

Actually the rate of diagnosis has risen due to better techniques, prior it was under diagnosed, while I agree that sometimes children are misdiagnosed it takes a lot of dedication much of the time to get a diagnosis for a child with an actual disability never mind one who doesn't have anything wrong.

Medication is not necessarily the best thing for all child with disabilities, but it can help.

Re: The same technique...

[sophia-sadek.livejournal.com]

It seems to help the teacher more than it helps the student.

BTW, one researcher found that data on pharmaceutical treatment of children for behavioral problems varies with geographic location.

Re: The same technique...

[lilenth.livejournal.com]

Did it correlate with average income? I ask because more money = more opportunity to get a child diagnosed and treated for a disabily.

Re: The same technique...

[sophia-sadek.livejournal.com]

I have read about the SES correlation elsewhere. It is one of those areas where being poor can be advantageous. In my work with people in ghetto communities, I found a healthy skepticism toward the medical profession.

Re: The same technique...

[lilenth.livejournal.com]

I was born in low income area myself, one thing I found out early on was the help you got depended on having good parents, or well off parents if it had to be paid for.

That X amount of people in a neighbourhood do not get help does not prove that they do not need it.

Re: The same technique...

[sophia-sadek.livejournal.com]

When the "help" causes more problems than it solves, then we can do without it.

Re: The same technique...

[lilenth.livejournal.com]

Actually it doesn't cause more problems, your bias is showing.

Re: The same technique...

[mahnmut.livejournal.com]

And your level of rudeness has been escalating lately.

[gunslnger.livejournal.com]

No, I'm obviously not serious.

[nano-muse.livejournal.com]

I think first off we need to stop pointing to every societal problem and slapping a mental disorder on it to avoid dealing with it. A lot of people have depression, ADHD, and Aspergers. A lot of people don't, and are just having a rough time, don't like to sit still, and can't read others' emotions easily. Then maybe we'd stop wasting mental health resources on people who don't need them.

To be honest, institutions were actually a step forward, even if they weren't a step very far. While a few were caught abusing patients, most mental health hospitals were relatively okay, just trying to help the patients (even if it was with limited success). Unfortunately, the public's tendency to base the character of the many on the actions of the few has led to shut downs not due to any comprehensive studies but the public's refusal to take a deep look at mental health issues even while condemning the institutions helping them.

Whether it's systemic community support homes or mental health hospitals or any other new ideas society can come up with, we need a comprehensive and pervasive plan, a way that is easy for people struggling just to get by with mental health issues to get the help they need, before they hurt someone else with something that isn't their fault anyway (to which I add is the reason I don't think involuntary incarceration is the answer).

[lilenth.livejournal.com]

Well that's wonderfully dismissive. Fact is they don't "waste" resources on anyone, if they actually gave the help needed? The bills would sky rocket, if anything the help available is under utilized due to stigma and a lack of diagnosing conditions early enough to help more. They ration out help, once you've had X sessions, you need to go back on the waiting list and wait half a year to get more.

Actually many institutions were harmful to patients, either out of ignorance, or bad beliefs. While a few were outright intentionally abusive, many more did harm without intending to be abusive.

First we'll need to tackle disabilist ideas in current doctor schooling and mental health groups. Mentally ill people are more likely to die from treatable conditions because often a diagnosis of mental ill health is taken to mean the patient is completely unreliable when it comes to reporting their symptoms. We often railroaded, I've had doctors shout at me because I questioned their prognosis for me, I've been threatened with being sectioned because I didn't want to take pills that were far too strong for me and that were making me a danger to myself, all because a doctor wanted the first pills to work straight off when it typically takes several tries to find a drug that works for someone.

Sectioning is only something that should be done when a patient is a danger to themselves or others, it should not be used as a threat because a doctor does not want to try another type of tablet on a patient who reports the tablets are not helping. In fact getting confined to hospital sends me into a depression spiral because of how often I get nasty attitudes from prejudiced staff members who think I'm a waste of resources because I don't look sick.

Until that problem is addressed the medical community will continue to serve mentally ill people poorly.

[lilenth.livejournal.com]

Actually if you really want to fight threats to public safety? Ban booze and illicit drugs, the true vectors for violence are alcohol followed by illicit drugs.

In fact in a room of mentally ill people? You'd be safer than you would be in a room of drunk people. Statistically mentally ill people are more of a threat to themselves than to anyone else (and other people are more of a threat to them than they are to other people), unless they're drinking or taking illicit drugs both of which can cause or exacerbate mental illness.

You are confusing causality and correlation. Mental illness often accompanies homelessness because the reasons for homelessness can bring it on, people who are alcoholic (a large reason for homelessness and violence) tend to also be mentally ill because they are not only poisoning their bodies, but they're trapped in spiral that causes depression, the most common mental illness. Prisons raise the rate of mental illness as well, as do illicit drugs, MJ has been connected with a higher rate of mental illness in adults who smoke it as teens.

While I do criticise the current "care in the community" for sucking (any disability being cared for in the community receives piss poor help in my experience), poor generalisations and not knowing the facts hurt mentally ill people. You started this with a list of attacks by mentally ill people, which gears up people to believe that's the problem, and did not appreciably take away from it even when you admitted that mentally ill people commit violent crimes at the same rate as everyone else.

[raichu100.livejournal.com]

Are you serious about wanting to ban alcohol and drugs?

As for the rest of what you said, I agree, but I think you've misunderstood the point of the post (Mangos, correct me if I'm wrong). At least I certainly didn't get the impression she was trying to attack or dismiss the mentally ill.

[lilenth.livejournal.com]

I didn't say I wanted to ban alcohol and drugs, I pointed out that they are the true vector for violence, so to stop violence the best thing to do is to ban them.

Even if they didn't intend to do so, it came of as such.

[raichu100.livejournal.com]

Ah, okay, I wasn't sure. That's why I asked. =)

I think you have a point, but I also think more violence comes from the illegality of drugs than the use of them. (Alcohol is a similar but slightly different story, as drunk people do tend to be more violent, or at least some of them do. Also what you said about them mixing is likely true.)