Opening A Discussion On Severe Mental Illness

[Reefgazer]

Sorry in advance that this is lengthy, but this has been eating at me this past week...

 

Every year, my kids and I work at a homeless shelter in January - cleaning, cooking meals, being overnight monitors for the shelter, etc...  Monday after serving dinner I sat down to visit with the guests, and one young man caught my eye because he stuck out like a sore thumb - pacing like a trapped animal, very young (17/18, I guessed; at the outside 20), very handsome and in good physical shape, clean clothes, and he did not have that beaten down look that so many have.  So I tried to start a conversation, and the only thing he wanted was "Meat, good bloody meat."  I told him we were completely out of meat (we were, although he didn't believe me), but I offered him other food, which he rejected, saying he needed protein.  So I offered PB + J or a cheese sandwich, but he was having none of it, he wanted "clean" protein.  So I figured, given his decent physical shape, he was probably an athlete in high school or recently in high school, or that he was a body builder and wanted his protein for that, so I offered up scrambled eggs.  Nope, he wasn't interested in that, but he did ask for eggs whites, raw, which he rejected as having been contaminated by the yolk.  Anyway, I asked him why he wasn't sleeping and he said he couldn't because he needed meat.  So I suggested he at least sit down and rest, and I chatted him up, or rather tried to.  But conversation was impossible because as I was trying to talk to him, he was holding 2 separate conversations with imaginary people who were obviously part of his recent past.  His attention would bounce from me to imaginary person 1 and on to imaginary person 2 and so on.  When he was conversing with "us", the conversations were very short and sometimes one of my questions were followed by a completely non-sense answer, and sometimes I got a decent snippet of conversation out of him.  I did learn that he was 18 and recently attended a local high school, where he was on the basketball team.  He apparently had a girlfriend who broke up with him because she told him he needed to see a doctor for his schizophrenia, which he refused because "he didn't have that."  One breath later, he tells me his head isn't right, and that I must be working for his girlfriend who tried to get him to take medication, because I work at the same place as his girlfriend's mother, so clearly, she put me up to working him over.  Anyway, someone at the shelter told me his symptoms were of schizophrenia, and I realized this kid has an entire life to live and here he was out on the street with no one to care for him, in the heavy snow and bitter cold that southern Virginia got this past weekend.

 

I looked at that kid and I didn't know what to do for him; I don't think he can be helped unless he gets treatment.  There is no way he could hold a job and rent an apartment; he can't even hold a conversation for more than 30 seconds.  Which brings me to what I have been pondering for a while:  Involuntary treatment for the mentally ill.  I have mixed feelings about this.  On one hand, I would not want treatment forced on me, and having the government force someone into medical treatment is disagreeable to me.  OTOH, his life is lost if he doesn't get treatment. 

 

The week at the shelter wasn't all bad, though.  I met a person who grew up in my hometown and graduated the same year as me, but from a different school.  We had common memories of swimming at the lake, shopping at the local mall, and so on that we talked about.  When I moved to NYC, by coincidence so did he.  When I moved from NYC, he did as well, to the same town where I moved!  And then, when the Navy brought me here to Norfolk, VA, the Navy brought him here, as well.  We both met our spouses in the same way (we each went to the same high school as our spouses, but got together with them years after high school).  And here we were, by coincidence, in the same shelter in Virginia!  It was an amazing coincidence!  Then there was the 60-something man who had just been released into a bitter cold snow and blizzard from a 5-day hospital stay after having suffered a heart attack.  The guy had no hat, no gloves, no coat that zippered, and the hospital released him!  WTF?  But he had a good outcome - his medical condition sent him to the top of the list for housing, and he will be leaving the homeless shelter by tomorrow.

 

ETA:  I'm not sure what the point of my post is, except to maybe discuss treatment for the severely mentally ill.  But I wanted to get this off my chest anyway.

 

 

Edited January 11, 2017 by reefgazer

[Anne in CA]

This stuff is so heartbreaking. I saw plenty of it myself at the downtown shop we had for a year and a half. There is nothing you can do to make someone get treatment, and treatment isn't always there if you want it. As a society we have to acknowledge that some people are not going to be fully functional members of society and should be protected as well as respected. You should still get respect as a person even if you are not going to be a contributing member of the community for any reason. These people also need to be protected from themselves. I have seen the equivalent of the elderly man sent from the hospital after a heart attack with no place to go. He needed someone to stand up for him. 

 

We have a long way to go as far as mental health in the US. There are too many things wrong to pick a few to fix. 

[Scarlett]

That breaks my heart. I have an almost 17 year old.....it makes me ill to think of him in the situation you described.

 

And I have mentally ill brother. His illness causes him to do such bizarre and hurtful things that a relationship with him is impossible.

 

I know forced treatment has its bad side.....but mentally ill people totally without support is a nightmare.

[happi duck]

Mental health care is such an impossible maze to navigate.

 

I'm not for *forced* care but I think it should be way easier to get appropriate help without fear of being locked up.

[Carrie12345]

 Which brings me to what I have been pondering for a while:  Involuntary treatment for the mentally ill.  I have mixed feelings about this.  On one hand, I would not want treatment forced on me, and having the government force someone into medical treatment is disagreeable to me.  OTOH, his life is lost if he doesn't get treatment. 

 

 

Even before getting into the ethics of the concept, the logistics are disheartening (imo.)  I suppose institutionalization could make medication as consistent as physically possible.  (It's a given that not all pills get swallowed.)  But therapies?  They're pretty uneffective without willing participation.  I know plenty of privileged suburbanites who struggle to accept and implement the words of their highly paid, very experienced counselors.  You could count me as one of them sometimes, and I am a HUGE proponent of therapy!

 

Regardless, I do think treatment should be available AND ACCESSIBLE.

[TechWife]

One of the major problems is accessibility. Even if people wanted treatment, often it simply isn't available. There is a shortage of psychiatric beds and practitioners. There is a severe shortage of funding. As a society, we simply aren't doing a good job of taking care of our most vulnerable citizens. Ideally, there should be safe places for a non-compliant mentally ill person to live. There should be a real safety net, not just a reliance on the mercy of a patched together network of homeless shelters and then, sometimes prison. 

 

It's just my observation, but I think often we confuse our desire to see people behave the way we want them to behave (in a "moral" manner) with the moral obligation to provide food, shelter, clothing and care. Our care for others shouldn't be dependent upon circumstances beyond anyone's control, such as mental illness. 

[SparklyUnicorn]

Even with treatment his life is likely "lost" (using your word).  Treatment isn't magical in many cases for severe mental illness.  I grew up with three people who have/had a severe mental illness.  I can tell you there is no magical treatment.  It's a life long struggle.  Even if you are willing to do everything they tell you to do, you don't come out of that whole.  You just don't. 

 

It's hard and he would probably find some benefit in treatment, but he needs to get to that point himself.  His behavior is very typical for his age and illness.  All three people I know very very well behaved exactly the same way at that age.  They did eventually get treatment, but there was a lot of hiccups along the way and they did not really ever lead a "normal" life exactly. 

 

I agree accessibility is a HUGE massive problem.  That has to change anyway.

[SparklyUnicorn]

They used to institutionalize people fairly regularly.  There are family members on my mother's side who basically lived most of their life in institutions.  It's not better than living on the street.  It's abusive, neglectful, and a horrible crappy existence.  Criminals get better treatment.  I have not one good thing to say about it.  So in order for that to be of any use (institutionalization) it needs to be a hell of a lot better than it was.

 

 

[Ottakee]

Accessibility is a terrible problem. We live in an area with the phenomenal medical care and actually great access to mental health care and it is still terrible.

 

A friend's son was inpatient for his 5th suicide attempt (this one required over 50 stitches) and by day 2 they were wanting to discharge him.

[maize]

I do think we need good options for involuntary treatment. While it would be great for every adult to be able to make their own decisions, we depend on functioning brains in order to reason our way through those decisions. A badly malfunctioning brain such as you encountered is not up to the task in any way--a three year old is more capable of reason than a person in the midst of severe schizophrenia.

 

Fortunately many of these illnesses of the brain are now treatable, it is not uncommon for a schizophrenic to attain complete remission. But treatment is crucial.

Edited January 11, 2017 by maize

[SparklyUnicorn]

 

Fortunately many of these illnesses of the brain are now treatable, it is not uncommon for a schizophrenic to attain complete remission. But treatment is crucial.

 

Must be very recent.  I've never met a person who attained complete remission.  My sister definitely has it better than my mother, but it's absolutely not remission.

[JFSinIL]

Facing a possibly dire situation with one kid here - not the kid with autism, he has services in place and even got selected for funded housing (if we can find a slot in a group home or create one ourselves). No, it is his fraternal twin brother who may be in trouble.  25 years old, so aging off our insurance in the fall of this year.  BUT - can we get him on Medicaid before then, or will the new administration be reducing Medicaid to the point where he won't be able to get it with a mere "mental illness" (bipolar, anxiety, etc.)?  He is on six different meds and is fairly stable, but can not drive (getting behind the wheel panics him now, and too many of his meds say do not operate heavy machinery anyway).  He is starting ONE class at the local cc to see if he can do it.  This is the kid who almost graduated with Honors in Chemistry in 2014, but damn mental illness robbed him of the ability to function.  He tried to work last summer for a farmer locally who used him before, but the combination of meds and hot sun was not good (understatement) so he is unemployed, too.

 

 

An update a year later, in case anyone reads this....son with autism DID get into a group home about 25 minutes away, he has his own large room, friendly housemates, and after months in a less than fun day program (too many severe folks screaming all day, poor dears) he moves into a smaller day program for adults with autism - and most are his level of functioning or higher, I checked - February 2018.

Son with bipolar etc - two meds failed towards the end of term and he missed too much to finish his one stinking class. He did retake it this past fall (2017) and got through with an A. He starts another class - Anatomy and Physiology, TODAY. After work - in the summer he got a part time job at a lab nearby that processes blood, urine, etc samples from doctor offices. He doesn't have a finished degree, so is opening boxes and labeling stuff etc for the actual folks with degrees (and higher pay) to examine. He is working slowly towards a certificate in Histology (sp?) at the local CC. Finishing his four-year degree is not going to happen. He did try to attend the local State U last winter and insomnia and depression kicked in a week after we moved him into grad. hosing (too far away to commute). So he is trying to at least get a certificate in SOMETHING that is sort of in his area of education. He may never leave home - he won't be able to afford it. His part-time job is now 30/hours a week, but at $12/hour he just can't move out. Plus Monday he had to give up trying to drive to work in the snow due to a panic attack from the car sliding a bit on the slick streets. We now know, in bad weather I need to drive him in my bigger car (unless being driven in bad weather triggers an attack). Meanwhile his 30 hours a week got him just high enough in income to be able to get his own insurance plan instead of Medicaid, so his doctor (who doesn't accept Medicaid and is $300 a pop w/o insurance) and all his meds are still covered.

 

He does forget a lot of things - I am "back-up brain" now and keep track of "did you turn in the FAFSA form" or "Did you sign up for a class?" and I had to be there when he bought insurance (and then BCBS accidentally canceled his plan instead of removing him from our insurance and we had to re-buy it) on speaker phone. I think he uses up all remaining brain power on work and school.

Am looking into possible making our home eventually a group home - it has five bedrooms, so three for "clients" like my son with autism and two other disabled men with funding, a room for the aides (since I was told it is easier to staff a group home if the aides can be there a few days at a time, like firefighters do at the local fire station, rather than try to hire staff to cover 8 hour shifts 24/7)...and a room I will insist is for son with mental illness, so he has a place to stay even if he does not ever get state funding (which he won't here in Illinois). Not ideal, since only two bedrooms are ground floor, but might be best we can come up with.  Course no idea where we would live then...

 

Money (from our insurance settlement after our car crash) was to be used to buy a ranch house to make a group home for son with autism.  But now I think I have to reserve the money to cover doctor fees and meds etc. for the other twin.  Can't risk him falling through the cracks and going even a day without meds. I doubt he will ever be able to hold a full time job with insurance benefits.  Not counting on it, anyway.

 

Meanwhile our Blue Cross monthly payment went up 150%...more than our mortgage payment now,   I had just gotten signed up to get some funding as my autistic son's part-time support worker (paid to be mom!) and the increase in our insurance costs just took it all.

 

Got a little off topic here, but the thread just brought all this out.  Obviously been on my mind for a while!

Edited January 17, 2018 by JFSinIL

[eternalsummer]

They used to institutionalize people fairly regularly.  There are family members on my mother's side who basically lived most of their life in institutions.  It's not better than living on the street.  It's abusive, neglectful, and a horrible crappy existence.  Criminals get better treatment.  I have not one good thing to say about it.  So in order for that to be of any use (institutionalization) it needs to be a hell of a lot better than it was.

 

Furthermore, you can't just say that only the people who really really need to be institutionalized (however you define that, if you're expanding it in scope from right now, where you can only be forced if you're a danger to yourself or others) will be forced into it.

 

Instead, you'd have to recognize that for every person who, according to the new criteria, needed institutionalization and was forced into it, 3 more people who *didn't* really need it would be forced into it.  That kind of power creep seems really dangerous to me.

[SparklyUnicorn]

Facing a possibly dire situation with one kid here - not the kid with autism, he has services in place and even got selected for funded housing (if we can find a slot in a group home or create one ourselves). No, it is his fraternal twin brother who may be in trouble.  25 years old, so aging off our insurance in the fall of this year.  BUT - can we get him on Medicaid before then, or will the new administration be reducing Medicaid to the point where he won't be able to get it with a mere "mental illness" (bipolar, anxiety, etc.)?  He is on six different meds and is fairly stable, but can not drive (getting behind the wheel panics him now, and too many of his meds say do not operate heavy machinery anyway).  He is starting ONE class at the local cc to see if he can do it.  This is the kid who almost graduated with Honors in Chemistry in 2014, but damn mental illness robbed him of the ability to function.  He tried to work last summer for a farmer locally who used him before, but the combination of meds and hot sun was not good (understatement) so he is unemployed, too.

 

Am looking into possible making our home eventually a group home - it has five bedrooms, so three for "clients" like my son with autism and two other disabled men with funding, a room for the aides (since I was told it is easier to staff a group home if the aides can be there a few days at a time, like firefighters do at the local fire station, rather than try to hire staff to cover 8 hour shifts 24/7)...and a room I will insist is for son with mental illness, so he has a place to stay even if he does not ever get state funding (which he won't here in Illinois). Not ideal, since only two bedrooms are ground floor, but might be best we can come up with.  Course no idea where we would live then...

 

Money (from our insurance settlement after our car crash) was to be used to buy a ranch house to make a group home for son with autism.  But now I think I have to reserve the money to cover doctor fees and meds etc. for the other twin.  Can't risk him falling through the cracks and going even a day without meds. I doubt he will ever be able to hold a full time job with insurance benefits.  Not counting on it, anyway.

 

Meanwhile our Blue Cross monthly payment went up 150%...more than our mortgage payment now,   I had just gotten signed up to get some funding as my autistic son's part-time support worker (paid to be mom!) and the increase in our insurance costs just took it all.

 

Got a little off topic here, but the thread just brought all this out.  Obviously been on my mind for a while!

 

You are a good person.  (or whatever the secular version of a saint is)

 

That's something too I think many don't realize.  Sure you can stabilize someone, but that doesn't mean they aren't gong to still need a ton of help.  Many people in this situation really cannot hold down a job.  Even at my sister's best she can't handle working.  It stresses her out and that leads to issues.  And with mental illness people still have a hard time understanding it can be very debilitating.  The person might act and seem very normal when stable, but they can't handle the stresses of life too well.  So having to be to a 9 to 5 job day after day is difficult or sometimes impossible.  I mean think about it.  Even people who handle stress fairly well have trouble with the stresses of life from time to time.  Throw in someone with mental health problems that are severe and forget about it. 

 

And sure there are stories of highly successful people who have a mental illness.  So I think we are led to believe that there is some magical combination that is out there for everyone that could make them lead a normal life.  It's worth trying, but it may never happen.  Mental illness is not tested for with a blood test.  They look at a series of behaviors and feelings and go from there.  So a schizophrenic technically could end up being someone who is fairly fine on medication to someone who is barely functioning with medication.  I wonder if those two extremes are even the same illness.  Different doctors claimed my mother had different illnesses. 

 

[maize]

Must be very recent. I've never met a person who attained complete remission. My sister definitely has it better than my mother, but it's absolutely not remission.

You know, it is possible I am mis-remembering something I read. I am certain it was a serious mental illness that I thought of as life-long but a not-insignificant minority attained remission; I'm not 100% sure it was schizophrenia though.

[SparklyUnicorn]

You know, it is possible I am mis-remembering something I read. I am certain it was a serious mental illness that I thought of as life-long but a not-insignificant minority attained remission; I'm not 100% sure it was schizophrenia though.

 

It's also possible that person didn't actually have the diagnosed illness too.

[Scarlett]

You are a good person. (or whatever the secular version of a saint is)

 

That's something too I think many don't realize. Sure you can stabilize someone, but that doesn't mean they aren't gong to still need a ton of help. Many people in this situation really cannot hold down a job. Even at my sister's best she can't handle working. It stresses her out and that leads to issues. And with mental illness people still have a hard time understanding it can be very debilitating. The person might act and seem very normal when stable, but they can't handle the stresses of life too well. So having to be to a 9 to 5 job day after day is difficult or sometimes impossible. I mean think about it. Even people who handle stress fairly well have trouble with the stresses of life from time to time. Throw in someone with mental health problems that are severe and forget about it.

 

And sure there are stories of highly successful people who have a mental illness. So I think we are led to believe that there is some magical combination that is out there for everyone that could make them lead a normal life. It's worth trying, but it may never happen. Mental illness is not tested for with a blood test. They look at a series of behaviors and feelings and go from there. So a schizophrenic technically could end up being someone who is fairly fine on medication to someone who is barely functioning with medication. I wonder if those two extremes are even the same illness. Different doctors claimed my mother had different illnesses.

 

My brother can't work. He did fairly well holding down the same full time job for about a decade. Then he had a serious car accident and he just fell apart. He got disability VERY easily.....I have never understood how it happened so fast....but I am glad. He also self medicates still....although he claims it is helpful I think it makes him worse.

 

His half brother is now 52 and has been institionalized since he was 19. Very very sad, but he is in a small town, in a nursing home and they take pretty good care of him. I am glad he has a warm, dry place to live. It is relatively safe.....much better than being on the streets IMO.

[SparklyUnicorn]

You know, it is possible I am mis-remembering something I read. I am certain it was a serious mental illness that I thought of as life-long but a not-insignificant minority attained remission; I'm not 100% sure it was schizophrenia though.

 

You know when my dad achieved remission?  When he stopped working.  But we don't even want to help people with their healthcare let alone support them for their entire lives without them being productive.  It's a little bizarre.  We will go to extremes to keep someone alive even if they are poor, but we won't do much else.  We'll prop your body up, but the rest of it isn't our problem.

Edited January 11, 2017 by SparklyUnicorn

[SparklyUnicorn]

My brother can't work. He did fairly well holding down the same full time job for about a decade. Then he had a serious car accident and he just fell apart. He got disability VERY easily.....I have never understood how it happened so fast....but I am glad. He also self medicates still....although he claims it is helpful I think it makes him worse.

 

His half brother is now 52 and has been institionalized since he was 19. Very very sad, but he is in a small town, in a nursing home and they take pretty good care of him. I am glad he has a warm, dry place to live. It is relatively safe.....much better than being on the streets IMO.

 

My dad got disability easily when he asked his doctor about it.  He suffered for years and years.  I'd say he is doing the best I've seen him.

 

Unfortunately, after years of being on lithium it has completely ruined his body.  But overall he is still doing fairly well.

 

Another thing people don't realize.  The medications have very very bad side effects and they ruin your health.  It's still better to take them verses not taking them, but they aren't magical by any stretch.  It's basically trading one problem for another. 

[SparklyUnicorn]

Oh and the cost!!!!  OMG....even years ago my parents spent their money on three things.  Rent, food, and medications.  They spent more money on medications than anything else.  My dad actually made fairly decent money, but we had to live quite poorly because they had to spend every dime on their medications.  And they had top notch insurance. 

 

 

Edited January 11, 2017 by SparklyUnicorn

[lmrich]

It is so hard. I hope that the public starts to take this topic serioiusly so that a serious solution can be found. 

[maize]

Found some data on schizophrenia; according to this link, approximately 25% of those diagnosed are considered to have recovered ten years later. I think that's about what I was remembering--I had assumed it was always a life-long thing. Outcomes are significantly better with early treatment (relevant to this discussion--if the young man in the OP could get treatment now his chances of a positive outcome are much better).

 

http://www.schizophrenia.com/szfacts.htm#

Edited January 11, 2017 by maize

[Bluegoat]

I do think there are risks with forced institutionalization.  And in some cases it doesn't work unless there is a buy-in - this is typical with substance abuse issues in my experience.  But I think it is a little different with some other mental illnesses. 

 

In those cases, it really can be the active illness that is preventing the person making decisions or seeing clearly, and once the symptoms are controlled the individual can make much better decisions and see that things weren't right before.  My dad is diagnosed as b-polar though we've never been sure its a very accurate diagnosis, but in any case he's on some pretty powerful medications to control it.  Several times they have gone really out of whack or he's stopped taking some because of side-effects - often both go together - and things really fell apart before anyone realized.  At that point, he couldn't make a decision, see that he wasn't fit to drive, that he was acting crazy.  It always took getting into hospital and having his meds fixed so that he could be rational, but unfortunately things had to get really bad before he could be admitted without his agreement.

 

And I've heard of similar instances with schizophrenics - my mom worked with a university professor convinced that the KGB was after him, and once he was more stable he was very motivated to improve his situation, but it just wasn't possible when he was barricading himself in rooms.

 

How to fix this is a problem, of course.  I think it can be done though, and maybe rethinking what institutionalization looks like would be a first step.  There was a mass closure of mental institutions here a  while back, and many people who had lived in mental institutions were sent to pretty much fend for themselves.  Many people feel they aren't really better off.  I don't think it's necessarily a bad life for some, there are still a few permanent in-patients at the mental hospital near me, and the patients are out and about in the day but have a lot of support.

[SparklyUnicorn]

Found some data on schizophrenia; according to this link, approximately 25% of those diagnosed are considered to have recovered ten years later. I think that's about what I was remembering--I had assumed it was always a life-long thing. Outcomes are significantly better with early treatment (relevant to this discussion--if the young man in the OP could get treatment now his chances of a positive outcome are much better).

 

http://www.schizophrenia.com/szfacts.htm#

 

Yeah my mother was treated starting as a child. Which at the time was highly unusual.  She never recovered.  But like I said, they were never sure of her diagnosis.  They have some newfangled diagnostic terms and my sister has a diagnosis that basically encompasses the conflicting diagnoses my mother had.

 

(omg...forgive my wording...how do you spell the plural of diagnosis?)

[maize]

I think diagnoses is right.

[SparklyUnicorn]

oh good

 

LOL

 

 

[maize]

I know I've read that statistically schizophrenia is more common among those born in winter months (true for both northern and southern hemispheres). They don't know why, there is speculation about vitamin D levels and/or influenza during pregnancy contributing.

[SparklyUnicorn]

But imagine, "I" was the abnormal one growing up.  That's an interesting position to be in. 

 

I worked as a social worker for a bit.  Majored in psychology.  I thought I wanted to help people in this area.  That I had something to offer.  I don't.  Not really.  I speak up whenever I get the chance because I want people to know about it, but man I'll tell you, I don't have a good sense of "normal" behavior.  The guy in the example...I would have believed him.  I wouldn't have noticed anything was off.  I can't tell.

 

 

[regentrude]

Before jumping to the difficult question of involuntary treatment, it would be important to have treatment accessible at all. Long waiting lists to even get to see a mental health professional for an initial consultation, high cost of therapy and meds, limited insurance coverage and insurance availability, lack of beds for inpatient treatment - there are so many things that could be improved to help people long before it has to come to involuntary hospitalization. For many, it's not possible to receive help even if they desperately want to. 

Edited January 11, 2017 by regentrude

[SparklyUnicorn]

I know I've read that statistically schizophrenia is more common among those born in winter months (true for both northern and southern hemispheres). They don't know why, there is speculation about vitamin D levels and/or influenza during pregnancy contributing.

 

Strikes me only as a correlation. 

Edited January 11, 2017 by SparklyUnicorn

[SparklyUnicorn]

Before jumping to the difficult question of involuntary treatment, it would be important to have treatment accessible at all. Long waiting lists to even get to see a mental health professional for an initial consultation, high cost of therapy and meds, limited insurance coverage and insurance availability, lack of beds for inpatient treatment - there are so many things that could be improved to help people long before it has to come to involuntary hospitalization.

 

Yep

 

My dad once was forced into hospitalization.  They didn't have a bed for him.  They had him sleep out in the common area.  This was a state hospital with a high population of criminally insane people.  And he got in because he had good insurance.  But that's not particularly good treatment and he wasn't safe.

[maize]

Strikes me only as a correlation.

Yes, at this point all we have is correlation. But a consistent correlation between winter birth and higher schizophrenia rates indicates that something is causing those higher rates. If we can figure out what maybe it is something that can be addressed.

Edited January 11, 2017 by maize

[MamaBearTeacher]

More money and will has to be put into finding cures for mental illness and all serious illness. This money has to come from people and governments and not drug companies. We have come so far in this world in producing technology and we can send spacecraft into outer space. Why are we so inept at helping those who are suffering?

 

I have 2 children with severe special needs. With all my heart and soul, I believe that there is a cure out there for them. There really is no will to do real research that could help. They suffer so much. I feel so frustrated!

[J-rap]

I was hearing a story on NPR about this just the other day.  They were talking about the shortage of beds for people with severe mental illness who really need urgent care, and how they often have to be sent to an out-of-state hospital just to find a bed available.

 

Back in the early 80's, I once visited an elderly neighbor at the infamous St. Elizabeth's mental hospital where John Hinckley was held.  It was like the stereotypical horror movie image of mental hospitals -- kind of terrifying!  I was caught up in a weird series of events there when no guards happened to be around.  It made me realize the depth of the failing of our mental health system here.  I've assumed it has improved since then, but I don't know. 

 

I still remember one giant room there  (the size of a gym) where they brought patients (there were probably 50+ in the room), some belted to their chairs, with a television in front of them.  I was in that room for about two hours, and the patients just continued to sit there, glassy-eyed and subdued, probably all medicated.  It was very, very sad.  

 

 

 

[Scarlett]

I know I've read that statistically schizophrenia is more common among those born in winter months (true for both northern and southern hemispheres). They don't know why, there is speculation about vitamin D levels and/or influenza during pregnancy contributing.

 

 

Interesting.  My brother was born in the winter. His half brother was born in October.

 

I am good friends with the psychiatric nurse of the half brother.  I am listed as 'sister' and have rights to info on him.  That term escapes me.  But anyway my nurse friend has treated the half brother for years and he told me that ANY of us have the potential to become mentally ill.  It takes the right combo of genetics, circumstances etc and poof you are messed up.  Half brother suffered abuse as a child and young adult. And also young adults often begin self medicating which hastens the mental illness and makes it worse.

[Carol in Cal.]

The mental institutions and abusive involuntary confinement and treatments had horrible problems, but the pendulum has swung too far the other way now.  In theory you can be confined and treated for your own protection when you are danger to yourself or others, but in practice it's hardly seamless.  It's a mess.

[zaichiki]

I am in favor of forced treatment for some mental illnesses and this is why --

One of the *symptoms* of schizophrenia is not wanting treatment. Can you imagine not treating a physical illness because the person was suffering with one of its symptoms?

 

We have to think of mental illness just as we do physical illnesses -- beyond the control of the person suffering -- and yet they still deserve help.

 

Once schizophrenics are in treatment, they usually appreciate being able to function. Why keep help from them because they are unable (due to the disease) to ask for help?

 

When it comes to some forms of mental illness (like schizophrenia) I am also concerned about safety of others.People with schizophrenia harm and kill themselves and others while they are delusional. (Obviously not all. But it happens.) I'm not ready to say that the rights of the person with schizophrenia not to get treatment overrule the right of another person to live (or to be safe). For many years mentally ill people in NYC have pushed others to their death on the subway tracks. For the narrow minded -- I am not suggesting all deaths on subway tracks have happened this way, but the simple fact is that it has happened many times over the years, and if each of those people had been in forced treatment, each of those dead and/or injured would be alive and well today. That is just one example. People with schizophrenia kill others (and themselves) in other ways. We cannot save all innocent lives, but here is one example where treatment can prevent MANY innocent deaths if we will just provide it.

 

I grew up loving a family member with schizophrenia, so I know what the disease looks like, how it affects lives, and how it can be treated. My family member was involuntarily treated fore most of her adult life (for years before I was born that meant occasional institutionalization and repeated electric shock therapy, but during my lifetime it meant pills and then, later, time-released injections of medicine). She was involuntarily treated because not wanting treatment is part of the disease. Please remember that it didn't mean she didn't *want to* or *deserve to* function normally. Truthfully, though, she never really functioned normally because even with treatment (allowing function) schizophrenia is always there affecting her daily. But she could think mostly clearly and her own personality was able to emerge when she was treated. Plus, she was safe to herself and others -- safe to be and safe to love. The most important part , IMO, is the safety of innocent others, NO ONE should have to be harmed or die at the hands of another because of a treatable disease that is not being treated. And again, just because it cannot be stated loudly enough, the rights of other people for safety override the right of the sufferer (but IS it a right if not wanting treatment is a symptom they cannot control???) not to be treated.

 

It goes without saying that we need adequate amounts of money to be put into care so it is accessible and ethical. IMO we could find it in our government's budget if we decided it was a priority to save these lives (above some of the other places we put our money...).

[zaichiki]

The mental institutions and abusive involuntary confinement and treatments had horrible problems, but the pendulum has swung too far the other way now.  In theory you can be confined and treated for your own protection when you are danger to yourself or others, but in practice it's hardly seamless.  It's a mess.

THIS!

[zaichiki]

Before jumping to the difficult question of involuntary treatment, it would be important to have treatment accessible at all. Long waiting lists to even get to see a mental health professional for an initial consultation, high cost of therapy and meds, limited insurance coverage and insurance availability, lack of beds for inpatient treatment - there are so many things that could be improved to help people long before it has to come to involuntary hospitalization. For many, it's not possible to receive help even if they desperately want to. 

 

I don't believe one has to come before the other. Involuntary treatment is often the MOST necessary kind.  We *can* do it simultaneously (if there are no people "queing" for the treatment, it will not be made accessible because there are those who will not see it as urgent).

 

People who need involuntary treatment need to be moved to the "top of the list" (not that there SHOULD be a waiting list -- there shouldn't -- we should put our money where our mouths are and make this happen YESTERDAY.  These people are the ones who have been deemed dangerous to themselves and others. Innocent lives are at risk if we prioritize voluntary services over emergency, involuntary treatment. 

[zaichiki]

Furthermore, you can't just say that only the people who really really need to be institutionalized (however you define that, if you're expanding it in scope from right now, where you can only be forced if you're a danger to yourself or others) will be forced into it.

 

Instead, you'd have to recognize that for every person who, according to the new criteria, needed institutionalization and was forced into it, 3 more people who *didn't* really need it would be forced into it.  That kind of power creep seems really dangerous to me.

We can do it *right* just like we can do other types of emergency health care ethically.

 

Obviously we need creative thinkers to solve this problem, because we can't just go back to the way we, as a society, treated mental illness "before."  It didn't work well. I think we all acknowledge that.

 

But we CAN do it right and save lives if we will only prioritize it.

[Scarlett]

I am in favor of forced treatment for some mental illnesses and this is why --

One of the *symptoms* of schizophrenia is not wanting treatment. Can you imagine not treating a physical illness because the person was suffering with one of its symptoms?

 

We have to think of mental illness just as we do physical illnesses -- beyond the control of the person suffering -- and yet they still deserve help.

 

Once schizophrenics are in treatment, they usually appreciate being able to function. Why keep help from them because they are unable (due to the disease) to ask for help?

 

When it comes to some forms of mental illness (like schizophrenia) I am also concerned about safety of others.People with schizophrenia harm and kill themselves and others while they are delusional. (Obviously not all. But it happens.) I'm not ready to say that the rights of the person with schizophrenia not to get treatment overrule the right of another person to live (or to be safe). For many years mentally ill people in NYC have pushed others to their death on the subway tracks. For the narrow minded -- I am not suggesting all deaths on subway tracks have happened this way, but the simple fact is that it has happened many times over the years, and if each of those people had been in forced treatment, each of those dead and/or injured would be alive and well today. That is just one example. People with schizophrenia kill others (and themselves) in other ways. We cannot save all innocent lives, but here is one example where treatment can prevent MANY innocent deaths if we will just provide it.

 

I grew up loving a family member with schizophrenia, so I know what the disease looks like, how it affects lives, and how it can be treated. My family member was involuntarily treated fore most of her adult life (for years before I was born that meant occasional institutionalization and repeated electric shock therapy, but during my lifetime it meant pills and then, later, time-released injections of medicine). She was involuntarily treated because not wanting treatment is part of the disease. Please remember that it didn't mean she didn't *want to* or *deserve to* function normally. Truthfully, though, she never really functioned normally because even with treatment (allowing function) schizophrenia is always there affecting her daily. But she could think mostly clearly and her own personality was able to emerge when she was treated. Plus, she was safe to herself and others -- safe to be and safe to love. The most important part , IMO, is the safety of innocent others, NO ONE should have to be harmed or die at the hands of another because of a treatable disease that is not being treated. And again, just because it cannot be stated loudly enough, the rights of other people for safety override the right of the sufferer (but IS it a right if not wanting treatment is a symptom they cannot control???) not to be treated.

 

It goes without saying that we need adequate amounts of money to be put into care so it is accessible and ethical. IMO we could find it in our government's budget if we decided it was a priority to save these lives (above some of the other places we put our money...).

 

 

The woman who drove into a crowd at a college homecoming in OK was sentenced this week.  A plea deal.  She killed 5 people and injured more.  I am pretty sure she was mentally ill.  I haven't delved into the story to be positive but she claims she was suffering from severe psychosis. 

 

My 'brother' who is institutionalized has never been violent but he has had two psychotic  breaks in the last 5 years.  The medicine works less and less it seems.  Very sad. 

 

And I know another man who has PS who terrified me.  When he was medicated and stable he was gentle as a lamb....but he wouldn't take his meds and he was very scary. 

[zaichiki]

The woman who drove into a crowd at a college homecoming in OK was sentenced this week.  A plea deal.  She killed 5 people and injured more.  I am pretty sure she was mentally ill.  I haven't delved into the story to be positive but she claims she was suffering from severe psychosis. 

 

 

For those who disagree that involuntary treatment should not be a priorty --

 

If she had been treated, even involuntarily committed, those 5 people would be alive today. Whose rights are more important (her right to freedom/not treatment or their right to live)???  

[zaichiki]

And I know another man who has PS who terrified me.  When he was medicated and stable he was gentle as a lamb....but he wouldn't take his meds and he was very scary. 

 

In my experience, Paranoid Schizophrenia is always scary when the person is having an episode.  It is scary to see someone "not themselves" and doing illogical and unpredictable things. You see immediately that they are capable of doing *anything.* That is scary.  (And then weapons can be involved... or normal, everyday things can be wielded as weapons by otherwise sweet and loving people...)

[zaichiki]

I believe that the descriptions of demon possession, in the Bible, are actually descriptions of schizophrenia. That is exactly what it is like. Or sudden alien abduction/mind control.

And if a person's body was being possessed by a demon/alien, who was controlling the mouth and making it say that it didn't want help, who would stand by and do nothing?!

[maize]

For those who disagree that involuntary treatment should not be a priorty --

 

If she had been treated, even involuntarily committed, those 5 people would be alive today. Whose rights are more important (her right to freedom/not treatment or their right to live)???

And--what about her right to a functioning brain--which would require treatment, involuntarily if necessary.

 

There need to be serious safeguards, but one big difference between our time and the institutions of a couple of generations ago is that we do now have a lot of decently effective treatments. For many people, inpatient treatment would only need to be temporary in order to get them sufficiently stabilized to manage continuing outpatient treatment, with a brain functional enough to make rational decisions.

 

Breaking down the stigmas surrounding mental health problems and treatments is a necessary component of developing a more effective system. Personally I would like to see the distinction between "mental health/illness" and other health/illness go away. We have more than enough data at this point to acknowledge the physiological reality of illnesses that impact the brain. We don't separate out illnesses of other organs in the same way.

Edited January 11, 2017 by maize

[SparklyUnicorn]

Then again I sometimes don't want to be treated.  I sometimes see the treatment as worse than the problem. 

 

With paranoid schizophrenia, yes this is particularly difficult because the person already thinks people are out to hurt them.  Unfortunately, sometimes people do hurt them.  They need care, but they need to be respected and treated humanely and advocates.  I can 100% understand why some of my family members didn't like getting treatment.  They were often not treated very well. 

 

 

I am in favor of forced treatment for some mental illnesses and this is why --

One of the *symptoms* of schizophrenia is not wanting treatment. Can you imagine not treating a physical illness because the person was suffering with one of its symptoms?

 

We have to think of mental illness just as we do physical illnesses -- beyond the control of the person suffering -- and yet they still deserve help.

 

Once schizophrenics are in treatment, they usually appreciate being able to function. Why keep help from them because they are unable (due to the disease) to ask for help?

 

When it comes to some forms of mental illness (like schizophrenia) I am also concerned about safety of others.People with schizophrenia harm and kill themselves and others while they are delusional. (Obviously not all. But it happens.) I'm not ready to say that the rights of the person with schizophrenia not to get treatment overrule the right of another person to live (or to be safe). For many years mentally ill people in NYC have pushed others to their death on the subway tracks. For the narrow minded -- I am not suggesting all deaths on subway tracks have happened this way, but the simple fact is that it has happened many times over the years, and if each of those people had been in forced treatment, each of those dead and/or injured would be alive and well today. That is just one example. People with schizophrenia kill others (and themselves) in other ways. We cannot save all innocent lives, but here is one example where treatment can prevent MANY innocent deaths if we will just provide it.

 

I grew up loving a family member with schizophrenia, so I know what the disease looks like, how it affects lives, and how it can be treated. My family member was involuntarily treated fore most of her adult life (for years before I was born that meant occasional institutionalization and repeated electric shock therapy, but during my lifetime it meant pills and then, later, time-released injections of medicine). She was involuntarily treated because not wanting treatment is part of the disease. Please remember that it didn't mean she didn't *want to* or *deserve to* function normally. Truthfully, though, she never really functioned normally because even with treatment (allowing function) schizophrenia is always there affecting her daily. But she could think mostly clearly and her own personality was able to emerge when she was treated. Plus, she was safe to herself and others -- safe to be and safe to love. The most important part , IMO, is the safety of innocent others, NO ONE should have to be harmed or die at the hands of another because of a treatable disease that is not being treated. And again, just because it cannot be stated loudly enough, the rights of other people for safety override the right of the sufferer (but IS it a right if not wanting treatment is a symptom they cannot control???) not to be treated.

 

It goes without saying that we need adequate amounts of money to be put into care so it is accessible and ethical. IMO we could find it in our government's budget if we decided it was a priority to save these lives (above some of the other places we put our money...).

 

[wapiti]

Personally I would like to see the distinction between "mental health/illness" and other health/illness go away. We have more than enough data at this point to acknowledge the physiological reality of illnesses that impact the brain. We don't separate out illnesses of other organs in the same way.

 

This.  The idea that the brain is unaffected by other systems will be left on the ash heap of medical history and that day can't come soon enough.  Unfortunately, I do think there is also too much separation of illnesses of other organs, too much specialization in medicine and not enough big picture.

 

When I hear things like "well, we treat ocd as ocd, and strep as strep," and in the next breath, smugly, "we practice evidence-based medicine," what I really hear is "our practice is so. last. century. and we're proud of it!"

[SparklyUnicorn]

And--what about her right to a functioning brain--which would require treatment, involuntarily if necessary.

 

There need to be serious safeguards, but one big difference between our time and the institutions of a couple of generations ago is that we do now have a lot of decently effective treatments. For many people, inpatient treatment would only need to be temporary in order to get them sufficiently stabilized to manage continuing outpatient treatment, with a brain functional enough to make rational decisions.

 

Breaking down the stigmas surrounding mental health problems and treatments is a necessary component of developing a more effective system. Personally I would like to see the distinction between "mental health/illness" and other health/illness go away. We have more than enough data at this point to acknowledge the physiological reality of illnesses that impact the brain. We don't separate out illnesses of other organs in the same way.

 

I was reading this story recently.  Some link I clicked on Facebook (so yeah take that with a grain of salt), but the gist was a story about a woman who suddenly developed what appeared to be a severe mental illness.  They were ready to commit her to a psych hospital.  They had no clue what was up.  So the doctor asked her to draw a picture of a clock and she drew it in such a way that indicated a particular type of brain damage caused by some I dunno parasite...blah blah.  You get the idea.  But what struck me was the comment that they almost made a mistake in diagnosing her with a mental problem verses this physical problem.  What the?!  AS IF...mental health problems are some nebulous thing or outside evil force.  No..they ARE physical things.  Just because we don't know or see the physical cause/issue doesn't mean there is no physical issue.  I thought we had gotten a little better about saying stuff like that, but I guess not. 

[SparklyUnicorn]

To add about institutions.  Institutions have pretty terrible track records for cures and treatment.  People often come out worse than when they went in.  And I've seen it myself.  I remember working at the nursing home a family wanted to place their mother there.  This woman needed some basic help with taking her medication and I guess she really couldn't safely be alone as much as they needed to leave her alone.  I think she would have been MUCH better off with an in home caregiver.  She was vibrant, articulate, by all other accounts pretty highly functioning, etc.  Really it was her situation that made me decide that kind of job was not for me.  Part of my job was to basically "sell" the nursing home.  Especially if the potential client had money.  Within a month that woman was completely different.  It broke my heart really.  She didn't belong there.  But that is how institutions tend to be.  The people who work there are just doing a job.  You are another body to take care of.

 

 

 

 

[wapiti]

Sparkly, that may have been about the book Brain on Fire.  It's been a while since I read it, but IIRC, the problem was anti-NMDA receptor encephalitis.  This is just one type of autoimmune encephalitis (where antibodies affect the brain).  It is not the only type of AE and I suspect that more types of AE will continue to be discovered.  Indeed, only recently one of the lead researchers of PANDAS at the NIMH referred to it as a form of AE (duh).

 

I feel like we're in the Stone Age days of understanding.  For example, serotonin only came to be accepted as a neurotransmitter in 1980 and that acceptance was not without controversy.  (and where is 80% of the serotonin in the body produced?  hint, not in the brain.  what else is in that location?  a substantial part of the immune system.)  Now there's almost too much focus on serotonin to the exclusion of the many other neurotransmitters.

Edited January 11, 2017 by wapiti