Reopen the mental hospitals?

[just Warren]

He makes some good points, but...

I've read a lot of accounts of horrible conditions, non-existent treatments, staffers that make the worst VA people look like saints, and a lot of folks being confined unjustly. Plus you're not solving the problems, just hiding them away.

So this isn't a silver bullet of an idea to solve the mental illness problem.

But could it help? Is it worth the chances of revisiting the horrors listed above to try?

[MillCreek]

In this regard, I have said that if we want to make effective change, we should reduce the criteria for involuntary commitment, forced mental health treatment, and removal of children from dysfunctional homes.  I see these problems every day in my clinics.  Of course, this would have considerable civil liberties and who is going to pay for it issues.

The grand experiment to decentralize mental health treatment from large asylum settings to smaller community-based settings has been a dismal failure, primarily due to lack of funding.

[Scout26]

He makes some good points, but...

I've read a lot of accounts of horrible conditions, non-existent treatments, staffers that make the worst VA people look like saints, and a lot of folks being confined unjustly. Plus you're not solving the problems, just hiding them away.

So this isn't a silver bullet of an idea to solve the mental illness problem.

But could it help? Is it worth the chances of revisiting the horrors listed above to try?

All we did was take the mentally ill and turn them into the homeless.  As bad as some places may have been, at least they were sheltered from the elements, occasionally bathed, and provided meals.

On the streets...not so much, along with all the other problems listed.

[230RN]

Objections based on previous problems with mental health care facilities do not invalidate the basic premise that dude Scalia presented:  "We don't need gun control, we need nut control."

Whoever that dude is, he seems to have cut through all the bullbleep to the basic problem.  I'd hire him if I had a job opening, and I invite a résumé from him to keep on file.

Terry, 230RN

[Hawkmoon]

He makes some good points, but...

I've read a lot of accounts of horrible conditions, non-existent treatments, staffers that make the worst VA people look like saints, and a lot of folks being confined unjustly. Plus you're not solving the problems, just hiding them away.

So this isn't a silver bullet of an idea to solve the mental illness problem.

But could it help? Is it worth the chances of revisiting the horrors listed above to try?

What's the problem you're trying to solve? "Hiding them away" solves the problem of having them buy guns and shoot up schools. Some statistician needs to parse mass shooting data and see if there's an "uptick" (as the media loves to say) after the move in the mid- to late 1970s to deinstitutionalize and "mainstream" nut cases out of mental institutions.

I think it's necessary to reinstate mental institutions. If the quality of care in them was poor, that's a different problem and it can be addressed.

[Pb]

Right now, crazy people seem to rotate between the gutter, the jail, and the emergency room.

It's hard to believe mental hospitals would be worse than what we are doing now.  I may be wrong though...

[lupinus]

It's the usual pendulum swing from one extreme to the other, while managing to swing right past and miss the happy middle ground.

We've gone from making it to easy to toss someone in the nuthouse and often poor conditions and poor treatment, to the other extreme. I may not be a subject matter expert and I won't pretend to have slept at a Holiday inn last night, but it would seem to me there has to be a happy middle ground in there.

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[DittoHead]

Right now, crazy people seem to rotate between the gutter, the jail, and the emergency room.
It's hard to believe mental hospitals would be worse than what we are doing now. 

They are ending up in places that absolutely not equipped to help them in any meaningful way. Mental hospitals won't fix everything, there are a lot of things that aren't "fixable", but they would at least be better equipped to handle the problems of these people.

[MechAg94]

I would like to see someone take a real hard look at the drugs we are feeding people with real or perceived mental issues and what side effects are possible and/or allowed.  I don't know much about them, but I have heard "homicidal tendencies" and other similar things have been added to the list of side effects for some of them.  that is not even getting into the suicides related to some of these drugs. 

[Pb]

I would like to see someone take a real hard look at the drugs we are feeding people with real or perceived mental issues and what side effects are possible and/or allowed.  I don't know much about them, but I have heard "homicidal tendencies" and other similar things have been added to the list of side effects for some of them.  that is not even getting into the suicides related to some of these drugs. 

Hmmm... I think possibly is a bigger issue is the the homeless insane aren't taking any prescribed medications to control their conditions. 

[charby]

I'd be fine with bringing back the county homes/poor farms, (which in Iowa were the local mental hospitals and assisted/full care for the destitute) if the conditions were where everyone was treated like a human being.

The question is who is going to pay for it, seems there is a push in many states to reduce taxes (income to the government) and reduce services.

[MillCreek]

Back when I was on the Medic One unit, we called this 'dying with your rights on', as we took care of the floridly mentally-ill people on the street who ended up dying of exposure, untreated disease or violence.  They had the perfect legal right to refuse treatment or housing and the perfect legal right to end up dead, because they were incapable of making a rational decision due to their illness.

[lupinus]

I'd be fine with bringing back the county homes/poor farms, (which in Iowa were the local mental hospitals and assisted/full care for the destitute) if the conditions were where everyone was treated like a human being.

The question is who is going to pay for it, seems there is a push in many states to reduce taxes (income to the government) and reduce services.

I'd be interested to see an actual and honest comparison of the cost of ignoring the problem, vs the cost of tackling the problem in an efficient manner. Granted it's the government, so the efficient manner part is laughable. But it'd still be nice.

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[MechAg94]

Hmmm... I think possibly is a bigger issue is the the homeless insane aren't taking any prescribed medications to control their conditions. 

I was not thinking about the effect of drugs on homeless people, but suicides and the mass shooter types. 

Part of the issue with the homeless is liberal city leadership seems to not only tolerate their presence, but actively encourage and accomodate them. 

[MechAg94]

If they tried to put homeless institutions, I foresee a lot of lawsuits and all sorts of money spent trying to accommodate various regulations and court orders.  The cost would likely be high.

[Hawkmoon]

I would like to see someone take a real hard look at the drugs we are feeding people with real or perceived mental issues and what side effects are possible and/or allowed.  I don't know much about them, but I have heard "homicidal tendencies" and other similar things have been added to the list of side effects for some of them.  that is not even getting into the suicides related to some of these drugs.  

Good call. IMHO the medical profession has become much too nonchalant about psychotropic drugs and their potential side effects.

Case in point: Me. I'm being treated by the dermatology clinic at the VA hospital for lesions on my lower legs. They're ugly, annoying, and they itch. At my last appointment (this past Monday), they prescribed Doxepin HCL "to help control the itching." The explanation was that it would make the nerves less sensitive.

I picked up the prescription at the pharmacy and went home. As I usually do with any new medication, I read the fact sheet. What I learned is that Doxepin is a psychotropic medication, and its primary use is treating depression. (That was red flag numero uno, right there.) So I read on.

WARNING:Antidepressant medications are used to treat a variety of conditions, including depression and other mental/mood disorders. these medications can help prevent suicidal thoughts/attempts and provide other important benefits. However, studies have shown that a small number of people (especially people younger than 25) who take antidepressants for any condition may experience worsening depression, other mental/mood symptoms, or suicidal thoughts/attempts. Therefore, it is very important to talk with the doctor about the risks and benefits of antidepressant medication (especially for people younger than 25), even if treatment is not for a mental/mood condition. Tell the doctor right away if you notice worsening depression/other psychiatric conditions, unusual behavior changes (including possible suicide thoughts/attempts), or other mental/mood changes (including new/worsening anxiety, panic attacks, trouble sleeping, irritability, hostile/angry feelings, impulsive actions, severe restlessness, very rapid speech). Be especially watchful for these symptoms when a new antidepressant is started or when the dose is changed.

Yeah, I really want to take this stuff because my shins itch. NOT! I'll take my chances with the itch, thanks just the same. I wrote a letter to the docs and dropped the unopened pill bottle off at the VA hospital on my way home from work this afternoon.

I'm a bit pissed off because, after a similar incident several years ago, there's supposed to be a flag in my record that I DO NOT want any psychotropic drugs. In this case, the doctors (two of them) didn't tell me Doxepin is a psychotropic drug, and they didn't mention anything about the possible side effects. With all the problems they're having with veterans committing suicide, one might think that's something they should have mentioned.

[lupinus]

Good call. IMHO the medical profession has become much too nonchalant about psychotropic drugs and their potential side effects.

Case in point: Me. I'm being treated by the dermatology clinic at the VA hospital for lesions on my lower legs. They're ugly, annoying, and they itch. At my last appointment (this past Monday), they prescribed Doxepin HCL "to help control the itching." The explanation was that it would make the nerves less sensitive.

I picked up the prescription at the pharmacy and went home. As I usually do with any new medication, I read the fact sheet. What I learned is that Doxepin is a psychotropic medication, and its primary use is treating depression. (That was red flag numero uno, right there.) So I read on.

Yeah, I really want to take this stuff because my shins itch. NOT! I'll take my chances with the itch, thanks just the same. I wrote a letter to the docs and dropped the unopened pill bottle off at the VA hospital on my way home from work this afternoon.

I'm a bit pissed off because, after a similar incident several years ago, there's supposed to be a flag in my record that I DO NOT want any psychotropic drugs. In this case, the doctors (two of them) didn't tell me Doxepin is a psychotropic drug, and they didn't mention anything about the possible side effects. With all the problems they're having with veterans committing suicide, one might think that's something they should have mentioned.

Right.

Because you don't want to take a certain type of medication, the entire medical profession is nonchalant about it? Tell that to the folks who benefit immensely from those meds.

And good luck finding a prescription without a mile long list of potential side effects.

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[Hawkmoon]

I'd be interested to see an actual and honest comparison of the cost of ignoring the problem, vs the cost of tackling the problem in an efficient manner. Granted it's the government, so the efficient manner part is laughable. But it'd still be nice.

And, given that it's the government, good luck ever getting an honest comparison of the costs.

[Hawkmoon]

Because you don't want to take a certain type of medication, the entire medical profession is nonchalant about it? Tell that to the folks who benefit immensely from those meds.

And good luck finding a prescription without a mile long list of potential side effects.

Thank you for making my point. It isn't just the antidepressant they prescribed for me that has potentially negative side effects. The warning language I quoted didn't say Doxepin may result in depression and suicidal thoughts, it said "antidepressants." And I know that's true, because two years ago my daughter made seven (confirmed, probably one and possibly two more unconfirmed) attempts at suicide within the span of eight months -- all while being treated by psychiatrists and psychotropic drugs.

Are the doctors nonchalant? Damn straight, Skippy. They didn't warn my daughter the stuff might backfire. Did you read what the warning I quoted said?

it is very important to talk with the doctor about the risks and benefits of antidepressant medication

How can a patient talk to the doctor about the risks if the doctor doesn't even bother to tell the patient that the prescription is an anti-depressant ... and, oh by the way, it may make you feel suicidal. Remember, I'm a combat veteran, the kind of people the VA is supposed to be worried about committing suicide. Maybe I'm naive, but it seems more than a little irresponsible to prescribe a medication that warns it should be discussed, and not have the discussion or even tell the patient it's that type of medication.

So, yes, I think the profession is too nonchalant about those meds, and it's based on more than just my anecdotal episode.

[MillCreek]

Doxepin for chronic itching/rash/hives is a common 'off-label' use of the drug.  There is abundant medical literature supporting use of the drug for this purpose. 

[charby]

Caffeine is an antidepressant. Just saying.

[Hawkmoon]

Doxepin for chronic itching/rash/hives is a common 'off-label' use of the drug.  There is abundant medical literature supporting use of the drug for this purpose. 

I understand that. It can still have the same side effects, and they didn't warn me about those before prescribing it. (Or after.)

[lee n. field]

In this case, the doctors (two of them) didn't tell me Doxepin is a psychotropic drug, and they didn't mention anything about the possible side effects.

That seems to be very common with doctors, not telling patients things it would be very helpful to know. 

Perhaps Millcreek has an insight for us.

Good call. IMHO the medical profession has become much too nonchalant about psychotropic drugs and their potential side effects.

Case in point: Me. I'm being treated by the dermatology clinic at the VA hospital for lesions on my lower legs.

...

I'm a bit pissed off because, after a similar incident several years ago, there's supposed to be a flag in my record that I DO NOT want any psychotropic drugs. In this case, the doctors (two of them) didn't tell me Doxepin is a psychotropic drug, and they didn't mention anything about the possible side effects. With all the problems they're having with veterans committing suicide, one might think that's something they should have mentioned.

A couple weeks back I was doing some computer work for a nearby county veterans assistance office.  (Oh, my goodness, that computer was clean when I re-did it 2 years ago, how did they manage to mess it up so?)

Anyway, in the 2+ fruitless hours I spent there I got to overhear some conversation.  The VA doctors screwing up medication sounds "not uncommon".

[lupinus]

Thank you for making my point. It isn't just the antidepressant they prescribed for me that has potentially negative side effects. The warning language I quoted didn't say Doxepin may result in depression and suicidal thoughts, it said "antidepressants." And I know that's true, because two years ago my daughter made seven (confirmed, probably one and possibly two more unconfirmed) attempts at suicide within the span of eight months -- all while being treated by psychiatrists and psychotropic drugs.

Are the doctors nonchalant? Damn straight, Skippy. They didn't warn my daughter the stuff might backfire. Did you read what the warning I quoted said?

How can a patient talk to the doctor about the risks if the doctor doesn't even bother to tell the patient that the prescription is an anti-depressant ... and, oh by the way, it may make you feel suicidal. Remember, I'm a combat veteran, the kind of people the VA is supposed to be worried about committing suicide. Maybe I'm naive, but it seems more than a little irresponsible to prescribe a medication that warns it should be discussed, and not have the discussion or even tell the patient it's that type of medication.

So, yes, I think the profession is too nonchalant about those meds, and it's based on more than just my anecdotal episode.

While I'm very sorry about your daughters attempts, antidepressants don't magically make you want to off yourself. Sometimes folks taking heart medicine still have heart attacks, ya wanna blame that in the particular heart medicine to and claim the doc was nonchalant about prescribing it?

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[MechAg94]

While I'm very sorry about your daughters attempts, antidepressants don't magically make you want to off yourself. Sometimes folks taking heart medicine still have heart attacks, ya wanna blame that in the particular heart medicine to and claim the doc was nonchalant about prescribing it?

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Is one of the side effects of the heart medicine that it causes a higher risk of heart attacks in some people?  I think discussing that would be appropriate.  

From everything I have heard, if you are forewarned of the risk of suicidal thoughts, you are much more likely to realize what is happening if those thoughts come up.