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America's forgotten Patients
Started by ronin12
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Thanks for this--sobering and sad reminder of how far we have yet to go.
It became even more sobering that this issue was highlighted by a Non-US media outlet and we don't hear a word in our "media".
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I disagree. This has been highlighted by American news. Just not on the front page. There have even been reports on the matter. This guys video is just a summary of the report. Plus, lets not forget that every prisoner is going to say, that they would prefer to be in a psych hospital over a prison.
We know that back in the day aslyums were awful places. Gave a bad image to society, and such places were abused. I remember stories from my grandparents about farming communities commiting an eldest son because they didn't want to give the family farm to him. They would hang out in an asylum until the next oldest was able to take it over. Naturally, such things wouldn't occur today.
So, the question is, should we be bringing back asylums that integrated with day therapies and other sort of different levels of commitment?
We know that back in the day aslyums were awful places. Gave a bad image to society, and such places were abused. I remember stories from my grandparents about farming communities commiting an eldest son because they didn't want to give the family farm to him. They would hang out in an asylum until the next oldest was able to take it over. Naturally, such things wouldn't occur today.
So, the question is, should we be bringing back asylums that integrated with day therapies and other sort of different levels of commitment?
We do have group homes, Assisted living etc, but they are far and few and very difficult to get patient accepted.concerning hx of abuse in psych hospitals,it does not necessitate complete closure .strict accountability could have stooped this abuse. it has happened throughout hx of medicine and psychiatry should not be the only one to be blamed. if you look at the hx of medical research in us, experiments on black prisoners were conducted like they were guinea pigs and in Germany Jews were treated like animals.But today we have far more stringent regulations and accountability for human medical research. Systems evolve over time including psychiatry. But unfortunately, we still fail to get good alternatives for psych hospitals and we are paying the price in the form of prison system, rather then psych long term facilities.
"lets not forget that every prisoner is going to say, that they would prefer to be in a psych hospital over a prison. "
That is the precise point you are missing, had they be treated in secure and stable therapeutic environment, they should not have committed these crimes.
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This is a point I clearly understand. However, it does not discount my statement that prisoners who are discontent with the current residence would be willing to be in a more comfortable setting, in other words, a malingerer. They do exist.
In forensic settings it is very unlikely a prisoner can get out of prison by faking his symptoms or in simple words fooling a psychiatrist.as you learn more about psychiatry you will know that in real world it is pretty difficult to achieve. defense on the basis of insanity is pretty rare phenomena.
I have seen some media on this issue most every year since it was introduced to me ~1983. Not front page, but something.
County jail can be one of the most rewarding places to practice psychiatry, because you can truly "save" some people from the penal system. If you can notify the prosecutor and defense attorney that the pt is blatantly psychotic and has been for years, new programs can often get the charges dropped (or moved to Mental Health Court) and maybe get the pt moved to the psych hospital quite quickly.
The downside is that elected officials cannot afford to look "soft on crime" and sometimes say they know someone is mentally ill, but they have to get the conviction because anything else would look bad in the papers. Some high profile cases (like letting an "insane murderer" escape from attendants while on a field trip at a county fair, or a psychiatric pt pushing someone to her death on a subway platform) whip the public into a frenzy of "throw away the key."
We're getting closer with forensic FACT teams and police CIT (as shown in the video), but we still have mostly a choice between completely unsupervised outpt tx and short-term acute locked inpt care. A former dept chair at my residency was often quoted, "Community Psychiatry. It's a great idea. It's a shame nobody's tried it." We never really did what our industry told the 1970's public and legislators we could do in terms of treating pt's in the community - and we never did the science that might have showed that we can.
County jail can be one of the most rewarding places to practice psychiatry, because you can truly "save" some people from the penal system. If you can notify the prosecutor and defense attorney that the pt is blatantly psychotic and has been for years, new programs can often get the charges dropped (or moved to Mental Health Court) and maybe get the pt moved to the psych hospital quite quickly.
The downside is that elected officials cannot afford to look "soft on crime" and sometimes say they know someone is mentally ill, but they have to get the conviction because anything else would look bad in the papers. Some high profile cases (like letting an "insane murderer" escape from attendants while on a field trip at a county fair, or a psychiatric pt pushing someone to her death on a subway platform) whip the public into a frenzy of "throw away the key."
We're getting closer with forensic FACT teams and police CIT (as shown in the video), but we still have mostly a choice between completely unsupervised outpt tx and short-term acute locked inpt care. A former dept chair at my residency was often quoted, "Community Psychiatry. It's a great idea. It's a shame nobody's tried it." We never really did what our industry told the 1970's public and legislators we could do in terms of treating pt's in the community - and we never did the science that might have showed that we can.
I don't see this changing anytime soon.
There are all kind of issues at hand, but I believe that money is the main issue, jail is a short-term, cost-effective solution. And these solutions always win out. Fix the now cheap is how things get done unfortunately.
2 psych staff to treat 1300 pts in jail vs. a properly staffed and equipped long-term facility to treat 1300 pts? Put that up to vote and see how taxpayers will choose.
There are all kind of issues at hand, but I believe that money is the main issue, jail is a short-term, cost-effective solution. And these solutions always win out. Fix the now cheap is how things get done unfortunately.
2 psych staff to treat 1300 pts in jail vs. a properly staffed and equipped long-term facility to treat 1300 pts? Put that up to vote and see how taxpayers will choose.
