Article of interest for us.

[OldPsychDoc]

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Mental-health gulag?
As you well know, America's solution to mental health needs is frequently incarceration.

 

[Ibid]

Mental-health gulag?
As you well know, America's solution to mental health needs is frequently incarceration.

The UK has the same problem if not to quite to the same extent. Lord Bradley's report contains the blue print for part of the UK solution as prisons have become, as described above, de facto psychiatric hospitals.

http://www.dh.gov.uk/en/Publication...tions/PublicationsPolicyAndGuidance/DH_098694

Solzhenitsyn "The Gulag Archipelago" is worth a read.

 

[F0nzie]

It's a sad state of affairs we live in today- to see sick individuals incarcerated without receiving the appropriate treatment. The current economic atmosphere is the not helping the situation as we're seeing many inpatient psychiatric hospitals closing down and reductions in mental health services at the state level. Private practices in medicine are shutting down due to low reimbursements from insurance companies and Medicare that are not keeping up with the rising costs of healthcare and inflation. The biggest hits are in primary care, although recently I have read of a few psychiatrists and cardiologists (relatively recent 30-40% cuts in stress tests and echos) shifting from private practice back to institutions. If there is no money in the system to pay for psychiatric treatment, then the default is to minimize costs by placing these severely mentally ill people in prison to keep them from harming themselves or others.

On a separated but related note, I was surprised the other day to find out that insurance companies reimburse my residency program on average $120 for an psychiatric intake evaluation with a $15 copay and this figure has not changed over the last several years. My understanding is that over the past 10 years, this figure has not changed significantly either! Out of pocket for an intake is $250, however, if you contract with insurance companies you are not allowed to request from the patient to pay for the difference (thus insurances artificially setting the market value to $120 +copay). We don't even accept Medicare because they'd pay us in nickels and dimes. Our institution gets more money from 1 missed appointment (since they are out of pocket payments) than 1 intake evaluation!

What further shocks me is that patients refuse to pay out of pocket for an appointment when their insurance runs out. They adamantly request med adjustments over the phone or call the on-call resident after hours. It only costs $50 for a 15 min med check every 1-3 months. Yet they don't seem to complain about paying for their HDTV cable subscriptions or cell phone bills which they probably pay $50-100 per month each. I don't complain or ask questions when I pay my plumber $100 to fix my toilet or my landscaper $60 to cut my grass and trim the hedges. Bottom line in my opinion is: everybody wants + needs services, nobody wants to pay, and our current system accounting for 17% GDP is crumbling with an insurmountable amount of evidence that it is an unsustainable model.

 

[billypilgrim37]

My brother-in-law w/ schizoaffective d/o was kept in solitary confinement untreated for 30 days. My in-laws had called the police because he was psychotic and screaming and clearly dangerous at the time. They, of course, wanted him taken for treatment. Instead, he was taken to jail and didn't receive any kind of evaluation for weeks. He made his final suicide attempt about a month later, followed by a pretty devastating funeral.

 

[nitemagi]

My brother-in-law w/ schizoaffective d/o was kept in solitary confinement untreated for 30 days. My in-laws had called the police because he was psychotic and screaming and clearly dangerous at the time. They, of course, wanted him taken for treatment. Instead, he was taken to jail and didn't receive any kind of evaluation for weeks. He made his final suicide attempt about a month later, followed by a pretty devastating funeral.

Billy, that's terrible. Sorry to hear that.

 

[billypilgrim37]

Billy, that's terrible. Sorry to hear that.

And it all happened while I was on my M3 psych rotation. Talk about a "this will make me either do this specialty or run away from it screaming" experience.