Mental health centers are changing to "behavioral" health centers

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Well, you mentioned the "bad old days" above, so I wondered what about the current days is "better." Most mental illness is "treated" in jails now, isn't it? It's not "shameful" because society doesn't seem very ashamed, and it's not just "common" - it's actually the norm now, at least in some places.
Point taken. At the same time as the treatments for mental illness have improved, the way many people with mental illness are treated by society (i.e. thrown in jail for petty offenses or even shot and killed by police officers) has continued to decline. I view doing what one can to turn this tide as a responsibility of all mental health professionals. Mental health treatment is better today for those who most psychiatrists see as patients, which is what I was referring to in my post, but it's vitally important not to forget about everybody else.

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In general the situation with the mentally ill in prison is not really due to the failing of mental health providers, its much more the result of shortsighted and/or corrupt politicians that are much more willing to funnel state dollars to prisons than they are to fund mental health. The "war on drugs" also has been a huge driving force in the exploding prison populations across the US.
 
Point taken. At the same time as the treatments for mental illness have improved, .

it has? At least from a pharmacotherapy perspective, I would disagree with this. What meds have come out in the last 2 decades which have really been a *significant* improvement on previous ones?
 
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it has? At least from a pharmacotherapy perspective, I would disagree with this. What meds have come out in the last 2 decades which have really been a *significant* improvement on previous ones?

Ummm, what about Pristiq, Aplenzin and Ambien CR?
 
Just an aside - how often are you able to correctly diagnose ASPD and schizophrenia in the same patient? The criteria for ASPD state "the occurrence of antisocial behavior is not exclusively during the course of Schizophrenia or a Manic Episode." I would think if you succesfully treat the psychosis, then the patient will have been "restored to competence" (i.e. they can reason about their legal case in a non-psychotic fashion). Then it is time for them to face their charge, correct? Do you evaluate them for ASPD then? It seems to me it might be hard to do an unbiased ASPD evaluation for someone who has a pending legal charge. A lot depends on their plea, and the outcome of the case. (I.e. if someone's charged with murder, but pleads innocent, you shouldn't just slap on an ASPD diagnosis no matter how unremorseful, etc, they seem, until at least a jury has weighed in on it.) And it might be hard to evaluate past symptoms and behavior because you can't be sure if they were psychotic at times in the past where they engaged in antisocial-seeming behavior.

In any case a competency restoration unit is a quite specialized setting. Must be very interesting to work there.
The cases where I've seen both diagnoses and been confident have extensive child and adolescent psychiatric and criminal records documenting a conduct disorder, along with ASPD, prior to a first break.
 
The cases where I've seen both diagnoses and been confident have extensive child and adolescent psychiatric and criminal records documenting a conduct disorder, along with ASPD, prior to a first break.
Good point this ^^^. It's all in the collateral. I get very suspicious when you start seeing ASPD only appear after the patient has developed psychosis.
 
The cases where I've seen both diagnoses and been confident have extensive child and adolescent psychiatric and criminal records documenting a conduct disorder, along with ASPD, prior to a first break.
Good point this ^^^. It's all in the collateral. I get very suspicious when you start seeing ASPD only appear after the patient has developed psychosis.

Yeah I agree. Once those two things, psychosis and ASPD, are intertwined, there's no splitting them up and getting a clear picture of the patient. Don't forget, ASPDs are known to feign psychosis, and do so quite well!
 
The cases where I've seen both diagnoses and been confident have extensive child and adolescent psychiatric and criminal records documenting a conduct disorder, along with ASPD, prior to a first break.

That's really cool. My second favorite activity in all of psychiatry is documenting a true blue history of conduct disorder, especially if the history is positive for fire starting. How something that specific got validated to be in the DSM I have no idea; I'm just amazed they haven't removed it yet. (My first favorite activity, I think, is interviewing patients who meet all the criteria for bona fide eating disorders. If I ever meet an arsonist, then that will probably upset the ranking). Here's what I like about getting a good ASPD history: a) it's usually interesting, and b) generally, they don't over-endorse. If they do, it's out of bravado. As opposed to the legions of anxious and depressed people who so want me to empathize with how bad their insomnia is.
 
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