Anyone who has worked in the mental health system can recite a litany of patients who spin through the revolving doors again and again. They become familiar faces and stories, some like, some disdained.
this subgroup of patients return again and again for many reasons, but mostly is a contempt of drugs. This happens often because of money and access to, other times because of the flat-out rejection.
Accidents often laugh at our weakest, and some of these people end up floating face down in a river after a successful suicide, or muttering in the corridors of the state mental hospital in which they are buffed-mentally competent to stand trial for a bloody violence. The rest? Well, they walk among us.
As I wrote in a post the past, the mental health system in America is bleeding to death. The causes are surely legion, but the bleeding may be related to the creation of laws and infrastructure to get the most seriously mentally ill treated. How do you do?
assisted outpatient treatment (AOT)
There is prima facie impression that only a relative handful of us to provide mental health care. Anyway, last week Congress had to pass a law just to push the mental health benefits up to par with other medical treatments. Psychiatrists are the lowest paid medical specialists in the nation. Psychiatric programs are often relegated to the furthest corners of the medical centers. Mental health staff are often among the lowest compensated employees. Indeed, he may feel reluctant to give service.
Realistically, mental health is the black sheep status is more a matter of evasion of indifference, of indignation, but dislike, even though the mixture of all these. Sometimes they coalesce to create a perfect storm.
Kendra Webdale
In rainy Sunday afternoon in January 1999, a 32-year-old Kendra Webdale was waiting on Manhattan subway platform. a young man named Andrew Goldstein approached her and asked for time. Just as the train screeched to them, Goldstein fell to Kendra gruesome death on the rails.
Andrew Goldstein was one of those caught in the revolving door of mental health. His life started full of promise as he possessed an exceptional, perhaps a nice, um. It is a promise broken, however, when he was first psychotic break as a freshman in college.
diagnosed with paranoid schizophrenia, Andrew has gone through multiple psychiatric hospitalizations and, despite the fact that one p.m. Aliens attacked without provocation, all the women and expressed fear that they will act on their violent impulses toward another woman, he was released, again and again.
As you might expect, Andrew was not in compliance with their medications, mostly because of debilitating side effects, and is always released before it is really stable.
In the aftermath of this terrible episode, New York passed the law of assisted outpatient treatment for mentally ill, and he called Kendra's Law.
Shortly afterwards, another tragic incident to point out the failures in the mental health system, this time 3000 miles away in California.
Laura Wilcox
On a break from Haverford College in 2001, nineteen-year-old Laura Wilcox was working for a few days in the Nevada County Mental Health Clinic. 41-year-old client named Scott Harlan Thorpe showed up for his appointment on the 10th January But to the horror of everyone around him, he pulled out a gun and opened fire, killing two clinic employees. Laura was one of them. Scott then drove to the restaurant and shot his 24-year-old manager.
As Andrew Scott was not in compliance with his treatment, including medication. By the time he went on his shooting spree, he descended into hell, where the delusional being tormented and haunted by the FBI. His family stood by, helplessly watching its outcome, can not do anything to force him to treatment.
Like Kendra, Laura did not die in vain, either. California lawmakers make their own AOT laws, largely based on Kendra's, and call it Laura's Law.
Whatit
Under AOT, patients with severe and persistent mental illness can be ordered in the outpatient treatment, rather than leaving them. If the patient does not appear for treatment, the peace officer or a field, clinicians can lead them to the emergency room. The patient is evaluated for possible 72-hour involuntary hospitalization (5150 in California). For complete details of this otherwise complex laws, visit the Treatment Advocacy Center.
deficiencies in the law: comparing New York and California
New York and California versions of AOT are almost identical, except for one difference risky. Kendra's Law allows the rejection of outpatient treatment will be sufficient grounds for involuntary hospitalization. Laura's Law, on the other hand, explicitly prohibits this. So what's the problem?
One longtime patient I know goes off his medication regularly and systematically purge his system so he can go to "tweekend" crystal meth and sex. We know when this is happening because he disappears from his clinic therapy. In drug-induced psychosis, he will reenter the hospital to endure the depressive crash to come. A few days later he was released and the cycle repeated over and over again.
that he was in New York, his plans could be foiled. The first notice of his absence from the therapy, it could be collected and hospitalized. But in California, he could be detained for assessment, then immediately released to the party.
This is not to say that Kendra's Law is much harder than Laura's. defects in both of them might not even allowed to participate in treatment will be grounds for contempt. But this is precisely the type of result that should be established, if for no other reason than as a deterrent to professional patients are abusing the system.
I'm reminded of the man who practically lived in Los Angeles in psychiatric hospitals, ranging from one to the next, costing taxpayers millions of dollars in the process. Is he mentally ill? Besides being disturbed enough to decide to chill in psych wards, the answer is no. What is his game, then? Simple arithmetic.
By the fall of hospital beds, and not his, he gathered enough money from his disability checks to cruise around in Mercedes Benz and untold buy something second-somethings. I can tell you that therapy is not one of them.
Imagine that the AOT law forced him into treatment for his fake mental maladies, and find him in contempt of court, if it was a no-show. I do not think we'd ever see him in the psych club again, freeing up beds and money to someone who really needs help.
This is money that is the decisive difference between New York and California AOT structures. New York is well organized and funded the program. California's a little known legislative mandate without funding for its implementation. For Golden State, it is all talk and no action, at least for now.
Meanwhile, the investment paid off handsomely for New York, as the social costs and the toll of human suffering. Specifically: 59% reduction in repeat hospitalizations, 75% reduction in incarcerations, 57% reduction in homelessness, a 53% increase in medication compliance. If this is not enough, the Office of Mental Health Web site features even more impressive data.
patients' rights
subtext, perhaps because of the lack of political and financial will to implement Laura's Law in California is simple complacency. It was 36 years of well-meaning but fundamentally flawed Lanterman-Petris Short act effectively tied the hands of everyone. Compulsory treatment for even the toughest mentally ill were sacrificed in the name of patients' rights. So, floridly psychotic patient who believes that the King of Pasta on the moon, which is made of cheese is considered legally competent to refuse antipsychotic drugs. Mind you, I'm not suggesting that we ignore or violate constitutional rights in any way, but in order to allow seriously ill patients to dictate their treatment appears ludicrous at first blush, and then really ridiculous in practice.
If you are a patient who has chronic paranoid schizophrenia, 20 or more psychiatric hospitalizations during the last two years, and boring preference for doping in which you spend your entire monthly government check, we as a society have an interest, if not moral obligation , you force the treatment? Or maybe I just really do not care if you end up dead at 35 behind a trash Skid Row dumpster. One less loser to worry about, right?
Final thoughts: the right can be wrong
The irony is that the rights of patients they can also be undone. People with severe mental illness through the carousel door asylum, because they can not function in the settings to follow. They can easily escape, such as alcohol and drugs leading to hard falls, such as homelessness and imprisonment. They are basically children and adolescents in adult bodies. Those of us need to structure their lives, to support them, to help them make decisions, and that their time-outs when they are spinning out of control.
Continuing with the business-as-usual approach, in fact, the greatest violation of the rights of mentally ill person can commit. AOT laws can not be perfect, but they are a good first step for our patients' recovery.
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