Another May, another Mental Health Awareness Month. Have we made any progress since the last Awareness month?
Well, not much. There are even fewer hospitals with ever fewer services. The U.S. now has the same number of state psychiatric beds proportional to the population as we had in 1850: 14 beds per 100,000 people. From 2010 to 2014 we lost 14% of state hospital beds (from 50,509 to 43,318). Since 2014 an additional 4,471 completed or announced bed cuts have been added. Ten states have cut approximately 50% of available beds (The Treatment Advocacy Center).
That’s for state mental institutions? What about people lucky enough to have insurance? That covers short term hospital treatment, Anti-depressant medications take weeks to become effective, if the right drug works on the first try. So the patient leaves the hospital still too sick to function. Even after up to 14 weeks on Celexa (a popular antidepressant), only ⅓ of patients achieved remission, according to a 2006 study published in the American Journal of Psychiatry. About half the patients did see some improvement in their symptoms according to their scores on a depression inventory.
Psychosis responds dramatically to anti-psychotic medications. Sounds good, except for the metabolic syndrome the atypical anti-psychotics often cause–huge rapid weight gain with accompanying diabetes and cardiovascular issues.
So, let’s say you’re in a state or private hospital, desperately waiting to feel better. If you’ve been seeing a psychiatrist or psychologist as an outpatient, you’re unlikely to see your doctor in the hospital. In this line of work, the most inexperienced doctors tend to treat the sickest patients. Once the doctor’s practice is established, she doesn’t want the time-consuming hassle and low pay for “visiting” a hospitalized client. The doctors who make money see most or all of the patients on a given ward–no travel time, short sessions, one after another. There are no private offices for the patient and doctor to actually discuss anything. The doctor does a cameo in the patient’s room, checks with the staff, adjusts the medication. Next.
So, no room at the inn for enough time to feel well. The lucky patients go home. It’s a great relief if someone else is there to help them with a sometimes overwhelming medication regime, make sure they eat, and sleep, and call the doctor if matters take a scary turn. That responsibility sometimes wears out even the best of relationships.
Where do the sickest patients end up? On the street, in the prisons, and in nursing homes. Every so often, someone goes psychotic and shoots up a public space or takes down an airplane. Such events increase restigmatize the mentally ill, making sick people even less likely to speak up when they’re feeling desperate.
Mentally ill patients living on the street–one-fifth of the homeless population according to the Department of Housing and Urban Development. Rick Jervis of “USA Today” tells us 2 psychotic men. David, 56, sleeps on a park bench for 22 years so he can conduct “a long term socio-economic study.” Miguel, 56 lives in a underpass since “federal agents stole his identity.” Jervis tells us about “suicide bridge,” the Colorado Bridge in Pasadena for those who can’t take it any more.
How about Mr. Roberts, a bipolar young man imprisoned for flicking a cigarette at a cop, He spent 97 days in a county jail, alone in a cell 23 hours a day. He refused his bi-polar medication because he thought the staff was trying to poison him. The maximum sentence for the man’s crime (the cigarette hit the officer’s hat) was a week less than he was already incarcerated. The staff said he became increasingly “bizarre.”
Chief U.S. District Judge Marsha Pechman had something to say about that. “Jails are not hospitals, they are not designed as therapeutic environments, and they are not equipped to manage mental illness” (“Wall Street Journal” Ap.20.2015). Ironically, the required competency hearings, when they finally get scheduled, may be the only mental health service some people receive. See Rhona’s post “Chicago’s Criminalization of the Mentally Ill,” which quotes the Cook Country Sheriff: “The largest mental health provider in the state of Illinois is the Cook County Jail.”
So that’s a vignette or two about the street and about jail. How are we doing on the nursing home front? The 2004 National Nursing Home Survey found that 55% of nursing home residents have unmet mental health services needs. In any given month 4.5% of mentally ill nursing home residents receive such services, over a year, 19%. Of the 996,000 new admissions since 2005, 12% had dementia only, 19% had mental illness alongside demotion, and 24% had one of 4 diagnoses: schizophrenia, bi-polar disorder, depression, or anxiety.
What if you’re rich, young, bright, and lucky? How are the privileged amongst us doing at prestigious universities? On college campuses, suicide is an epidemic. MIT had 6 suicides in the past year; 3 from the same George Washington University dorm killed themselves in spring 2014. At Yale, a sophomore suicided while home over winter break (“Wall Street Journal.” Ap. 27.2015). Mentally ill students who take a leave of absence are faced with another challenge. Yale’s re-admission policy requests that students spend their leave “constructively” and submit a new application when they return. Evidently, whoever put that policy into effect hasn’t experienced the deadening paralysis and hopelessness of a major mental illness.
The pharmaceutical companies seem to have lost their way, churning out expensive variations on the same few formulae. Some have cut their research on mental illness meds because they don’t yet know how the brain works. Dr. Insul in Science sums it up: There are very few molecular entities, very few novel ideas, and almost nothing that gives any hope for a transformation in the treatment of mental illness.” (Read Rhona’s post “Few Psych Meds Coming Our Way.”
Is there any good news? Those courageous famous individuals willing to let the world know that they suffer from a mental illness may be doing something about removing stigma. It’s nice to have a stunning bi-polar symbol like Catherine Zeta-Jones. Even bad news Robin Williams added to the public dialogue. But how many famous and beautiful psychotics make the news? And the well-known, glamorous anorexics make things even worse for the thousands suffering from that scourge.
This post is so, yes, depressing, that I can only finish by honoring another national day. Yesterday was National Apology Day.