Do we need to increase the number of psychiatric beds?
For quite a wile, psychiatric hospitalizations have been on the decline.
New drugs are responsible for a lot of this; what used to be untreatable is now often controllable. In addition, there is Szaszian PC mental-illness-is-a-myth thinking, which began to take hold in the early 1970s.
But many patients don’t take meds and/or remain in dire straits despite meds. In addition, because of the decline in psychiatric beds, many people don’t get a chance to become stabilized in the first place. The reduction in beds has been extreme:
…the number of public psychiatric beds available has plunged, to 11 per 100,000 people from 360 per 100,000 in the 1950s, according to Dr. E. Fuller Torrey, founder of the Treatment Advocacy Center, which lobbies for more investment in psychiatric beds for people with severe mental illness.
“There’s simply nowhere to put people with severe mental illness to stabilize them,” Dr. Torrey said.
“No one seemed to care enough a generation ago, when so many become homeless,” he added. “Now that they’re going to prison, well, these are horrendous tragedies, and if there were beds available, you wonder how many of these tragedies could be avoided.”
Dr. Torrey estimated that more than 90 percent of people with psychosis could be stabilized and discharged within a few weeks or so ”” that is, with short-term or acute care. This is a clinical point on which both sides of the debate generally agree: Many people with psychosis need acute care in a hospital, finding the treatments that help before returning to their families. The loss of psychiatric beds means less care of this type is available in many areas.
Dr. Torrey parts ways with opponents of asylums in that he favors longer-term institutionalization for the 5 percent or so who do not improve with acute care, along “with continual, unannounced inspections” to prevent abuses.
Seems reasonable to me. Just because there were some really bad abuses in the past doesn’t mean it would have to continue that way. Deinstitutionalization and homelessness have gotten out of control. Is the current policy really doing anyone any favors? I’m generally somewhat inclined towards the libertarian view of things, but it can easily be taken to extremes, and I think those extremes have been reached.
Of course, there’s the financial end of it, too. Who would be paying for these hospitalizations? Or is it a question of paying now, or paying later?
I remember when the left let them out..
they were all over my neighborhood in a bad area of the bronx
on nother note…
its hard to tell if we need more beds
when there is wacko strangeness like this
you can confirm the radar stuff, by reproducing the work
but its SURE makes things very weird…
even more so given other things prior to it.
Las Vegas Shooting Flight Radar Data
https://www.youtube.com/watch?time_continue=186&v=7iBul1OpYvY
i have no idea in this case…
it could be set up for filming the event and security
and have NOTHING to do with things…
OR.. it could be other things we dont want to see
which is a problem
since when we dont want to see things,
we tend to make it so we cant…
Problem with this is involuntary institutionalization. It’s not like a guy being dragged to ER with a broken ankle. It’s confining a guy and messing with his head, his personality, who he is.
And without any of the protections afforded criminals.
Who decides when eccentricity reaches the point of requiring capture and confinement and treatment? And who keeps politics out of this? Hell, see Telford grooming. Some people get the attention of the State and some don’t. While I hope the Brits don’t hear this…what if they decide people complaining about Asian grooming gangs need ten years in the giggle emporium? What’s to stop them?
“Or is it a question of paying now, or paying later?”
Yes.
We are paying much more than the cost of more psych beds in ER treatments, police intervention, municipal clean-up and monitoring (don’t go to San Francisco; some people have left more noxious things than their hearts).
The argument is over WHO formally pays the bill.
Much as I dislike government involvement in heath care, I’m not totally opposed to adding psych beds to Medicaid.
There will always be abuse of the system (forced but unneeded institutionalization, bad hospital staff, etc), and profiteering and unneeded use, BUT there is a trade-off on every package deal.
Right now, we need to move back to the sane proposition of putting the insane under care.
I agree that more institutionalization is required, but I’m also aware of “Be careful what you wish for” remembering quite clearly the sign that hung over the entrance to Der Fé¼hrer’s Hell:
“Arbeit Macht Frei”
They kept quite a few out of general circulation,
but, not to worry, there were more at das Kehlsteinhaus
@neoneocon: Just because there were some really bad abuses in the past doesn’t mean it would have to continue that way. Deinstitutionalization and homelessness have gotten out of control. Is the current policy really doing anyone any favors?
Screwtape sez:
My understanding is that a major factor in the closing of the mental hospitals was a Supreme Court decision in the early Seventies that said that people could not be held against their will unless they are receiving treatment. Custody alone was not enough.
“Who decides when eccentricity reaches the point of requiring capture and confinement and treatment? ”
Until we get to a point where this is not the first question asked, we will have homeless and 50% of the prison population will be psychotic.
Frederick Says:
March 20th, 2018 at 6:01 pm
Is the current policy really doing anyone any favors?
Screwtape sez: …
* * *
Never gets old.
@AesopFan:Never gets old.
Screwtape is literally timeless.
Sad part is that without med care, this is what we do.
people are alarmed because why?
but note, two forms of power, the power you have and the power you feel. the power you feel can only be felt by forcing people to accept something against their will, the other kind, doing what is right and they like, gets no reward
The squeaky wheel gets the oil, the bent nail attracts the hammer, the tall grass gets cut down, all speak from a old age to a new age in which the absence of such good power, everyone has to scream to have any power other than those who abuse it, who get to be distracted in a special way that “let them eat cake” while not said, sums up quite nicely!!!!!
put in translate:
The Irvine City Council
Gorodskoy sovet Irvina
ГородÑкой Ñовет Ирвина
Democrat areas are moving people around inserting them into living spaces against the will of the people they are to represent and no one thinks that is not normalized to that end? that slicing the salami has desensitized us to such? that the whole similar argument that came historically before this and this is a repeat is 1930s occupation satellite states.
Here they are equivalently moving people around like Stalin did, but within their power limits, which were different for Stalin, and they are even doing it for the same/similar spravka reason (which is not their reason, but the reason to sell it to the public by). the reason?
well humans (in the west) prior to the improvements had pedigrees, they knew their past and their families were important, but now, most of the non elite class have been reduced by feminism, changing breeding to randomized mutts (whether we like that description or not).
One must realize that this was the old serfdom concept. All such elite has to do after that is assert their pedigree, while everyone else lost theirs – even if they ended up being a prince with a “purple pimpernel on his posterior”.
Americans do not study (are now incurious), do not care to understand even academically, nor even believe any of it works – they are well prepared….
they fear tiny actors with pittance money of 100 million, and ignore pachyderms sitting on their chests preventing breathing that have real armies, real training schools, real billion dollar budget equivalents and complete freedom to act in any way they want to act without any fear of any real reprisal on any real action…
veddy interesting people…
Richard Aubry (voice 2 in this chain) epitomizes the freedom-to-the-max, trust no one over 30, anti-establishment thinking born in the 1960s. He seems entirely willing to have delusional psychotics living in cardboard boxes on the streets sharing drugs and hepatitis viruses because, you know, you cannot trust The Man with his Institutions who is unavoidably corrupt and cruel.
IIRC, I have previously posted on this blog some anti-Dr. Thomas Szasz remarks. He was a tenured professor of psychiatry at the School of Medicine of Syracuse University, who started the nihilistic foolery of “There is no such thing as (organic) mental illness” in the 1960s. His “Myth” book was published in 1961. I know this well, having been exposed to this nonsense as a medical student in a nearby school then. BTW, he did not ever resign his tenured faculty position. His writing (inadvertently or not?) boosted the irrational mob mentality of the 1960s: the Establishment is evil and must go! Uhuru! Freedom!
This nihilistic foolery, combined with the civil rights movement, yielded civil rights for the profoundly mentally ill, the guys who though they were Napoleons, who were empowered to refuse anti-psychotic drugs. State mental hospitals, sanctuaries for the crazies that provided food, clothing, shelter, 24-hour medical and nursing care, and a modest purpose in life such as tending a garden, were abandoned. The Beltway created ambulatory “Community Mental Health Centers”, which are a poor (voluntary, for psychotics!) substitute. My brother, a shrink, still works at one. He is of course paid with taxpayer dollars.
The first generation anti-psychotics worked, but had terrible side-effects, some permanent. Despite this evidence, ideologues like Szasz persisted.
Szasz had little effect on my medical school class, due to a very powerful (does that not sound odd?) psychiatry dept. About 20% of my class went into psychiatry! I did not give that the slightest consideration, in part because I witnessed a paraplegic woman in severe pain, a psych in-patient for a week pronounced a Freudian “conversion reaction” by all the chin-strokers, until better X-rays showed spinal cord compression and vertebral destruction by metastatic cancer. I did not want to join a profession like that. They would not/could not do basic neurologic exams, which would instantly have shown her paralysis to be of organic, not hysteric, cause.
It is ironic that the certifying Board is the American Board of Neurology and Psychiatry, and yet psychiatrists have so little neurologic knowledge.
Just read on Wiki:
“Szasz maintained throughout his career that he was not anti-psychiatry but was rather anti-coercive psychiatry. He was a staunch opponent of civil commitment and involuntary psychiatric treatment but believed in, and practiced, psychiatry and psychotherapy between consenting adults.
“His views on special treatment followed from libertarian roots, based on the principles that each person has the right to bodily and mental self-ownership and the right to be free from violence from others”
This reinforces the comments I previously posted.
Szasz caused immeasurable harm.
A friend from college has a 48 y/o daughter who is in the trenches with these people. Her daughter fixes meals from privately donated food twice a week at the First Christian Church in a small Sacramento Valley town that like much of California is overrun with homeless. At Thanksgiving last year the church was filled with a constant stream of them. According to her they are comprised of mentally ill people, many self medicating with street drugs, others simply drug addicts who have burned themselves out.
If you ask her why she does this, she will tell you that she can’t stand to see human suffering no matter the cause, but especially the mentally dysfunctional, that no one seems to care, not the government, the police, nor their families. They are the lost souls living under bridges, in tents, stealing to survive and buy drugs and food. They can’t function in most jobs, although many do work. She sometimes sees families with small children who are living in cars while one or the other parent works picking olives or other low pay work.
The truly mentally ill among these people need to be housed and cared for, if not for their sake, for ours. They are the ones who often break into homes and cars. The jails are full of them, and they don’t belong there. Szasz was wrong. Many of these people need to be institutionalized.
As to my friend’s daughter, she worked for 10 years as a nurse in an AIDS hospice back in the 90s. Were she Catholic she’d be a candidate for sainthood.
Seattle has about 9000 homeless people. Many are psychotic. Their lives are those of feral animals. Seattle will spend $275 million on the homeless in 2018. About $30,000 per person. Their circumstances may be somewhat improved but not to the level of a place to sleep, three meals day, and mental health treatment. Instutionalization is bad, but living on the street is worse.
For several years now police in our community, when they apprehend someone who is obviously in a psychotic state, simply drop them off at the Emergency Room of the hospital I work at. There they stay. Legally we have to keep them until we can discharge them in stable condition, or transfer them to an appropriate level of care. Which isn’t available.
We’ve had psychotic patients, including many who were quite violent, essentially living in our ER for months at a time. We aren’t equipped or trained to deal with them. Lots of injured RNs.
Thirty years ago I worked in an institution that had a locked psych unit where these acutely ill people could be admitted and eventually stabilized. Those facilities need to be brought back.
I have a close family member with schizophrenia so I have seen the system upclose. The following comments apply to severe organic mental illness such as schizophrenia or bipolar disorder with fairly effective medicines available not others such as severe depression for which IMO there are no effective medicines.
I was going to make a long post about our experiences but do not want to invade her privacy. Suffice it to say I have lived with a person I care deeply about who has schizophrenia for about 40 years so I know whereof I speak.
My family member is a female and as is typical she had her psychotic break later than men, in her late 20’s. Women also tend to have milder symptoms than men. Since then with a few terrifying exceptions she has been good about taking medicine so she functions fairly well.
And that to me is the key. If you go to websites like schizophrenia.com you will see that the almost universally family members want their loved one to take medicine. The stuff really works for the illnesses I mentioned and people who take it are much better off than those who do not.
The problem with finding a medicine is that there are no physical tests. You just try a new one and observe the symptoms. The risk of course is that the patient gets so psychotic that she will not take any medicine.
My bottom line is that we do not need more psychiatric beds. We need a way to get people with the illnesses I mentioned to take medicine. If they won’t take a pill, there are other ways. Most medicine has a liquid form, which is a lot harder for people to fake taking. Of course this brings up civil rights issues but if you compare the loss of rights to the damage of living on the street anyone who cares about the person will lean heavily to strong measures to get her to take medicine.
All is proceeding according to the plans of the Deep State. Nothing Americans can or have done has changed that.
If people try to fight it by promoting some kind of “solution”, that has already been accounted for in the fail safes.
The false choice is another Red vs Blue.
Some people get the attention of the State and some don’t. While I hope the Brits don’t hear this…what if they decide people complaining about Asian grooming gangs need ten years in the giggle emporium? What’s to stop them?
Americans couldn’t even stop a local New Orleans city from confiscating people’s weapons during Katrina. I doubt anybody else in the country will have the organization effectiveness to do much of anything when they come across the Deep State.
We need a way to get people with the illnesses I mentioned to take medicine.
Medicine isn’t going to cure spiritual problems.
It’s a temporary gloss over the symptoms, while providing a permanent crutch.