Friday, June 3, 2011

Obligatory Yet Timely Mental Healthcare Rant [with update]

Mental healthcare has never been good in this country.  The HMOs effectively drove the final nail into its coffin.  There was a time when someone with mental issues would go to the Happy Place<tm> and stay there for a month or so, until some progress was made.  This was so long ago I only hear stories about it.

The reality of the situation is that mental healthcare has deteriorated into mere warehousing for people with ideas about hurting themselves or others.  And believe me when I tell you this: I have inadvertently become an expert in matters of mental healthcare.  Oddly enough this isn't even my field.  Although I find psychology fascinating, I come by this knowledge via my wife, whose main diagnosis is Dissociative Identity Disorder (formerly Multiple Personality Disorder).

One cannot get admitted to a mental facility unless there is suicidal ideation with a definite plan.  Otherwise the insurance will not pre-certify the inpatient stay (assuming, of course, there is insurance).  In the absence of insurance, the locality can provide coverage for the stay via Medicaid for the most part.

It's been about ten years since my wife saw the inside of a facility.   We both hoped that phase was long over.  Unfortunately it became necessary again recently.  The experience is even more alarming this time out.

Yes, there is bound to be change in ten years - one would hope for the better.  But not this time.  The intake was flawless, I have to give them that.    After that, things seemed to head downhill fairly rapidly, with small upward bumps.

There are a few places in the U.S. with Dissociative Disorders Units (DDUs) but none of them are closer than a few hours and insurance is a little picky about this.  As a result, it was back to the place from ten years ago.

As the HMOs were pounding the final nails into mental healthcare, the facilities became warehouses for the patients.  They were kept until they no longer felt like doing harm to themselves or others.  I am not making this up.  And heaven help the person who gets admitted on a Friday, as nothing happens on the weekends.  Nothing.

The intake people were nice enough to give me the name of the unit and information about visiting.  I felt good about this right up until I showed up for visiting hours.  Each of the signs for the unit said something different, some directly contradicting each other.  Every door I went through led me to a unit that did not have my wife.  One person told me she wasn't on the unit and turned away.  Fortunately a nice person made a call to find out where I had to go.

As it turned out, she wasn't on the unit I was told about.  At one point I swore that the next time I heard the word no, I would wind up being involuntarily committed.  Because of the incorrect unit and touring the entire campus, total visiting time was about thirty minutes.

While I do not expect every hospital to have a Dissociative Disorders Unit, my wife didn't expect to be the only clean person on a drug addiction unit.   Here's a fascinating little tidbit: drug and alcohol addiction seems to qualify for longer stays than most other disorders, mostly without insurance.  There does not appear to be a requirement for suicidal ideation either.

Here are a few small notes and issues:
  • patient hears staff mocking the contents of wallet and pocketbook
  • Most staff with MD after their name are arrogant, rude, and dismissive
  • Psychiatrist says the meds that have been working for years are wrong and some can't possibly work.  Tries to change to one med that causes zombification.
  • Psychiatrist, upon hearing diagnosis, asks if any of the alters are going to be a problem
  • personal effects dropped off at 8am didn't appear till dinner
  • some patients will wait days to see a social worker
  • family and friends are having difficulty locating the patients

Don't get me wrong - many of the people who are not doctors were quite polite, helpful, and informative.  I even observed a staff member talking to patients like actual humans.  But all of the above does not engender a warm feeling about this institution and the competence of its arrogant professionals.  Will they keep the majority of patients from committing harm?  Probably.  Will much more happen?  Probably not.

I will suggest one small improvement to the system: mandate weekend work, so the facility can do some good, as opposed to warehousing.

I truly hope to not type another word about this.


But alas, here I am.

I went to visit my wife today.  We discovered the reason why she was on the detox ward: because the shrink refused to prescribe her pain meds for her and knew she was going to go into detox.

Apparently this crowd took the hypocritical oath instead.

For anyone keeping score, here we are:  a patient comes to the hospital, the shrink refuses to prescribe meds that the patient has taken for years and throws her into detox from her legitimately prescribed medication. At no point does anybody check with the prescribing physicians.

On top of this, the patient has gotten absolutely no help for her actual admitting issue.  Literally nothing.  She was more than welcome to go to the AA meetings, though.  The place was a warehouse.  There was no therapy or much of anything else happening.  The most exciting moments of the day for the patients were the smoke breaks.  Even the non-smokers went because it was something to do.  This was not a healthy or healing environment.

I checked in with my wife to make sure she was ok (she was).  We asked again for pain meds and got the same runaround.  We signed her out and I'm typing this from my favorite chair.  My wife, meanwhile, is resting and dealing with all the symptoms of detox caused by the hospital.

I am not a lawyer but this smells like the definition of malpractice to me.   Someone needs to put this hospital and its insecure shrinks in line for the good of the patients.  The constant refrain was that the unit staff was great but the doctors were from hell.

We have long semi-joked that hospitals are the greatest deterrents against going into the hospital.   This really drove the point home.


  1. A sad state of affairs. Sounds all too typical, in an age of rampant greed and detached apathetic health care, governed and controlled by pharmaceutical companies who view us as guinea pigs and lab rats (expendable). Where are Hawkeye Pierce and John Carter? Alive and well in syndiaction. I wish you and you wife the best in your pursuit of help.

  2. Au contraire, correspondent. Health care in this country has, for the last 70 years or so, been excellent... compared to most of the rest of the world. There may be a country here or there that presents better health care in major urban areas, but for the most part, we have it good--better that most of the rest of the world.

    Which is to say that health care, in this country, is, in many cases, still abysmal. You could have started by just omitting the word, "mental", in your first statement, although I recognize that mental health care may have a particular hold on the word, abysmal.

    In the position of being responsible for the health care for a 90 year old parent, who has both physical and mental issues, I have had an almost weekly experience of interfacing with the medical community on many fronts for many years.

    The key to getting good health care, anywhere, is universally the same: MONEY. If you have it, you can get good health care. If you don't, you can't.

    If you don't have money, you can't get more than death-averting care unless you are a danger to the community at large which will add incarceration to the death-averting care. This is particularly true if they can get you out the door for less than about $2500.

    For people who exist somewhere between no money and unlimited funds, there is the "health care system" although "system" may be gilding the lily.

    With regards to treating mental illness, there may be some people who will tell you that having a mental illness no longer stigmatizes the patient. You can believe that if you also believe that there is no longer any racial prejudice. My opinion is that people with mental impairment should stay away from mental health care for as long as possible (understanding that there is a point when that becomes no longer an option--most of the rest of our population shares this opinion.) In other words, attempt to mimic mental health for as long as possible--most other people do.

    -- to be continued --


  3. -- from above --

    In Mumbai (Bombay), India, they deliver home cooked lunches better than the US delivers health care (See dabbawala.) You would think that India would be able to apply that to health care as well, but...

    Because of disability, my parent was late to a doctor appointment by 20 minutes. The doctor's office, who had not yet seen the two patients scheduled before my parent, said that we must re-schedule the appointment for another day. Because of where I live, it takes me 4 to 6 hours to get my parent to a 15 minute appointment with the doctor. At the re-scheduled appointment, for which we were on time, we waited an hour and 45 minutes to see the doctor. Um, actually longer--we were seated in an examination room by an assistant who took vital signs and then waited an additional 15 minutes after that to see the doctor. Total time at the doctor's office: 2 hours 20 minutes or another almost 6 hour day for me.

    However, I could compare that to health care in Africa which is mostly non-existent or ineffectual. Or Haiti. Or anywhere, there are clinics that operate on a first-come/first-served basis for the general population where the wait could have been for most of the day. At least here, you don't have to walk a day to a clinic and wait a day to be seen.

    The largest problems with US health care are capitalism, congress, and communication.

    Open a few government sponsored schools of medicine and give the education away for free, to children coming from families making less than $30,000 per year, in exchange for the graduated MD's operating in general practice for 15 years at a salary equivalent of say, $80,000 per year. Build one of those schools, with a minimum of 500 seats per freshman year, in each of the 50 states. I bet the seats would be full of qualified students. That would change medical practice in the US.

    Congress doesn't have the spine.

    My parent needs annual checks and follow-ups for vision deficiency, cataracts, and macular degeneration. Yet, for every visit to the same eye doctor (4-5 times per year), I must get a referral (an insurer requirement) from the primary doctor. The communication system for this, involving computers and networks, doesn't work. Every referral costs me 1-2 hours of my time and 30% of the time, mistakes are made that causes the referral system to just not work. It would cost less time and effort just to have people do it all with a telephone call, or better yet, realize that a referral for this stuff just shouldn't be necessary. Would people cheat the system? Yeah, probably, but which costs more?

    ...and that's one of six doctors. For the last three years, my parent has been hospitalized about twice a year (about 10 days total) for, so far, something different (visible symptoms) each time. Communication with hospital personnel is never easy. Despite my parent's inability to follow the explanation for any simple medical procedure, my relationship, and release forms, I must still jump through flaming hoops to get information.

    Hospitals changing medications without consultation is nothing new to me.

    Oh yeah, I forgot, my time is worthless.

    Weekends. People live for weekends. It's when, for most of them, when we were a christian-oriented country, time off from work was granted to clean house, maintain property, worship, relax and recreate.

    Saturdays for suppliers used to be half-work days--that's when the trades picked up supplies for the following week.

    Except for military, police, firefighters, and nurses... As a nurse since the 1960's, and still working (so we can maintain decent health insurance), my spouse works two weekends out of four. In better physical rehabilitation hospitals, the physical therapists also work weekends. Other hospital personnel are staffed at minimum on weekends as watchdogs of the systems they run.


  4. -- and yet a bit more --

    See, everybody wants the weekend off. That's when you have the opportunity to be with friends and relatives because they have the weekend off.

    My spouse has missed 22 Christmas mornings, 22 Thanksgiving dinners, 22 July 4th picnics, other holidays, and never gets a 3-day weekend. My spouse's days off are Tuesday and Thursday (not even two days together.) At least half of all weeks worked in a year are more than 40 hour weeks.

    It seems that nobody wants to be a nurse, a person who knows mostly sick people, who is constantly exposed to communicable disease and who therefore exposes the family to communicable disease, deals with unhappy patients and unhappy patient families (some of who actually have reason to be unhappy), and who helps patients with body fluids that no one else wishes to touch in addition to being subject to the other medical personnel with arrogant personalities. ...and does all that while other people are putting their lives in order and having fun. ...and somehow manages to remind me, every time I whine, that I have it better than most of the rest of the world.

    I really do wish prosperity on the rest of the world.