When Mental Hospitals Resemble Jails

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A friend recently forwarded me this article from The Atlantic, arguing how the Cook County Jail in Chicago could be considered the “largest mental-health facility” in America due to the high percentage of inmates who have received or are eligible to receive mental illness diagnoses, as well as the massive size of the jail itself. The article examines the appropriateness or lack thereof of such an arrangement, mentioning an added layer of mental health screening, jail diversion options, and the admirable amount of “advanced mental health training” that the prison staff receives.

What immediately came to mind for me was not how jails can sometimes resemble mental health treatment centers, but how mental health treatment centers can come to resemble jails. I will share a true anecdote from a psychiatric hospital in a certain city in a certain Southern state in the United States. Without revealing too much, I will say that this particular state received a D grade for mental health treatment from NAMI in 2009.

The sad tale: An older woman of Asian descent, having immigrated with her family to America decades ago, receives regular government disability checks. Her physically and emotionally abusive father and sister demand that she turn this income over to them. If she refuses, they retaliate by having her committed to a hospital for being “crazy.” She is placed on a geriatric unit with older, far less functional individuals with dementia – many of them sleep through the day on heavy medication cocktails or are even placed in restraint chairs. Because English is not this patient’s first language, she has difficulty communicating her needs and story to the nurses and psych techs, and they often dismiss her as an annoyance. A rotation of fly-by-night psychiatrists have pressured this woman into receiving electric-shock therapy, a procedure that she hardly understands and instantly regrets. She complains of shooting pain throughout her entire body that makes it hard for her to sleep in the days afterward. Her involuntarily commitment order has long expired, and so has a follow-up legal request to hold her against her will. The doctors, nurses, psych techs, and social workers are ignorant of the actual legal steps to extend a legal hold, and no effort has been made to provide legal representation, or to inform the patient of her rights. She waits in an illegal, unethical state of limbo for over a month as she continues to receive pressure to conform to invasive and harmful procedures from medical staff that know almost nothing about her. Nobody cares. Nobody takes action. The facility never faces a single consequence. When insurance stops paying, the patient is discharged back to the home of family members who steal her money and beat her.

America’s Overmedicated Kids

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My first exposure to the impact of psychiatric drugs was in 4th grade. A classmate named Joshua, from a Jehovah’s Witness family, sat alone in the large grass field at school. Formerly more or less behaviorally on par with the rest of us elementary-aged boys and girls, Joshua was now sullen and isolated, spending all of his nutrition and lunch periods searching for four leaf clovers. He told me he was taking something called Ritalin. I have many memories through the years of other classmates from that time – how their personalities developed, what they ended up doing with their lives, etc. For Joshua, my memories end with him sitting in that field. He had become like the residents of the Doldrums in ‘The Phantom Tollbooth,’ a book I had read that same school-year, stuck in a ‘colorless place where thinking and laughing are not allowed.’

In an article on Governing.com, Chris Kardish reports that “more kids in the U.S., especially low-income and foster-care children” are on psychotropic medication than in any other country. That claim comes as no surprise to me, with our quick-fix mindset, our politically correct inability to blame anyone or anything for personal problems, our naturalism-materialism worldview that cannot conceive of anything other than a bio-genetic-evolutionary basis for mental distress, and our crumbling social infrastructure of intact families and the middle class.

The article is well worth a read. It primarily focuses on the increase in psychotropic prescriptions among low-income and foster-care children in the state of Kentucky, but touches on other states as well. Here are some highlights:

  • “I remembered thinking you shouldn’t be on more medications than your age.”
  • Children in the United States are on drugs for longer and more often than kids in any other country.
  • Between 1997 and 2006, American prescriptions for antipsychotics increased somewhere between sevenfold and twelvefold, according to a report by the University of Maryland.
  • A researcher at the University of Kentucky found that antipsychotic prescriptions for Medicaid children had increased 270 percent from 2000 to 2010, compared with 53 percent among adults.
  • “We’ve reached the limits of medicalization,” says Julie Zito, a professor of pharmacy and psychiatry at the University of Maryland. “We’re medicating poverty.”
  • Brenzel and others suspect that many of Kentucky’s prescriptions come from primary care physicians who haven’t performed comprehensive assessments to prove the drugs are appropriate.
  • … “atypical antipsychotics” promised better results with fewer side effects (both claims have been disputed), and aggressive marketing made them a common fix for routine depression and anxiety.
  • Children over the past decade have increasingly been given antipsychotics to combat aggression and other behavior problems, which are unapproved uses.
  • … the U.S. prescribes psychotropic meds at two times or three times the rate of Western European countries.
  • [In Connecticut, a report showed] a threefold increase in amphetamine prescriptions and a fourfold increase in antidepressants. Some of the children receiving prescriptions were as young as 3 years old.

Read the full article here.

The Trap of Medical Necessity

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When I worked in community mental health in North Carolina, I would try to help individuals and families by providing Medicaid or State-funded services from a moving smorgasbord of options. The system was in constant flux, especially in the era of ‘mental health reform’ at the legislative level. Some treatment options during my time included ‘Community Support,’ ‘Intensive In-Home,’ ‘Multisystemic Therapy,’ and more. Of course, the approved interventions, duration, and reimbursement rates changed seemingly every few months for these service options. One thing did not change – in order to provide such services, it must be proven that the treatment was “medically necessary” for the consumer / client.

Part of the process of proving medical necessity was the assignment of (at least one) diagnosis to an individual. Sometimes a psychiatric nurse practitioner might spend 30 minutes in an interview, or a Qualified Mental Health Professional would review an intake assessment, make a best guess of diagnosis out of the DSM-IV TR, and have that diagnosis signed off on by somebody with a higher credential. Within relatively little time, somebody as young as 6 years old could have a label affixed to them by a stranger. Such a label, indicating a disorder or psychiatric illness, might follow this individual through their entire lifespan, influencing how others view and treat them, and even eventually impacting how that person views their self.

In order to help suffering individuals trying to make sense of the hurts in their childhood and dysfunctional family systems, we were forced to provide a psychiatric diagnosis in order to get approved for services and ultimately receive financial reimbursement. Through the chaining of treatment to a medical / disease model of mental illness, I believe we risked contributing to long-term stigma and self-fulfilling prophecies in the lives of consumers – the very people we wanted desperately to help. To their credit, my co-workers would try to choose relatively benign diagnoses, such as Adjustment Disorder (unspecified, 309.9) or Mood Disorder (not otherwise specified, 296.90). But as legislative changes continued, certain diagnoses were not extreme enough to warrant the approval of treatment. Mental health providers were and still are incentivized to emphasize the negatives and downplay strengths in order to get treatment approval.

As one step in the right direction, I believe a category of “psychological necessity” needs to be recognized. A qualified counselor should be able to advocate to an insurance company or government agency that it is “psychologically necessary” for an individual to receive certain kinds of treatment. We need to stop forcing consumers through the funnel of disease model psychiatry in order for them to receive help.

Anti-Psychiatry / Psych Reform Reading List

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For those of you who’s interest in the Anti-Psychiatry / Psych Reform / Mental Health Abolition movement has been piqued by my previous post, here is a list of relevant books that I am currently making my way through. Some of them I have read and some I am just now getting around to.

  1. Insanity: The Idea and Its Consequences (Thomas Szasz)
  2. Toxic Psychiatry (Peter Breggin)
  3. Your Drug May Be Your Problem (Peter Breggin & David Cohen)
  4. Medication Madness (Peter Breggin)
  5. Guilt, Shame, and Anxiety (Peter Breggin)
  6. Unhinged (Daniel Carlat)
  7. Mad in America (Robert Whitaker)
  8. Anatomy of an Epidemic (Robert Whitaker)
  9. Psychiatry Under the Influence (Robert Whitaker)
  10. The Emperor’s New Drugs (Irving Kirsch)
  11. Saving Normal (Allen Frances)
  12. The Book of Woe (Gary Greenberg)
  13. Crazy Like Us (Ethan Watters)
  14. A Mind of Your Own (Kelly Brogran & Kristin Loberg)

Those should get you started!

Mental Health Abolitionism

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I can read about a new tragedy every day in the newspaper without batting an eye. I can respond to the latest political scandal with utter nonchalance. But show me an abuse in the mental health field and my blood starts to boil. Now, I do not have personal experience nor did I have family members struggling with mental health issues growing up, but something about the way God has wired me and my ten years working in almost every facet of the mental health field makes me rage against the system when I see injustice, when I see the blind leading the blind down paths of perpetual human misery.

Anti-Psychiatry is a well-known term and a label that would not be inaccurate to affix to me. However, it is too narrow. Psych Reform is broader and more positive in connotation. Still, I consider myself first and foremost to be a Mental Health Abolitionist (abolitionism being defined as a movement to end slavery, whether formal or informal). Those suffering from so-called mental illness are not only captive to intense emotional pain, distorted thinking, spiritual malaise, and personality dysfunction, but often to the very “treatments” deemed necessary to reduce their symptoms, control their behaviors, and protect society at large from experiencing discomfort or danger.

The unifying of rigorous Christian theology with evidence-based psychology, compassionately applied to benefit the mental health population is essentially THE cause I have dedicated my life to – call it “Applied Psychotheology.” In case I ever lose sight of my mission, I carry around with me the following letter written by a patient in a psychiatric hospital. Names and identifying details have been removed for the sake of confidentiality. I can personally vouch that none of the statements in this letter are exaggerated.

To Whom It May Concern:

               This letter is to inform you of the gross mistreatment of the patients in the ___ hall in ____ Hospital. I have been a patient since ____ at 10:15am. The lack of organization & compassion by most (not all) of the staff is horrendous.

               Most of the nurses have attitudes, they will not answer medication questions, they slam the doors in your face when you have the nerve to question the medication that they are trying to give you.

               Sometimes when the doctor comes on the unit, he either wakes you up @ 5:30am when you are half asleep, groggy off of medication, and asks you a series of questions, which is hard to even remember what you have been waiting to ask him all day/night. Other times, he pulls you into the hallway in a 3 min interview (if that) at the nurses station in front of other patients which is a direction violation of HIPAA privacy laws.

               The weekend doctors make promises of discharge and then the weekday doctors immediately come in and dash all hopes of leaving. How is that supposed to NOT cause agitation in a patient with an already fragile mental state.

               Some of the technicians (mostly on afternoons & evenings) look down on the patients as if we are sub-par human beings. We have a disease! Just like someone with diabetes or cancer, it is a constant battle everyday. These people are here to TREAT US, not leave us in a room trapped like caged animals. Since I have been here, there have been maybe 4-5 groups ran. Nothing at all dealing with coping skills or how to deal with our illness, just karaoke, coloring & arts & crafts.

               We are GROWN WOMEN! Some of us here voluntary for treatment & some involuntary, but all here for the same thing: to get medicine, therapy & to get healthy. What goes on in this ward can be considered GROSS NEGLIGENCE and abuse.

               I hope that someone actually takes the time & reads this letter, so the higher-ups know what goes on in the day-to-day activities in ___ hall … we have girls sleeping in the HALLWAYS! Women have psychiatric breakdowns every 3 hours and staff ignoring her! Nurses who refuse to explain medication & when we ask questions, noting we “refused” medication. As I write this the evening medication nurse just scolded me for refusing the very same medication that I “overdosed” on 3 days ago. Stating that I should know what I’m taking and to tell her what I want. Why should I tell you what medications I am prescribed especially when you have my chart? I AM NOT AN R.N.!! and this was done with 4 patients standing behind me hearing the entire thing, and I still had to remind her about a medication. Then she proceeded to slam drawers & throw down pills and slam water in what I can only describe as a tantrum.

               So, in conclusion, I hope that this letter brings these issues to your attention. We all feel that that this an environment not conducive to our recovery. We actually feel that this program is hindering our recovery.

               It may be too late for me to see a change but hopefully helps the next set of females that pass through ___ hall.

               Thanks in advance for reading, _____________________.

The Psychological Need for Aesthetic Beauty

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Sometimes it is hard to reconcile the natural beauty of creation with the spiritual call to not love the world or the things of the world, and to instead long for a heavenly country. Now, not to say anything about natural disasters, corrupt civilizations, or human depravity and suffering, there is within most of us a deep reaction to the remaining beauty of the created world: a breath-taking sunset, autumn colors at their peak, the vista from a mountaintop, etc.

In the creation story found in Genesis, what God created at the beginning of human history was good. More than that, it was “very good” (Genesis 1:31). As part of God’s original design, he “planted a garden in Eden, in the east, and there he put the man whom he had formed” (Genesis 2:8). Sometimes we assume that this was a wild, sprawling rain forest – we picture Adam being fully in touch with primordial nature like Tarzan. However, cultural studies of the Ancient Near East indicate that such concepts of Paradise have more in common with walled-in private (even botanical) gardens. Indeed, being left out alone in the wild of our planet as we know it today is not usually a pleasant experience – it is a struggle for survival against the elements.

Rather than untamed jungle in the Garden of Eden, we see the intersection of Nature and Design. “And out of the ground Yahweh Elohim made to spring up every tree that is pleasant to the sight and good for food” (Genesis 2:9). The Creator not only provided physical nourishment for the first humans, but also aesthetic pleasure – perhaps we could consider this psychological nourishment. Research does indicate that colors can affect our mood. The concept behind ‘seasonal affective disorder’ is that seasonal changes such as cold, gray, short winter days can impact our emotions and behaviors. Whatever the case may be, scripture notes that God specifically chose flora “pleasant to the sight” to be in the Paradise of his design. There is a human need to experience beauty.