Mental Health, Pills & Gun Violence
Obama, what about our broken mental health system?
By Jessica Kasevich
Why are there more shootings today? Are people crazier than when we were kids?
Do we create laws that limit the amount of screen time children engage in, viewing violence as a form of entertainment? Do we reinstate our mental health institutions that were deinstitutionalized in 1955?
Yes, deinstitutionalization! What is deinstitutionalization? Deinstitutionalization was the process of moving mentally ill patients out of mental institutions, (We all remember One Flew over the Cuckoo’s Nest) and into the community which started in 1955. The goal was for the government to “save money” on hospitalization costs as they believed outpatient treatment with a therapist and a psychiatrist would be cheaper and more liberating for the patients. They also believed that it would be cheaper to pay this population’s disability benefits to help them pay for their basic needs over costs of an institution. If you are not aware, being severely mentally ill qualifies one to receive disability benefits.
Another influence on the movement for deinstitutionalization was the development of anti-psychotic medications. These new drugs allowed patients the opportunity to overcome their debilitating psychiatric condition and strive to become active members of the community (so was thought by the government at the time). How many people do you know who are severely mentally ill, receive monthly disability benefits and are actively employed?
Ten years after deinstitutionalization began the government realized that mentally ill patients were not getting the services they needed in the community. The government decided to mandate that Community Mental Health Centers (CMHC) become parts of communities to help this population. The government would and has funded these centers since 1965. Just like any other government organization there are cut backs leaving this population in an even more helpless state at present time? For those of you who do not know what a Community Mental Health Center is, there is one located on 3rd and Grand next to St. Francis Church. This CMHC is affiliated with Hoboken University Medical Center.
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What exactly is a Community Mental Health Center?
A CMHC is a counseling center where therapists and psychiatrist help individuals manage their diagnosis of: schizophrenia, schizoaffective disorder, depression, bi-polar, anxiety and many personality disorders, through medication and talk therapy.
Who goes to this center? Most of the patients at the CMHC are Medicaid patients. Medicaid is a government issued medical insurance given to those who make less than $900.00 a month. Recipients have to be citizens or, legal residents of the USA for five years. So what about the population of mentally ill patients that are neither? If you are mentally ill and do not qualify for Medicaid your will not receive government aid to pay for your anti-psychotic medication or therapy to help increase coping skills to address your illness. One may stay in a psychotic state for quit sometime until they are picked up by the police for bizarre or dangerous behavior and then will be medicated in the emergency room.
So, Obama has said that we need to change our mental health system. How about giving psychotic people access to free medication if they do not have insurance? Is this a national security issue? Maybe we should call Bush.
How does a CMHC work? At a CMHC patients whom feel that they need assistance venture in for an initial assessment. Yes, we leave this decision up to them as independent members of society to seek psychiatric help. By the way, most mentally ill people have limited insight to the fact that they are mentally ill and do not seek treatment. For example, usually once they start feeling better they stop taking the medication because they think they are cured when actually the medication is doing what it is suppose to do, WORK, relieving the negative symptoms of the disorder. In the assessment these questions are asked: How many times have you ever attempted suicide, have you ever had homicidal or suicidal idealization, HOW MANY TIMES HAVE YOU BEEN PSYCHIATRICALLY HOSPITALIZED? The last question admits that society will most likely fail this population. We never had to ask people who were institutionalized how many times they were a danger to society.
Waiting for treatment
After the assessment is completed an appointment is made with a therapist a month or two down the road. Think about it, If you were feeling depressed after you mother died and had two suicide attempts in the past, which shows limited coping skills to deal with stressful events, how would you react to seeking help and being told you will have to wait two months? We have seen in many publicized cases that impulse control of a mentally ill person is OFTEN none existing.
So let’s go back to the feed up patient who wants help but has to wait. Most of these patients never show up for their appointment when the appointments come around at the CMHC. I have sat as an intern therapist at the CMHC in Hoboken waiting for patients to show up who requested services months ago. Most of the patients who wait for a month or two ends up in psychiatric units because they cannot wait for medication or talk therapy to decrease their symptoms. So I guess we are really not saving money by getting rid of institutions because we are paying for hospital stays and prison terms when they become a danger to themselves of others: admission criteria for hospitalization and jail.
Hospitalization / Recidivism: First they go to the ER because they want medication to help with the depression or anxiety they can no longer manage. Then they take an “initial” psychiatrist assessment, pretty much the same questions as the ones given at the CMHC.
When I worked in Hoboken Hospital as a psychiatric screener I use to look back at the last time I did the same assessment with the same person. Many times within a month. Then they are admitted to the hospital for medication management to stabilize their depression or anxiety, GETTING RID OF SUICIDAL THOUGHTS that could have been avoided if they were initially given medication when they asked for it. The hospital stabilizes the patient on medication and discharges them to the community where their medication will not be paid for if they have no insurance. Therapy will also not be received. Oh, the cycle begins again…
So what is the answer to changing our system?
Do we continue to deny psychiatric medication to assist those who do not qualify for Medicaid?
Do we turn a blind eye yet again?
I would love to see Obama spend a month in a hospital and see how many uninsured psychiatric patients are wandering around. Would Obama discharge people into the community from a psychiatric unit if he knew that they were not going to be able to get their medication? ObamaCare or lack thereof!
Are we as a community taking care of those less fortunate? Are we suppose to? Who is?