Friday evening blues
Well, I’m leaving my office now — last day is kinda weird. Monday I start the new gig, but the first two days are intensive orientation days, so I won’t have any time to blog. But I will be publishing comments received either over the weekend or on those two days. So talk to each other! And I’ll be back on Wednesday.
Heart,
Me
liz | 5:33 PM | Uncategorized
The other side
Okay, I haven’t received an email yet saying it’s okay to run the following, so I’ll just say it’s from an advocate for SB 226 (not a legislator). The advocate writes:
I read your blog on AOT today and was curious to understand more about your comment … “Is Senate Bill 226 the answer? I can’t say.”
I honestly just want to understand – what are are your concerns about this type of legislation? The length of time? – the initial period is just six months which is not very long but might be long enough for prescribed medications to start really working. That too many people with mental illness would qualify? – statistics from Kendra’s Law show less than 1%. The way it is implemented? – follow-up is in the community wherever the person lives, not in a hospital. Most hospital stays these days are barely a week, anyway, hardly enough time to stabilize and think clearly enough to continue medications when discharged.
If you believe with the intent of the proposed law, that severely ill people should have treatment and SB 226 would require that they do if they have a history of hospitalizations, what is your hesitancy? Since this bill is meant only for the small minority of those whose lives are the most desperate and sad situations that yo u can imagine, (short of those who end up in jail or prison, which is often what happens with untreated mental illnesses) I don’t know why you wouldn’t think an assisted outpatient treatment law wouldn’t be the answer. What do you think a family member should do when their loved one is psychotic, talking to themselves, following the voices in their heads, becoming parinoid and delusional – other than wait until something dangerous occurs?
People who most often are affected by AOT lack insight that they have an illness and therefore do not want any treatments, especially medications. One of the best-known experts on AOT is Dr. Xavier Amador, and if you haven’t read his book, “I’m Not Sick, I Don’t Need Help,” it explains what this means for an individual, and for his family and friends who want to help them. Pages 31 and 32 of the latest 2007 edition of the book talk about the research about poor insight and the connection to the frontal lobe dysfunction in the brain.
liz | 4:40 PM | Uncategorized
Reader reponse to SB 226
HS writes:
Forced outpatient treatment is psychiatry’s unique attempt to enlist patient motivation and commitment. Non-compliance is an issue in all branches of medicine but only psychiatry has been allowed to FORCE treatment on it’s patients. Imagine legally requiring morbidly obese patients to comply with stomach stapling procedures to control their out of control eating which so taxes the medical system (diabetes, hypertension, worn out joints, sleep apnea, ripped pants seams.)
The hope, however, is that by forcing patients into psychiatric treatment they will “clear” and recognize the benefits of compliance with treatment. We all know forced treatment sucks, but don’t many people see it as part of their growth toward understanding their illness and the utility of medication? Ultimately, doesn’t it help people to avoid hurting themselves when they are really really sick?
liz | 1:26 PM | Uncategorized
Onward: The Mental Health Association’s response to my post
From Susan Rogers, of the Mental Health Association of Southeastern PA:
I just saw your post about SB 226, which the Mental Health Association of Southeastern Pennsylvania will be testifying against at the Oct. 2 hearing. You may want to direct the readers of your blog to this Bazelon Center for Mental Health Law Web link . It includes position statements from a number of advocacy organizations opposing involuntary outpatient commitment (IOC) — which SB 226 calls assisted outpatient treatment:
Also, this Web site belongs to an advocacy organization in New York State. They have firsthand experience with Kendra’s law:
I would also like to quote from an article in Psychiatric Services by Michael Allen, J.D., and Vicki Fox Smith (“Opening Pandora’s Box: The Practical and Legal Dangers of Involuntary Outpatient Commitment,” March 2001): “We have the technology to provide essential services and supports, even to the hardest-to-reach people, but we have failed to fund the effort to do so. Outpatient commitment appears to be a short-sighted solution that may over time also undermine long-term treatment alliances. We believe efforts are far better directed toward fundamentally improving our public mental health system.”
In short, forced treatment doesn’t work and SB 226, if enacted, would drain vital resources from the system – resources that should be used to improve and expand much-needed services and supports.
I really suggest everyone visit the links Susan referred to. The second one, in particular, has a list of myths and facts that puts many of the issues surrounding this subject in some perspective. Plus I love that format, because I’m always like, “Oh my god — I totally believed that!” Fun.
liz | 12:25 PM | Uncategorized
But wait!
I just quickly want to publish a response I sent to an email fro the people who support SB 226, who asked me why I didn’t wholeheartedly support it on the blog. Here’s what I wrote:
I suppose my reluctance comes from my advocacy work with consumer groups, many of which are led by or composed of people who have a history of involuntary commitment and horrible abuses as a result. I have always said, as you know, that hospitals are better than prisons. But let’s not kid ourselves: hospitals are terrible too. I have rarely profited from a hospital stay. There’s so much incompetence and negligence, it’s unbelievable. Most of the time we sat around watching TV. I could have done that at home. Nurses are burnt out and indifferent. Doctors come sporadically, and are often condescending and cruel. Patients who are “acting out” are inappropriately restrained. People are forced to have treatment that doesn’t help — that does, in fact, great harm. Is it better than prison? Of course. But this application of this legislation would not be confined to that dichotomy: prison or hospital.
Additionally, I’m uncomfortable with force or coercion being used when the health care system is so subpar and when we know so little about how some psychiatric treatments work. Also, given the influence of the pharmaceutical industry and insurance companies on type of care and quality of care, how can I have faith that forced treatment will be the right treatment?
liz | 11:25 AM | Uncategorized
It’s as though I have a crystal ball
Yesterday, in my psychiatrist’s office, I whined to him about my most recent post on AOT. I said, “Tomorrow I predict there will be two opposing groups sending me salty emails. I feel like I’m caught in the middle.” And lo, the emails came. (To be fair, neither group was salty, but I just like using that adjective that way.)
So let’s clarify matters. There are two camps I’m in contact with: those who support Senate Bill 226, and those who oppose it. Both make good points. And there’s clearly caring on both sides. But the bottom line is that I’m not prepared to either condone or condemn SB 226. I simply don’t have enough knowledge and information to do so.
So let’s play Court TV. The next post will be from one side or the other — whoever I get a “yes, you can publish my comments” email from first. It’s a random way to decide which group is the plaintiff and which group has the rebuttal. After those two groups chime in, we’ll open up the floor to further discussion — assuming there is one.
If not, I predict a Cute Fix in your future.
liz | 10:51 AM | Uncategorized
Depression Confession: Drew Carey
Drew Carey has admitted he suffered from depression and tried to commit suicide. According to MSNBC, he told Access Hollywood’s Nancy O’Dell:
“I was depressed for a long time,” Carey revealed.
In fact, both at 18 and in his early 20s, Carey attempted to take his own life by swallowing pills.
“Living in Hollywood, you can get disconnected from everybody. You can feel like you are the only one,” Drew explained. “So you feel it, you hold it in and you don’t let it go and you don’t try to find help because you think, ‘Oh man if I tell anybody, I’m going to seem like I’m weak. I won’t get a movie deal. I won’t get invited to…’ whatever goes through your head.”
But his experience, it seems, hasn’t taught him much empathy. When O’Dell asked him what he thought of “the Owen Wilson thing,” Carey said:
“It’s going to sound cold, but I wasn’t reading the paper going ‘Oh poor guy.’ I was thinking, I hope he’s learning what he is supposed to be learning from this whole experience and not wasting the opportunity to learn.”
Um , yeah. It does sound cold.
You know, I never liked Drew Carey. Now I know why.
Drew Carey talks about his darker days
liz | 3:54 PM | Uncategorized
Fun with Google News alerts
This headline popped up for my “bipolar” news alert.
Disc Of Silicates Found In Heart Of Magnificent Ant Nebula
In the article itself, there’s much talk of bipolar, but having nothing to do with mental illness. Worse yet, until I read the article (or, um, some of it) I seriously thought it was about ants — like picnic ants. Je suis idiot.
liz | 2:22 PM | Uncategorized
Are you A-OK with AOT?
There ain’t no controversy like the one surrounding Assisted Outpatient Treatment (AOT). Right now Pennsylvania is considering Senate Bill 226, which amends the act of July 9, 1976 (P.L.817, No.143), entitled “An act relating to mental health procedures; providing for the treatment and rights of mentally disabled persons, for voluntary and involuntary examination and treatment and for determinations affecting those charged with crime or under sentence,” adding provisions relating to assisted outpatient treatment programs. For the full text of the bill, click here. And please do read the entire text of the bill before making any judgments, pro or con. I think people don’t do that enough.
As I’ve said before, I have concerns about this type of legislation, but on the whole, am in sympathy with its intent, which is to get severely ill people treatment when they desperately need it — providing enough safeguards so people’s rights will not be trampled. I know it’s a tall order. Is Senate Bill 226 the answer? I can’t say.
Though I’m leaving the Prison Society tomorrow, my support for its mission — to better the lives of incarcerated people — remains. That includes making sure they have appropriate access to health care, whether for diabetes or schizophrenia. It also means recognizing that not everyone who’s incarcerated needs to be there. Many, many people get caught up in the criminal justice system for years — decades even — merely because they did not have access to treatment for their mental illnesses. The conditions within prisons are, I assure you, much more punitive and destructive than those in psych hospitals. I have seen both sides of this, and the ugliness of incarceration — and the incredible abuse and hostility people face behind bars — is hard to describe. The isolation, in particular, that mentally ill inmates are forced to endure is horrible. I know I’ve said this before, but it’s worth repeating.
The hearing for SB 226 takes place in Harrisburg on Oct. 2. I can’t go — new job, and all that — but if you have time and are interested in learning more, it would be worth the trip.
liz | 10:22 AM | Uncategorized
I got an email from the Pennsylvania Medical Society
And it said:
Recently, the Pennsylvania Medical Society’s Institute for Good Medicine studied the impact of pharmaceutical television advertisements on Pennsylvanian adults. The study was conducted through “The Patient Poll,” a periodic survey of Pennsylvanians on various health care issues. Pasted below is a news release on the findings.
A poll of Pennsylvania adults 10 years after the first direct-to-consumer pharmaceutical television advertisement ran suggests that nearly half of the participants have asked their doctor about a specific prescription drug or medical procedure they saw advertised.
But, instead of getting upset about this situation, one physician says it’s better for his colleagues to be prepared for questions.
“Most physicians are divided about whether or not pharmaceutical advertisements directed towards patients are good,” said Dr. Peter Lund, founder of the Pennsylvania Medical Society’s Institute for Good Medicine. “Some say it’s good to have patients informed, while others say it’s bad because of induced demand and incorrect self-diagnosing. Our advice to Pennsylvania physicians is to be alert to what’s being advertised and be prepared to answer questions since there’s a good chance they’ll be asked.”
liz | 4:15 PM | Uncategorized
