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Why in-patient help is not worth it.


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I was online looking at Austin State Hospital because I know someone who is there right now. It opened up in 1861 as the Texas State Lunatic Asylum. In 1925 it was renamed to what it is today.

Things have changed quite a bit since then. We have the new mental health parity law, but it boggles the mind (my mind anyways) at how we humans generally still refer to the old outdated map of what mental illness is all about!! Why have psychiatric institutions to begin with?? Why not just have a department in each medical hospital specializing in mental health just like any other disease. I do know that there are hospitals out there that do. Mental illness is physical and has to do with a very important organ in our body: the brain.

I've just been reading posts of folks here who don't get help (including myself) because of the lack of beds and treatment programs for those with mental illness. But it is my understanding that you have to have an addiction to get any treatment at all. And also in order to be admitted, you have to be a threat to yourself or others. Why wait until it gets that bad? What if we put off cancer until it was too late??? It's just not done.

Personally I avoid going to the hospital because it takes hours to see anyone, longer to get admitted, and even worse just wasting your time in a place where they just lock you up because they have nothing better to do with you!! Just because it safe?? It sucks! Things are going backwards.

We may have this new parity law, but what we really need are good treatment programs and more beds for those that need them now, not two hours from now, not two days from now, but now...

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Hi WinterSky,

Wow Mental Health care is some what different here. We have the unit (department) attached to the hospital. You can even walk through the main entrance of the hospital to get there. It is a mixed unit catering for all issues from respite to 24/7 watch. So you don't have to be in danger to gain access but there must be some kind of criteria I guess.

At times the doors are not even locked it just depends on the patient risks. Patients are even able to take escorted or unescorted leave for ranges of time depending on nurse assessment an approval from the pdoc. There is even a family room where if necessary beds can be made up and the family can stay a night.

There are down sides too though, having patients with all types of mental health disorders and illness living under the same roof (in different rooms) is kind of chaotic. For me suffering PTSD it became a constant trigger of situations from patient management to people in my personal space or people behaving in unsafe ways constantly. It is truly stressful when one is in a state of hyper vigilance.

Mental Health care is changing here still, at present decision makers are trying to close down this type of facility and move care back into the community. They believe that the healing takes place better close to family and friends. I am unsure of this new approach. I think there is a place for both models but I do know there is no way that I could of stay at home with my family when I was as unwell as I was.

The Mental Health unit although on paper sounds friendly it freaks me out. I do what I need to do to stay away. But when it has got real bad I would sooner sacrifice myself to type of care than burden my husband and children. Well it's not like I really have an option at that stage anyway.

Winter it must be frustrating to think people may die waiting to get the help they really right now.

Confused12

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Inpatient psychiatric care has its place. It used to have a bigger place, for better and for worse than today, but then with the advent of 1) modern psych medications, 2) deinstitutionalization, 3) managed care "reform" and the like, things have scaled back much. today, the hospital is probably best thought of as a safety container. It is a good place to be when you are psychotic or in serious danger of suicide, maybe not always from the perspective of the person who has to be there, but from society's point of view. It is an opportunity to keep someone safe while doing medication adjustments, both from a suicide risk and similar perspective and also from the perspective of having doctors right there if something medically goes wrong. It is a place where someone who is a threat to self can come off the crisis however briefly they may be able to stay. It is a place where treatments like ECT, detox can be done safely, etc. Some therapy gets done on an inpatient unit, but mostly it is a container.

Partial hospitals are wonderful things, to my mind. They are that step between outpatient and inpatient - where you sleep in your own home, but come for therapy 2-6 hours a day. Some communities offer this sort of thing as a transition, but many don't offer it. Far more psychosocial therapy can be done in such an environment than is possible to do on a unit which is much more about medication and safety.

There are deep historical reasons for why mental health has been segregated from the mainstream of health. I think it has to do with the way that much mental illness has no obvious physical manifestation - so people though it was a spiritual affliction or demon possession. It had more of a religous or moral character and was associated more with the soul, than obvious physical illnesses which left the mind intact. And, in keeping with the religous idea of a split between mind/soul and body and an afterlife, it wasn't as scary to think that your body was having a problem because your mind (which would survive death and be immortal) was still okay. but vice versa, that was more frightening, I think. Psychosis and the severe mental illnesses are really deeply frightening and hard to relate to for most people.

These days the science is such that the deeply rooted idea that the mind and the body are different things is very difficult to take seriously anymore. We know today that we can alter the mind by altering the brain, and vice versa, we can alter the way we think and show measureable brain changes. But old habits die very hard. Things are changing very slowly, but some progress is occurring. Advances in neuroscience and medical imaging (brain scans) are helping to make mental illness more legitimate, as are the invention of all the psychiatric medications that so many people are upset about, but at the cost of making mental illness into a new form of physical illness.

Another facet is that severe mental illness makes people poor. If you have a severe mental illness, you pretty much get disabled more often than not, and it is often chronic. This is not generally the case with physical illnesses, although there are many many exceptions to that statement. where I'm going with this is that poorer people are less influential on goverment who prioritizes less resources their direction.

The parity legislation is not trivial, by the way. It took decades to get that to be recognized. These things take generations to occur.

Mark

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The parity legislation is not trivial, by the way. It took decades to get that to be recognized. These things take generations to occur.

Mark

I have more to respond to from here later but do not have the time. I just wanted to say that I do not trivialize, nor did not mean to appear to trivialize, the new parity legislation here in the US. It is a very important piece of legislation and my point was that things are changing and we are making progress. We need to continue to make progress.

I guess the rest of my post was just about my own immediate needs along with my frustrations. I just wish the stigma would go away. I don't mind telling anyone that has had the opportunity to get the general idea of my personality, to tell them that I have a mood disorder. They don't seem to mind like they used to when I was a walking donut hole (as it relates to my sense of self within and my projected self). But back then they said never to tell anyone, so I did not.

Which leads me to another pet peeve of mine, when I was discriminated against in the workplace and placed on probation for the symptoms of my disability, thus losing my job later on. At the time I was still told not to tell anyone about my mental health issues. But years later I was told, well if they knew back then about your disability you could have saved your job. :confused:

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Well ... I for one am proud to be "crazy" and yes I do joke about it ( no disrespect intended) with my other "crazy" friends... our biggest joke with the Normies... is that they are just jealous cause the voices are talking to me....

I really do not mean any disrespect... but I find joking about it makes it easier for me....

As far as the hospital goes.. they will not admit you here if you are under the influance... however .. come back the next day and say I am going to kill myself... or Jo Blow and they Have to admit you....

I LOVE the hospital.. wish I could live there... but alas... I have no insurance... they run me off as fast as they can!!!

JT

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Well ... I for one am proud to be "crazy" and yes I do joke about it ( no disrespect intended) with my other "crazy" friends... our biggest joke with the Normies... is that they are just jealous cause the voices are talking to me....

I really do not mean any disrespect... but I find joking about it makes it easier for me....

As far as the hospital goes.. they will not admit you here if you are under the influance... however .. come back the next day and say I am going to kill myself... or Jo Blow and they Have to admit you....

I LOVE the hospital.. wish I could live there... but alas... I have no insurance... they run me off as fast as they can!!!

JT

Hi JT, was this post directed to me? I ask because you say you meant no disrespect. I am a little confused, why would I take offense. I, too joke around with those people around me. It's like when African-Americans might say certain things to each other, it is quite okay with them and they might find it amusing; but if you are white and you say those same things to them, it is considered racist and you might find yourself in trouble.

Similarly, I (and many others) don't like it when folks with disrespectful attitudes towards the mentally ill make jokes against any person with mental illness. We ALL have mental health, whether it be good or bad. Mental illness can happen to anybody, that is if you have a brain. Well I guess no one is immune!! ha! :P

I used to know a parakeet that had a personality disorder! She had anger management issues! :eek: They used to tease her because she was a hen. So she not only was discriminated against because of her mental illness but also because of her sex!! :D

Not to make light of a serious subject. :o

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Hi WinterSky, Wow Mental Health care is some what different here. We have the unit (department) attached to the hospital. You can even walk through the main entrance of the hospital to get there. It is a mixed unit catering for all issues from respite to 24/7 watch. So you don't have to be in danger to gain access but there must be some kind of criteria I guess.

At times the doors are not even locked it just depends on the patient risks. Patients are even able to take escorted or unescorted leave for ranges of time depending on nurse assessment an approval from the pdoc. There is even a family room where if necessary beds can be made up and the family can stay a night.

It used to be like that in the 1980's and 90's here where I live (in the US in Texas). I gather you do not live in the states? The last time I was in the hospital was in 2001 and the people there did not even speak proper English as if they didn't even finish high school. One lady was really quiet and mean, too. Back in the 80's they had folks work there (at the same hospital) who had college degrees.

There are down sides too though, having patients with all types of mental health disorders and illness living under the same roof (in different rooms) is kind of chaotic. For me suffering PTSD it became a constant trigger of situations from patient management to people in my personal space or people behaving in unsafe ways constantly. It is truly stressful when one is in a state of hyper vigilance.

This reminds me of a place I went to in the early 2000's where people were treated like crap and there were homeless people there. It was a day treatment place for emergencies only, and I was one of the people who they kept for overnight. They would not let you close the door of the room. And one guy kept bothering me so they moved everyone closer in and had security guards posted inside the units! :eek: I was there because I was afraid for my own physical safety after having read the autopsy report of my sister who died several years ago, and I was trying to figure out the truth of what actually happened; I was freaking out over it.

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Guest ASchwartz

It is true that, here in the United States, conditions found on in patient units of hospitals vary greatly. In my experience, those in large urban areas tend to be less desirable. I think that budgets and crowding have a lot to do with it, as well as financing. For example, I found that in patient in the State of Colorado was a lot nicer than in patient in New York City, particularly for city or public hospitals. It is a very difficult issue. At least, now, the amount of time on in patient is very limited and people get out as fast as two or three days.

Allan

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I LOVE the hospital.. wish I could live there... but alas... I have no insurance... they run me off as fast as they can!!!

that has been my experience. It is still the case that many people fear being "locked up" for good and avoid the hospital on that account (and others), but the reality I've seen (in my limited experience) is that the normal experience is that they force you out the door before you're feeling ready to go. Really the moment they can get away with it from a liability point of view, you're on your way home. I have worked with only one person (again, in my limited experience) who was mandated to involuntary long term state hospitalization lasting six months or more. That person had a very severe DID issue and was highly suicidal, and also unable to care for a minor child in his custody. I've seen lots of people mandated to a 3-5 day involuntary stay and lots of people stay in the hospital voluntarily for up to 2-3 weeks, but very very few staying longer than that. I've seen some hospitals that were not very nice, but have not worked in them myself. The hospitals I've worked in, inpatient, have been staffed by professionals and, while not super comfortable, have been decent places as these things go.

Mark

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Dr. Dombeck, I have finally been able to sit down and read your article. It's very good. With my psychiatrist it is a partnership. Although things are moving towards medicalization, I find that it is still subjective, based on what the patient says to the doctor. And it still seems rather inefficient to try medications to see if they work, only to find out that they don't. For example, I started on lamictal on October 14, 2008 and did not even reach a theraputic dose until last Saturday. And again it is being raised from 200mg to 400mg.

I think there needs to be more use of brain scans and the like. I don't know why that would be so expensive. I mean, we have so many other expensive medical diagnostics tests right now. It seems that the parity legislation will hopefully allow for this.

In your model for Medicine, I don't believe that it ought to be that way generally, but yes I find that this is so. I think the patient ought to be more proactive and understand why a doctor is taking a certain approach. Have you ever seen the program on Discovery Health called "Mystery Diagnosis"? It costs many folks a lot of money to find the right diagnosis only to find out that another doctor is wrong. Doctors are people, too. And they can be wrong.

This is the Information Age, and people are going to do research. Pharmaceutical companies are going to advertise medications so that people can research them and talk to their doctors about these other alternatives to treatments.

Lance Armstrong didn't win 7 Tour de France titles by sitting on his butt waiting for a doctor to tell him what to do. He did research. And so did others who had his best interest in mind. People die if they aren't proactive.

Just my 2 cents. What a bargain. :P

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In the early 90's there were still quite a few good in-patient programs and since then many hospitals closed and many of those that remained have become mainly "holding tanks" - places where people can be stabilized on new med regime and be kept safe if they have made a suicide attempt or have serious suicidal ideation. Not much actual psychotherapy goes on there anymore -- though I guess after a hospital stay, if someone has had a hard time getting into the "system", unable to get a therapist if they have been relying on community mental health and were on a wait list, it may bump them up to be able to get off the wait list or to attend a day program.

The wait list thing is really ridiculous -- if someone is in crisis "now" why should they have to wait 3 or even 6 months before they can be seen in therapy?

The other thing that we have noted is that there used to be more creative art therapists -- (art, movement, music, etc) and the hospitals hve reduced them. for example an art therapist we knew, left her job at a hospital and her postion was never replaced.

Appleby

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I'm hearing you Appleby. Entirely....

I guess when I started this thread, what I was really needing was to go to a safe place where I could go and get my meds sorted out, to keep myself from hurting myself. and just deal with the varying degrees of moods and emotions I have been feeling. The hospital setting doesn't work for me, because we all know that sorting out medication can take weeks. And they won't let you out to walk. And on top of that, the food promotes the problem of obesity, not healthy eating.

I've been trying to get into IOP (Intensive OutPatient) all week, now I don't know if I need it anymore. But what about if I get into a crisis again?? When I actually need it, there is really nothing there. :P

One can go to their favorite hospital for medical problems and get quality health care. But when it comes to mental health needs, it sucks.

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Phsyciatry is a tricky thing in my opinion.... what may work for one person may not work for another..... As I have stated somewhere else, I have been on 20 diffrent meds .. I still do not know if they have it right. And yes it does seem they tend to push meds and leave out the rest... the therapy etc... the follow up.. I mean if someone is suicidal and you send them home with some meds and do not hear from them again.. perhaps it would be a good thing to check on them... I know SOME of the professional care, however some are so tired of having their hands tied that they have given up.... Just MHO....

WINTER... I wasn't really referring to you... Just I am use to getting jumped on for saying things on other sites.. and this site is so much better about that. BUT some people get offended ( mostly Normies) when you joke about mental health etc.... was just trying to not start a fight with anyone! :P

JT

PS I really do not know what you can do in a crisis... except goto the hospital. But you do not want to do that....

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Hi JT, I hear ya about going to the hospital thing. But who wants to sit there for hours when you are in a crisis, waiting to be admitted to the hospital? It's like telling a volcano, "not now, we don't have time; you'll have to wait your turn" and then plugging up the top so that it doesn't explode. Does that work? Just an analogy is all.

But you are right I don't want to to that. But I would like to be able to go someplace and deal with my feelings when it needs to be done, and where I am not so alone. It would be easier if we humans were robots and they could just turn us off and throw us in a heap until they can get to us. :P

Maybe next time I am in a crisis, I will go check myself into a hotel for a night with my laptop. There I can write in my journals, take whatever meds I want, go to the lobby where there is a fireplace and just sit and think, perhaps shoot the breeze with someone I don't know or have any conflict with... :cool:

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I have done that before.. went and got me a motel room.. took a nice long hot bath and then put on something comfy and fell asleep watching TV.. Perhaps have a pizza delivered....

Around here we have a thing called the "clubhouse" where you can go from 8 am until 2pm.. get a hot meal.. play some cards.. socialize and talk to a councilor if you would like...

JT

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As a teenager I 'lived " in mental Hospitals for 2 years. Then in a group hom for a year. Geez it took at least anther yr. to feel like I was a part of the outside world after bein glocked up for so long.

Now, as an adult, I never, ever want to be 'locked" . It is funny, but true, stay away from certain words and u will be safe from being locked up. Don't say u are going to commit suicide, or going to kill someone. I can hurt myself like hell, and that is ok, as long as I tell everyone I see I did not do it to kill myself! Then they can't lock u up.

I have though had the unfortunate experience of A 5150 , a few times in the past year or so. IT is just an involuntarty psych hold , where you go in there talk to a few people, then your fate is decided.

Mine, I get out, mine are typically from self injury, and not to die. Again, using the right words saves me. YES< I am aware of how the system works.

My last psych hold was done in CCU , and stupid ques were asked. I mean very dumb stuff. LIke repeat the last three words I told u after a few min. later. Dumb stuff like "where are u" whats your name? ANd usually after a bad incident of SI I am better equipped to take on the world anyway. So it is hard not to laugh at these so called experts.

Ah well, My biggest goal is to keep out of the Hospitals, and i kind of been around the block a few times , so I believe I can answer them and keep out of there.

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I too know what to say and what not to say.... depending on what I want to do. If I do not want to get "locked" up I say I have no idea what so and so is talking about ... I have no intention of killing myself ( although the whole time I may be thinking just wait till I get home and can do it) ... Needless to say I no longer tell anyone when I feel that way.

I do not mind being locked up.. but I have Pocket ( the diabetic) and the rest of my dogs that need me. BTW I haven't been actually suicidal for a while.. I have thought I want to die.. but no plans were made. Well... I did take a handful of pills one night ( totally on impulse) and then made myself throw them right up. They probiably wouldn't have killed me anyway.. but I just HAD to do something.. you know a real strong overpowering urge....

If you want to get "locked" up... you are suicidal or homicidal... they have to take you if you say that... Surely these People know we know this stuff.... I know some of them think we are dumb as rocks.. but history shows that many famous and smart people had mental illness... Like Einstien, and I can't remember all of them but there is a poster with all of thier names on it...

I do not know ALL but I see myself as intelligent and I have common sense... At times I make bad choices.. or do things on impulse...

It just erks me... and I know some people are that bad off... but a lot of the Programs around here are tailored to people that have no common sense.. I joke about in out paitent they teach you how to brush your teeth, use a microwave and when to take a shower!!! But I am serious they actually do that.... Like I said I know some people need that... but what about the rest of us??

Many of us hold down jobs, and have families... even raise kids... Some go to school.... Other than my not wanting to do anything.. or go anywhere or socialize.. ( what is so bad about that??) MOST of the time I am ok... I may be manic or depressed but I am home and I am not bothering or hurting anyone ... and it passes --- normally...

Think I got totaly off topic... OH RIGHT we were talking about hospitalization.... There is not a wait around here unless they do not have a bed and in that case there are several other hospitals close.... I have tried those crisis hotlines... some are people that want you to pray with them... some just want to know what kind of insurance you have ... I did call one night and get a hold of a young man and talked to him for hours.. he did not send the white coats. And I felt better just talking to him.

You can always call me .. but other than listen I may not be able to help....

JT

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I think it's fairly universally agreed: "they" are idiots. :-)

Absolutely! We have sure seen this in my family. "They" in our case were relatives, friends (only a few), fellow church-goers, neighbors, and pastors.

In fact, a pastor was a primary offender, making things worse (producing feelings of guilt, then abandoning our family). Then, we got a double dose of fellow church-goers ignoring and avoiding us, because we objected (directly to the pastor with discretion) to the pastor's behavior. This continues 2-3 years after the pastor moved on.

"Their" response was the last straw that resulted in withdrawing from relationships with "close" relatives.

Keeping it clean, this is for "them": :D :mad:

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That is the truth in Texas and I never knew how bad it was until my husband got put in patient to a "hospital" here. He has called the police made reportsof kidnapping been able to cut off the phone, gas and electric from in patient status, can call and get out even when he is put in there under a court order, has no ramifications about not taking his meds even when they are court ordered. I hired an attorney to help with his care and had medical power of attorney of him, to which he can verbally revoke even in a mania state and have a doctor not talk to his own wife because he knows if I get involved his mania period will be over. No wonder we are ranked 50th in the US.

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Guest ASchwartz

Hi Everyone,

Having witnessed inpatient in many places I am aware of the fact that many of them leave a lot to be desired. This is especially true of the public hospitals that tend to be poorly funded and also tend to get the sickest and poorest patients, but, who are also mixed with many others, making for a complicated situation.

But, and here is my point, when someone is in real danger of committing suicide or of committing homicide, they are better off being in the hospital where they can be safe until medications are adjusted, started or whatever. I would rather have a former patient who was unhappy with the experience than to have one who killed themselves.

What do the rest think?

Allan

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I do not particulary like being away from my home.... however, the hospital to me is a place to rest. I have no stress, unless I allow people from home to bring it. I call them, they cannot call me... If I do not want to see someone on visiting day , then I do not have to. If they upset me they have to leave.

You are required to do the group things... but well I do not know how to explain it... To me it feels safe. I am protected.. from everyone .. wheater they are doing someting to me for real or it is my imagination...

There were a few times I wish I could have went and probiably should have.. someone would have tookl care of the dogs I guess....

But around here the hospital to me is nice... now you have some other patients sometimes that get out of hand.. but they are handled...

JT

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  • 3 months later...

It all depends on the place. I was in one psych ward that really helped me, i've been in another that was an absolute waste of time and i still want to smack those idiots in the head.

Unfortunately, you have no way of knowing beforehand if a place is going to actually be helpful or not and of course getting out is harder than getting in "Hey, you guys suck, so let me out now" ehhhhh doesn't really work.

Poet

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