Okay macht nichts
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Okay macht nichts
Sent from my iPhone using Tapatalk
Just a dog chauffeur that used to hold the dumb end of the leash.
From the perspective of the emergency department (where they all invariably end up), it is extremely hard to actually do anything. The real problem is more or less what pablo and lon alluded to - the lack of a long-term game plan for a chronic problem. The Emergency Dept is designed to diagnose + treat acute and/or life threatening problems and then send people on their way. When we get a patient who is altered/combative/intoxicated and in police custody we can load them up with haldol and versed and they will be super cooperative and easy for the next 4-8 hours, but beyond is not our job and not something we could fix even if we wanted to. The underlying problem never gets fixed and so they hang out in the world getting into increasing trouble with money/substance abuse/law enforcement/etc and invariably end up back in the ED in the not-so-distant future with some other acute exacerbation of their psych problem because it turns out becoming homeless and getting a crack habit isn't good for your schizoaffective disorder.
I can't speak for other states, but long-term psychiatric care, especially for those with severe mental illness, is extremely hard to get in CO. If your family is loaded you can easily find a private psych rehab center in Connecticut or whatever, but if you are of limited means you will be waiting for a long time. Hell even at the academic medical center where I am doing my preceptorship we have a hard time getting patients admitted to the psychiatry inpatient service.
We once had a guy who was ~26 y/o meth head with bad frostbite on his toe from walking miles and miles in the snow without shoes on - black and nasty and clearly needed attention. but podiatry wouldn't see him until the AM and he didn't really have a clear game plan for what was gonna happen once he walked out of the ED. It was one of the rare instances when the guy was young and clearly was self-medicating for underlying mental illness and might actually really improve with the right treatment, so my attending requested an M1 hold (emergency psychiatric hold, 72h). However, psych - who has to approve all M1 holds and admit them to their service - bounced him back to us, saying his problem was "98% meth and 2% mental health" even though the guy was clearly not high at all at the time and definitely had some pretty florid psych disease of some kind. Dude ended up wandering back out into the snow. I'm sure I'll see him again sometime soon.
Another time I had a guy taken from federal custody to the ED. He had almost completely chewed off his right index finger because "the voices told him to." I am no expert but it does not seem to me that the mentally ill in our prison populations are exactly getting very much in the way of good psych care, either...
Last edited by Nephrology; 04-26-2016 at 07:49 PM.
Treatment of the mentally ill sucks in this country. With the mentally ill you have the ones that are truly dangerous and the ones that are just trying to get by but when confronted by an authority figure will react in ways that make no sense to regular people. The CIT program can definitely help. It is a tragedy that in too many areas the police who gets called when a person is in crises. It would be nice if there was someone else that friends or family can call to deal with a situation that is not a criminal act requiring a law enforcement response.
Unfortunately, stigma is also a big factor. It causes some to avoid treatment and in some cases effects how an officer deals with an EDP. A couple of examples, I have a friend who has schizophrenia. As long as he takes his medication he can take care of himself. However, his demeanor is off just enough that he has had people call the police when he has been doing normal, routine things like shopping or going for a walk. He is to the point now where he rarely leaves his apartment unless he has another person with him because he knows he will not react "properly" when dealing with the police. I have a close family member with mental illness, including psychosis. The most recent time they tried to get help, it took dozens of phone calls to find a doctor willing to take a new patient. When he finally found a doctor who would see him, the earliest appointment available was 4 months away. That is a problem when someone knows they are going into a crises and just wants to get some medication and therapy. He actually had several doctors tell him that the best way for him to get treatment would be to go to the ER and tell them he was a danger to himself and others. I don't see how that will have a good outcome. This family member has a full time job and worries about keeping it. The recommendation by the doctors made him distrustful of doctors and more resistant to treatment. I could see things getting out of control quickly if the police were called out to deal with him.
I don't know what all of the solution is, but better access to mental health services and involvement of family members would be a good start. In the meantime we get the police being the primary mental health service provider with all the costs and problems of dealing with the problem. The CIT program helps, but is still a long way from solving the problem. The is just the opinion of a civilian who has personal involvement with the mentally ill.
I don't exactly agree that the problem is "access" to mental health care, as I think that word gets overused. The resources aren't there, so there's nothing to "access" anyway. Our society has decided that the personal liberty of the mentally ill is the overriding concern, so we act accordingly. Even if the person has no capacity to act rationally in that liberty. Even if that liberty is used to self-harm or hurt others. The resulting chaos serves the political purposes of those who created the mess to begin with...another 'crisis' to address with more money, another 'program' or law, etc.
For VDM, our home-grown program was superior, in my opinion, because it was aimed at training the entire department, not just certain officers. It involved more contact with and learning from the actual mental health professionals working in our city, as well as more actual learning from mental health patients themselves, who recounted their experience with LE from their perspective. This was a far from hostile group, too. It was invaluable hearing first hand how that experience felt from the other side. Some of that is included in our "Memphis Model" program now, but every officer who has gone through both programs felt the original was superior. It was discontinued by our Police Commission in favor of CIT for a number of reasons, not least of which was acronyms and spiffy terminology. Our own program had stalled halfway through training the whole department due to cutbacks. Rather than re-start and accelerate the program, they chose the CIT approach. Involvement in the program is voluntary....so of course, no one volunteered. That left the probies, who can't say 'no'. Now, when dealing with folks in mental health crisis, I as a supervisor have to defer to some 26 year old millennial with a CIT pin and an inflated sense of their own experience and knowledge. Not a recipe for success in my opinion. Your city, and your program may differ, but my town could screw anything up. And we did.
The goal, in our jurisdiction, is to have all first responders (fire/EMS, police, sheriff) CIT trained. There is one CIT school put on once a month here with twenty slots per class.
The jails have become dumping grounds for EDPs. I have read somewhere that the LA County Jail system is the largest MH provider in the US.
It's an ugly, unwieldy system at the very best. Even in a longer term secure environment you have people cycling through their behavior patterns while the right amounts and types of medication are determined.
Medication eventually helps modify their behavior, but many of the acutely mentally ill are also homeless and have no access to the medications that work when released; have no one to 'force' them to take meds on the appropriate schedule and won't take the medications unless forced, due to the way it effects their perception of feeling 'normal' and functional.
Add in the use of recreational drugs and you have the recipe for a truly ineffective treatment system.
-All views expressed are those of the author and do not reflect those of the author's employer-
I've seen a handful of people do well with the social services in my city. Usually this is for people who haven't had length criminal problems, who are responsive to pharmacotherapy, and who are basically with it enough that they can hold down the job and apartment that these programs will help them find. Not common, however.Originally Posted by FNFAN
It truly is an ugly and unwieldy system. I couldn’t have said it better myself. Many mentally ill people are also homeless as a direct result of their mental illness. As far as recreational drugs, while some acute psychotic behavior can be caused by recreational drugs, A great many of the mentally ill are self-medicating as a result of lack of proper medical care and difficulty getting access to proper medication. Unfortunately, it can be very difficult to tell the difference and that difference can make a big difference in treatment options.
As for social services, that varies widely in availability and effectiveness. In my area, there is a group that provides mental health services for uninsured or low income people. If they are with it enough that they can hold down a job (for now at least), they have to find a private doctor who is willing to take new patients. That is very hard to find and comes with very long waits for treatment. Eventually, the person who started out able to hold down a job finds themselves out of work because their illness got worse from lack of treatment. But at least they can now get help from the mental health services group that serves the uninsured, provided they are still with it enough to go in and ask for help.
This problem of leaving the police as the primary group to deal with the mentally ill is a sign of worse problems. Yes, you will always have some that end up becoming a problem that law enforcement has to deal with, but many can be helped other ways. Having trusted family and friends to provide a support network can go a long way in preventing many from becoming homeless. It is also helps many stay on their medication and follow up with their doctor. Unfortunately, that would require people to take the initiative and care enough to help others. Our society has reached the point where that is asking too much of most people, It is easier to let the police deal with those embarrassing and annoying crazy people. Out of sight, out of mind.
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