Over at Shrink Rap, the latest post is about Congressman Timothy Murphy’s bill to allegedly help chronically ill patients, especially the psychotic ones, access better care and help the community simultaneously. Really, do you think a Congressmen’s legislative efforts are truly interested in the mentally ill first? Get real!
I have written about this issue of AOT and conditional release several times, and some of them were tied into more pure political posts I have since redacted from my site due to the specter of those trolling for hassles just due to my political points of view, but I found this one from over a year ago to at least note what I started out saying at that point:
In there was this:
“I get it that some patients need strong coaxing to either begin or get back into treatment, but there is a sizeable percentage of C.R./A.O.T. people who aren’t interested in care, just either “get out of jail” passes, or deflections/diversions to avoid the reasons why a judge issued the order to begin with. And if they reveal no interest in what the treatment process involves and expects of the “patient” to commit to in order to benefit and be stable, well, then they need to go back to the P.O./judge and find an alternative that resolves the legal problems.
I don’t work for any court in Maryland or any other state, never want to, and expect people who come in for care to participate as asked for services, or they can offer realistic alternatives for treatment I am willing to consider, or they can go find another provider or drop out of treatment.
It is that simple. It is a shame there are colleagues who want to tolerate incompetent, irresponsible, and per the way the courts act most often, inconsiderate requests of providers who have the right to say “no” per situations presented. Just remember this, the people who are the loudest and most persistent in demanding questionable expectations of treatment interventions almost always don’t participate in the process themselves.
The most stupid and irresponsible decisions/laws are those made by people who aren’t affected by such decisions/laws, and don’t ask for input from those who are affected by the decisions/laws. Welcome to American politics and our legal system. And you wonder why we have the recidivism rates for mental health problems that involve the courts!”
Anyway, here is the most recent post from Shrink Rap (SR) to this issue:
You’ll see I am in the thread, saying the same things now as above.
But, while I kick myself in the butt for trashing some of my old posts, as they had applicability to mental health issues, as alas, I instinctively hate and distrust politicians to think they alone can fix mental health problems. Unfortunately, people don’t want to read about politics at a mental health site. So I have to tone down my rhetoric for my safety, some allude to me. Yikes to any and all who just support that attitude of both political correctness and expediency; they respond as quick as they hit the john for basic biological functions.
I noted some links to my first comment at SR’s thread above, and now offer some more, and I really do believe that Congressman Murphy might have some honest interest to help people. However, when out of clinical care environments as long as he has been for at least 15 years now, he isn’t completely aware and well versed what is reality and with limits, versus pie in the sky good intentions but very seriously negative outcomes. Here are some found today:
this one a repeat from the SR thread, but include here again:
and finally this one,
The last link has this to say:
“Several provisions in the Murphy bill are widely regarded as positive steps – funding for law-enforcement training, reauthorization of a program that serves students with mental health or substance-abuse issues on college campuses, funding for suicide-prevention programs and expansion of telepsychiatry grant money, among them.
But several others have generated much debate.
For many of those who have big issues with the Murphy bill, the trouble begins with its title, the “Helping Families in Mental Health Crisis Act.” Barber’s bill is titled the “Strengthening Mental Health in Our Communities Act.”
According to Vicki Smith, executive director of Disability Rights North Carolina, the difference in those titles “speaks volumes.”
The Murphy bill proposes a change to the Health Information Portability and Accountability Act, or HIPAA, that would give physicians and mental health professionals the authority to disclose “protected health information” to family members or other caregivers about a loved one who is believed to be in a mental health crisis.
The intent is to better protect that loved one, who, it’s presumed, requires help making good choices.
The Bazelon Center for Mental Health Law counters in a critique of the Murphy billthat “it is people with psychiatric disabilities who are often most in need of privacy protections due to widespread prejudices and stereotypes.”
And, Smith said, people with mental illness often do know what’s best for themselves, and that may run contrary to what the family thinks is best.”
As I wrote in my comment today at SR thread, we are just to reflexively put more faith and response to what family member CLAIM are the issues at hand all the time, and then put patients in punitive oriented systems to allegedly improve their lives? Yeah, well let me tell any objective and unbiased readers here, having worked in Mobile Treatment and most recently an ACT program that has these patients in Conditional Release (CR) systems mandating outpatient care here in Maryland (Not AOT, but damn close to me), there are more than isolated situations where family living with the patient are as incompetent, inappropriate, and downright just trying to abuse the patient through mental health services. Don’t believe me, talk to others who have done this work.
But, I am not interested in railing further, as have other topics to discuss today.
New issue of Scientific American Mind cover story on Burnout, here is the link as best I can provide
I can’t get to anything on the Net for full access to the story, but will at least give you these 2 pages from the article that I think is a good start for readers:
In there was this I will briefly retype:
“yet the reviews were not all glowing. The hospitals found the personnel cost of implementing CREW [Civility Respect and Engagement in the Workplace] to be a burden. Participants had to go out of their way to fit the sessions into their workdays. Applying the lessons to their day to day work life also required sustained effort. Given the occasionally irksome nature of the program, it is actually pretty impressive the CREW can be effective”
Read it as able, and get the issue if it really hits home for a reader dealing with this. I bought it ’cause I am tremendously burnt out with all the intrusions, clueless behaviors, and micromanagement by so many non clinical parties, it is amazing that people get better with mental health care as is per 2015. And now as related to the start of this post, we as clinicians have to treat people who are going to be forced into care even more than what CR in MD is doing now!?!?
Then there was this in the Jan 2015 issue of Psychiatric Annals, I will copy the front page of the article and allow you all to seek it out:
At the end was this: “Godding died while working at St Elizabeth’s on May 6 1899, at a time that preceded the discovery of psychotropic meds, psychoanalysis, ECT, and most of the techniques we now employ. Nevertheless, he seemed content with his work and with how his patients fared. Why did he, members of his family, and the staff that worked for him not appear to tire of their work? Without the availability of therapeutic communities, do we not increase the fragmentation and dissatisfaction in the lives of our patients, and also in our own lives as caregivers?”
Hmm, seems to tie into the concept of Burnout to me at least, and then above at the top, why are we court ordering chronically ill people who are better served more often than not in Asylums, sorry to use that label but sticking to the story above from Psych Annals.
And finally, this from Page 4 of the January 2015 issue of Clinical Psychiatry News, too big to copy for this blog, but I will type it out and give the source, and you can again look it up for more scrutiny (I can’t find a direct link after 5 plus minutes of searching CPN’s site):
from advisers’ viewpoints for CPN, the first from Lee H Beecher, MD–“Ultimately, the answer to this question depends on creating and maintaining access to effective professional care and social supports for the true health care ‘customers’ we serve– for example, people with mental illnesses and their families.”
WTH!? When I read that earlier this week, before the Sci Amer article and the Psych Annals article and then recently the SR post, I thought, “this guy is an adviser for a relatively well read periodical for psychiatry, is a physician, and writes we treat “customers” and not patients”?
So, to tie in this blog article fully, psychiatry is in trouble from the outside and inside, and we don’t have real allies and colleagial support now. No, we are being sabotaged and disrupted from so many fronts, Burnout is the kindest response from psychiatrists who are trying to make a responsible and healthy difference for the public, in the many facets we interact with them.
Oh, and by the way, one reason why I don’t have a Facebook page nor Twitter account, because you can’t sum up this concern and discussion in 140 characters nor make it pretty and “friend” friendly, because blogging requires time, energy, and even sometimes money. Hence why Facebook and Twitter are so popular, because you really don’t spend much time and energy just spouting off what is on your mind or just copy a Net picture or video literally in that moment. No, blogging requires you think and put those thoughts into sentences and presentation.
Plus, who needs the stalkers in your life. End of line…
FYI: this post took over an hour to write, so donations accepted as willing to offer. Just kidding!