For those who go to Shrink Rap, also known as http://www.psychiatrist-blog.blogspot.com, they just can’t stop pushing their book “Committed: the Battle over Involuntary Psychiatric Care”.  Now they have a separate site just for their book.  (you can go to the above link and find it yourself, will not sell their message here)

Umm, does the word “pretentious” fit here, or am I being too critical?  (and yes, one can accuse me of being judgmental without reading the book, but, I got the gist in reading reviews they gleefully added at their initial blog site…)

But, they have made a little mistake, and with one of the authors, Dr Hanson, who is a Forensic Psychiatrist, well she should know better than what they are peddling.  As I have been working in the State Inpatient setting now for 8 months with another 3 to go, it is about enforced care, not involuntary care.

Because the State of Maryland, as well as many other states I would suppose, have just made psychiatry a weapon of at least figuratively, if not really literally punishing people.  At one hospital, Springfield Hospital Center, over 95% of the patients are court ordered to care.  Think about that percentage for a moment, the State has used a facility that was previously intended to treat chronically ill mental health patients now solely for forensic use these past 10 or more years now.  So, if you or a loved one has a serious mental illness, like schizophrenia, and haven’t committed any  crimes, it is highly unlikely such a patient can get needed intensive care services that inpatient care often is essential to access to get stabilized.

Nope, you will instead need to commit some type of crime, maybe just trespassing or minor destruction of property, don’t advise some minor assault, but, after getting arrested and spending time first in a county or city jail, then you can have a judge court order you into an assessment for competency, or better yet, define if you are Not Criminally Responsible (NCR).  If you were to go to some General Hospital or Private Psychiatric Hospital, and had a chronic, impairing mental illness, they would only keep you in the hospital for at best 2-3 weeks before finding some creative way to discharge you back to the streets.

Well, sometimes a patient does get kept for a month or more, but that is because such a patient would need to be so pervasively and persistently dangerous to oneself or others, usually by repetitively harming oneself or assaulting staff and other patients on the unit, that the liability to release such a person puts the hospital at risk too!  Gee, more legal issues to drive clinical care decisions!!!

Wow, gotta love the system the way it operates now.  It isn’t about doing what is best and most effective from a clinical care point of view, but, what is legally, administratively, and bureaucratically convenient and protective.  Hmm, why politicians were able to force Obamacare on us, eh?

That’s another post, so, back to Enforced care, just remember this, again from my opinion point of view, inpatient care is about what you have to do, not what you chose to do.

Imagine being hospitalized for a cardiac problem and having to take meds and see the cardiologist once a month for 5 years.  Get the perspective now?…

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