Actually, it’s more embarrassing than that.
Schizophrenics, for instance, tend to recover better if NOT treated by psychiatric medicine.
That says that certain schizophrenic people may not need medication. It does not say that medication is unnecessary to treat all schizophrenics. It also does not says (at least in abstract) whether this same group might’ve done better with medication than their current improvement/lack of decrement. In other words, try this with another person and they may get much worse.
Well, I can tell you mental health is also a ‘Cinderella’ issue in the UK.
Despite having a universal state funded health care system that is regarded by many like a secular religion, if not a merely a fundamental right. The mentally ill, if their disturbed behaviour affects others, are often failed by mental health services, the pieces are picked up by the police and the prisons become social trashcans.
I once had the misfortune to see someone go through a progressive mental decline that was threatening to others. Given to paranoid raving, drug and alcohol abuse she menaced many who knew her. Someone who was once a respected and articulate professional began to keep the company of criminals and drug addicts. Inveigling them to join her to punish people from her life who had done her wrong or, indeed she suspected of doing wrong to others. Some kind of narcissistic personality disorder has turned what was a nice person into a menace who was given to making abusive phone calls, emails, sms, slanders on social media.
She became a female stalker, visiting peoples homes late at night and hurling abuse and threats, vandalising property. Everyone affected agreed to record the incidents and report each one the police. She was arrested many times. The police were heartily frustrated with her antics. I counted at least half a dozen people being targeted, mainly men. People tried to talk to her, some of the mature, wiser women who she might trust. But her she was unshakable in her beliefs that great evil lay in others and she was the person to confront them.
After one of many incidents, I discussed the matter with a police detective. What could be done for this person who was quite clearly a danger to herself and others? Would she see a doctor? Could she get help? His reply was not reassuring. They could only act on reported crime and that had to work its way through the judicial system. There is little provision for emergency mental care, least of all for someone who does not accept that they are ill. Even when the it goes to court and the judicial system takes its course, often they are released on condition they accept treatment. The emphasis, for a few decades now, has been on community based treatment rather than institutional. I shudder to think what the consequences might have been if she had access to a firearms. Sad to say, it ended in a suicide. I cannot help but think that this was someone who was clearly in a mental crisis, yet there really was not a public service that was equipped to help her.
These sort of cases perplex and frustrate social workers, police, the judiciary, prison staff and the friends, family and community in which the person lives.
The US with its easy access to guns seems particularly blighted with an alarming frequency of homocide at the hands of the mentally deranged. Other countries have the same problem, but the incidents are less frequent because possession of guns is heavily restricted. Nonetheless, the UK has had some terrible incidents when people have gone on the rampage with guns. It does not get much worse than the Dunblane incident.
Even in peaceful places like Norway, these outrages happen. Rare, but quite devastating and deeply shocking.
However, the incidence of homocidal rampages is not a good measure by which to judge mental health services. They are public outrages, but they are small fraction of the huge number of people who harm no-one but themselves and suffer quietly, often with little support.
It is very much the case that the options for treatment are limited and mental health care is expensive. Quite apart from people who suffer from problems during the earlier part of their life, the increased longevity and consequent aging demography of most developed economies is making the mental care of the elderly a rising public policy issue.
If any country has an answer to this, I would expect the world to beat a path to their door.
I’m not understanding how a better safety net wouldn’t help these people. Maybe it wouldn’t cure them of their problems. But surely having shelter, food, and access to healthcare is better for one’s mental health than homelessness and marginalization.
Even if treating an illness is not possible, psychotherapy can still help by providing support, so that an individual doesn’t deteriorate and can maintain a basic level of functioning. A therapist can help keep a patient on his meds. Or help coordinate care providers and support programs. Or just be a kindly soul who listens without judgment when there’s no one else around who will.
People who are “in the system” have social workers who are trained to provide these services, but they’re overworked and underpaid. Maybe they only meet with a client once a month.
If a person is living in a roach-infested flophouse on $50/month of foodstamps, totally cut-off from family and largely ignored the world of the sane and the sober, it’s no wonder he or she wouldn’t recover from their illness. Why would they?
The idea that we should throw up our hands if we can’t “cute” mental illness is, well, crazy. We don’t have this model for other illnesses/conditions. If a person is mentally or physically disabled, we make accommodations for them. We say they are “differently abled”. Perhaps this is how we should start conceptualizing some mental conditions.
Compared to the UK, Norway is awash with guns. Something like 5x as many per capita*.
*This figure specifically England & Wales.
One important reform should be making “disability” a non-binary condition. At present, the assistance criteria generally consider that people are either disabled and hence unable to work at all, or not disabled and no disability assistance for you.
But many disabled people, especially among the mentally ill, aren’t so incapacitated that they can’t work at all. And even sporadic or infrequent paid work does a lot for workers’ self-esteem and healthy lifestyle—and again, this is often especially true for the mentally ill.
Disability benefits should be reduced in proportion to earned income: e.g., for every dollar you make working, you lose seventy-five cents on your disability payments. This would incentivize disabled people to do some paid work if they could, without penalizing them for not being able to work full-time or consistently.
I recommend hunting out this book:
The Art of Asylum - Keeping: Thomas Story Kirkbride and the Origins of American Psychiatry
The author, as I recall, suggests that in good nineteenth century asylums, staff (and local volunteers) convinced themselves that patients were being cured by being given a period of pleasant low stress rest*. In and around 1900, a series of scientific studies came out showing that the patients weren’t really being cured. True or false (should a long remission be counted as a success or a failure?), this led to loss of public support, lower staff morale, and worse care.
I’m afraid that the best physicians may no longer be going into psychiatry because the income there is so much lower than in many other specialties. I think that Medicare and Blue Cross should adjust reimbursement so that the specialties don’t vary in pay, except as needed to address shortages. This would require reform or elimination of the RUC committee process which values surgeons and cardiologists the highest on the supposed basis, as I understand it, that the work is more difficult and stressful.
- No meds? Actually, they used herbal extracts that may have had similar effects to today’s medications, but were more difficult to titrate. In other words, it was hard to give the right dose since the strength of each batch varied.
Could I see a cite that psychotherapy prevents deterioration of schizophrenia, and that schizophrenics who receive psychotherapy are more likely to maintain a basic level of functioning? TIA.
Regards,
Shodan
The statistic refers to the population as a whole and not to individual cases, that is correct. In general, your recovery is more likely if you do not receive psychiatric medication. The study did try to control for severity and other factors as of the time of the divergence so as to prevent the subpopulation who were prescribed meds (and took them) from simply being the more impaired group, but I think it’s otherwise an undifferentiated aggregate.
It doesn’t, therefore, mean that if YOU are a schizophrenic YOU are more likely to recover if you stay away from psych meds. It does appear to mean that if we know nothing more about you than the fact of your diagnosis as a schizophrenic, the ODDS favor your recovery more highly if you stay away from psych meds.
Well, no. If you read the abstract it clearly states that the authors feel they have identified a subgroupof schizophrenics who may be able to experience long periods of remission without meds. From the abstract it’s unclear exactly who this subgroup is (“favorable outcome is associated with…favorable prognostic factors”. Alert the Nobel committee!). Presumably if you read the article you could make a more informed decision about your personal situation, but these authors are certainly not claiming that schizophrenics in general should avoid medication.
A bit of a tangent to the OP, but relevant to the extent that the context is gun control…
Adequate mental health diagnosis and treatment is a challenge almost everywhere. If universal health care doesn’t fix it (it doesn’t) then good luck trying to fix it in the US. The issue of those with serious documented mental health problems being able to easily obtain guns is just part of the outrageous ridiculousness of the US gun fiasco, but it’s only part of the problem. Mental health is a continuum, not a black-and-white distinction. A perfectly “normal” individual who might be just a little bit wonky could turn a whole lot more wonky after a series of misfortunes over time, or very suddenly as a result of discovering an unfaithful wife or treacherous co-worker who causes him to be fired in what he construes as a career-ending event.
As I mentioned in another thread, the ready availability of guns is what ultimately enables guns violence, and while mental health treatment is a noble cause, it’s not going to do a whole lot to end gun violence. Every time I hear the hackneyed old phrases about “responsible gun owners” and “law-abiding gun owners” I have to laugh in a black-humored sort of way. I think of the mother of the Newtown shooter, who was a suburban upscale parent and surely thought of herself as being both “responsible” and “law-abiding”. And now she’s dead, along with a bunch of kids, and along with thousands of other “law-abiding gun owners” who were perfectly law-abiding – that is, until they or some close member of their family started shooting people.
hm, just wrote a detailed response to the OP which seems to have been eaten by gremlins and instead reposted my earlier post. Will try later, maybe.
While I’m ignorant about our own mental healthcare system(s), I am even more so about other countries’ systems. But I think it would be useful to learn by example. Assuming we have a way of sorting them well.
Thanks, this is exactly the sort of thing I was looking for.
Regards,
Shodan
The specific cite I gave you might not have been the best one to give—this one appears to be a better cite for it based on this blurb referencing it but there’s no direct info on the referenced page—but at any rate it is true that, all other things being equal, schizophrenics tend to recover at a higher percentage rate if NOT receiving psychiatric treatment than if they DO.
It is furthermore true that the medications prescribed for schizophrenia create neurological dependency which in and of itself interferes with recovery.
The system is not “binary,” at least not in New Jersey: I worked for two years in a sheltered workshop. Many of the clients there received disability benefits. Half their earned income was taken off their benefits (for every dollar they earned, fifty cents was cut from next month’s benefit).
Hurray for head-meds!
The second longest stretch I’ve gone seizure-free since I was diagnosed with epilepsy was seven months during my sophomore year of college. I had gotten frustrated with pill popping and stopped taking my medication. :rolleyes: (Then I had six seizures in one day) <sigh>
Most mental disorders aren’t as stylish as other big name medical conditions. Anyone can get cancer so we have celebrities and heroes to overcome it or die as martyrs. Alzheimer’s brings up images of your grandparents slowly forgetting who people are. Autism has cute little kids.
On the other hand schizophrenia, bipolar disorder, epilepsy, psychosis, anxiety disorders, etc. bring up images of maniacs, killers, demonic possession, and/or people you wouldn’t leave your kids alone with. (Gee, thanks, medieval medical science)
How are we to complete for the money, time, and care of the public with that kind of PR?
I’m really pleased by the even-handed and knowledgeable responses so far in this thread.
I’ve put a lot of thought into this topic, and I’m afraid that, while I could say quite a lot about it, I have very little that I can say that is actually organized and constructive at this point.
For one thing, I am one of those unfortunate people who has suffered from a form of depression which was unresponsive to treatment. This has left me rather unsatisfied and skeptical about psychotherapy and psychiatry. Of course, skepticism is a good thing, IMO, and generally agreed to be so around here (although often misinterpreted by certain individuals when it comes to this particular topic).
For another thing, I studied Psych as an undergrad. My interest was in research, and I quickly discovered that there was a fairly strong schism between scientific psychology and clinical psychology. I could drone on about this for ages, but, for a nutshell, consider Elizabeth Loftus’ career in debunking some of the egregious harms caused by unscientific psychotherapy. I’m certainly no Elizabeth Loftus, but her work exemplifies the type of problem I wish to express and explore when it comes to mental healthcare.
And yet another thing, I’m a fan of science fiction, the future, and technology. There are many such people on this board, and, from our perspective (as has been noted by other posters, above), the field of mental health is in its infancy. Easy to say, but it takes a great deal of imagination and effort to recognize the drastic implications of that statement. From that viewpoint, the most important improvements we can make to mental healthcare in the US is to make progress in related fields.
Finally, there are huge tensions between two functions of our mental health system (such as it is). One function is to promote mental well-being, particularly in those who have little of it. Another function is a police function, wherein we expect mental health professionals to be able to enforce treatment and somehow restrict individuals from things like gun ownership. These two functions are severely at odds with one another, from the ground up. Do you want a hard-nosed cop to be your nurse? Do you want your self-empowerment guru to be responsible for your safety in a dangerous neighborhood?
But that’s just the background. From that starting point, I’d say that in order to move forward in this field we need some pretty sweeping reformations in how we approach the subject of mental healthcare, on a societal level. We’d need to focus on everything from destigmatization to normalization, and, also, especially on applying rigorous scientific criteria to a field that is, frankly, highly resistant to such things (while at the same time maintaining it’s sheen of respectability via a glamour of seemingly scientific grounding).
And this is where my depression kicks in, my pessimism. Because the people who work in the field currently feel attacked, and react as such (although you’d think they’d respond better, given their field of interest, than recalcitrant twelve-year-olds) when criticized for not operating in a more respectable (scientifically-speaking) fashion. Because the field is far more market-driven than it is driven by scientific principles or even humantistic ones (a problem that is ubiquitous in a capitalistic society, but easily avoided by those who aren’t greedy… if you can find them). Because…
Because mental health takes place in a milieu that is unlike any other (except that it isn’t) in that it is far more sensitive to its milieu. Which is to say, that every single person who interacts with other people has some level of responsibility for one another’s mental health – because that’s how it fucking works. And yet, we are abysmal at handling this. We treat one another horribly. Especially in this forum.
And… you can see where the depression and pessimism are taking over. The question of the OP is “how do we improve mental healthcare in the United States,” and I don’t have a constructive response. Because unless we can adequately address everything from stigma to pseudo-science to the excesses of market capitalism, in addition to that mysterious quality of human on human cruetly, there IS no constructive response to this issue.
Funding user-run self-help alternatives seems to be a good idea. And, credit where it’s due, the mainstream mental health organizations have been advocating exactly that, and putting their money where their mouth is.