Psychiatric Asylums?

No.  Definitively no.

I’m actually going to start this post off with something I have yet to do but am happy to do in the future when it makes sense: a link to an article on the topic I am discussing.  Here it is:

I provide this article when, in fact, I am making the case against these Asylums that the article suggests should be brought back.  But let’s start there.

Sure, it seems forever ago when “One Flew Over the Cuckoo’s Nest” was released, and it seemed unclear as to what exactly the setting was in “12 Monkeys.”  Even a newer movie “Shutter Island” is also about a time likely even earlier than present-day in “…Cuckoo’s Nest” and others.  Back then Hollywood liked to use the notion of Psychiatric Hospitals (Asylums) in thrillers and horror movies.  It was rare that the message from such media was that they were the desired destination for Americans.

Even the newer “Gothika” seemed to suggest a more recent timeline again suggesting these locations are regular or semi-regular and simple slip-ups or misunderstandings can land a person locked away in them forever.

I get it, it makes for a useful narrative, and I actually like the 3 more recent movies I mentioned.  However, as a useful discussion piece around the subject of Asylums, they are horrific.

There is this persistent notion in America that Psychiatric Hospitals (Asylums) are commonplace and can be found all over every city.  This just isn’t the case.  Please refer to the article I linked you to at the start that admits that 45,000 patients inhabit such facilities at press time.  Out of over 350 million Americans, that is a very, very small number.  They are NOT as prevalent as you may have been led to believe.

So in their absence, other places need to fill in the gaps.  Although it is very apparent that as time goes on, we understand more and more about what mental illness truly is and different mechanisms for handling it.  Still, reading the article you note that unfortunately many of the people that supposedly would have been in long-term care in an Asylum are instead in prison, homeless or dead.

So, yeah, you will not find me advocating for our mentally ill population in America to have to find themselves down any of those 3 roads.  So what then?

Well, while Psychiatric Hospitals (Asylums) rarely exist today, many traditional Hospitals have Psychiatric units or wards.  I have had my fair share of them and they have pros and cons like most things in life.  Almost polar opposite to how Asylums used to be perceived, these psych wards are typically short-term options.  They are for acute care and intended for Crisis Management.  The most obvious version of this is a suicide attempt and/or an overdose of a specific kind.

They do NOT include Therapy of ANY kind.  There are usually group activities which can be helpful.  But without undermining HIPPA or other protections, I will just say that even these activities are not forms of therapy.  That is not what they are chartered to do.  It is not within their mandate in the health care system.  They, again, are Crisis Management centers.  They seek to get you stabilized and back on your medication regularly and back out in the world as quickly as is feasible.

So then what?  Well, you need to find a Psychiatrist at least for ongoing Med Management.  You can occasionally find Psychiatrists who provide Psychotherapy solutions as well.  This is increasingly uncommon in America and almost non-existant here in the State of Illinois.  There is a reason why many patients here refer to these doctors as their new drug dealers.

So you’ll likely want to find therapy of some kind.  Here, it can seem like the choice is akin to going to Baskin Robbins and realizing there are more than 31 flavors now.  For all I know, you may even be able to claim to provide therapy sessions with no qualifications or credentials.  But the starting point credential that I have experienced would be an LCSW (Licensed Clinical Social Worker) all the way through a Psychologist who may have earned a doctor’s degree.  Many opt for seemingly middle to upper end of the road with LCPC (Licensed Clinical Professional Counselor) who can handle most psychotherapy needs.

So is that enough?  Even the most hands-off over-booked Psychiatrists may be willing to see you as often as once a month if you request it.  And it’s not unheard of in Illinois for you to get on the books with your therapist even as often as once a day, particularly at key points in your life.  (I won’t bother to fall into the trap set by Hollywood of LA housewives going to their therapist 3 times a day for “1st world problems” that are more about getting along with others than they are mental health concerns.)

To answer the question – while plenty people in these professions can be great at their jobs, the system as it is currently designed is not optimal.  As I said, the hospital units are purely Crisis Management with no psychotherapy at all.  Then, your Psychiatrist is unlikely to offer this either.  You may get this from your therapist or counselor, but unless they work at the same location as your Psychiatrist and you’ve given permission for them to share notes, it may be difficult for them to fully comprehend your situation from a medication perspective.  When you do get a great therapist – feel lucky.  But everyone should realize that even these typically outpatient facility options are also still REACTIVE as opposed to PROACTIVE or PREVENTATIVE.

Sadly, this is where I lose my footing for my argument.  So instead of pretending I’m capable of continuing this argument past this point, I will admit what I can do.  I can be a catalyst for an extremely important and frank national conversation about how to approach this topic from this point moving forward.

How do we handle and address our seemingly growing mental health issue in America?  How, exactly, does anyone involved in the system, including the great therapists working in it transition to a proactive or preventative setting or strategy?  I honestly don’t know.  I have no formal education in these fields at all.  But I suspect that much of what is taught is not from a preventative perspective anyway.  Just as a pretty basic, possibly common, maybe even seemingly mundane example, how about a person such as myself going to see my therapist?  Having Bipolar II Disorder with Anxiety and Depression, even in at most maybe a 50-55 minute session, if I’ve been with them long enough, can my therapist recognize the early signs of a transition in my mood?  That would be anything from medium to down and depressed or from medium to elevated and hypomanic or even manic.  At worst, it could be noticing a seemingly hyper-cycling state of short-term ups and downs that I will eventually address in a later blog.  I mean, if family members of mine can notice such changes during less frequent and sometimes shorter phone conversations, can’t a trained professional do so?

Yes, they can, and many times maybe they do.  But then what?  If the response, from a seemingly proactive perspective, is to reaccess the state of mind simply from a medication standpoint, effectiveness will be lost.  I’m not even saying your therapist should look to commit you to the aforementioned psych units in a hospital when noticing current or pending mood changes.  While they may be seen as the only real option or solution, I have already illustrated why they should not be the end-game solution.  Something else needs to be done, however.

So back to the original point, what about these Psychiatric Hospitals (Asylums) making a comeback and housing 10 or 20 times or more patients in America than they currently do?  Well, one of the few points I will agree with the writer of the article is that if that path was selected, it can only be done if drastically different than they use to do it.  I’m not even talking about the super obvious need to no longer do blood-letting (Re: a person with headaches) or lobotomies (Re: a person anxious about their job).  I’m not even talking about the more common practice in today’s hospital of ECTs.  Go ahead and look up that charming forced seizure “solution” for yourself.  Do you want to catch a glimpse into what Asylums could look like in today’s society and environment where everyone is overly litigious while also being scared of being litigated, all while people in the patient’s life are still vigilant about the care the patient is receiving?  That’s easy.  Go to a Nursing Home.  Or, better yet, find a way to stay in one for at least a week if you’re an undercover journalist or something.

I’m not saying these places are filled with nothing but Nurse Ratchets and administrations and owners who are 100% focused on short-term financial gains and nothing about attention to healthcare.  But if Asylums were allowed to expand greatly in America again for some reason, I’d suspect they would be less like Hollywood depictions and more like a heightened version of what you find in a 24/7 care lock-down Nursing Home today.

I tried to give you my perspective of how I see the current landscape, including its shortfalls and maybe areas for improvement.  I feel I failed to adequately address why a comeback for Asylums would be a really bad idea.  If there were comments and discussion on this blog, I’d suspect I could form a better view there.  But, unfortunately, this blog is not at a community-based discussion inflection point yet and likely won’t be for some time.  I guess I will leave you with this thought to ponder.  If prisons are allowed to operate now on a for-profit basis, and if the supposedly “new idea” developed by the warden in “Shawshank Redemption” of slave labor by prison inmates on projects the prison can bid on to gain contracts was remotely true, where does that lead?  Well, many inmates in prison systems in America do have jobs and get paid something, albeit usually considerably less than minimum wage.  But now expand that to for-profit Asylums that are as concerned about occupancy rates as hotels are and have absolutely no financial incentive to stabilize a patient to return to society (unless, of course, such a patient provided less revenue to the facility for some reason than a hypothetical next patient on the list would in a full occupancy scenario) – what about that seems to be in the best interest of mental health patients or even society at large?

Let’s start the discussion today.  Do not wait until you hear the news about a mass shooting and the next news cycle that alleges the perpetrator was mentally ill in such a way that suggests that all mentally ill individuals are a hair-trigger snap away from being the next mass murderer.  Such suggestions are patently false, do nothing to further the discussion in a healthy manner and give way to average American’s perceptions being totally off base in this regard.



Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s