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Update

Two quick updates, and I'm putting these at the top because they are important.

I wrote a line below that inadvertently denigrates those with learning disabilities. I apologize. Rather than edit the line, I'm issuing a mea culpa. It was poorly stated and offensive. I mistakenly attempted to draw a contrast between those who are mentally capable of making decisions for themselves and a class of people who cannot. I do not have enough experience or information to make that distinction in relation to those with learning disabilities. I apologize.

Secondly, I am aware that what I have written about below, while attempting to implement an ideal, is not either implemented in an ideal way or even all that common. Too many community-based systems come nowhere near this due to many factors. I still believe that empowerment and comprehensive treatment and rehabilitation is far superior to institutionalization. There are better ways, and patient-directed and oriented ways, that I try to present below as generally successful where they are implemented.

Thank you for reading.

----

Mental illness effects 1 in 4 of every adult across every demographic divide. Race, gender, age, economic status, none of that matters. Like many other indiscriminate diseases, mental illness doesn't care if you are rich, poor, white, black, male or female. The illnesses in question range from anxiety and depression to bipolar and schizophrenia, with a smattering of more complicated disorders.

There has been some recent interest in how to treat the mentally ill in this country. Some of that has focused on hospitalization, and how the paradigm for treatment of mental illness has moved away from warehousing people in institutions. For some reason, a lot of people feel that this is a bad thing. It is not.

Mentally ill persons are human beings. They are not mentally retarded. Like all other factors mental illness ignores, it can strike anyone of any level of intelligence. Mentally ill persons have every right and ability to decide for themselves how to live a normal, productive life, but like any given physical disability, severe mental illness limits those choices and often needs outside support.

Please journey with be below to learn more about the mentally ill community, what it is, what it does, and what it needs. Here's a foreshadowing of what is to come: they don't need any of you to tell them what is best for them.

My own journey with mental illness started long ago. I clearly remember the moment, when I was 14 years old: I was taking a shower, and inexplicably and suddenly, I started to think about ways to kill myself. Being the introspective sort, I was more than curious about the meta: its a weird sort of thinking to think about something, but think even more about the why of the thoughts than the thoughts themselves. Anyway, I realized then my depression. The details aren't important, but over the years I ended up dropping out of school, getting my GED instead and failing miserably at college. My life was screwed up to the point where I was no longer functional. I survived thanks entirely to the help of my father who had fought his own battles with depression during and after divorcing my mother.

My father got me into counselling. The psychiatrist I met with reached out to his contacts in the psychiatric rehabilitation field. That is where I became involved with this invisible community of the severely mentally ill who were, by all accounts, living normal well-adjusted lives.

De-institutionalization of the mentally ill started in the 60s and 70s, driven by three primary factors: a movement for community-based mental health services, availability of psychotropic medication, and financial pressures related to maintaining long-term institutions. To be fair, the result has been a bit of a mixed bag. While of a general benefit to mainstreaming and integrating the mentally ill into society, many have been left homeless and without care.

The benefit not obviously stated, however, is that the mentally ill themselves, now functioning members of society when well-treated, are able to advocate on their own behalf. Not much is mentioned about this in the linked Wikipedia article, but if you want to know more, check out NAMI - National Alliance on Mental Illness.

Due to de-institutionalization and the Community Mental Health Act signed by President John F. Kennedy, the medical and psychiatric community were, essentially, forced to find new solutions to treating the mentally ill. Beyond basic medical treatment and conventional psychotherapy, new models of psycho-social treatment have been developed and improved upon over the last few decades.

The basic concept of Psychiatric Rehabilitation is that by helping mentally ill patients reintegrate socially into their communities, a patient can "recover" from mental illness. Psychiatric rehabilitation rejects the idea that the mentally ill are permanently disabled and encourages the idea that mentally ill persons can function as productive members of society with the proper support. Along these lines, Boston University's Rehabilitation Research and Training Center on Psychiatric Rehabilitation has been the leading institution on changing the models of psychiatric practice from reactionary symptomatic treatment to proactive rehabilitation.

Why Not Institutionalization?

Forcibly committing mentally ill persons into a hospital environment is no longer necessary. Short-term hospitalization has its uses in the same way short-term hospitalization of medical problems does: to stabilize the life-threatening condition. That condition can then be treated post-discharge with proper support and medication.

Hospitalization is expensive. One of the drivers of de-institutionalization was the cost which was, at the time, absorbed almost entirely by state in the U.S. Reasonably, when those costs began to shift to the federal government, the federal government responded by finding ways to decrease those costs. Community mental heath services was the solution.

Mentally ill people aren't "insane," they are disabled. When you break a leg, you are disabled. A lot of broken legs require rehabilitation once the leg heals to get the leg back to full function. It is now recognized that mental health disabilities aren't all that different. Rehabilitation can build up skills that people need just as physical rehabilitation can build up the muscles that have atrophied.

There is no justification for forcibly institutionalizing mentally ill people. Mental health law generally specifies three conditions for forced hospitalization: suicidal ideation, homicidal ideation, and attempt at self-harm. Medically, the only condition that can force hospitalization is altered mental status - a person who is fully alert and aware of who they are, where they are and when they are cannot be forced to do anything against their will. There are times those conditions for forced hospitalization are met for the mentally ill, but once those conditions are stabilized, there is no longer an ethical, medical or legal reason to hold them against their will. It is simply unethical and immoral to do so.

What happens after discharge?

The answer to that depends, unfortunately, on a state-by-state basis. My experiences are with New York State which has a number of really good, really progressive policies and grassroots organizations such as NYAPRS.

At the very bottom, where a person is entirely disabled by their mental illness, that person will collect SSI - disability insurance provided by social security. They will also be eligible for Section 8, subsidized housing, medicaid, and SNAP. Some classes of the disabled will also be eligible for medicare. This meets some of the criteria that Boston University has identified as crucial supports for the mentally ill, but by no means not all.

A smaller class of the mentally ill disabled population are not eligible for all of those benefits. The most important of those benefits is medicaid coverage which is restricted to income levels. One of the advocacy objectives of mental health organizations has been a push at the state level to allow a medicaid buy in, where a person could pay a premium for medicaid on a sliding scale based on their income. This, to my knowledge, has never happened. Currently, medicaid is based on a spend down: the entirety of one's assets are considered in determining eligibility. That means if, for example, you own land, the value of that land is considered in your application. You are forced to sell that land, then exhaust the money from that sale, then you may be eligible for medicaid.

For all you progressives out there, this is a great point of alliance you can have with the mental health community: states are well within their rights in medicaid law to enact buy in legislation for medicaid. That is the closest you are going to get to a public option under current law: yeah, you'll have to pay a premium based on your income level, but if the law excludes assets, it would be cheap compared to any private insurer on your state's ACA exchange. Forget medicare for all, push for medicaid buy-in.

So what does that health insurance pay for? It pays for rehabilitation. It pays to help mentally ill people recover from their illness. It helps to define what recovery really means, and that depends a lot on what illness a person has and the severity of it.

The dominant paradigms that drive mental healthcare are: single point of entry, and continuity of care.

Single point of entry is a pretty simple concept. It simply means when one is experiencing a psychiatric emergency or crisis, there is a standard place to go. One admits herself or is committed to a Comprehensive Psychiatric Emergency Program, or CPEP. This is essentially an emergency room for psychiatric patients that usually holds patients for 24 hours to three days. Depending on the specific circumstances, a person may be discharged once stabilized, or transferred to a longer-term ward or facility for further care.

Its important to note CPEP is a regional program. Your mileage will vary depending on where you live and what psychiatric services are available and whether single point of entry is even a part of the comprehensive psychiatric care system in your area.

The much more important part is continuity of care, specifically what happens post-discharge. Again, it depends on one's individual diagnosis and prognosis what happens then, but I'll describe the overall arc of how the severely mentally ill move from hospitalized to independent. Note that nothing that follows guarantees that an individual won't relapse and require further hospitalization but, with persistence and support, there is no reason a mentally ill person cannot fully recover to the point they can reintegrate into society.

Immediate post-discharge most often will move a person into a halfway house or group home for the mentally ill. These include professional staff to ensure one follows their treatment plan and takes their medications. Think of this like intensive rehabilitation in a nursing home - they are not permanent residents here, but still need the close attention and support medically trained persons. Actual rehabilitative efforts do begin here as residents are generally responsible for their own living area and, in group homes, given responsibilities to maintain the home such as cooking and cleaning.

After moving on from here, there are programs of supported living where persons are placed into independent homes (individually or with a roommate living in an apartment). There are then regular visits by mental health professionals to the home. The goal is increased independence. Medication is no longer given out, for example, but held by and taken by the individual as prescribed. Much of the focus at this point is simple living skills: maintaining a living space, maintaining physical and mental health, and doing so independently but with support.

Eventually, an individual will be encouraged to move into a completely independent living situation.

During this entire time, intensive psychiatric rehabilitation would ideally be underway in order to give the mentally ill person every chance to succeed and thrive.

What is mental illness rehabilitation?

Quite simply, it means a person who is mentally ill can function in free society.

That means no institutionalization. Depending on the illness and its severity, it can mean complete re-integration including employment, but it could also mean the more severely ill are supported by disability programs. In no case is the possibility for improvement abandoned. In no case is putting persons with mental illness into forced hospitalization a goal. That is a situation to be prevented and avoided. We can do better and de-institutionalization and community care were implemented in recognition of the fact that we can to better.

The clubhouse model of rehabilitation of mental illness is one fairly popular program. These are member-directed day programs, but different from day programs in that the staff are not psychiatrists or therapists. It is a physical place and a social place to which the members (and they are members, not patients) belong and contribute to. The staff exist simply to provide a structured environment in which the members operate. Every function necessary to maintaining the club are done by the members themselves.

One of the functions of the clubhouse you may not guess at is political advocacy. Mentally ill people are just as involved in politics as any of us here at Daily Kos, though their interests are of course very specific. Primarily the focus is on parity, which aims to get legislation that treats mental illness in an equivalent way to physical illness in insurance and disability matters. Another important matter, as noted before, is the Medicaid buy-in option, which would allow one to be employed without risking losing their medical coverage. For the mentally ill, the underlying issue is most likely to be chronic, so continued support of psychiatry, medication and counselling is paramount in order for that person to be successfully employed.

Members of the clubhouse are encouraged and indeed do participate in the direction of their own care. I was a member of a clubhouse in 2001, and one of a number of our members selected to travel to the catskills on September 11th for a NYAPRS conference. As you can imagine, the news on the van's radio that day was extremely traumatic. The other members attending had their moments, especially during an improvised prayer session at the conference that offended some, but what struck me most was how everyone was able to focus on the reason they were there: mentally ill people themselves attending workshops on psychiatric rehabilitation that were intended for professionals, but giving their own input on the programs presented, and learning from the presentations to assist their friends who could not attend.

Psychiatric rehabilitation generally defined is a psycho-social (as opposed to medical) form of treatment. A portion of that of course includes medical and professional treatment of the underlying conditions, but rehabilitation focuses on social, economic and living issues. It is generally directed not by psychiatric or medical professionals.

There are eight specific areas of focus in psychiatric rehabilitation. IPRT, or Intensive Psychiatric Rehabilitation Treatment, is one such program that attempts to implement the overall goals of mental illness rehabilitation. Sorry I do not have a link, all the information I could find is behind paywalls, but I will describe what I know from my experience with it.

IPRT is "consumer-driven." I'll say right away I hate that term, but it is meant to indicate that the program is tailored to the wants and needs of the people that use it. IPRT provides small-group focused education on specific areas of need. The main areas IPRT focuses on are psychiatric, vocational, social, and living.

The eight generalized areas psychiatric rehabilitation means to provide for, with detail as necessary, are as follows:

Psychiatric: Focuses on symptom management and coping mechanisms. Teaches individuals how to recognize their symptoms as they are happening and what to do to ameliorate the psychological, social and somatic effects.

Social: Assists in creating or maintaining healthy relationships with family, friends. Trains persons in recognition and respect for boundaries. Improves communication skills with others. Helps involvement with community, as desired.

Vocational/Educational: Tracking individuals into vocational or educational programs. This may include advocacy necessary for the individual for accommodations within those programs.

Basic living skills: personal hygiene, providing one's self with appropriate nutrition, ensuring safety (including feeling safe), and identifying chores with a normal routine.

Financial: managing a budget (often a fixed budget with SSI and SNAP)

Community/Legal: Provision and access to resources to help secure necessary accommodations for the individual's disability.

Health/Medical: Secure the continuity of care necessary for full rehabilitation.

Housing: Safe and secure living accommodations, preventing most of all homelessness, but also giving individuals a safe "home base," a place that they own and feel secure within.

Putting all that into bullet-point list of eight items might seem a bit weird to a normally functioning person, so many of them are just a given. Who thinks about hygiene, for example? That's just something you do... unless you are mentally ill. How many of us need a Social Security lawyer? I know some of the physically disabled about here know the answer to that.

Psychiatric rehabilitation aims to identify the specific needs of the mentally ill and provide for those needs, and to do so with the knowledge and support of the mentally ill themselves. Psychiatric care does not exist to meet the needs of society as a whole, it does not seek to bury the problem in the sand as advocates of institutionalization would have us do. Psychiatry is about health of the person, and that person is just as capable of deciding their own fate as you are at deciding your own.

I would urge progressives to try, in any way they can, to make allies with the mental health community. So many of our and their (our mine and your) issues align. Mental health issues and progressive issues share a lot of the same ideas, yet some of the solutions are unique and incredibly progressive in character. Don't discount this potential ally and don't dismiss them because of their disability. They aren't stupid.

They can decide for themselves. Don't you forget it.

Originally posted to RadicalParrot on Mon May 13, 2013 at 08:01 PM PDT.

Also republished by Mental Health Awareness and Community Spotlight.

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Comment Preferences

  •  My grandmother was an RN in a (10+ / 0-)

    State Hospital for years. I don't think I've ever seen this brought up this way here on DK. Good diary, thanks.

  •  This topic is nonsense (5+ / 0-)
    Recommended by:
    marina, Rich in PA, Amayi, gramofsam1, MNPundit

    ...without discussing the degree of mental illness being examined.

    If you are using this stat, particularly:

    Mental illness effects 1 in 4 of every adult across every demographic divide.
    ...your essay has no meaning. "Lock-up" does not apply to 99 percent of them.

    Furthermore, this is just ignorant:

    Mentally ill persons are human beings. They are not mentally retarded.



    Denial is a drug.

    by Pluto on Mon May 13, 2013 at 08:22:29 PM PDT

    •  Sorry. That was a bit harsh. (26+ / 0-)

      I over-reacted -- although I stand by my criticisms.

      I see, too, where you are coming from.

      However, your narrative about deinstitutionalism in America belies the ugliness of the policy in the late 70s, when mental institutions were closed and patients dumped on the streets of America.

      Most of them died on the streets or in prison.

      We still have no serious public health care for the mentally ill.



      Denial is a drug.

      by Pluto on Mon May 13, 2013 at 08:34:33 PM PDT

      [ Parent ]

      •  Not arguing there.. (15+ / 0-)

        my reply below was before I saw this, so I'll reply to this as if starting over.

        You're absolutely fucking right, and it still goes on to this day that mentally ill people are being dumped out onto the streets with no support.

        Perhaps I should have gone more into what the general state of mental health is currently than the ideal which I went through in my community. Most of the country has nothing like what I wrote about for community support, and that is terrible.

        I still would rather see more on the side of empowerment and community health support than forced institutionalization that really is not ethical or necessary (or financially viable)

        “Birds…scream at the top of their lungs in horrified hellish rage every morning at daybreak to warn us all of the truth. They know the truth. Screaming bloody murder all over the world in our ears, but sadly we don’t speak bird.” Kurt Cobain

        by RadicalParrot on Mon May 13, 2013 at 08:48:20 PM PDT

        [ Parent ]

        •  Or like the folks in Nevada did (do?) (2+ / 0-)
          Recommended by:
          Pluto, CuriousBoston

          bus them over the line to Sacramento or SF with a bag of pills and 10 bucks - if they are lucky. Maybe with a phone number to a half-way house.

          If... the machine of government... is of such a nature that it requires you to be the agent of injustice to another, then, I say, break the law. ~Henry David Thoreau, On the Duty of Civil Disobediance, 1849

          by shigeru on Tue May 14, 2013 at 03:21:25 PM PDT

          [ Parent ]

          •  !!! Yours and the comment just below..... (1+ / 0-)
            Recommended by:
            shigeru

            If that had happened to me I doubt I would have survived. Tazed, shot, left in an ER room watched by a security guard, police called instead of EMTs, in 2013.

            Does any person with any kind of mental disabity need a tatoo on their forehead? Do we need a badge or braclelet identifying us to the police? Should deaf people wear a sign so THEY don't get tazed?

            2012-2016 President Obama, Vice President Biden, Senator Warren. For a LIFETIME, federal judges. Get the filibuster changed. Steamroll. http://www.whitehouse.gov/contact/submit-questions-and-comments

            by CuriousBoston on Wed May 15, 2013 at 02:11:29 PM PDT

            [ Parent ]

            •  Unfortunately there have been cases where (1+ / 0-)
              Recommended by:
              CuriousBoston

              the deaf have been tazed and shot for not hearing the commands.

              If... the machine of government... is of such a nature that it requires you to be the agent of injustice to another, then, I say, break the law. ~Henry David Thoreau, On the Duty of Civil Disobediance, 1849

              by shigeru on Wed May 15, 2013 at 02:36:57 PM PDT

              [ Parent ]

              •  Yes, I've read on DKos about people that (1+ / 0-)
                Recommended by:
                shigeru

                happened to.

                2012-2016 President Obama, Vice President Biden, Senator Warren. For a LIFETIME, federal judges. Get the filibuster changed. Steamroll. http://www.whitehouse.gov/contact/submit-questions-and-comments

                by CuriousBoston on Wed May 15, 2013 at 03:05:22 PM PDT

                [ Parent ]

      •  Patient dumping (19+ / 0-)

        Is alive and well in 2013 as Nevada ships out seriously ill patients to other states with no chaperones, no contacts there, three days worth of meds and instructions to call 911 when they get there.

        Shameful.

        We don't send out sick animals out onto chaotic city streets, but we do this to our most vulnerable citizens.

        © grover


        So if you get hit by a bus tonight, would you be satisfied with how you spent today, your last day on earth? Live like tomorrow is never guaranteed, because it's not. -- Me.

        by grover on Mon May 13, 2013 at 09:28:15 PM PDT

        [ Parent ]

        •  it is not just shipping them out (7+ / 0-)

          but the total lack of networks in many places for the long term issues of people who aren't going to get better, have no close family support, and truly can't manage their lives.  This includes many people in early dementia, etc.

          They are sitting ducks for every con artist that comes along.  And well meaning people with out experience who try to help an elderly neighbor or fellow parishioner at their church, aren't prepared for the person they are helping to turn on them and accuse them of trying to take advantage, maybe call the police and make accusations, etc.

          There isn't any one size fits all solution to this kind of problem.   A younger adult that can manage on  therapy and maybe still hold a job with support is easier to deal with in a mainstream environment.   Older people tend to end up isolated, unable to recognize their needs and need some place safer to live where they get social contacts and supervision of their medicine, food/water intake.  In any event, drawing the line about when a person is dangerous to themselves, unable to care for themselves is hard.  It is hard to deal with people who do well 90% of the time, but need much more intervention part of the time.  Someone besides the person needs to be monitoring that, but that is just one step from 'parole' and prison, too.

          I am in no way advocating going back to the old forced institutionalization approach.  I am in favor of a lot more money and a lot wider variety of services to meet various needs levels.  But not everyone can function independently and stay safe and that needs to be recognized as well as the fact that  all persons have basic rights to self determination of their lifestyles.

        •  A very good diary (4+ / 0-)
          Recommended by:
          Pluto, ladybug53, bluesheep, CuriousBoston

          But please delete the sentence about mental retardation. It's not necessary, and it puts down another group disabled to varying degrees by brain damage.

          When I worked in a state hospital in 80's, the people who could successfully utilize the rehab model had already been placed in the community where they were functioning adequately. We kept trying to get these programs to work with our folks, but they would not adapt for those needing that much more structure. Our folks were dirty or wandered off or swore too much.  Drinking and drugs were also barriers to mental health programs, while psychotropic drugs were often a barrier for drug rehab programs.

          These people need a stronger array of services including beds at various levels of need, and this is what is usually lacking. I have an adult son who is mentally ill and uses substances, and is often non-compliant with treatment and/or homeless.

          Stronger case management is also needed for these folks, and this often involves interaction with criminal justice and homeless shelters. Strong and persistent outreach is needed.

          My son is unable to apply for services for himself, and there is no one in the system who will help him through the process. He gets disability (more since I became disabled by depression) and has a payee, but no one informs the courts that he has these if he does not. Case managers are too often tied to their desks and unable to help with these tasks. They also turn over so often that my son is unable to develop a trusting relationship with any of them. I'm sure he is not the only person this applies to.

          Republicans want to make government small enough to fit in your vagina..

          by ramara on Tue May 14, 2013 at 01:28:25 PM PDT

          [ Parent ]

      •  Hardly most. You exaggerate there (5+ / 0-)

        and don't differentiate.

        Many people were locked up for life on very flimsy evidence of SDMI and once out had the same problems as people getting out of prison — learning to live in a world that had changed and suffering from the stigma that interferes with getting a job or housing.

        I was there in Tuscaloosa when they started freeing masses of people from confinement from the 5000 bed hospital there — and from the 3000 bed institution for those that were called retarded at that time.

        I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

        by samddobermann on Tue May 14, 2013 at 02:48:34 AM PDT

        [ Parent ]

      •  And being locked up in an institution isn't a (15+ / 0-)

        prison? I'm severely mentally ill, with multiple severely mentally ill family members. I agree with you that the diarist's picture of health care for the mentally ill is not a world that I recognize. The diarist's picture makes a lot of sense to me, but I haven't seen it enacted anywhere ever. If it is, it's exceedingly uncommon in this country.

        On the other hand, if you think that dying in an institution is significantly better than dying in prison, you haven't seen the inside of institutions that I have. The dumping of the mentally ill on the streets was an evil act, but it's also evil to lock the mentally ill up like criminals, or worse, because they are seen have no potential for rehabilitation. Out of sight, out of mind, right?

        Also, your idea that distinctions need to be made between mild and severe mental illness? Sure, in treatment. The reality, though, is that there is too much shame and stigma around mental illness to enact effective treatment programs for any degree of mental illness. And the point of the 1 in 4 numbers is that this is fucking ludicrous and self-hating.

         Also, you really don't sound like you know what you're talking about as far as the treatment of degrees mental illness. Without my drugs, I'd be hearing voices 50% of the year. On the other hand, my drugs work a lot better for me than folks I know with "milder" mental illnesses. So who has the more "severe" mental illness as far as day to day life? It's far more nuanced than you give it credit for you.

        But, thanks, I love it when people suggest that I should be locked away like a dog who's misbehaved. And that the dog deserves to be let out, but I don't.

        •  and locked up without trial (2+ / 0-)
          Recommended by:
          socindemsclothing, kyril

          no unanimous jury verdict beyond a reasonable doubt, no release date, and forced electroshock "therapy". In sum, criminals were treated much better.

          •  Many mentally ill people end up in prison. (0+ / 0-)

            Especially dark skinned and/or poor males. A study found that males with XYY chromsomes felt a need to have a larger "personal" space. I'd be curious to know the percentage of males in prision that have that chromosome arrangement.

            Prision is cheaper than treatment. Privitizing prisions will cost even less.

            2012-2016 President Obama, Vice President Biden, Senator Warren. For a LIFETIME, federal judges. Get the filibuster changed. Steamroll. http://www.whitehouse.gov/contact/submit-questions-and-comments

            by CuriousBoston on Wed May 15, 2013 at 02:19:13 PM PDT

            [ Parent ]

        •  We need to change things (1+ / 0-)
          Recommended by:
          kyril

          Allowing the mentally ill to be homeless or to be institutionalized if they don't need it is totally evil. We do have treatment programs that are generally effective and most of them are reasonably inexpensive (at least by the standards of institutionalization).

          For the chronically mentally ill, we need an expansion of medicare that guarantees their treatment and training for all medical practitioners to make certain they take the steps they need to get that help to the people who need it.

          I suppose there are a few folks who prefer to be homeless and unable to deal with society, rather than accept treatment, but I'm not going to make policy based on their desires.

          Americans can make our country better.

          by freelunch on Tue May 14, 2013 at 05:42:52 PM PDT

          [ Parent ]

          •  Medicare pays mental health providers half of what (0+ / 0-)

            they pay other health care providers. MassHealth is such a red tape quagmire paying so little even dedicated providers do not try to enroll.

            Even MA, trying to find a psychiatrist is difficult if you have to choose from a list provided by your employers insurance. If you dare to use your employers insurance at all.

            The treatment programs may or may not be effective. Wait times are very often too long.

            Hospitals are closing psychiatric beds, especially pediatric beds. The hospitals that specialize in psychiatry are for the rich.

            2012-2016 President Obama, Vice President Biden, Senator Warren. For a LIFETIME, federal judges. Get the filibuster changed. Steamroll. http://www.whitehouse.gov/contact/submit-questions-and-comments

            by CuriousBoston on Wed May 15, 2013 at 02:27:02 PM PDT

            [ Parent ]

        •  Very well written. Thank you . Agreed. n/t (0+ / 0-)

          2012-2016 President Obama, Vice President Biden, Senator Warren. For a LIFETIME, federal judges. Get the filibuster changed. Steamroll. http://www.whitehouse.gov/contact/submit-questions-and-comments

          by CuriousBoston on Wed May 15, 2013 at 02:13:46 PM PDT

          [ Parent ]

      •  "Mentally retarded" people suffer a brain disease, (4+ / 0-)
        Recommended by:
        jessical, marina, gramofsam1, kyril

        as do mentally ill people. The word, by the way, is developmentally disabled. Diarist, you should know that, and add an apology and explanation.

        Please see my other comment. Thank you.

        2012-2016 President Obama, Vice President Biden, Senator Warren. For a LIFETIME, federal judges. Get the filibuster changed. Steamroll. http://www.whitehouse.gov/contact/submit-questions-and-comments

        by CuriousBoston on Tue May 14, 2013 at 06:46:24 AM PDT

        [ Parent ]

        •  "Mentally retarded" vs "developmentally disabled" (0+ / 0-)

          Ya know, they really mean essentially the identical thing.  There is nothing inherently wrong with the term "mentally retarded".  The only reason one is now preferred over the other is that "retard" is used as an insult.  I remember the day when "spazz" was a popular insult, but "spastic" never fell out of medical use.  What will "developmentally disabled" change to when "devo" becomes an insult?

          Note there are major medical journals that use the word "retardation", such as the American Journal on Mental Retardation.

          To call on the commenter to apologize is a bit much.

            •  I did, but it doesn't really address my points (0+ / 0-)

              I won't dispute that the acceptability of the word "retarded" is changing, but it is a long way from being complete.  Again, no need to insist people apologize for using it.  Pointing out the changes in use of the term would be better.

               

              •  It's been changing for years- (0+ / 0-)

                at this point it's pretty much changed for people in the field or people who follow the issues. If someone writes a diary about mental health issues, it would seem responsible for them to understand the terms they choose to use.

              •  No, it is not a long way from being complete. (0+ / 0-)

                It would be faster if Kossacks insisted that the term not be used in their presence. Ya know, I doubt that devo will ever become an insult. Do you have a relative or friend that is developmentally disabled? Do you know any teachers of developmentally disabled children or adults?

                Do you see any grocery store baggers that are being coached? Or any working without coaching?

                Try using the insulting word.

                2012-2016 President Obama, Vice President Biden, Senator Warren. For a LIFETIME, federal judges. Get the filibuster changed. Steamroll. http://www.whitehouse.gov/contact/submit-questions-and-comments

                by CuriousBoston on Wed May 15, 2013 at 02:33:34 PM PDT

                [ Parent ]

      •  Yeah, but you didn't even dis the diarist (0+ / 0-)

        for the misuse of "effects"

        so, you used * some * restraint!

    •  99 percent of "them", is it? (5+ / 0-)

      because they aren't "like" you.

      Talk about ignorant. They are disabled. Read the whole thing about how such disabled persons can be supported, or ignore it just because I oppose forced institutionalization and believe human beings are capable of deciding for themselves what is best for them.

      You obviously do consider the severely mentally ill incapable of making their own decisions. Some are, in their acute phase, and almost all in that state are temporary conditions. Your ignorance is in believing that those people cannot recover. They can and they do and quite often they succeed if the support is there.

      “Birds…scream at the top of their lungs in horrified hellish rage every morning at daybreak to warn us all of the truth. They know the truth. Screaming bloody murder all over the world in our ears, but sadly we don’t speak bird.” Kurt Cobain

      by RadicalParrot on Mon May 13, 2013 at 08:42:41 PM PDT

      [ Parent ]

    •  Are you kidding? what do you (2+ / 0-)
      Recommended by:
      jessical, kyril

      object to in

      Mentally ill persons are human beings. They are not mentally retarded.
      Do you object to the use of the word retarded? It does convey the meaning. Many people with severe mental illness are treated as if they have a mental age of 4 or so. They have also been treated as if they don't feel pain normally. Or that they are doomed after one serious episode.

      The diarist perhaps should have distinguished between the Serious (sometimes Severe), Disabling Mental Illnesses (SDMI) from the other forms. But people react to hearing that a person suffers from a mental illness as if all were incapacitating.

      I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

      by samddobermann on Tue May 14, 2013 at 02:40:38 AM PDT

      [ Parent ]

      •  The quote is a bit offensive...more than a bit (11+ / 0-)

        It more than suggests that if they were mentally retarded, they wouldn't be human beings.

        You know, I sometimes think if I could see, I'd be kicking a lot of ass. -Stevie Wonder at the Glastonbury Festival, 2010

        by Rich in PA on Tue May 14, 2013 at 04:33:56 AM PDT

        [ Parent ]

        •  I didn't take it that way (8+ / 0-)

          I read it as two statements. "Mentally ill people are humans, so they deserve dignity." "And mentally ill people are not mentally disabled, so they can make their own decisions."

          Mentally disabled ("retarded") people are also human beings worthy of dignity, but I don't think anyone objects to the idea of their guardians making decisions on their behalf, since their mental state is that of a child.

          It's incorrect to assume that "mentally ill" and "mentally disabled" are mutually exclusive, though. There are plenty of unfortunate souls who are both.

        •  Well, it hit me that way, too, at first. But you (5+ / 0-)

          can also read it as saying that the mentally ill need different assistance than the mentally retarded. Society doesn't seem to make any distinction between the two, which is to the detriment of both classes of people. The diarist didn't actually say there's something wrong with being mentally ill- the diarist just made a distinction between the two. I can't read the diarist' mind but neither can you.

          •  I don't have to read their mind (5+ / 0-)

            It was the only really grossly jarring note in an otherwise very good essay.  Issues of phrasing aside, it says "I'm not one of those people", and so detracts from the larger point and makes the reader distrust the writer's voice.  

            If you look at the specifics, it is a clear implication that intellectually disabled people don't deserve agency, everybody knows that, so much so I can reference them as a class and stand on their heads when advocating for my own agency in society.  It was completely unnecessary to the piece, in both wording and emphasis, and it detracted badly -- and clearly I am not alone in this opinion.  

            I tipped and rec'd but it was entirely to spite that.  I do so wondering at my own prejudices and with concern that I might not have done so if some other group had been used as such an example.

            ...j'ai découvert que tout le malheur des hommes vient d'une seule chose, qui est de ne savoir pas demeurer en repos dans une chambre.

            by jessical on Tue May 14, 2013 at 06:45:02 AM PDT

            [ Parent ]

            •  I agree with you. The diarist got no tip, but (2+ / 0-)
              Recommended by:
              jessical, gramofsam1

              a recommend, hoping that people will read my comments.

              2012-2016 President Obama, Vice President Biden, Senator Warren. For a LIFETIME, federal judges. Get the filibuster changed. Steamroll. http://www.whitehouse.gov/contact/submit-questions-and-comments

              by CuriousBoston on Tue May 14, 2013 at 06:53:18 AM PDT

              [ Parent ]

            •  Agree and I especially appreciate this part (2+ / 0-)
              Recommended by:
              jessical, gramofsam1

              of your comment:

              I do so wondering at my own prejudices and with concern that I might not have done so if some other group had been used as such an example.

              Metaphors be with you.

              by koosah on Tue May 14, 2013 at 07:17:44 AM PDT

              [ Parent ]

              •  yah, well (1+ / 0-)
                Recommended by:
                socindemsclothing

                Especially bad because intellectual disability is one that insures near-invisibility in a forum like this.  And the entire piece begs the question of whether the goal of social justice is to be "free" or whether it is more appropriate to consider how some folks need social and economic supports to get to the same "free" that others take for granted as normative, and how deeply that winds into our assumptions and speech.  Ultimately the borderland between dignity and institutionalization is decided by what we are willing to pay for and be bothered with.  We're better off by far making common cause, than we are with approaches which frame our particular group as being good (while the others, well, we know about them...)

                I was discouraged to see the diarist didn't address these things.  I don't expect perfection (of myself or others) in diaries -- if we don't put it out there, we never learn.

                I have known enough people who lived through the era of heavy institutionalization though that -- even though I know lots of mental health professionals who struggle daily against the ways hospital care has become unavailable, and even though I thought this article didn't address that well at all -- I had to rec it up.  There was a time in my parent's lifetime when the weird were sent off to the mental hospital, no joke, bye bye Auntie.  It wasn't OK.  Neither is sending home anorexia patients begging for a little more time to get better, or putting people who have no support infrastructure into jail.  

                Meh.  This comment was a depressing mistake :(

                ...j'ai découvert que tout le malheur des hommes vient d'une seule chose, qui est de ne savoir pas demeurer en repos dans une chambre.

                by jessical on Tue May 14, 2013 at 12:21:04 PM PDT

                [ Parent ]

        •  That was my issue, though in reading forward, (2+ / 0-)
          Recommended by:
          socindemsclothing, kyril

          it seems unintentional. I think the diarist truly wanted to point out that the mentally ill were human beings AND that they could have a range of IQs but putting those two sentences together was a poor choice.

    •  My husband is a job coach for folks with (8+ / 0-)

      developmental disabilities.  They despise the word "retarded" as much as the physically disabled hate the word "cripple."  It carries a lot of extra very negative baggage around with it anymore, to the point where the word itself has the ability to become the focus of attention.  Its usage distracts from rather than enhances conversation.

      "Retarded" is on my list of words like "cripple," "fag", the "n-word" and a host of others. They have been used to make people feel bad about themselves just because of who they are.  If the people in those groups want to use those labels, fine.  Since I don't belong to those groups, I'm not going to try to tell them whether they should be offended or not by the labels.    

      "Retarded" is a word I don't like to even type anymore and it will get scare-quotes from me every time.

      Metaphors be with you.

      by koosah on Tue May 14, 2013 at 06:35:45 AM PDT

      [ Parent ]

      •  "Scare quotes" ?? (2+ / 0-)
        Recommended by:
        bluesheep, marina

        Plus, see my comment above re use of "retarded".  

        It's one of those words whose acceptability is changing, but  please there is no comparison to words like "cripple," "fag", or the "n-word", which were solely used as insults and slurs.

        •  Turn the clock back a few years, maybe centuries, (1+ / 0-)
          Recommended by:
          kyril

          and you will find "cripple" "fag" and the "n-word" used legitimately by people with no intention of slur.  I read your comment above.  You are behind the times.  "Retarded" hasn't been used legitimately in casual conversation for awhile.  Celebrities as diverse as Rahm Emanuel and Lady GaGa have issued apologies after flying the word "retarded" around.  

          As for there being no comparison, I respectfully and vehemently disagree.  Developmentally disabled folks do know when they are being disrespected.  They do know when someone calls someone else "retarded," that it is a slur intended to compare that someone else's intellect unfavorably.  It hurts their feelings precisely because the word is being used to make someone else feel bad about themselves.

          Look, my husband works with developmentally disabled folks, but I work with kids.  I know that kids use that word to hurt each other.  Kids do not care when they call each other "retards" what psychologists mean when they label someone "retarded."  Kids don't know that its meaning is evolving, because for them it has only ONE meaning.  It is a slur!  

          My husband also has cerebral palsy.  When he was a small child, he was labelled "crippled."  He actually attended a school called the "Easter Seals Crippled Children's School."  40 years ago, that was what you called people with a disability.  "Crippled."  It was never a slur back then.  Move forward a bit and things are very different.  My husband HATES that word!  More importantly, only the most grossly insensitive jerk would call someone a "cripple" anymore.

          So look at all these comments about the word "retard."  It has failed utterly at the diarist's intention of communication and it has instead derailed the discussion.  Why?  Because most of the readers recognize that it was a poor choice for clear communication.  For no other reason than that, the word "retard" should be avoided.  

          Plus, ask yourself, really?  Do you really want to use a word that you have been told hurts other people at the core of their being?  You want to defend that?  And the people whose emotions you are wanting to stomp on by defending the clinical usage of the word "retard" are some of the most defenseless in our culture.  How much more time needs to pass before YOU get to tell THEM that it is no longer acceptable and that they shouldn't get fussed about it until then?  

          I continue to assert that the people who are being hurt get to define their own pain.  I am not going to tell any group that their perception of hurt or slur is not valid simply because I know the historical or clinical lineage of a word.        

               

          Metaphors be with you.

          by koosah on Tue May 14, 2013 at 01:09:43 PM PDT

          [ Parent ]

          •  I never use the word "retard" (1+ / 0-)
            Recommended by:
            marina

            That's obviously a slur.  I just think getting worked up about the word "retardation" to describe a condition is excessive, as it still widely used in the professional literature.  It means exactly "developmentally disabled".  

             At any rate, it is changing.  I have no doubt, however, that a slur will come into use before too long that derives from "developmentally disabled".

            Anyhow, I truly have no strong feelings about it one way or another,  I just think calling out someone for "an apology and explanation," as was demanded above, is not reasonable.

            That's all I have to say.

          •  Oh, one other thing (0+ / 0-)

            I really don't know what you mean by "scare quotes."

            •  Usually when someone puts quotes around (1+ / 0-)
              Recommended by:
              marina

              something it means they are literally quoting someone.  These days (jeez, that makes me sound old, doesn't it?) these days, people put "quotes" around all sorts of things to imply other, non-traditional meanings or impart extra importance to something.  When one does this in oral conversation by wiggling two fingers in the air, that's called using "air quotes."  "Scare quotes" kinda means that too.  From Wikipedia:

              Scare quotes are quotation marks placed around a word or phrase to imply that it may not signify its apparent meaning or that it is not necessarily the way the quoting person would express its concept.
              The term also is sometimes used derisively to imply that the quoting person (the person putting quotes on a word) is adding way too much emphasis to a word.

              The kids these days, with their continually changing lingo!    

              Metaphors be with you.

              by koosah on Tue May 14, 2013 at 01:35:07 PM PDT

              [ Parent ]

  •  RadicalParrot this is a post of great note. (16+ / 0-)

    You success on many fronts in giving the reader an overview of mental illness and our current ways of dealing with many issues.  I also like the way you remind people that people with mental health issues can and do decide how to conduct their lives and may be more than open to progressive ideas as allies.   I wish I could get a copy of this it would be a great education tool.

    For the record I have worked in the human services field for almost 50 years and I currently am the director of a residence for people who are homeless long-term (2 years or more) and challenged by mental health issues.  

    •  Thanks :) (11+ / 0-)

      I feel like I need to update this to reflect that what I experienced and know about is very regional... I could not find that IPRT, for instance, exists anywhere outside of NY and MA, nor do I know of a CPEP program outside of Syracuse. The mental health continuity program here is extremely comprehensive and collaborative. I get the very distinct idea from my research that that is incredibly rare.

      “Birds…scream at the top of their lungs in horrified hellish rage every morning at daybreak to warn us all of the truth. They know the truth. Screaming bloody murder all over the world in our ears, but sadly we don’t speak bird.” Kurt Cobain

      by RadicalParrot on Mon May 13, 2013 at 08:57:33 PM PDT

      [ Parent ]

    •  Boston Beans, Select the whole thing (1+ / 0-)
      Recommended by:
      ybruti

      copy and paste in into a text file or into a word processor document.

      I keep several TextEdit note pages open all the time when I am on line. I have one for random clippings each month and one for health related clips by month also.

      For something important I open a fresh sheet, label it for myself, block, copy and swing over and paste it in. Then save it to an appropriate sub directory with a descriptive name.

      Which I am doing now.

      I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

      by samddobermann on Tue May 14, 2013 at 02:55:39 AM PDT

      [ Parent ]

  •  having been 'in services' myself (12+ / 0-)

    with the local MHMR organization for my untreated bipolar disorder and PTSD, I completely agree with Boston Beans and appreciate how you've framed this diary in terms of how the mentally ill do have agency and a role in participating in their own care.

    Anyone who scoffs at happiness needs to take their soul back to the factory and demand a better one. -driftglass

    by postmodernista on Mon May 13, 2013 at 08:36:42 PM PDT

  •  Where in your progression of severity should (1+ / 0-)
    Recommended by:
    marina

    legal and civic responsibilities begin to accrue to the afflicted, if ever?

    •  everywhere and always. (4+ / 0-)

      What sort of question is that? What do you mean. Would you stop diagnosed people from voting — en masse?

      If you are referring to the "insanity defense" you need to read up on the requirements for asserting that. It is usually a very high hurdle to meet particularly in the US. Each state is different. And there is a lot of prejudice against its use.

      I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

      by samddobermann on Tue May 14, 2013 at 03:06:58 AM PDT

      [ Parent ]

      •  I more curious in regard to every day social (1+ / 0-)
        Recommended by:
        CuriousBoston

        interaction. The diarist lists a scale of mental illness severity. At some point along that scale he says they should be considered fully functional members of society, albeit with lingering, manageable mental illness problems. I'm merely curious as to his views on whether it's valid to expect them to conform with community norms and laws, and what to do when they don't. It's not an argumentative question.

  •  I couldn't find anything for Sarah (14+ / 0-)

    Then again, we're in Maine. There were even points were she desperately wanted help and saw the problem. She needs a group home situation--but she won't get it.

    And so 'we' aren't 'we' anymore, and she's in jail, and it breaks my heart.

    Get 10% off with KATALOGUE2013 at my shop, or go to the Kos Katalogue!

    by LoreleiHI on Mon May 13, 2013 at 10:50:44 PM PDT

    •  My heart is breaking too (12+ / 0-)

      My 20-year old son is bipolar and has spent more than a quarter of his life since turning 18 in jail. When he's stable, he can hold a job and have productive relationships. When he's manic, consequences have no meaning and he doesn't want to change.  Right now, he's out on bail and a danger to himself and others because he refuses to stop driving. My wife and I have looked at community-based programs and think they could be a great place for him, but he's not ready to commit to one. All we can do is pray for him to be safe and to become ready to deal with his disability.

      We're going to start working with the local NAMI chapter and possibly AlAnon to help us help ourselves and him.

      I wish you and Sarah peace!

      •  Very sad (3+ / 0-)
        Recommended by:
        MsGrin, kyril, marina

        We have a bipolar family member and we are thankful she has been stable for quite a while.  

        I am curious as to what you think you should do given he refuses to stop driving and is a danger while the road, and not only to himself?

      •  I just finished (3+ / 0-)
        Recommended by:
        kyril, marina, CuriousBoston

        The Family to Family course that NAMI offers.  My son has been ill his whole life and his first bout of psychosis was at age 18.  He is 29 now.  Most of the class was rehashing what I have already been through but it was still a worthwhile endeavor. You will learn about resources and get suppport. Good luck to you and your child.

        Everyone! Arms akimbo!

        by tobendaro on Tue May 14, 2013 at 07:49:20 PM PDT

        [ Parent ]

  •  I disagree strongly (16+ / 0-)

    There are some mentally ill, and some mentally retarded who are mentally ill, who need the safety and security of an institution because they cannot function on their own.

    This is personal and I won't go into it, but your flat-out refusal to consider the well-being of those who are worse off than you betrays a lack of familiarity with individuals who do not have your grasp on reality or, probably, your resources.

    •  If you don't point to specific examples of (3+ / 0-)
      Recommended by:
      marina, socindemsclothing, kyril

      people who must be institutionalized, they are just bogeymen you've created. You don't have to get personal, but you really need to back up an assertion that extreme.There are plenty of models for group homes, and community treatment that aren't institutions. No mentally ill person deserves to be treated like they are subhuman, ever.

      •  Seems pretty clear the "specific example"... (4+ / 0-)

        ...is someone close, and he'd have no choice but to "get personal" to satisfy your request/demand...

      •  I am really not wanting to jump into the middle of (13+ / 0-)

        anything here, but you asked for examples.  A friend of mine has a relative who is in the process of succumbing to alcoholic dementia.  Physically he is doing pretty well, ie his body is pretty healthy.  The same cannot be said for his mental state.

        This is a large, powerful guy who is becoming increasingly violent and often this violence is paired with some pretty inappropriate sexual advances.  It's not his fault, really.  He wasn't like this before the dementia.  But that doesn't mean his behavior isn't unpredictably dangerous to most of the people who work with him.

        He started off in his own home with supports.  Then he "graduated" to an assisted living type facility as his family became unable to adequately care for him.  (They were neglecting him, rather than deal with any "unpleasantness," so a social worker stepped in and "recommended" a placement.)  From there, he moved to a nursing home, as he needed more round-the clock supervision.

        He has now reached a place where the nursing home personnel do not feel safe around him.  I'm not sure of the entire story, but apparently he's not responding to medications very well.  Meanwhile, his violent outbursts are increasing, along with his sexual outbursts.  They are concerned for his own safety as well as their own.  

        Long story short, the nursing home and his social workers are now recommending that he be placed in a state run hospital with more capability to handle violent patients.  I didn't know that my state (Oregon) still had a state hospital--I thought it had been shut down like so many others.  It needed to be!  It was the scene of terrible abuses for years!

        I don't know how things are going to be resolved for this man.  If he were rich, then likely his family could find some sort of secure private facility to care for him.  Since that is not possible, I can also see the side of the folks working at that nursing home (his fourth one, BTW).  They do not get paid enough and are not supported enough to handle someone like him.  No one should live under the threat of being violently sexually assaulted at their workplace.

        I don't know what the best answer is for patients like him.      

        Metaphors be with you.

        by koosah on Tue May 14, 2013 at 06:15:57 AM PDT

        [ Parent ]

      •  let's find common ground (11+ / 0-)

        While "No mentally ill person deserves to be treated like they are subhuman, ever." is absolutely true in every instance, I frankly think you are wrong in your assertion that there are never any instances where someone could be utterly mentally devastated (!!) and not *need* to be institutionalized long term.

        I've been locked up in the psyche ward twice. The first time was right after I realized I was wrapping a belt around my neck, fixing to hang myself. I was in for a week and during that time I had very little say over anything and I was so grateful for that. The second time I had just barely gotten myself out of a terrible relationship (with someone who I feel certain was a narcissist). For months and months she would call me at 3 AM and wreck my sleep and I was going downhill FAST. Again locked up for about 10 days but that was 10 days of undisturbed sleep, no worry about anything because I was being taken care of.

        Ok, not the best examples because this was not against my will and certainly not long term. My uncle suffers from paranoid schizophrenia and has for nearly 40 years now. There were many times in the 80's when he was locked up against his will for months at the time. He raged against it! He was so furious! You know why? It was NOT due to lack of freedom, it was because he was convinced he was NOT ILL. In fact, it was only TWO years ago that he finally got on the proper medication and NOW he recognizes how sick, how demented, how delusional he had been for DECADES.

        When he was locked up, he couldn't threaten people with his sawed off shot gun (people that were usually only in his mind) AND he was safe from abuse at the hands of assholes around him. He (and everyone around him) was so much safer with him locked up, against his will (which it was only against his will because his ILLNESS told him so!!!)

        You've written this beautiful diary, painted this amazing picture and NONE OF IT IS REAL for the VAST majority of Americans. It's a beautiful pile of bullshit. I WISH it was like this in reality, I really do. If it was, I would most certainly agree with you in almost all instances, but it is not.

        Another example for you, a young woman I met while in group dbt therapy (if you know what dbt is for, you might have a tiny clue about where I am really coming from). She had spent 10 years in the psyche ward, against her will because she had listened to and obeyed her delusions and set herself on fire. Even though she had eventually been set loose and was living in a group home, she told the dbt group many times how she still longed to complete burning herself up. Locking her up was the ONLY thing keeping her from doing that.

        Here's a newsflash. Not every form of mental illness is treatable with drugs and talk. None of the "anti-depressants" worked for me, talk therapy was really GREAT for helping me deal with the trauma of childhood sexual and emotional abuse, it was absolutely pointless for dealing with anything else (dbt was great but seems to have limited efficacy because there is only so much BULLSHIT a person with dbt can put up with before they say FUCK. YOU. and when that happens - at least for me - even dbt becomes yet more bullshit)

        I love your diary, I've re-read it twice since starting my reply but it seriously pisses me off. Do another one that shows (if you can) how it can possibly be better to let Mad Max be homeless VS locking Mad Max up "against his will" because THAT is the reality here in America overall, outside your utopia.

        Peace thru hemp / hemp for life!

        by Boudicia Dark on Tue May 14, 2013 at 06:42:39 AM PDT

        [ Parent ]

        •  This ^^^ (3+ / 0-)
          Recommended by:
          marina, David54, Boudicia Dark

          I wish we lived in the utopia the diarist describes. My own mental illness, major depression, is successfully treated with antidepressants and Buddhist practice. But I have read too many newspaper accounts of heartbroken families whose hands were legally tied except for many 3-day commitments, after which their loved one went on to kill others or themselves, including numerous instances of suicide by cop. I don't get the 3-day commitment idea, since most medications take 2-3 weeks or longer to take effect. How does this give people like this a chance?
           

      •  SUBHUMAN? Where did you get that from? Do (0+ / 0-)

        you want a medical history from a doctor? Extreme? You can look at CDC statistics of suicide. I'm not in those statistics. I could have been. Am I a bogeyman?

        2012-2016 President Obama, Vice President Biden, Senator Warren. For a LIFETIME, federal judges. Get the filibuster changed. Steamroll. http://www.whitehouse.gov/contact/submit-questions-and-comments

        by CuriousBoston on Wed May 15, 2013 at 02:58:06 PM PDT

        [ Parent ]

    •  I recced the diary as a whole, but you certainly (10+ / 0-)

      do have sound objections.  Very few solutions to any problem in life are absolute, and there will always be those who will never be able to reintegrate safely into the dangerous, demanding, and confusing modern world.  I'm vaguely assuming this is more along the lines of a call for more on the left to integrate the call for more money to be allocated to mental services, which, at least in my area, seem constantly to be run on a shoestring.

  •  My late mother was diagnosed in 1951 (11+ / 0-)

    and experienced the entire trajectory of mental health treatment in the last 60 years until her death this year.

    The first couple of times she was in the state hospital, she was committed against her will, and later she learned to commit herself when she felt like she was losing it. She was in a psychiatric ward for short duration only twice after the early 1960's.

    The diarist pretty much covers it. Institutionalizing was replaced by simply allowing the mentally ill to "disappear" to bridge abutments and underpasses throughout the country. Except for those with a loving family and enough resources, as my mother had.

    We could pretty much solve this problem, and so many others, if we were not allowing the 1% to steal the wealth of our nation and hoard it away in overseas accounts.

    Ditto the power of Big Carbon, which is obstructing the formation of a new robust middle class economy based on green energy.

    You can't make this stuff up.

    by David54 on Tue May 14, 2013 at 06:02:52 AM PDT

    •  "a loving family and enough resources" are not (1+ / 0-)
      Recommended by:
      marina

      enough. See my comment above.

      •  I agree totally. In our case, it was, by the hair (2+ / 0-)
        Recommended by:
        marina, CuriousBoston

        of our chinny chin chins...
        Mom attempted suicide once in the 90's and twice in the last 5 years.
        It would take a whole slew of diaries to explain, but I would say generally in the last 20 years of her life, she was the most sane one in our family.
        Our society is afflicted with a terrible disease that is characterized by the gop and the religious right. When we overcome that disease, this country will be able to heal. Until then, the most vulnerable are the mentally ill, disabled, the broken and beaten among  us. Any one of us may fall into this category someday, so we must do what we can with what we've got.

        You can't make this stuff up.

        by David54 on Tue May 14, 2013 at 07:55:28 PM PDT

        [ Parent ]

  •  One thing that frustrates me (15+ / 0-)

    is that with mental issues, health and illness is treated as if it is all or nothing, permanent once there.

    Mentally ill people aren't "insane," they are disabled. When you break a leg, you are disabled.
    Yup.  Some types of mental illness are chronic, some are acute, and symptoms and problems can get better or worse over time, depending upon how they are dealt with.  Just like other illnesses we consider 'physical'.
  •  My former neighbor (13+ / 0-)

    Was schizophrenic and the first couple of years she lived next door, she did drink a lot but was basically benign. Then she began terrorizing the whole street, but focused on me. The last four years she lived there, she made my life a living hell. And I had no recourse because I called the local mental health center and the police but there was no help for me, a person who had done nothing but live next door to this person. I was the person who was trapped in their home, while she was free to go around telling our neighbors fantastic stories about me that had no basis in reality, like telling a guy who was installing a new air conditionerin my home that I was making meth or calling the police and telling them I was trying to set fire to my yard during a dry summer -- things that could get me arrested (side note the police found burned paper in my back yard which she set fire to and could have caused a lot of serious damage.) After that I felt like a prisoner in my own home. That's just a couple of anecdotes. She did other things to me as well as other neighbors, and it was sometimes violent. I sympathize will mental illness because I went through difficult times where medication and counseling saved me. But what was I supposed to do when this happened. No one would take action. The only reason she moved was the foreclosure on the home in which she lived. Best day of my life.

    •  This raises a point I haven't seen here yet... (14+ / 0-)

      What about folks who refuse treatment?  What about the effect this often has on others, not to mention themselves? And so forth...

    •  What a terrible experience -- both the harrassment (2+ / 0-)
      Recommended by:
      marina, CuriousBoston

      and the threat to you, and the experience of finding that no one could or would do anything to help.  I'm glad you made it through okay.

      The treatment program the diarist describes for mental illness is wonderful, and would be of enormous benefit to most people with mental illness, while also helping society by bringing many people to a higher level of stability and independent functioning.  

      I would gladly pay higher taxes to support programs like this.  (Tho I'd like it even better if the rich paid their fair share, in which case my taxes wouldn't even have to go up.)

      But in a minority of cases, some mentally ill people need to be locked up for their own safety or the protection of others.  In most cases this should be temporary.  In rare cases it may need to be permanent.  If most mentally ill people are treated in the kind of program the diarist describes, I hope that we could maintain locked facilities that are decent, well-staffed facilities that make it their aim to help as many patients as possible to stabilize and leave, moving to a less restrictive level of care.

      I hope we can improve the treatment of people with mental health issues, to the point where the whole system aims to support healing and autonomy -- and yet also provides protection to people like you, or like the mentioned elsewhere whose husband killed her because he was schitzophrenic and the illness had taken control.

      --------------------- “These are troubling times. Corporation are treated like people. People are treated like things. …And if we ever needed to vote, we sure do need to vote now.” -- Rev. Dr. William J. Barber

      by Fiona West on Tue May 14, 2013 at 03:25:14 PM PDT

      [ Parent ]

  •  The word is not "retarded". The word is (6+ / 0-)

    developmentally disabled. One reason is not receiving enough oxygen at birth.

    To defend mental illness by citing mentally ill people are not "retarded" is cruel.

    You are speaking about me and the person I love most in the world.

    Crying now, remembering all the physical and emotional abuse I could not prevent.

    Please Kossacks. If you would not use the word "PWD, person with diabetes, do not use brain diseases to describe people.

    The pain inflicted is more than you know.

    Thank you.

    2012-2016 President Obama, Vice President Biden, Senator Warren. For a LIFETIME, federal judges. Get the filibuster changed. Steamroll. http://www.whitehouse.gov/contact/submit-questions-and-comments

    by CuriousBoston on Tue May 14, 2013 at 06:32:03 AM PDT

  •  My family is dealing with (9+ / 0-)

    the problem of continuity of care. My mother-in-law, Carol, has had problems with mental illness her entire life. She suffers from severe depressive episodes, and attempted suicide three different times when my husband was growing up. There were many doctors. She was diagnosed with schizophrenia at one time, another time as bi-polar. Medicines were prescribed and changed and changed again.

    For the last 15 years, Carol's condition was fairly stable. She was functional and independent. Then the stroke happened. Carol is 75. Depression after stroke is very common, in Carol's instance it was inevitable. She attempted suicide, was sent to the emergency room, was released. A month later she tried again. Another traumatic ER visit. A second stroke hit her about 3 months ago. Not long after she returned home from the hospital she took an entire bottle of aspirin, and ended up in intensive care.

    What is baffling to me is the seeming inability of the medical community here to connect mental health care to physical health care. She went to a psychiatric care unit, where she became dangerously dehydrated. She went to a nursing facility while she was recovering from stroke, but they were unable to cope with her depressive state. The latest ER trip was another episode of severe dehydration. Then she was moved to the psychiatric wing of the hospital. That meant that she could not have the IV saline drip, because the needle could be dangerous.

    She is home again. The home-health nurse "didn't work out," my father-in-law said vaguely. And so we are in medical limbo again. I should say we, her family, are in limbo. Carol is in hell.

    "YOPP!" --Horton Hears a Who

    by Reepicheep on Tue May 14, 2013 at 06:40:52 AM PDT

  •  A mentally ill man and his family tried to get (6+ / 0-)
    Recommended by:
    Reepicheep, marina, viral, Kimbeaux, liz, shigeru

    care at a hospital in RI. They were turned away. They then sought care at the hospital that is my source of ER treatment. They were turned away.

    He killed an 80 year old woman. The police said that in the squad room, he got a gun. (Insert police coverup here.) The police said he jumped out a window, that was how he sustained injuries. (Insert another coverup here.)

    He showed up in court wearing a mask identical to Hannibal Lectors. Because he was biting people. (insert another coverup here.)

    The mask, the orange uniform, covered his injuries. The shackles and hancuffs, and two bailiffs supporting his weight covered up his injuries.

    You can imagine my horror at comments I heard around me about what this man deserved.

    You bet I made arrangements with my doctors.

    2012-2016 President Obama, Vice President Biden, Senator Warren. For a LIFETIME, federal judges. Get the filibuster changed. Steamroll. http://www.whitehouse.gov/contact/submit-questions-and-comments

    by CuriousBoston on Tue May 14, 2013 at 06:42:34 AM PDT

  •  Republished to Mental Health Awareness nt (7+ / 0-)

    I'd like to start a new meme: "No means no" is a misnomer. It should be "Only 'Yes' means yes." Just because someone doesn't say "No" doesn't mean they've given consent. If she didn't say "Yes", there is no consent.

    by second gen on Tue May 14, 2013 at 06:53:19 AM PDT

  •  Well written diary with lots of good food for (1+ / 0-)
    Recommended by:
    koosah

    thought.

    Would guess that everyone has a degree a mental health vs some degree of mental illness, just as with physical health, there are degrees and opportunities for healing.  

    Classification of one's being "mentally ill" comes from deviation of some perceived "norm".

    The issues of stigma vs access to care and support are significant.

    Thanks for making us think.

  •  You've done a fine job of outlining an (6+ / 0-)

    excellent program for the treatment of mental illness.

    There are relevant quibbles which have been mentioned by others.

    All I'd like to add is this:  I've never seen such a fine program in operation in any state in which I've lived.  

    Instead, at some point in the idealistic program you outline, a certain number of people are 'released' from the program/system.  And a certain number of those quickly become homeless or a hazard to themselves or others.

    No, not everyone. Not even most.  But there are a good number of people on the streets who are lacking basic life-skills structure in their life and apparently are unable to create that structure on their own.  Not everyone can 'graduate' to self-care.

    I think your program would be wonderful if funded by the individual states, but even then, there are people who still need more care or supervision. Unfortunately, that care is often not available.

    In our state, even people who are obviously dangerous to themselves and others cannot find help or treatment at the underfunded state hospitals. For families without insurance or wealth, that has led to tragedy after tragedy.

    "The law is meant to be my servant and not my master, still less my torturer and my murderer." -- James Baldwin. July 11, 1966.

    by YucatanMan on Tue May 14, 2013 at 11:09:42 AM PDT

  •  For most people continuity of care is the (3+ / 0-)
    Recommended by:
    shigeru, Alice in Florida, marina

    most important. However, there are a few severely mentally ill people that present a danger to those around them. For example, my former neighbor had severe schizophrenia. At one point he killed his wife. We need to deal with people like him as well.

  •  Though I agree with a number of your points, (5+ / 0-)

    the removal of institutionalization as an option is one of the primary drivers of the massive increase in homelessness in this country.  Granted there may be other, more palatable solutions for some of those people, but our country appears to have neither the will not desire to do any of those things.  

    Republican threats amount to destroying the present if we don't allow them to destroy the future too. -MinistryOfTruth, 1/1/2013

    by sleipner on Tue May 14, 2013 at 12:46:10 PM PDT

  •  All good points about the disability and (2+ / 0-)
    Recommended by:
    high uintas, marina

    basic support. In states like NY, CA, MA and some other places it is possible to survive at or near poverty levels and get treatment if one is disabled. In other places there is nothing, thus we need to work on getting more uniformity in place.

    My only mild disagreement with you is regarding the homicidal and completely non-functioning who need more intensive long-term treatment. I don't know the magic answer, but do know that leaving them out on the streets or under bridges is probably not optimal either. And of course folks who function well with meds, but like many other people on lifelong medications (such as diabetics or myeloma patients) some get tired of taking the meds sometimes. Or like most chronically ill periodically stop following instructions. Then what?

    Maybe some increased recognition and support coupled with a way to hospitalize the dangerous and non-functioning. There are unfortunately some of them.

    But thanks for bringing up this very important issue.

    If... the machine of government... is of such a nature that it requires you to be the agent of injustice to another, then, I say, break the law. ~Henry David Thoreau, On the Duty of Civil Disobediance, 1849

    by shigeru on Tue May 14, 2013 at 03:34:25 PM PDT

    •  Agree on long term care (4+ / 0-)
      Recommended by:
      tobendaro, marina, Boudicia Dark, shigeru

      mr.u's brother is a schizophrenic and spent years being delusional and homicidal. He wanted to kill me and mr.u, tried to kill his parents and travel from NY to Utah to kill his own infant son.

      He was saved from completing his task by the fact that he went to the local police and told them that his son had been kidnapped by a demon's soul and he had to kill the boy in order for the real soul to reclaim the body.

      BTW, the police called in a state psychiatrist who said that he was no danger and should be released. The police disagreed and held him long enough for us to get things together to get him back to the institution in NY.

      His disease has run it's course. He is no longer dangerous or institutionalized but lives a sad and lonely life in a slum in Utica. His life was destroyed, half by the disease and half by our inability to truly help him.

      "The scientific nature of the ordinary man is to go on out and do the best you can." John Prine

      by high uintas on Tue May 14, 2013 at 06:30:59 PM PDT

      [ Parent ]

  •  RadicalParrot -- thank you for writing about the (1+ / 0-)
    Recommended by:
    koosah

    concept of psychiatric rehabilitation and the programs you've been involved in.  It's hopeful and uplifting to hear about programs of this quality anywhere in the US.  I now have yet one more motivation for fighting to get the tax system back to something reasonable in this country -- because if the rich pay their fair share, we could afford to take care of our citizens in their times of greatest vulnerability, including illness, whether physical or mental.  I love hearing that better methods of supporting healing are in fact being developed -- and are already in existence.

    I have some criticisms of the diary, but my basic response is appreciation for writing about this complex topic.  I'm sorry that some of the responses you got were pretty harsh.  This topic is so emotonally charged.  Many people have had terrible experiences, or seen tragedy close up, and so reactions are very loaded.  I hope you're able to register the appreciative reactions too, and may write more about psychiatric rehabilitation in the future.

    --------------------- “These are troubling times. Corporation are treated like people. People are treated like things. …And if we ever needed to vote, we sure do need to vote now.” -- Rev. Dr. William J. Barber

    by Fiona West on Tue May 14, 2013 at 03:36:05 PM PDT

  •  Thank you for the mea culpa. n/t (0+ / 0-)

    2012-2016 President Obama, Vice President Biden, Senator Warren. For a LIFETIME, federal judges. Get the filibuster changed. Steamroll. http://www.whitehouse.gov/contact/submit-questions-and-comments

    by CuriousBoston on Wed May 15, 2013 at 02:03:53 PM PDT

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