The Gap After Clinical Care

The 1950’s and 1960’s saw the de-institutionalization of patients suffering from mental illness.  Why is that?  Well two things: 1) Due to the lack of institutional oversight, the institutions themselves were wrought with problems and cases of patients being abused; and 2) the Civil Rights Movement.  A person diagnosed with a mental illness hasn’t committed any sort of crime or done anything wrong.  Yet, due to a diagnosis, people were losing constitutionally protected rights.  These two forces moving together, brought about states closing in-patient psychiatric facilities.  For more information on this, see How The Loss Of U.S. Psychiatric Hospitals Led To A Mental Health Crisis posted on NPR.

So what happened to these folks?  Unfortunately, a good number of the residents who were living in the psychiatric hospital ended up homeless or caught up in the criminal justice system.  While there is certainly a portion of the patients that require clinical hospitalization, there are a good number of folks who only require help with medication management and a more structured environment to call home.  They are capable of holding jobs and navigating the world.

So why don’t more people voluntarily get treatment?  Good question.  I don’t know that I have “the answer,” but I think one of the biggest barriers to mental health treatment is just the stigma attached to acknowledging the need for it.  For some reason or another, people get embarrassed by the thought of therapy or medication.  The person feels shame associated with the problem he or she may be having.  Personally, I think the biggest hurdle is the fact that most folks who need help lack insight.  How many of us have sat in a room or watched something and thought to ourselves, yup, that speaker is COMPLETELY disconnected? That speaker isn’t the problem, it’s the rest of us.

So what happens when a person needs treatment, but doesn’t get it?  If the person is non-clinical – nothing.  If you aren’t a risk to yourself or another, you have your freedom.  Just like you can’t force an obese person on a diet, or make someone take heart medicine, you can’t force someone with a mental illness to go to therapy or take medication (there are limited exceptions).

But even when a patient is clinical – meaning a risk to self or others – the path to treatment still feels narrow.

The most common route for clinical treatment is through the Emergency Department of a hospital.  The threshold to be admitted for treatment through the Emergency Department is extremely high.  The person must be found to be a risk to self or others.  What does this mean?  Just that.  A person has the right to rant, rave, throw fits, spend money, do whatever he or she wants – and there will be no medical intervention unless the person is a physical risk to self or others.  This can be agonizing to watch.

Anecdotally, I have found a physician’s determination of “risk to self or others” to be completely subjective.  There have been instances where I’ve seen a patient be committed against the person’s will on a third-hand account of the patient driving too slow on the freeway.  On other occasions, I have seen patients screaming, yelling, and jumping up and down on beds IN THE EMERGENCY DEPARTMENT and the physician is unwilling to commit the person against his or her will because the patient is, technically, not a risk to self or others.

There are things you can do to protect your loved one who is ill, but it is not an overnight fix.  Reach out to attorneys who have handled this issue before and can empathize with your situation.

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