Saturday, November 14, 2009

Institutionalization Today

Although the mental health system has come along way since the days of the "asylum" we still have a long way to go.


(source)
An Abandoned Asylum

Yes, patients are no longer cooped up and chained in basements, sprawled out in their own excrements. Psychiatrists now know that dunking patients into vats of freezing water will not rid a person of psychosis.

However, I still believe that we are in need of more humane treatment.
Quakers (social reformers) were the ones who suggested that patients needed calming environments in which patients could be given small responsibilities rather than sit doing nothing. It was the Quakers who offered the opportunity for patients to take walks and garden and participate in their own recovery in various ways. In other words patients were treated like people.

Hospitals today are much different. Psychiatrists eventually took over the mental health system and now it's all about discharge. Get them in and out! It's about money and the psychiatrists are pressured to discharge patients quickly. The hospital's role is to "stabilize" the patient on medication and then find a place for them to go. Even though patients are offered them outpatient services, many do not follow up as they are not truly stable enough to recognize that they need on going treatment.

I understand that mental hospitals are no longer long term facilities. While this is a good thing in many ways, many patients are too ill or have no insight into their illness and are discharged too quickly. The system requires patients to re-enter the hospital a certain number of times before they are eligible for certain services in which social workers can follow a patient, visit them at their home, make sure they keep therapy appointments and receive their medication. Some patients are gravely disabled and can't take care of themselves in very basic ways.

It is not illegal to release a patient to themselves. This means that a patient may be released from the hospital without a plan. Some return to homelessness.

Hospitals make it clear to that they are not housing programs.
Well I think that they SHOULD be. I think that hospitals need to take on the responsibility to find adequate housing. I am furious patients are discharged before they are ready. Patients who are still actively psychotic are not ready for discharge.

Some patients aren't fortunate enough to have families to return to and even when they do, families need assistance.

Psychiatric social workers in inpatient hospitals are under the thumb of the doctors and the doctors are under the thumb of the higher up authorities.

Patients need better services. We need psycho-educational groups and stigma reduction groups.
These things exist outside of the hospital however some patients are too sick to understand much of anything.

I have spoken to so many patients who refuse services because they have given up hope and feel that they are too much of a burden on their families and society.
If WE don't help them who will? If they are in our care then their problems should be our problems. If we don't attempt to decrease stigma who will? If a patient refuses services I don't think it is okay to throw up our hands and say "oh well!"

Perhaps my readers won't get much out of this rant. But what I would like to stress is that those who endure a mental illness are people too. The stigma that affects them is profound.

So, the next time you see a homeless person talking to themselves or claiming to be Jesus, maybe think twice about laughing or offering a strange look. They are troopers and have such strength. They are ill not crazy and they in need of help. They are human just like you and me. They are a part of our earth whether we acknowledge them or not.


(source)
An Abandoned Asylum


And to all of us social workers, psychiatrists, nurses, psychologists, let us do the best we can within the framework we've been given. Let us do our best to humanize our patients rather than allowing them to fall between the cracks.

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