Saturday, February 21, 2009

The unhealthy state of mental health institutions

Recently, Kings County Hospital's G (mental health) building made it to the papers because last year a patient died in the ER under guards' supervision and nobody gave much of a darn about it. One of the sad lessons- people in health care don't really care much about the sick ; they care even less for the mentally ill.

On my current assignment more than 50% of the residents have a psychiatric diagnosis. Many lead decent institutional lives and they are symptoms are controlled for months and even years.
Some become victims of the heavily regulated nursing home system. An in-house doctor, internist, decides that a patient is on too many psychotropic drugs and decided to reduce/discontinue some of them. The results are usually pretty quick. The resident starts seeing things, hearing things, think things, say things, or just act crazy. They a psychiatrist is called in to start the whole medication-adjustment process all over again.

In some instances, residents decompensate so quickly that they have to be admitted to a psych hospital. (Psych hospitals deserve a few entries of their own) And that's the reason for this post...
Here's a 'case study':
Time was admitted to a nursing home after 7 weeks of psych hospitalization for some 'unruly' behavior. When I first came to see him, he was a scary crazy man- talked to himself non-stop, looked through you if you addressed him, inconsistently followed basic conversation, the works.
After staying in the nursing home for less then 2 weeks he was hospitalized for some unacceptable behavior.

Tim was readmitted to the nursing home a 3 weeks later. He was almost unrecognizable- he looked physically healthy. His conversations not only became coherent but also very intelligent and pleasant. Tim was a new man, but sadly, not for long. After a month or so, his conversations became less coherent, he became more preoccupied and frequently inappropriate. Two weeks after the reappearance of his symptoms he was back in a psych hospital.

That hospitalization lasted a bit over a month. But based on the hospital paper work, they weren't treating his symptoms but rather 'managing' them. In hospital he received medication for agitation which was frequently given to him via injection ( to kick in faster). After weeks of such ' management' ( my guess is-hospital was hungry for some of Tim's insurance $), Tim was ready to come back to the nursing home.

Tim was readmitted early in the afternoon. I saw him in the lobby and welcomed him back. He thanked me. But as kept walking, he told me that I have a nice body " and a sharp mind" he added quickly. I told Tim he was inappropriate. He apologized but I wondered what exactly did they do for Tim in the hospital?

Half hour later I heard very loud screams and cursing in the lobby. It happens quite frequently, so I ignored the screams at first. My coworker said it was one of the residents who was upset about the new smoking hours. But the screaming continued on and off for 5 minutes. I decided to check out the situation for myself.

There were 2 EMS guys standing in the middle of a hallway. Near a wall, 2 female cops were trying to handcuff someone. That someone was Tim. He had a somewhat surprised look on his face, trying to tell something to the cops. EMTs looked sympathetic and even a bit embarrassed. The cops were just doing their job. And I felt physically sick.

It took a few minutes after Tim was handcuffed and put in a chair for the paperwork to be filled out. And then Tim was led away into the freezing cold in just a tshirt, back to the same hospital which didn't do much for Tim. Yet Tim had to pay for the incompetence of the doctors by being subdued, handcuffed, and humiliated, and be sent there for more 'management of his symptoms'.


Barb Chansky said...

The first time you told me this story, it made me sad; the second time around was not much better. Sometimes I really hate the uncaring members of medical profession.

SubWife said...

This is truly sad. As if having one of these diseases is not bad enough.

La Poutine Cachere said...

So utterly heart-breaking.

I have quite a few friends who are health professionals, most of whom have somehow managed to still regard their patients as people. But the others have been honest enough to admit that they view their patients differently than when they started, just so they can get through the day...

Moshe said...

As if treatment of not mentally ill patients in NY hospitals is that much better.

Sally Hazel said...

LPC -it's true that some people have to remove themselves from the reality of 'mental health' tragedy in order to function. But as Moshe mentioned, it's the general attitude in NY hospitals and other health care facilities that's rather lacking.

Advocate 366 said...

As a mental health advocate and a parent of a daughter with schizophrenia, I can attest that the overall approach by the mental health care system is rather poor. There are many kind and compassionate people in the system but the system rules for access to treatment promotes failure of treatment and reoccourence of symptoms. There is also a great reliance upon drugs to control symptoms for temporary purposes, but not adequate support to help those who are ill to stabilize on a treatment regimen. Unlike those with AIDS and other diseases for which there is more popular support, mental illness is more likely to be viewed as a charachter defect. Having lived with and observed my daughter I can assure that no one would want to choose to be in her condition.