Tuesday, September 11, 2018

Welcome To My World

h/t IOTW

IOTW links to a story called "Why it’s so hard to get mentally ill Californians into treatment"
(besides the obvious answer, which is because my fellow Californians keep electing them to office):
(EXCREMENTO, CA) For years, Diane Shinstock watched her adult son deteriorate on the streets.  Suffering from severe schizophrenia, he slept under stairwells and bushes, screamed at passersby and was arrested for throwing rocks at cars.Sometimes he refused the housing options he was offered. Sometimes he got kicked out of places for bad behavior.  Shinstock, who lives in Roseville and works on disability issues for the state of California, begged mental health officials to place him under conservatorship—essentially, depriving him of his personal liberty because he was so sick that he couldn’t provide for his most basic personal needs of food, clothing and shelter.
But county officials told her, she said, that under state law, her son could not be conserved; because he chose to live on the streets, he did not fit the criteria for “gravely disabled.”

This is my life, every day for 20 years in the ER, and every other ER, nationwide, especially so if the community is larger than 50K people, and if it doesn't snow there in the winter, multiply that by a factor of 10.

We didn't have 500,000 visits a year at the Busiest ER On The Planet™; we had 1000 regulars who came in 500 times apiece.

I've now been to...fourteen ERs in three counties in nearly twenty years doing this, and it's no different anywhere you go.

Schizophrenia is like heroin addiction: it's a social death sentence, and it's almost never getting any better. The worst part, for family, is that Suzy or John (mostly John, victims are about 1 1/2 times more likely to be male than female) is perfectly normal until late high school or early college, even honors students, and then that last bit of wiring in their heads doesn't go in right. It short-circuits, and they stop being normal, brighter-than-average kids and become, frankly, batshit crazy. I can only imagine the never-ending horror for parents of raising a child, getting them safely past all the normal hurdles of growing up, sending them to college, thinking things are okay, and then watching them completely melt down before your eyes.

Meds help, but only if someone with schizophrenia takes them.
The meds make them feel "weird" (which is what we who aren't schizo call "everyday life" 24/7/365/forever), but they seem fine. So they decide they're not sick, and don't need the meds. And become actually weird, hearing voices who aren't there, seeing people and things that aren't real, and end up in my patch, barking, frothing mad. So we re-medicate them, they get put on a psych hold, they get better, go home, and the cycle repeats. And repeats. And repeats. And repeats. And repeats. And repeats. And repeats. And repeats. And repeats. And repeats. And repeats. And repeats. And repeats. And repeats. And repeats.

Frequently, after burning all bridges with family, friends, and everyone else, and being thrown out of every care facility in an entire time zone, for cause, they end up on the streets. Where they "self-medicate". I.e., with pot, meth, heroin, benzodiazepines, alcohol, bath salts, paint, glue, or pretty much any substance they can get into their hands, and their bodies.

In a lucid moment, a juvenile patient once confided to me, straight-up, that he got wasted because when he got The Voices In His Head drunk or stoned enough, he couldn't understand them or hear them any more. Pure medical genius, right there.

Oh, and The Voices? They never tell you "You look great!" "Everybody loves you!" "You're a wonderful human being!"

That would be too easy, right?

The Voices always say "You suck. Kill yourself. Everyone hates you. Why don't you die?"

Go watch A Beautiful Mind. Or every scene with Gollum in the LOTR movies. (No points for guessing which sections of those latter movies I will completely skip over, wholesale, in that entire trilogy, because it's too much like pulling a shift at work, except without getting paid.) There was even a great TV MOTW with James Garner as the sane brother, and James Woods as the nut, that they showed in nursing school, because the writers and actors got it so right.

The article tries to pin this mess on Reagan (color me shocked), for signing Lanterman-Petris-Short in CA in 1967. But every other state was doing the exact same thing, and in fact LPS was in the legislative pipeline and conceived under Democrat CA governor Pat Brown, Moonbeam's father, before Reagan was even thinking about politics.

The state - in fact every damned one of them - wanted to get rid of psych hospitals long before One Flew Over The Cuckoo's Nest (which was outdated tripe from 30 years earlier when the film was made, but why let facts interfere with a good screed, right?), simply because crazy people don't pay their bills, you do. So warehousing them in Bedlam was nothing but a money hole the size of the Grand Canyon, nationwide.

And the do-gooders got together with the penny-pinchers, and decided collectively that since psych hospitals were so terrible, understaffed, under-funded, and yet still too expensive, because staff needs salary and crazy people need food and medicine, why not just turn everyone so "unjustly imprisoned for life" out onto the street?
What could possibly go wrong?
"The state budget will save millions!"

Whereas instead, as we all experience daily, they're free to run into traffic, attack people, burglarize and rob and steal to get money for drugs/alcohol/whatever, crap on the streets, and generally validate every reason that we have for why we used to throw a net over them and lock them up for life.

Which we can't do, because you have to be a "danger to self, danger to others, or gravely disabled", the definition for which last means that if you are mentally with it enough to scrounge garbage to eat out of a dumpster, drape yourself in trash bags when it rains, and construct a cardboard pallet and hovel to sleep on and in, you're not "gravely disabled."
Just...eccentric, and living an "alternative lifestyle choice".
Don't believe me, ask the district attorney, the state bar association, and the Do-Gooders League Of America. This ain't a California thing, it's a U.S. of A. thing, coast-to-coast.

So they're free, and now everyone else has to lock their doors, put up bars, keep their kids inside, and pack heat, so that these literal lunatics can run wild and free.


And the article shows that TPTB haven't figured it out, even after 50 years' time.

The do-gooders just want them to be free (and to hell with their best interests, or anyone else's).
The rent-seekers want more money, and no rules for them.
The families want somebody else to solve (and most importantly, pay for, their batshit crazy uncles, cousins, brothers, and sons).
And the police, the hospitals, and the courts are simply tired of dealing with their bullshit, and that of the interest groups who want it to continue more than they want what we have now to stop.

My bent is a libertarian approach.
After three trips to hospital on a 5150 for being off your meds, we throw a net over you.
We put you in a helicopter, and we drop you off on one of the Channel Islands currently inhabited mainly by goats.
Once a week, the helicopter flies over, and they kick out food bundles.
There are no trees, and the islands are 30-40 miles away, in waters best described as sub-arctic even in July; those people aren't swimming or floating back, ever.
If the family is all broken up over this, they can pay for private care. They can visit them on Shutter Island whenever they like. They can bring them food, clothes, or anything else to make their stay more pleasant. They can even bring doctors and medicine there to address any other needs. The whackjobs are now free to chase butterflies, run around naked, or even try to fly off the cliffs; I don't care.
I don't want them euthanized, or harmed in any way. I want them free. Over there.

What they aren't free to do, is continue to run around in traffic, assault people and each other, crap on your porch, or walk around in society off their meds.
Three strikes, and you're out.
Now they're free, and so are we.

The do-gooders have tried it their way. So have the penny-pinchers.
Now it's time to solve the problem.


Jess said...

That's probably the least cruel way of handling the problem. I doubt the bleeding hearts would think it is, until they have a family member lose their head because the "voice" demanded the action, or find their life in ruins because of a sufferer allowed to roam their neighborhood.

Allen said...

There really is no helping these people beyond enforced containment and medication. Or, some sort of cordon sanitaire as you mention. I would help carry the net when a friend went out searching for his brother, after his brother started thinking he no longer needed his medication. Someone who hasn't dealt with it is not ready for it or should have much to say about it.

Beans said...

Worked at a mental-holding facility where they dug a moat and planted Spanish Bayonets all around the inside of the moat. Thinking no sane person would crawl through cactus, Spanish bayonet plants, through a moat with gators... At a mental-holding facility (can't call them prisons, the 'residents' weren't criminals due to insanity.)

A week after they opened, moat was filled in and double barrier wire like in a real prison was hastily put in.

I'd see if we could buy Devil's Island off the French. Or use Puerto Rico...

jabrwok said...

Don't forget to sterilize them before exile. Otherwise you'd just be breeding a new generation of problems.

AB.Prosper said...

Thanks you for this

Some bleeding heart housed one of these nut jobs across the street from me and I have to listen to this lady scream all the damned time at her imaginary ho's in Spanish.

Now on the other side of the equation, I know a guy we'll call him Kyle who has been schizophrenic since his twenties and yet functions fine as he always, never fails to take his meds . He has a cheap little house and even works when he can as a scavenger.

His wife is well, she goes off her meds and manic but you know despite his disability, he mans up and takes care of her crap and his his. No kids happily.

If all the schizophrenics were like him and they sure as frack aren't getting rid of the institutions would have been fine but as it is, all this policy does is create more human suffering

As for the Island, I'm liking that idea.

lineman said...

Only if it is like Skull Island don't give them one in the tropics...

Anonymous said...

No, welcome to MY world.

Eight years ago my son, in college, had a psychotic break. Schizophrenia. He lived with us, violence in our home sporadically. In and out of jail, assault, malicious mischief, etc... Not taking meds, drinking. Bad combination.

The current mental health facilities are our homes or the jail. Sure, blame Reagan. Just like every thing wrong in society today, you'll find a leftist do-gooder behind it. See also: https://en.wikipedia.org/wiki/Community_Mental_Health_Act

He lives on his own now, we got him to agree to take meds by injection, and they are mostly working. It's hard. What should we do? He's our son. Should we throw him away? Some families do, and I don't judge them. We chose to help, love and fight for him. We believe that he will can and will have a happy and healthy live someday. (Crazy Christian hope...).

Thanks for hearing/reading my rant.

Aesop said...

The people who take care of their own kin are the blessed and far-too-few exceptions to the rule.

Most simply can't deal with what has to be a fairly devastating turn in life, and those examples, which is most of them, all end up on the street, and in and out of jail.

If I'd wanted to work psych, I'd have signed up for that.
But by default, then end up in the ER for what isn't an emergency, but has become a dumping ground for problems no one else will deal with, or pay for, or budget for, and it's killing people.

When I'm in a twelve-bed ER with six psych holds that won't get placed for days, and we get a stroke or a heart attack, you figure how that works.

If more people would do what you and your family do, it wouldn't be a problem.
Just like if everybody swept the sidewalk or shoveled the snow in front of their own house...

Anonymous said...

When I worked psych as a tech (orderly) back in the mid-90s we called for TTOL after 3 strikes of not taking meds...our resident psychologist agreed in theory not practice.

Therapeutic Termination Of Life.

Oh and I thought we were blaming JFK for letting the inmates out of the asylums. My Bad.

I say bring back bush therapy.

waepnedmann said...

Jails and juvenile halls have become our de-facto mental institutions.
Couple being 5150 with drugs, alcohol, abuse (both mental and physical), the nanny state, budget pressures and
you have plague without end?
I like the island idea.
Let's organize a committe to study the idea using a multi-million dollar grant to pay for it instead of
buying helicopters and MREs and actually doing something that addresses the problem.

Anonymous said...

Hey Aesop were you ever a paramedic? You sound just like I did (and many others) during my many years riding around in ambulances "saving lives" and "stamping out disease" Seeing the same people over and over again for the same problem and nobody could get anything done about it. Psych's,alcoholics and druggies waste more time when some decent person was out there needing help. Loved my career but retired now and don't miss it.

John F. Opie said...

Great piece. Let's not forget those who want to rub all of this in our bourgeoisie faces because it's capitalism's fault that people are this way. Back when I was an undergrad with a philosophy/psychology major, that was the straight-faced explanation why the asylums must be closed. Mental problems were caused by capitalism, you know, and it's time that the bourgeoisie were forced to deal with that, hence make the problem highly visible to help destabilize society and help create a pre-revolutionary scenario. Oy.

Stealth Spaniel said...

God Bless You-my RN mother loved every part of ER but the "nut cases". The public doesn't understand how dangerous these people are to nurses, doctors, other patients, etc. Most of the mentally ill exhibit superman strength when really rocking the casbah. She had one patient, who managed to escape his zipties and grab her arm when she came back in the room. He ripped her brachioradilis muscle; the pain and immobility was unreal. It took 3 doctors and a passle of psych nurses to wrestle the yahoo down. Mom ended up with surgery, therapy, and a cast. I support the island idea. At least the mentals can only damage themselves.

Aesop said...

@Stealth Spaniel


Eaton Rapids Joe said...

A couple of fictional vignettes in mythical post-Crazy-Cali