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Mental health (in the USA and elsewhere)

 
 
firefly
 
  1  
Reply Mon 17 Dec, 2012 12:38 am
@hawkeye10,
So, the problem isn't that mental health treatment services are lacking, it's that people aren't availing themselves of the services or treatment.

That article also isn't really about those suffering from the most serious major mental disorders, like psychoses, or bi-polar disorder, where the presenting symptoms are often so extreme that hospitalization is required. Those people tend to be diagnosed and placed on medication much more rapidly than someone who is experiencing a much less severe or chronic psychiatric problem, and their continuing treatment is generally done by a psychiatrist rather than a primary care physician.

From Walter's comments, I am under the impression that he has been referring to mental health care for those suffering from the most major psychiatric disorders--those we generally think of as the "mentally ill"--and not to the entire gamut of emotional, and personality, and behavioral problems that exist in the general population. And, for that most seriously disturbed group, the services, and programs, and disability benefits, seem quite similar in both the U.S. and Germany, based on what he has said.

Lots of people in the general population are now placed on anti-anxiety or anti-depressant medication by their primary care physician, without also being referred to a mental health professional to better evaluate the diagnosis as well as the need for additional treatment, such as psychotherapy. Is this a good method of treatment for the less major and more common psychiatric disorders? Not really. Very few anxiety and mood disorders are successfully treated by medication alone, and some of the anti-anxiety meds carry an addictive risk. But it's cost-effective for the insurers, provides additional patients for the primary care physicians, and may satisfy those patients who don't want to do more self-examination, or who don't want to think of themselves as in need of mental health care, and who prefer just popping a pill from the family doctor. For those who do want other modalities of treatment, they are available, but people have to want the treatment, and seek it out. There really is no lack of mental health clinics, or mental health practitioners, but people have to initiate such treatment if they want it.

hawkeye10
 
  1  
Reply Mon 17 Dec, 2012 12:53 am
@firefly,
talking here about another crazy doing a shoot-em up:

Quote:
Little of this understanding seems to inform our current discussion about Loughner, though. Instead, members of Congress are calling for laws that would ban bringing guns near members of Congress or regulating talk radio. Gun control measures will be proposed and die quietly, no doubt. But mental health care—long ignored as the province of neurotic yuppies taking to the couch to discuss their frigid mothers—is barely an afterthought. Yet of all the possible solutions to such mass violence, real mental health reform holds the most promise for saving lives by ensuring that people with brain diseases get the care they need before they seek out the always easily accessible American firearm.

Sometimes these tragedies do lead to change. In 1999, for instance, after serious advocacy by the family of a woman who was pushed in front of a subway by an untreated schizophrenic, New York State created a much stiffer mental health law to allow for violently mentally ill people to be court-ordered into community treatment and essentially forced to take their meds. But when sick people invoke political leanings before shooting members of Congress or sending mail bombs to timber industry lobbyists, politics always seem to prevent a sensible, effective response.

In light of the Tucson tragedy, it would be nice to see the mental health system, or what's left of it, come up for real discussion, including serious consideration of vastly expanding mental health services so that people like Loughner's parents or his philosophy professor or his algebra teacher could have actually gotten him the help he needed before he killed someone. (In the past year, Arizona cut $36 million from its mental health programs, nearly 40 percent of its budget.) If nothing else, maybe it's time for some public service announcements about the symptoms of schizophrenia—how to distinguish them from ordinary teen angst or political passion, and how to intervene. Lots of research now shows that the longer someone with a brain disease remains untreated, the more severe their dangerous delusions are likely to become. Yet most people go years before such disases are properly diagnosed. Early intervention could save a whole lot of lives.

At some point, the country's political leaders will have to find some self-interest in tackling the problem. An estimated 4.5 million Americans suffer from the severest forms of brain disorders, schizophrenia and bipolar disorder. The National Advisory Mental Health Council estimates that 40 percent of them—1.8 million people—are not receiving treatment on any given day. While most of those folks will remain law abiding citizens, enough of them will make headlines with an act of violence that failing to find a way to treat them isn't just a public health crisis, but a public safety one, too.

http://www.motherjones.com/mojo/2011/01/jared-loughner-tucson-mental-health-reform

but it is all a failure of the crazies to demand help, the rest of us have no responsibility for the failure, most certainly not the mental health pro's....according to firefly.
hawkeye10
 
  1  
Reply Mon 17 Dec, 2012 01:15 am
@hawkeye10,
a little refresher here:



crazy=not of sound mind



but it is all up to them to get uncrazy, according to firefly, we cant trample on their right to be sick in the head.

note to firefly: i am a socialist, as such my devotion to individual rights has limits.
firefly
 
  1  
Reply Mon 17 Dec, 2012 01:16 am
@hawkeye10,
Quote:

this family has plenty of money and lives in a wealthy almost all white town with some of the best schools in the nation, yet this kid did not ever get the help he needed. i seem to recall a recent batman movie shoot em up.....exactly. the. same. story.

You don't know what sort of help Adam Lanza needed or got. Or whether he even suffered from a treatable disorder. What makes you think he never got some sort of professional help or evaluation?
If he suffered from an autism-spectrum disorder, like Asperger's, which is what it sounds like, there really isn't any definitive treatment, and the basis for the disorder may well be biological. But neither autism nor Asperger's is really associated with violent behaviors or anything like the potential to commit a massacre. And no one who has commented publicly about him seems to have had any contact with him in years, so we really have little or no idea of what he was like recently, or how he functioned, or what might have precipitated his killing spree, or what his underlying problems might have been, or even whether he was in treatment of some sort.

And, as far as the shooter in the Aurora movie theater, he was in psychiatric treatment immediately prior to carrying out the shooting, so I don't think it's reasonable to claim he didn't get the help he needed--he had been getting psychiatric treatment. And there were some concerns, on the part of his treating psychiatrist, about his potential for acting-out, but they apparently weren't extreme enough to motivate her to have him hospitalized. But he had been in treatment just prior to his shooting rampage.

If you're trying to make some sort of point, I fail to see what it is.

hawkeye10
 
  1  
Reply Mon 17 Dec, 2012 01:22 am
@firefly,
Quote:
If you're trying to make some sort of point, I fail to see what it is.


of course not because you either ignore or lie about anything that does not fit your agenda

the point: the american mental health system sucks ass, and very few people seem to care. maybe a few more shoot em ups will get our attention. i doubt it though.
0 Replies
 
Walter Hinteler
 
  1  
Reply Mon 17 Dec, 2012 01:47 am
@firefly,
firefly wrote:

From Walter's comments, I am under the impression that he has been referring to mental health care for those suffering from the most major psychiatric disorders--those we generally think of as the "mentally ill"--and not to the entire gamut of emotional, and personality, and behavioral problems that exist in the general population.
Not really, since I actually referred to "mentally ill" as to those, who are dealt with in psychiatric's practices and/or hospitals.

firefly wrote:

Lots of people in the general population are now placed on anti-anxiety or anti-depressant medication by their primary care physician, without also being referred to a mental health professional to better evaluate the diagnosis as well as the need for additional treatment, such as psychotherapy. Is this a good method of treatment for the less major and more common psychiatric disorders? Not really. Very few anxiety and mood disorders are successfully treated by medication alone, and some of the anti-anxiety meds carry an addictive risk. But it's cost-effective for the insurers, provides additional patients for the primary care physicians, and may satisfy those patients who don't want to do more self-examination, or who don't want to think of themselves as in need of mental health care, and who prefer just popping a pill from the family doctor.
Exactly that is done here mostly by specialists - and insurers think that it's (over all) cheaper.
hawkeye10
 
  1  
Reply Mon 17 Dec, 2012 01:49 am
@Walter Hinteler,
Quote:
People with mental or substance abuse disorders were more likely to get treatment from a primary care physician/nurse or other general medical doctor (22.8 percent), or from a non-psychiatrist mental health specialist (16 percent), such as a psychologist, social worker, or counselor, than from a psychiatrist (12 percent), though the survey did show that the adequacy of treatment — measured by number of visits — is best when provided by mental health practitioners

http://www.nimh.nih.gov/science-news/2005/mental-illness-exacts-heavy-toll-beginning-in-youth.shtml

do we do that? hell no, we are going the other direction with primary care docs doing much more than they used to do BECAUSE NO ONE ELSE IS HELPING THEIR PATIENTS!
firefly
 
  1  
Reply Mon 17 Dec, 2012 02:00 am
@hawkeye10,
Quote:

but it is all up to them to get uncrazy, according to firefly, we cant trample on their right to be sick in the head.

Unless someone shows some indication of being an imminent danger to themselves or others, treatment can't be forced on them. We don't force medical treatments on people--and that holds for the mentally ill and the physically ill.

I think you're quite delusional at times, and I've said so before, so should I be able to force you into some sort of psychiatric treatment, where you are forced to take medication you don't want?

I don't know why you're bringing up mass murderers. Most mentally ill individuals are not violent, let alone mass muderers. And those who do show some violent behaviors, or violent potential, can be hospitalized, at least for observation and evaluation. Or, if they violate a law, they can be arrested and placed in a mental health unit in a jail where they will also be evaluated and placed on medication if that is necessary.

I still fail to see your point. Psychiatric treatment is available for the seriously mentally ill, and many of those people are in treatment and are compliant with their medication. If people refuse to take medication, it really can't be forced on them unless they are an imminent threat to self or others. But many want to take medication because it helps to control psychotic symptoms they find distressing. Most mentally ill individuals aren't bothering anyone, and, as I said before, there is a wide-range in functioning levels among the seriously mentally ill, as well as a range of disorders, but those who behave in disruptive ways, or who act aggressively, are more likely to get noticed, and hospitalized, or to wind up in jail, where psychiatric treatment is also available.

Walter Hinteler
 
  1  
Reply Mon 17 Dec, 2012 02:09 am
@firefly,
firefly wrote:
Psychiatric treatment is available for the seriously mentally ill, and many of those people are in treatment and are compliant with their medication. If people refuse to take medication, it really can't be forced on them unless they are an imminent threat to self or others. But many want to take medication because it helps to control psychotic symptoms they find distressing. Most mentally ill individuals aren't bothering anyone, and, as I said before, there is a wide-range in functioning levels among the seriously mentally ill, as well as a range of disorders, but those who behave in disruptive ways, or who act aggressively, are more likely to get noticed, and hospitalized, or to wind up in jail, where psychiatric treatment is also available.
I agree here totally ... and actually, here the prison psychiatric hospitals (here) aren't bad at all.
firefly
 
  1  
Reply Mon 17 Dec, 2012 02:47 am
@hawkeye10,
Quote:
do we do that? hell no, we are going the other direction with primary care docs doing much more than they used to do BECAUSE NO ONE ELSE IS HELPING THEIR PATIENTS!

No, you don't understand the situation. It has nothing to do with a lack of mental health professionals, who could probably be of better help to those patients. The primary care doctors want to be doing this, it helps to insure their patient case load, and the insurers, and the drug manufacturers, want them to be the pill pushers, because that's the most cost-effective alternative and they can distribute the most meds to the most people, including people who'd never dream of going to a psychiatrist, and including people for whom some sort of therapy for anxiety or depression would be a more effective treatment than medication from the primary doctor. Big pharma wants everyone convinced all problems can be solved by taking a pill, and most physicians are more than willing to supply the pill, and, in return, to receive whatever perks the drug companies throw their way.

People are still free to seek some other form of treatment, for things like anxiety and depression, beside the prescription offered by the primary care physician, but we've really become accustomed to, and happy with, just popping pills, so not all that many people bother to do that.

Fortunately, the treatment of most major psychiatric disorders is still left mainly to the psychiatrists, because medicating those can be more complicated.

None of this is about a real lack of mental health services, or a lack of mental health practitioners--there really isn't a lack. It's mainly about the profit motive. It's more cost-effective, and lucrative, if primary care physicians don't refer their patients to mental health professionals and instead simply hand them a prescription. And most patients aren't asking for referrals, or seeking help elsewhere, because they'd rather just pop that pill. Unfortunately, that pill might not always be the best treatment option for that patient's particular problem.

Given the problems with health care costs, and the clout of big pharma, and the collusion between physicians and the drug manufacturers, none of this is likely to change.
0 Replies
 
firefly
 
  1  
Reply Mon 17 Dec, 2012 03:10 am
@Walter Hinteler,
Quote:
and actually, here the prison psychiatric hospitals (here) aren't bad at all.

All of our jails and prisons have mental health housing units, as well as staffs to provide psychiatric treatment and therapy to inmates housed in those units and also to those inmates housed in the general population of the jail who need or request treatment. The treatment provided is certainly as good as that available in the community at mental health clinics. And consistency of treatment may even be better--inmates tend to keep their appointments Smile and they are more likely to be compliant with medication because it's delivered to them.
Walter Hinteler
 
  1  
Reply Mon 17 Dec, 2012 03:36 am
@firefly,
That seems to be better than here: though there's (in our state) a medical unit in any prison, we only have one hospital, and that's one with a psychiatric ward.


Those criminals, who got a "hospital treatment order" by courts ("mental hospital order", "custodial addiction treatment order" (see here: section 63 + 64) are treated in various different specialised hospitals spread over the state.
0 Replies
 
 

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