Bringing mental health care closer to home
Irene destroyed the state psychiatric hospital. There was a huge scramble to find other places for the patients to go. There is still a very extreme shortage of bed space in psychiatric hospitals because of Irene, putting a lot of pressure on the idea of getting patients through the hospitals quickly. One of the main goals behind expedited non-emergency forced drugging of psychiatric inptients, is to shorten the hospital stays to make room for more patients coming in, because of the shortage of bed space. Some of the main arguments for expedited non-emergency forced drugging have to do with the shortage of bed space, including the stressed situations and long waits that happen in emergency rooms as a result.
The irony is that the drugs tend to cause worse and more prolonged mental illness and more relapse. (Read Robert Whitaker’s book "Anatomy of an Epidemic" to understand this.) Drugging patients more quickly, with less effort spent on trying to implement other modalities first, would exacerbate that problem. It would add to the problem it is supposed to solve.
For many years before Irene, there was an effort to expand community mental health as a prevention so that there is less hospitalization. The Irene event was used as an opportunity to move in that direction. I think that is a great goal, but pressuring it by not having enough beds in hospitals, is not working. It is creating an artificial "need" to drug patients more quickly, which is counter to the spirit of the original goal.
The goal was to create a more humane mental health system where people are less likely to be force hospitalized and force drugged. It degenerated into the current high stress situation because of Irene. Let’s not take a step backward into less humane mental health treatment, in reaction.
There are programs that were created in Act 79, the post-Irene effort to adjust the mental health system to the new reality of not having a state hospital, that aren’t even up and running yet. Soteria, the five-bed program in Burlington that is to treat nonviolent psychotic patients without drugs, is one of them. The amount of community mental health resources in place at this time, are also not adequate for the needs. The project of adding more resources other than typical psychiatric hospitals, is still in progress. Things are happening in a counterproductive sequence because of Irene. We don’t have adequate bed space or adequate alternative inpatient and community programs. We have neither one. We have an Irene-created mess. It’s a logistical nightmre caused by a storm.
When the hospital in Berlin opens, all other psychiatric hospitals should remain open until they are not needed due to lack of patients. There should be a well-monitored goal of causing them to close due to lack of patients. If there are patients in Morrisville, it means community mental health isn’t adequate yet. We should keep adding more community mental health programs -- peer support agencies, one-on-one community skills workers, intensive outpatient programs, ane whatever else is needed (based primarily on what mental health consumers say they need and have benefited from), steadily, untl we have such a successful community mental health program in Vermont that we can close a hospital due to too many empty beds.
We should always have a slight surplus of beds so we can afford to de-license and close hospitals if they engage in patient abuse. Instead of planning to close Morrisville, we should plan to close the next hospital that engages in patient abuse. If no such hospital presents itself and there becomes a lack of patients, then we would close Morrisville.
The logistical problems created by Irene should be solved directly, for what they are. Treatment protocols should be based on what is the best treatment. Decision making process should be what’s truly the best process. Right now, they are all mixed together. We need to solve the Irene-generated logistics problems, and then see what we think about the other issues at that point.
Heidi Henkel is a math tutor, dance teacher, fitness trainer and massage therapist who lives in Putney.
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