[Magdalen] Washington Post article on involuntary hospitalization of the ...

[James Oppenheimer-Crawford]

The successful models of community-based assisted living for the newly
discharged have been around for decades now, some even going back to the
fifties. Any mental health system that can only discharge to "independent
living" is committing a crime.  There is no excuse; the models are well
demonstrated and in place. Those who don't have them have chosen to run a
system designed to fail.

This can't be a system that lives by rules and laws, because the patients
need to be worked with over time to earn their trust and to know what they
can and cannot do.

There are even effective interventions to help the families to help the
patient succeed instead of inadvertently sabotaging the discharge.

I remember we had a Crisis Team whose job was to work with the most
difficult to place, most at risk patients.  They nominally had some
offices, but for the most part they worked out of their vans.  I remember
we all wondered how long it would be til they burned out. It's extremely
taxing and draining work.



James W. Oppenheimer-Crawford
*“If you have a chance to accomplish something that will make things better
for people coming behind you, and you don’t do it, you're wasting your time
on this Earth.”  -- *Roberto Clemente

On Sun, Feb 15, 2015 at 3:47 PM, Lynn Ronkainen <houstonklr at gmail.com>
wrote:

> And so the largest impact really came when many of these stabilized
> patients were released from institutional care and were unable to maintain
> their drug regimen unassisted? A policy where a successful  middle ground
> was never discovered between institutionalization and living on one's own.
> Lynn
>
> Sent from my iPhone
>
> On Feb 15, 2015, at 12:07 PM, James Oppenheimer-Crawford <
> oppenheimerjw at gmail.com> wrote:
>
> One of my friends, a nurse named Janet, recalled in the fifties in nursing
> school how they began using chlorpromazine hydrochloride, and immediately
> things changed.  The ill were no longer out-of-control ranting and raging,
> and it was possible to do things with and for them. To the day of my
> retirement there continued to be a place for a stat IM of chlorpromazine
> for a really out-of-control patient.
>
> Was it good treatment? Hell yeah, it was good treatment!  Before that, the
> person was untreatable, in constant intractable pain.  True, "the big T"
> made most people feel like they were in a fog or in an emotional
> straitjacket, but it was an improvement.
>
> Just like when LiCO3 first appeared on the scene, it was a major
> improvement.  Now, it isn't expected to be the miracle cure it was hoped to
> be (my best friend from high school was taking Lithium when he killed
> himself)
>
> Mellaril helped a lot of people, even though it did tend to make you go
> blind.
>
> And even though new meds came out every year, there were always some who
> just did not respond to the medication.  I will never ever, ever forget
> encountering Louise, a bright woman who has been a inpatient for several
> years.  As we met on the stairwell, she looked at me and screamed, "Is
> there any way any of you can stop the pain!!" And I knew there was not.
> Had to go back to my office and do paperwork for a while after that.
>
> Being at a state facility, you saw the worst.  Those who had insurance got
> to go to a private facility, and in many cases, they could be stabilized
> and returned to the community relatively quickly (think Tom Eagleton). We
> only saw the uninsured and those whose insurance had run out.
>
> James W. Oppenheimer-Crawford
> *“If you have a chance to accomplish something that will make things better
> for people coming behind you, and you don’t do it, you're wasting your time
> on this Earth.”  -- *Roberto Clemente
>
> On Sun, Feb 15, 2015 at 12:23 PM, Cantor03--- via Magdalen <
> magdalen at herberthouse.org> wrote:
>
> >
> >
> > In a message dated 2/15/2015 11:35:12 A.M. Eastern Standard Time,
> > oppenheimerjw at gmail.com writes:
> >
> > Mental  health care has generally been pretty decent; it's only that the
> > electorate  (you and me) absolutely will not pay what it costs to run it
> > correctly, and  never really has.>>>
> > I'm old enough to remember the transition from essentially no
> > drug treatment of mental health issues to the advent of Thorazine  which
> > I think was the first widely utilized psychotherapeutic drug.
> >
> > As a senior in UW-Madison Medical School, we had required day  trips
> > to the three State "mental" hospitals and the "Hospital for the
> Criminally
> > Insane"
> > for those with violent medical problems.  In every case, I  remember the
> > hospital administrators extolling the wonders of this new drug,
> Thorazine,
> > with comments like "If you had been taking this tour a year ago
> > (pre-treatment)
> > you would get the impression that mental hospitals are all Bedlam."
> >
> > Pretty much all of that screaming and sometimes violent acting out of
> > patients
> > had been replaced with tranquility.  Was it good treatment for the
> > patients?
> > Probably questionable.  Was it nice for the hospital  staffs?  Quite
> > certainly.
> >
> > In the succeeding years, the population of these four mental
> institutions
> > has dropped sharply, with better drugs used on an outpatient basis,  plus
> > the development of "half-way houses" in which an attempt at  ordinary
> > life is arranged for mental patients.
> >
> >
> > David Strang.
> >
> >
>