6 ms·

How to Help Save the Mentally Ill from Themselves

32 points by pavornyoh 11y ago

teslabox 11y ago
Medicine does pretty well with popping my friend out of her psychotic states. But people on the traditional treatment programs never truly get better, they're just on the treatment merry-go-round for decades. "The Doctor Isn't In" succinctly describes Psychiatry's big problem: https://news.ycombinator.com/item?id=10315705 https://news.ycombinator.com/item?id=10315705
- cbd1984 11y ago
  > But people on the traditional treatment programs never truly get better, they're just on the treatment merry-go-round for decades. You could say the same thing about a lot of neurological disorders. Or things like Type 1 Diabetes, come to that.
  - bjwbell 11y ago
    A lot of people can and do get better. I can't comment on whether traditional treatment works for that or not. Personally I think treating the person is more helpful in the long run.
- olliej 11y ago
  Your claim that it's a merry-go-round is seemingly based on a misunderstanding of how medicine works. You're right, medication does not necessarily ever stop. But it also never stops for heart disease, diabetes, arthritis, HIV, ... Some conditions can be cured, some conditions can be treated, some conditions require continual changes and adjustments to medications. For example, some people with mental illness can take drugs for a finite amount of time, and eventually come off them and never have to return to them. Similarly some people who have asthma can eventually come off an inhaler and never need it again. Even in those cases, some people in certain stressful situations can still end up needing to go back to the medication (e.g anti-depressant/inhaler) years/decades later. Some people have to stay on their medication forever, either asthmatics and their inhaler, or people with mental illness and their specific meds. For some people different meds are needed, but that applies to a huge array of drugs -- some people have to use specific brands of inhaler, even specific types of insulin, neurological drugs are no different. And if we start looking at the merry-go-round of changing drug regimes, there are other diseases with similar cases, most obviously HIV, where the treatments have to be continually monitored and changed for each individual, and many have to be taken at fixed times. Mental illness is not a unique disease, the challenges of treatment are not dramatically different from all other diseases. It's just a disease, and like any other disease, living with it takes effort.
DanBC 11y ago
> Most critically, the Murphy-Johnson bill provides incentives to fund expanded treatment, called assisted outpatient treatment, or A.O.T., If you decide to websearch for this be aware that AOT often means "assertive outreach teams". They're different, although they work with similar people. > only for those with a long history and pattern of proving a danger to themselves or others. This tends to mean at risk of killing are trying to kill other people, or at risk of dying by suicide. I'm not sure if the author's son would fit the definition. > The specifics of A.O.T. vary by state, but judges can order patients to undergo treatment while they live in the community instead of in prison or a hospital. In the UK "community treatment disorders" don't seem to reduce rates of re-admission to hospital. http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(15)00231-X/abstract http://www.thelancet.com/journals/lanpsy/article/PIIS2215-03... > But A.O.T. is not carte blanche: It still requires court action and has strict criteria to limit treatment to the most seriously ill. It's pretty scary. I'd want to see more details of the checks and balances involved. > Samhsa has used much of its budget to deal with less pernicious conditions like trauma and stress. Author is severely wrong here. "Trauma" covers stuff like borderline personality disorder, which can be a debilitating illness, with a high suicide rate, and high rates of accidental death, and a lot of very severe self harm. Also, early intervention is important. > It has also funded activist groups that oppose medication That's not outrageous. Medication often fucking sucks, and there's not much evidence that it works effectively. It's often better to give people techniques to live with their illness, and keep people engaged with MH services, than to just give them a depot injection every six weeks. > and mainstream psychiatric care for the seriously mentally ill. Again, you don't have to look too far to find serious unwarranted interference with human rights when you start looking at MH treatment. This isn't just force feeding, or forced medication, or restraint and rapid tranquillisation, or detention in hospital against your will, but the lesser (still important) stuff like being fully involved in decisions about your life - what you eat, what you wear, how you spend your money, where you live. Without details of the groups it's hard to know if they're idiots or reasonable.
- e40 11y ago
  >> It has also funded activist groups that oppose medication >That's not outrageous. Medication often fucking sucks, and there's not much evidence that it works effectively. It's often better to give people techniques to live with their illness, and keep people engaged with MH services, than to just give them a depot injection every six weeks. I know two people who absolutely cannot live without their meds and both are currently off them. One is homeless and the other is about to be homeless. Your knee-jerk reaction to the statement to which you are replying seems to indicate to me you've made up your mind about this, regardless of how much it helps or hurts. You know how shit works in the US. Lobbyists can oppose the most sane things for completely stupid reasons. People that "oppose medication" seems to me, based on my experience, like completely stupidity. That's an extreme position. The other side (always medicate) is also extreme.
SCAQTony 11y ago
Here is a summary of the Bill: http://murphy.house.gov/uploads/MHOnePager2.18.15.pdf http://murphy.house.gov/uploads/MHOnePager2.18.15.pdf Here is the text of the Bill: http://murphy.house.gov/uploads/HR3717%20Bill%20Text.pdf http://murphy.house.gov/uploads/HR3717%20Bill%20Text.pdf Here are speeches and interviews about the Bill: http://murphy.house.gov/helpingfamiliesinmentalhealthcrisisact#Bill http://murphy.house.gov/helpingfamiliesinmentalhealthcrisisa... Information
empressplay 11y ago
It's sad what happened to the author's son, but historically laws allowing the state to 'interfere' with a person's psychiatric care choices have had some not insignificant amount of abuse. The author seems to want to expand "threat to themselves or others" from the current interpretation of physical violence / suicide to simply acting against their own best-interests, and while I understand how they came to that position, it's far too nebulous a test to guarantee perfectly sane, rational people won't be medicated or locked up simply for acting counter to common expectations.
- jpatokal 11y ago
  Obligatory: https://en.wikipedia.org/wiki/Political_abuse_of_psychiatry_in_the_Soviet_Union https://en.wikipedia.org/wiki/Political_abuse_of_psychiatry_... Particularly: https://en.wikipedia.org/wiki/Sluggish_schizophrenia https://en.wikipedia.org/wiki/Sluggish_schizophrenia ...which allowed people who weren't crazy, but showed subtle signs (like, say, questioning Communism) that they might become crazy, to be locked up "for their own protection".
bjwbell 11y ago
I'm curious, are there any studies that show antipsychotics not being harmful vs no medication in the long term (5-10yrs)?
- xkcd-sucks 11y ago
  Pretty much all antipsychotics, including the newer "atypicals," cause tardive diskinesia in about 30 percent of patients who are treated for more than 5ish years. The other side effects can be nastier, but TD is arguably the worst because it's permanent.
qwerty_asdf 11y ago
Related: http://www.nydailynews.com/news/crime/man-found-dead-tent-erected-motel-room-article-1.2065448 http://www.nydailynews.com/news/crime/man-found-dead-tent-er...
throwaway13245 11y ago
I have had the experience of being taken into inpatient psychiatric care against my will. I fit the profile of someone that needed inpatient psychiatric help, but it would only be given to me if I was deemed a threat to myself or others. The doctors spoke with my family about possible things I had done that would fit that description, but I hadn't done anything to imply that. Finally, the doctors recommended to my family that they accuse me of danger to self or others anyway so I could get the "help I needed." They did and I was admitted. So there are apparently ways to work around it if you really want someone to be an inpatient. Perhaps sometimes that's a good thing since wanting to kill people isn't the only prereq for needing help. Unfortunately I am now labeled as someone who needed to be locked up as a danger to self or others when I wasn't.

32 points by pavornyoh 11y ago

Medicine does pretty well with popping my friend out of her psychotic states. But people on the traditional treatment programs never truly get better, they're just on the treatment merry-go-round for decades. "The Doctor Isn't In" succinctly describes Psychiatry's big problem: https://news.ycombinator.com/item?id=10315705 https://news.ycombinator.com/item?id=10315705

cbd1984 11y ago
> But people on the traditional treatment programs never truly get better, they're just on the treatment merry-go-round for decades. You could say the same thing about a lot of neurological disorders. Or things like Type 1 Diabetes, come to that.
- bjwbell 11y ago
  A lot of people can and do get better. I can't comment on whether traditional treatment works for that or not. Personally I think treating the person is more helpful in the long run.
olliej 11y ago
Your claim that it's a merry-go-round is seemingly based on a misunderstanding of how medicine works. You're right, medication does not necessarily ever stop. But it also never stops for heart disease, diabetes, arthritis, HIV, ... Some conditions can be cured, some conditions can be treated, some conditions require continual changes and adjustments to medications. For example, some people with mental illness can take drugs for a finite amount of time, and eventually come off them and never have to return to them. Similarly some people who have asthma can eventually come off an inhaler and never need it again. Even in those cases, some people in certain stressful situations can still end up needing to go back to the medication (e.g anti-depressant/inhaler) years/decades later. Some people have to stay on their medication forever, either asthmatics and their inhaler, or people with mental illness and their specific meds. For some people different meds are needed, but that applies to a huge array of drugs -- some people have to use specific brands of inhaler, even specific types of insulin, neurological drugs are no different. And if we start looking at the merry-go-round of changing drug regimes, there are other diseases with similar cases, most obviously HIV, where the treatments have to be continually monitored and changed for each individual, and many have to be taken at fixed times. Mental illness is not a unique disease, the challenges of treatment are not dramatically different from all other diseases. It's just a disease, and like any other disease, living with it takes effort.

DanBC 11y ago

> Most critically, the Murphy-Johnson bill provides incentives to fund expanded treatment, called assisted outpatient treatment, or A.O.T., If you decide to websearch for this be aware that AOT often means "assertive outreach teams". They're different, although they work with similar people. > only for those with a long history and pattern of proving a danger to themselves or others. This tends to mean at risk of killing are trying to kill other people, or at risk of dying by suicide. I'm not sure if the author's son would fit the definition. > The specifics of A.O.T. vary by state, but judges can order patients to undergo treatment while they live in the community instead of in prison or a hospital. In the UK "community treatment disorders" don't seem to reduce rates of re-admission to hospital. http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(15)00231-X/abstract http://www.thelancet.com/journals/lanpsy/article/PIIS2215-03... > But A.O.T. is not carte blanche: It still requires court action and has strict criteria to limit treatment to the most seriously ill. It's pretty scary. I'd want to see more details of the checks and balances involved. > Samhsa has used much of its budget to deal with less pernicious conditions like trauma and stress. Author is severely wrong here. "Trauma" covers stuff like borderline personality disorder, which can be a debilitating illness, with a high suicide rate, and high rates of accidental death, and a lot of very severe self harm. Also, early intervention is important. > It has also funded activist groups that oppose medication That's not outrageous. Medication often fucking sucks, and there's not much evidence that it works effectively. It's often better to give people techniques to live with their illness, and keep people engaged with MH services, than to just give them a depot injection every six weeks. > and mainstream psychiatric care for the seriously mentally ill. Again, you don't have to look too far to find serious unwarranted interference with human rights when you start looking at MH treatment. This isn't just force feeding, or forced medication, or restraint and rapid tranquillisation, or detention in hospital against your will, but the lesser (still important) stuff like being fully involved in decisions about your life - what you eat, what you wear, how you spend your money, where you live. Without details of the groups it's hard to know if they're idiots or reasonable.

e40 11y ago
>> It has also funded activist groups that oppose medication >That's not outrageous. Medication often fucking sucks, and there's not much evidence that it works effectively. It's often better to give people techniques to live with their illness, and keep people engaged with MH services, than to just give them a depot injection every six weeks. I know two people who absolutely cannot live without their meds and both are currently off them. One is homeless and the other is about to be homeless. Your knee-jerk reaction to the statement to which you are replying seems to indicate to me you've made up your mind about this, regardless of how much it helps or hurts. You know how shit works in the US. Lobbyists can oppose the most sane things for completely stupid reasons. People that "oppose medication" seems to me, based on my experience, like completely stupidity. That's an extreme position. The other side (always medicate) is also extreme.

SCAQTony 11y ago

Here is a summary of the Bill: http://murphy.house.gov/uploads/MHOnePager2.18.15.pdf http://murphy.house.gov/uploads/MHOnePager2.18.15.pdf Here is the text of the Bill: http://murphy.house.gov/uploads/HR3717%20Bill%20Text.pdf http://murphy.house.gov/uploads/HR3717%20Bill%20Text.pdf Here are speeches and interviews about the Bill: http://murphy.house.gov/helpingfamiliesinmentalhealthcrisisact#Bill http://murphy.house.gov/helpingfamiliesinmentalhealthcrisisa... Information

empressplay 11y ago

It's sad what happened to the author's son, but historically laws allowing the state to 'interfere' with a person's psychiatric care choices have had some not insignificant amount of abuse. The author seems to want to expand "threat to themselves or others" from the current interpretation of physical violence / suicide to simply acting against their own best-interests, and while I understand how they came to that position, it's far too nebulous a test to guarantee perfectly sane, rational people won't be medicated or locked up simply for acting counter to common expectations.

jpatokal 11y ago
Obligatory: https://en.wikipedia.org/wiki/Political_abuse_of_psychiatry_in_the_Soviet_Union https://en.wikipedia.org/wiki/Political_abuse_of_psychiatry_... Particularly: https://en.wikipedia.org/wiki/Sluggish_schizophrenia https://en.wikipedia.org/wiki/Sluggish_schizophrenia ...which allowed people who weren't crazy, but showed subtle signs (like, say, questioning Communism) that they might become crazy, to be locked up "for their own protection".

bjwbell 11y ago

I'm curious, are there any studies that show antipsychotics not being harmful vs no medication in the long term (5-10yrs)?

xkcd-sucks 11y ago
Pretty much all antipsychotics, including the newer "atypicals," cause tardive diskinesia in about 30 percent of patients who are treated for more than 5ish years. The other side effects can be nastier, but TD is arguably the worst because it's permanent.

qwerty_asdf 11y ago

Related: http://www.nydailynews.com/news/crime/man-found-dead-tent-erected-motel-room-article-1.2065448 http://www.nydailynews.com/news/crime/man-found-dead-tent-er...

throwaway13245 11y ago

I have had the experience of being taken into inpatient psychiatric care against my will. I fit the profile of someone that needed inpatient psychiatric help, but it would only be given to me if I was deemed a threat to myself or others. The doctors spoke with my family about possible things I had done that would fit that description, but I hadn't done anything to imply that. Finally, the doctors recommended to my family that they accuse me of danger to self or others anyway so I could get the "help I needed." They did and I was admitted. So there are apparently ways to work around it if you really want someone to be an inpatient. Perhaps sometimes that's a good thing since wanting to kill people isn't the only prereq for needing help. Unfortunately I am now labeled as someone who needed to be locked up as a danger to self or others when I wasn't.