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I'm a psychiatrist, and there are a few things to consider about this story: 1. The bulk of people in a psychiatric hospital are there voluntarily. They can wa
by phren0logy 9y ago
I'm a psychiatrist, and there are a few things to consider about this story:
1. The bulk of people in a psychiatric hospital are there voluntarily. They can walk out the door at any time.
2. When a patient is in a hospital involuntarily, their stay is subject to state laws about involuntary hospitalization. This, as far as I know, universally requires 2 independent professional opinions that a patient is actively suicidal, actively homicidal, or overtly incapable of taking care of themselves to the point it puts their health at risk.
3. Psychiatric stays are generally very short (less than 5 days), despite the fact that most medications don't start working that quickly. Stays have become unrealistically short.
4. Despite the general outcry about involuntary hospitalization, most family members of a person with a severe illness will tell you that they struggle to get their loved ones admitted even when the situation gets dire.
5. Again despite the outcry, a number of states have been expanding the liability of psychiatrists for the actions of their patients. For example, if my patient were to hurt themselves or someone else, I can expect years of depositions and lawsuits. This does not justify hospitalizing someone who does not need it, but does speak to a double standard about our role in protecting society.
THIS LIABILITY STILL APPLIES WHEN AN INSURANCE COMPANY TELLS ME THEY ARE GOING TO STOP PAYING FOR HOSPITAL TIME 2 DAYS AFTER SOMEONE TRIED TO HANG THEMSELVES. If I release them, it's on me. If I keep them, they face huge bills even if they have insurance. This sucks.
6. MOST IMPORTANTLY, WITHOUT INVOLUNTARY COMMITMENT MANY PATIENTS GO TO JAIL OR PRISON. I work in correctional settings. The decline in psychiatric beds is strongly correlated with the spike in mentally ill people behind bars. Without an avenue to get them treated, they end up getting arrested for their behavior, when they should have gotten treatment instead.
- psyc 9y agoCorrection: psychiatric stays are generally very short with private insurance, and months long with state insurance. May vary with the level of corruption in your area.
- phren0logy 9y agoI don't know of anywhere that has average stays anywhere near a month. Please provide a citation.
- hashkb 9y agoWill you provide citations for everything you said in your comment?
- phren0logy 9y agoThis is a totally fair request, but I am also super busy. Is there any point in particular I can get you some references about?
- roninb 9y agoCould you possibly do the same for your numbers: "less than 4 days"? I trust that you're a psychiatrist but you could be spewing old or incorrect numbers just as easily as anyone else who may unknowingly make a mistake.
- phren0logy 9y agoA fair point. Here you go: https://www.cdc.gov/nchs/data/nhds/2average/2010ave2_firstlist.pdf#x2013; https://www.cdc.gov/nchs/data/nhds/2average/2010ave2_firstli... Number and rate of discharges by first-listed diagnostic categories [PDF - 58 KB]</a>
- will_brown 9y agoIn Florida we have the Baker Act, which is common knowledge in FL outside even mental healthcare circles, and is a 72 hour involuntary institutionalization for examination. https://en.m.wikipedia.org/wiki/Florida_Mental_Health_Act https://en.m.wikipedia.org/wiki/Florida_Mental_Health_Act
- mozey 9y ago> most family members of a person with a severe illness will tell you that they struggle to get their loved ones admitted even when the situation gets dire In South-Africa you have to beg private hospitals to admit patients with certain psychiatric conditions. The default is to send patients to public hospitals, and that will likely involve much more restraint and much less care. My respect goes out to people that keep on trying to deal with these situations with limited resources.
- brookside 9y agoFirstly, it must be incredibly difficult to work with severely mentally ill populations, so I commend and thank you for taking on that responsibility. It troubles me, however, to to give a government the capability to detain citizens based on the (forgive the scare quotes) "medical" expertise of a psychiatrist. This has been abused [1] and I find significant issues with the credence given to testimony by psychiatrists in the US court system [2]. The lack of science in ever-shifting diagnosis criteria is saddening, and these diagnoses will mirror the prevailing social and political winds. Within some of our lifetimes, of course, homosexuality was a pathology in the DSM. I'm not sure of the answer here. We do need a way to keep people who are a threat to themselves and others in a safe place, but psychiatry has been and is such a troubling and far-too non-scientific endeavor, long drawing profit from conclusions far beyond our true capabilities to understand the human mind and behavior. I don't want people in the field with anything other than an attitude utter humility and possibly shame exerting control over others' lives. [1] https://en.wikipedia.org/wiki/Political_abuse_of_psychiatry_in_the_Soviet_Union https://en.wikipedia.org/wiki/Political_abuse_of_psychiatry_... [2] http://www.newyorker.com/magazine/2009/09/07/trial-by-fire http://www.newyorker.com/magazine/2009/09/07/trial-by-fire
- yourapostasy 9y ago> I'm not sure the answer here. Has anyone started making lots (like tens of thousands) high-resolution, 3D, video (i.e., not still snapshots, but over time and ideally during episodic moments) MRI and CAT scans of diagnosed psychiatric patients, pointed a deep learning system at the scans, and see if patterns can be detected? If the deep learning systems can pick up patterns we didn't notice before, then that could be a valuable empirical tool to add.
- phren0logy 9y agoYes, but this is expensive and difficult, and not many people volunteer to participate.
- yourapostasy 9y ago"Yes this should be tried", or "Yes, someone has started doing this"? If the latter, can you please post a link to their effort?
- maxerickson 9y agoI wonder if there is a way to setup the system so that a corrupt doctor that has lost their way is still mainly incentivized to work for the interests of the patient. Even in medical situations where patients do not face involuntary confinement, they are mostly left wondering if the doctors are working for them or working to bill them (I guess the outcome based payment schemes address this).
- phren0logy 9y agoWhat parts are left uncovered by the malpractice system?
- maxerickson 9y agoHow does malpractice address things like unnecessary tests? They generally aren't medically harmful, but it sort of sucks for most people to spend money that doesn't need to be spent.
- Ntrails 9y agoIf it's possible that failure to perform a test which is probably not going to helpful has a large downside for the doctor, and performing it has only got downside for the patient - you'll end up with incentives which clearly dictate excessive testing.
- ehnto 9y agoTest Driven Doctoring? Or perhaps they are practicing Defensive Doctoring.
- ehnto 9y agoInteresting anecdote. My country has public healthcare but you do have to be registered and present a card for it. I didn't have my card once, and the doctor was preparing me for a test when he read on my appointment sheet that I wasn't covered by public health care for that appointment. So he said don't worry about the tests, they are very expensive and I am pretty sure you are fine. Did the doctor's incentive to run the test when he thought the government was paying lie in the interest of me, the company who does the tests, or the government who wants a healthy populace? It's hard to know. But I will be honest and say that as I'm paying for just a fraction of it with my taxes, I actually don't mind and if they are being thorough even for the benefit of some medical company's coffer, at least the country can afford to be thorough.