5 ms·

I don't know of anywhere that has average stays anywhere near a month. Please provide a citation.

by phren0logy 9y ago

hashkb 9y ago
Will you provide citations for everything you said in your comment?
- phren0logy 9y ago
  This 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 ago
Could 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 ago
  A 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 ago
  In 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
  - DanBC 9y ago
    That's the assessment detention. After that there's a possibility of further detention for treatment. > a petition for involuntary inpatient placement (what some call civil commitment),
  - roninb 9y ago
    Right, but that's only for attempted suicide and it doesn't mean they aren't kept AFTER. I was looking for a citation that suggests involuntary stays are shorter than a month on average, saying that there is a minimum of 3 days in some cases doesn't give me an answer to that.
yequalsx 9y ago
Well how about the article in question? It doesn't say a month but the gist of the article is that profit is motivating at least one chain to make patients stay too long. Which is the essence of the point you are responding to. My wife is an inpatient psychiatrist. She gets a monthly productivity report. Her pay is based on the productivity. In her system she gets more money on the day of admission than for subsequent days. This gives her an economic incentive to get patients out the door. She hasn't yet succumbed to the pressure to release them early but it's foolhardy to think that economic forces don't or can't play a role. There are lots of examples of doctors doing very bad things for profit.
- phren0logy 9y ago
  I worked at an inpatient hospital that had monthly productivity reports. My salary was totally independent of them, and I still quit after a few months because I didn't like the implication. I would encourage your wife to do the same. For most of us, that's not why we went to med school.
pdkl95 9y ago
Does my three day involuntary hold (5150) that became a two week involuntary hold (5250) and then an unspecified (and very probably illegal) wait for an additional 4 days, because "we're waiting for the doctor to release you" count?. (yes, I know, one data point is not an average). I saw that doctor exactly 2 times during that time, for a cumulative total of maybe 3 minutes, who was simply a pusher of the latest (at the time) SNRI. The nurses emphasized it was important to "show compliance" and take their drugs, even though they were wrong and caused serious problems for months. Why? I apparently offended a psychiatrist when I insisted that escitalopram ("Lexapro") gave me mild/moderate visual disturbances (hallucination). "Lexapro doesn't do that!". Insisting it did, followed quickly with a (probably mildly rude) comment about observation-vs-theory and just-world fallacy only cut the appointment short and started the above stay. The paperwork was sensationalized fiction, with zero basis in reality. After the first 3 days, the nurses commented every single day about how unusual it was to be allowed (by insurance) such a long stay. Private insurance would never allow the expense, but apparently their scam worked on Medicare. I never generalize bad behavior into a stereotype. I'll assume your experience has been very different. I'm sure this kind of problem has a lot of variation. My stay was over 10 years ago, and I would like to believe your industry has improved in that time. It might be a good idea to look outside your normal situation with the goal of gaining a broader perspective. It is very hard to regain trust after it has been burned for legitimate reasons. That puts better doctors at an unfair disadvantage, which is unfortunate. This is why it's so important proactively find the "bad apples" and actually fix the situation before bad behavior becomes normalized[1]. [1] http://www.rapp.org/archives/2015/12/normalization-of-deviance/ http://www.rapp.org/archives/2015/12/normalization-of-devian...
- dsego 9y ago
  Cipralex? According to my psych it also shouldn't cause sexual dysfunction, yeah right.
tcj_phx 9y ago
My girlfriend has had three stays at two different UHS hospitals in Phoenix (UHS is the subject of this ars technica article). They tried to keep her indefinitely the first time. The second two times were unnecessary month-long "stabilizations" that did not address the causes behind her presenting symptoms (self medication with alcohol). At the third stay UHS got her addicted to benzos, which stopped working after a month... I know you're a psychiatrist, and it seems like you practice in a fairly conventional manner. My experience with the mental health system is that the doctors have good intentions, but have been misled by their training. Because my girlfriend's doctors have inverted cause and effect, they haven't been able to help her get her psychosis-provoking self-medication tendencies under control (they think that psychosis -> drug use, or that alcohol/drug use is a separate condition from her psychotic disorder). For her first stay at UHS, it took a few days of calls for me to figure out the "magic words" for my girlfriend to say to get them to let her out - this was after about 2 weeks of "stabilization" that was really just getting her used to the tranquilizers. Finally someone told me she had to say "against medical advice", and they let her out two days later. She started to come out of her zyprexa-maintained psychotic coma after about 3 days, then she resumed self-medicating her physiological imbalances. I knew that alcohol wouldn't help, but I couldn't prescribe what she needed, or force her to take it anyways. She was under a court order for the second two stays at a different UHS facility, so she was powerless to resist the obsolete theories that they used to worsen her condition. It is now known that psychosis is related to cortisol deficiency. Cortisol is produced in the mitochondria. Therapies which improve the metabolism are indicated for all mental health patients. The only helpful treatment that my girlfriend received was getting revived by the fire department (benzos amplify opiates, fyi). Her drinking was under control for about two weeks after those two doses of naloxone. Naltrexone (similar to naloxone) is FDA-approved to help people keep their alcohol use under control. I was able to verify that my theories were basically correct when she lived with me for about two months. But then she went to visit her mother, and made herself psychotic with the street pharmacy again (bad situation with her old not-friends -> alcohol -> meth amphetamine), and she's back to getting "helped" by professionals who don't care about cause-and-effect. Robert Whitaker's Psychiatry Defends Its Antipsychotics is a refutation of psychiatry's latest attempt to defend the use of anti-psychotics: https://www.madinamerica.com/2017/05/psychiatry-defends-its-antipsychoticscase-study-of-institutional-corruption/ https://www.madinamerica.com/2017/05/psychiatry-defends-its-... (May 21, 2017) I guess I'm just asking you to consider that anti-psychotics are most psychiatric patients' problem, rather than their solution. Since you work with the criminal justice system, you're in a position to do a lot of good for a lot of people.

I don't know of anywhere that has average stays anywhere near a month. Please provide a citation.

hashkb 9y ago

Will you provide citations for everything you said in your comment?

phren0logy 9y ago
This 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 ago

Could 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 ago
A 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 ago
In 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
- DanBC 9y ago
  That's the assessment detention. After that there's a possibility of further detention for treatment. > a petition for involuntary inpatient placement (what some call civil commitment),
- roninb 9y ago
  Right, but that's only for attempted suicide and it doesn't mean they aren't kept AFTER. I was looking for a citation that suggests involuntary stays are shorter than a month on average, saying that there is a minimum of 3 days in some cases doesn't give me an answer to that.

yequalsx 9y ago

Well how about the article in question? It doesn't say a month but the gist of the article is that profit is motivating at least one chain to make patients stay too long. Which is the essence of the point you are responding to. My wife is an inpatient psychiatrist. She gets a monthly productivity report. Her pay is based on the productivity. In her system she gets more money on the day of admission than for subsequent days. This gives her an economic incentive to get patients out the door. She hasn't yet succumbed to the pressure to release them early but it's foolhardy to think that economic forces don't or can't play a role. There are lots of examples of doctors doing very bad things for profit.

phren0logy 9y ago
I worked at an inpatient hospital that had monthly productivity reports. My salary was totally independent of them, and I still quit after a few months because I didn't like the implication. I would encourage your wife to do the same. For most of us, that's not why we went to med school.

pdkl95 9y ago

Does my three day involuntary hold (5150) that became a two week involuntary hold (5250) and then an unspecified (and very probably illegal) wait for an additional 4 days, because "we're waiting for the doctor to release you" count?. (yes, I know, one data point is not an average). I saw that doctor exactly 2 times during that time, for a cumulative total of maybe 3 minutes, who was simply a pusher of the latest (at the time) SNRI. The nurses emphasized it was important to "show compliance" and take their drugs, even though they were wrong and caused serious problems for months. Why? I apparently offended a psychiatrist when I insisted that escitalopram ("Lexapro") gave me mild/moderate visual disturbances (hallucination). "Lexapro doesn't do that!". Insisting it did, followed quickly with a (probably mildly rude) comment about observation-vs-theory and just-world fallacy only cut the appointment short and started the above stay. The paperwork was sensationalized fiction, with zero basis in reality. After the first 3 days, the nurses commented every single day about how unusual it was to be allowed (by insurance) such a long stay. Private insurance would never allow the expense, but apparently their scam worked on Medicare. I never generalize bad behavior into a stereotype. I'll assume your experience has been very different. I'm sure this kind of problem has a lot of variation. My stay was over 10 years ago, and I would like to believe your industry has improved in that time. It might be a good idea to look outside your normal situation with the goal of gaining a broader perspective. It is very hard to regain trust after it has been burned for legitimate reasons. That puts better doctors at an unfair disadvantage, which is unfortunate. This is why it's so important proactively find the "bad apples" and actually fix the situation before bad behavior becomes normalized[1]. [1] http://www.rapp.org/archives/2015/12/normalization-of-deviance/ http://www.rapp.org/archives/2015/12/normalization-of-devian...

dsego 9y ago
Cipralex? According to my psych it also shouldn't cause sexual dysfunction, yeah right.

tcj_phx 9y ago

My girlfriend has had three stays at two different UHS hospitals in Phoenix (UHS is the subject of this ars technica article). They tried to keep her indefinitely the first time. The second two times were unnecessary month-long "stabilizations" that did not address the causes behind her presenting symptoms (self medication with alcohol). At the third stay UHS got her addicted to benzos, which stopped working after a month... I know you're a psychiatrist, and it seems like you practice in a fairly conventional manner. My experience with the mental health system is that the doctors have good intentions, but have been misled by their training. Because my girlfriend's doctors have inverted cause and effect, they haven't been able to help her get her psychosis-provoking self-medication tendencies under control (they think that psychosis -> drug use, or that alcohol/drug use is a separate condition from her psychotic disorder). For her first stay at UHS, it took a few days of calls for me to figure out the "magic words" for my girlfriend to say to get them to let her out - this was after about 2 weeks of "stabilization" that was really just getting her used to the tranquilizers. Finally someone told me she had to say "against medical advice", and they let her out two days later. She started to come out of her zyprexa-maintained psychotic coma after about 3 days, then she resumed self-medicating her physiological imbalances. I knew that alcohol wouldn't help, but I couldn't prescribe what she needed, or force her to take it anyways. She was under a court order for the second two stays at a different UHS facility, so she was powerless to resist the obsolete theories that they used to worsen her condition. It is now known that psychosis is related to cortisol deficiency. Cortisol is produced in the mitochondria. Therapies which improve the metabolism are indicated for all mental health patients. The only helpful treatment that my girlfriend received was getting revived by the fire department (benzos amplify opiates, fyi). Her drinking was under control for about two weeks after those two doses of naloxone. Naltrexone (similar to naloxone) is FDA-approved to help people keep their alcohol use under control. I was able to verify that my theories were basically correct when she lived with me for about two months. But then she went to visit her mother, and made herself psychotic with the street pharmacy again (bad situation with her old not-friends -> alcohol -> meth amphetamine), and she's back to getting "helped" by professionals who don't care about cause-and-effect. Robert Whitaker's Psychiatry Defends Its Antipsychotics is a refutation of psychiatry's latest attempt to defend the use of anti-psychotics: https://www.madinamerica.com/2017/05/psychiatry-defends-its-antipsychoticscase-study-of-institutional-corruption/ https://www.madinamerica.com/2017/05/psychiatry-defends-its-... (May 21, 2017) I guess I'm just asking you to consider that anti-psychotics are most psychiatric patients' problem, rather than their solution. Since you work with the criminal justice system, you're in a position to do a lot of good for a lot of people.