Recently, a young woman living in New York City returned to her apartment, and a homeless man slipped through the locked entrance before it closed behind her. Following her up the stairs, he would murder her with a knife from her own kitchen.

Exhibiting a lack of escape plan, he barricaded himself in her apartment, forcing the police to break down the door. Calls to 911 by neighbors hearing a woman’s screams alerted them to the situation. The man was arrested and taken into custody, and he may be charged with a hate crime; the woman was Asian-American. Sources investigating the case found the man had multiple instances of criminal behavior and was released on his own recognizance.

This man is one of many who have fallen through the cracks in a mental health system in tatters and created by the well-meaning but inadequately managed deinstitutionalization movement after 1955, which picked up steam in the 1970s.

Unfortunately, it’s not the first time an individual in dire long-term need for care and treatment was left wandering the streets to assault and, in one case, murder a therapist in her office in New York City. The trial and that man’s insanity defense failed to place him in a hospital, and he went to prison.

With the closing of large, self-contained psychiatric hospitals that functioned much like small towns, many patients were sent to live in supervised housing or apartments or with their families. Promises of ongoing care and careful follow-up never materialized to the extent needed, and patients became homeless.

In some cases, repeated incidents of street or subway attacks never resulted in long-term care under strict supervision. Prisons became the “hospitals” for these patients who were now criminals. However, press coverage can lead the public to believe that all patients with a psychiatric illness are potential criminals or murderers, not so.

If the system is failing both the patients and the public, what possible solutions might there be that would meet the needs of both? One, of course, would be a return to the former hospital system where patients could live out their lives. I’m not sure the bucolic moral treatment existence related to me by old-time hospital staff was accurate, but it may have been better than our current state of affairs. Unfortunately, that wasn’t a time of intense data collection, so we have nothing to go on regarding incidents of criminality by the mentally ill.

I’ve worked in these hospitals, I’ve seen patients who could be safely returned to the community and ones that might never recover a rational ability to function outside the institution. One patient who was delusional and had killed his mother kept muttering that all women must die.

Patients on wards where I’ve worked had received treatment from insulin coma therapy, ECT, lobotomy, psychotropics, and behavioral therapies of many types.

Management at the hospitals wasn’t akin to anything resulting from an MBA. Some patients were “treated” with questionable psychotherapeutic techniques as they cycled through the wards. Therapists were unlicensed, physicians weren’t necessarily psychiatrists, and some were pediatricians in a hospital for adults.

The diagnoses ranged from mental developmental disorders, drug-induced delusions, to paranoid schizophrenia. And some of them had murdered one or many people. I worked with those patients, and I know some, who killed their entire families, did so by psychotic reasoning brought on by severe, extended stress. One wanted to die so he could join his family in heaven.

Today, I’m sure many of them live in communities near or far from the hospitals. I am not sure whether some of them would not have another break in their reality testing ability. Often, taking prescribed medication requires a level of care that is either lacking or there is resistance and discontinuance.

Do the mentally ill have constitutional rights regarding psychotropic medications and hospitalization, and how should these individuals be protected? One significant case brought before the US Supreme Court was a clever test of the issue of involuntary detention in a psychiatric hospital.

The case of Kenneth Donaldson was simple. Donaldson refused to take psychotropic medication, and because the hospital was not treating him, he argued he should have been discharged.

After the case was decided in his favor and the court agreed that Donaldson could sue those who took his freedom from him, he would write a book and be interviewed for a podcast. Today, in hospitals, we have legal procedures where psychiatrists decide whether a resistant patient needs meds, and they may then be forcibly administered.

Involuntary hospitalization remains one means of protecting those with mental disturbances from harm to themselves or others, but the question of competence remains. The statutes for obtaining orders to forcibly detain them vary by state, and they are known by many names. In Florida, it’s “Bakering” or the Baker Act. Most provide for several days of hospitalization before a person may request discharge if the medical staff agrees the current need for stabilization is over.

Where do we go from here? One aspect of this serious dilemma remains questionable; funding. If inadequate funds are authorized or poorly utilized when authorized, who will protect both patients and the public? Who is responsible for deaths and destruction of property when a patient is left to wander the streets and had been discharged to a community residential facility?

How much supervision do they receive in those residential housing units? I know of some places where staff leaves at 4 pm each day. There is no overnight coverage in the residence.

I remember a hospital worker once commenting on the excessive discharges of patients unready for release. “She’ll discharge them to a crate in the middle of the street.”

Civil rights and mental health issues clash frequently, and the outcomes are not precisely what is needed unless knowledgeable, caring, and prolonged planning is created. I once offered training for judges hearing mental health disability cases and never received a response. What type of training do judges receive in this area? I question whether they receive any.

The current state of affairs ensures that people will wander, people will be seriously injured or die, and the media will howl each time. But who will step up and attempt to fix the broken system? Anyone who presents themselves must be prepared for a rain of ire and accusations. It is not a pretty picture.

The post Senseless Murder Mandates Prison or a Psychiatric Hospital Admission? appeared first on Medika Life.

1. Understand the hospital’s visitation policy

In this current climate of the pandemic, visitation rules are constantly in flux and hard to predict. That being said, they usually have a rule where there is a primary visitor and a secondary or alternate visitor. This is a very important decision and needs to be take seriously, especially as it may be hard to quickly change the visitor assignment under short notice.

Having a good sense of who may be the most fitting to have these roles, depending on the type of relationship (parent, child, spouse, etc.), proximity to the hospital, availability to visit, and level of care involvement post-hospitalization, are all major factors to keep in mind when making this important decision.

2. Bring items that help you feel comfortable, relaxed, and that allow you to have some privacy

Patients can often be admitted to a hospital very far away from home if their local area doesn’t have the resources to support them. However, even if you live nearby the hospital, it can also feel as though you are very far away from home as well so any little comforts that you can bring in that is permitted can help make your stay that much more comfortable.

Ask your family or friends to bring in comfortable clothes, slippers (if this type of footwear is permitted) or perhaps cozy socks, your favourite sneakers, an extra blanket, a few photos of loved ones, personal toiletries, electronics (and earbuds to help you have more private conversations), a charger and extension cord for your devices, noise-cancelling headphones to help reduce distractions in the surrounding environment, books and other items connected with your hobbies and interests that can be stored at the bedside, and anything else you can think of that might help you feel at ease that is allowed by the hospital. You can check with the hospital administrator if you need more information about what you can and can’t have at the bedside. These are also just a few ideas to consider – choose items to have with you that suit your own unique needs.

3. Ask if there will be a discharge meeting with the doctor and if a family member can join in person or by phone

Depending on the length of your hospitalization, your medical team may decide to have a meeting with you to discuss your progress and next steps. You can ask if a family member can join this discussion in-person or by phone – especially if you are not fluent in English – or ask the hospital to provide an interpreter if that would be helpful. If a family member is allowed to join in-person or virtually, they can be that second person to either make notes or ask questions that you may forget or may not be comfortable raising on your own.

Some important topics to discuss in your meeting include: your physical and mental health, any new diagnoses and treatment plans, home care services, precautions to take or limitations to be aware of when you return home, when you should follow up with your family doctor, etc.

4. Make an appointment with your family doctor and record any hospital follow up appointments if relevant

Call your family doctor’s office to make either a virtual or in-person appointment to keep them updated regarding your current situation. They will continue to follow up regarding your medication refills and general medical needs and are your go-to health professional to assist you as you settle back into the community.

If the hospital has made any follow up appointments for you, make note of this in your calendar so that you get the follow up you need regarding any specialized health issues that require ongoing treatment. Similarly, if you need home care services for personal care needs, check in with your medical team or hospital coordinator regarding what services are recommended and when services are expected to begin after you return home.

5. Remember to take time for yourself – you need to rest as much as possible to improve your recovery process

In between all of your tests, scans, interdisciplinary team appointments, and other related tasks in your schedule, you need to prioritize your rest. Taking care of yourself is vital at this time. Sleep, hydration, nutrition, and exercise – even if it means engaging in some movement in your hospital room that is within your physical abilities – are all important domains that you need to focus on to get better.

Finding pockets of time to spend with your loved ones as well – whether virtually or in-person – is also good for your mind, heart, and soul. Keep up the good work and hopefully you will be on your way home soon!

The post Five Things to Consider When Being Admitted to Hospital appeared first on Medika Life.

Do we need research to tell us that we will receive something wonderful in return for thinking of others in their time of need? If that’s what anyone needs to help them rethink their behavior, OK, bring it on.

Literature and films all laud the heartwarming aspects of charity and caring for our brothers and sisters worldwide, regardless of religious beliefs. We watch a classic like “It’s a Wonderful Life,” and we feel renewed in our beliefs that things can turn around. How many saw Mary Bailey as the true hero here and failed to give her the due she deserved? Well, a WAPO columnist did.

Many of us will watch the several iterations of the film “A Christmas Carol” and see what pushes Scrouge to repent his miserly actions and channel the true spirit of Christmas. But first, Scrouge has to be scared witless by the three ghosts of Christmas. Who knew it had ghosts, or are they simply spirits? I’ll leave that to the literature scholars.

The season is a time of sharing, goodwill, and charity. Whether it’s a religious holiday (or holy day) isn’t the issue here. Human dignity and fair treatment of others are the emphases.

Those who celebrate Kwanzaa have returned to the true essence of the season where the cost of a gift isn’t the issue (really, a Lexus?), and it should be replaced with a gift made for the receiver.

I’ve worked in mental health centers where patients, who had been in psychiatric hospitals for decades, didn’t know what an appropriate Christmas gift might be. One man gave someone a pound of raw bacon, and he was a bit unnerved that he didn’t receive a hearty thanks for it. Another patient gave a single Bic pen wrapped in Christmas paper to a worker. The joy exhibited was moving.

The writer O’Henry enriched our reading and the spirit of love in difficult times when he wrote “The Gift of the Magi.” If you haven’t read it, you have a link here. Of course, in my readings, someone asked why one of the kings brought the gift of myrrh, an oil that is used for the solemn procedures before burial. Again, the scholars can debate.

Enter the Research

Research hasn’t failed us in providing proof that giving is as good to the recipient as the giver and perhaps more so. One form of charity doesn’t have the effect we would expect and it’s anxiety.

The so-called checkout charity solicitations often bring anxiety, and their “results caution managers that checkout charity solicitations may have unintended consequences on customers that result in negative encounter outcomes, particularly in service environments in which the solicitation is technology-mediated.” I’m reminded of the supermarkets asking if I wanted to “round up” on my order for charity. Pharmacy chains do this as well.

Guess what one incredible benefit of giving can be. All of you might be interested in a study that indicated that charitable giving might promote longer life. That’s like paying it forward big time.

This study indicates that “older people who are helpful to others reduce their risk of dying by nearly 60 percent compared to peers who provide neither practical help nor emotional support to relatives, neighbors or friends.” Maybe we should have plaques with “Give Unto Others and Prolong Your Life.”

Altruism does affect us by lowering our stress hormone levels and thereby increasing our immune system’s ability to protect us. Good? Better than good, and cancer may be tamed through charitable works. Volunteering is a wonderful way to help others, so money is not the issue.

All of us need a sense of worth and belonging to our culture. Research out of an Alzheimer’s center indicated that volunteering and giving of ourselves can contribute to possibly staving off neurological illness, heart disease, and stroke. Again, the return to the giver is in good health indicators.

When we feel our lives and activities have been limited, there is time for charitable works either via the internet or some other activity. Think about it.

The post Kindness and Charity Benefit Us More Than We Know appeared first on Medika Life.