"We know that hospitals are dangerous places if you don't need to be there," Dr. Eliot Fisher, who also led the study, said.
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From: Erin on 8 Apr 2008 11:53 marcia wrote: > On Apr 8, 10:05 am, Erin <squig...(a)sympatico.ca> wrote: > > marcia wrote: > > > On Apr 8, 7:20 am, Erin <squig...(a)sympatico.ca> wrote: > > > > Jan Drew wrote: > > > > > "LostBoyinNC" > > > > > > Advocates of deinstitutionalization see the world > > > > through rose-coloured glasses; completely blind to > > > > the cruelty, humiliation and outcasting that society > > > > throws on not just the mentally ill, but anyone who > > > > does not fit in to their clique. That's why a lot of > > > > mentally ill people who have no support end up on > > > > the streets, in prostitution, abuse, or somehow taken advantage > > > > of. For seriously ill people who need help, the solution is to > > > > improve > > > > hospitals, not to kick people out on the street. > > > > > > "Freedom's just another word, for nothing left to lose.." > > > > > > - > > > > Janice Joplin > > > > > You forgot to mention, "or in jail"--one of the more popular dumping > > > grounds for deinstitutionalized mentally ill. > > > > True, in the States it's scandalous -- and what a horrible place > > for the mentally ill. The shortage of beds and resources does > > not allow for the long-term stay that used to be the case pre-50s > > anyway. That goes for all hospitals now--- they would rather you > > were taken care of outside somehow. > > > > Erin > > Is the same true in Canada? Some stats; it's probably not as bad as in the States, but the trend towards community care instead of hospital care, which started in the 60s shares an ambiguity in economic/humanistic interests, imho. (see par. below). A seriously ill person in crisis may spend a couple of days in a hospital, but as in other areas of medicine, the shorter the time the better for government budgets. http://www.parl.gc.ca/information/library/PRBpubs/prb0402-e.htm "Mental Illness, Homelessness and the Criminal Justice System A. Health System Challenges - Deinstitutionalization and Funding for Community Health There continues to be debate over whether homelessness is a "pathway" to mental illness and substance abuse, or mental illness and substance abuse are "pathways" to homelessness. Regardless of one's position in this matter, research completed by the Mental Health Policy Research Group, Hwang, and Zapf, Roesch and Hart(18) suggests that mental illness and substance abuse are more prevalent amongst homeless persons. Historically, individuals with mental illness were institutionalized in psychiatric or other long-term health facilities. A policy of progressive deinstitutionalization, beginning in the early 1960s, resulted in a steep decline in hospital populations. The number of beds in Canadian mental hospitals fell from 47,633 in 1960 to 15,011 in 1976, a decrease of 68%.(19) In Greater Toronto, the number of long-term psychiatric hospital beds fell from 3,857 in 1960 to 761 in 1994, a decrease of 80%.(20) Although it has been widely reported that deinstitutionalization led to a rise in homelessness, this claim has been disputed. For example, it has been found that in the United States "the contribution of deinstitutionalization to homelessness was marginal at best."(21) Further, the Pathways Project reported that by the late 1990s, only 6% of homeless persons had been in a psychiatric facility in the 12-month period immediately prior to their homelessness.(22) It was intended that deinstitutionalization be accompanied by a corresponding increase in the availability of community-based treatment and support services. This commitment was not fulfilled to the extent needed.(23) Further, during the 1990s, some Canadian governments sought to control funding for healthcare(24) and community-based support services,(25) made social assistance more difficult to obtain,(26) and withdrew financial support for social housing.(27) It is arguable that the reduction in the provision of these services placed more individuals at risk of becoming homeless, and made it more difficult for homeless persons to acquire housing and to access services, including mental health services, necessary to reintegrate into society.(28) B. Legal System Challenges - Police Services, Courts and Correctional Facilities As the numbers of homeless persons have increased in all large Canadian cities,(29) and both homelessness and mental illness are strong predictors of involvement with the criminal justice system,(30) it is not surprising that large numbers of homeless persons have had this type of experience. As noted above, homeless persons in Toronto are far more likely to spend time in a police station or jail than a psychiatric hospital. Police services, courts, and correctional facilities are ill equipped to contend with these problems. Each evolved with a specific purpose and role, and none were designed to substitute for health and social services. Police officers may not be properly trained to deal with the complex needs of homeless persons and individuals with mental illnesses, and their powers under provincial mental health laws are restricted. Notwithstanding these limitations, in some communities police are forced to take on the role of mental health worker as their time spent dealing with individuals who have mental health problems has more than doubled.(31) Organizations such as the Canadian Mental Health Association have argued that insufficient and underfunded local mental health services have contributed to an increased criminalization of persons with mental illness. Having viewed the findings of Trends in Police Contact with Persons with Serious Mental Illness in London, Ontario, they noted that "community mental health services haven't had an increase in base budgets for more than a decade. That means people with mental illnesses and their families aren't getting the ... community services they need to help them cope and that means more pressure on the police, hospitals and other emergency services."(32) Ironically, while reduced community mental health services may cause more individuals to be conveyed to hospitals, beds are less available, as criminalization of individuals with mental illness has also resulted in fewer services for civil clients.(33) Moreover, when beds are available, homeless persons face the prospect of discharge to shelter facilities(34) that they may then be forced to leave.(35) The legal system is similarly ill equipped. The mental disorder provisions of the Criminal Code were enacted to contend with offenders who are seriously affected by mental illness and either are unfit to stand trial due to their mental disorder or are not criminally responsible on account of mental disorder. However, while the changes proposed to these provisions (36) in response to the report of the House of Commons Standing Committee on Justice and Human Rights(37) may allow the legal system to deal with mentally disordered offenders more readily, they will be of little assistance to many homeless people or individuals with mental illness dealt with through a criminal process. Although provision is currently made for specialized assessment, treatment and reintegration of mentally disordered offenders into society, these services are hampered by a chronic lack of resources(38) and may not be available to other offenders with mental illness. Homeless persons, and persons with mental illnesses, are being detained in remand centres in Canada and the United States. Zapf, Roesch and Hart found that 7.8% of persons detained in the Vancouver Pretrial Service Centre had been homeless for most of the six-month period prior to their arrest. In New York City, 21% of inmates at a pretrial facility were homeless the night prior to their arrest, and 40% had been homeless at some point in the three years before their arrest. (39) Once imprisoned or otherwise held in the custody of the correctional system, however, their prospects are unimproved. As discussed above, mental illness, substance abuse and suicide are more prevalent amongst offenders in federal institutions. It has also been found that the environment in many facilities may contribute to mental illness or addiction, the recurrence or worsening of symptoms of these disorders, and suicide. Moloughney reported that risks of violence and death, separation from family and friends, and worries about parole reviews or transfers to other facilities "can challenge one's mental health. Individuals with existing mental health disorders will tend to have fewer personal resources to cope with stressors, resulting in the potential exacerbation of their disorders."(40) Moreover, it has been established that "the inmate's risk of acting in a self-damaging or suicidal manner is the product of a complex and fluctuating interaction among the prison environment, the inmate's individual vulnerabilities, and current stresses."(41) Offenders, and particularly those with mental illnesses(42) or addiction, and those who were homeless prior to arrest,(43) face the prospect of homelessness upon release. Refusal to participate in discharge planning,(44) reduced availability of health and social services, and a lack of housing all contribute to this possibility. Regardless of whether these factors result in a first-time incidence of homelessness, or are part of a pattern of cyclical or chronic homelessness,(45) once back on the street the individual is again part of a community with a higher prevalence of mental illness and addiction, and a greater likelihood of contact with the criminal justice system." also, http://www.phac-aspc.gc.ca/publicat/miic-mmac/chap_1_e.html Erin
From: Twittering One on 8 Apr 2008 13:51 On Apr 7, 5:22 pm, MothWrangler <mothwrang...(a)hotmail.com> wrote: > Erin wrote: > > > Twittering One wrote: > > >>If admitted to a psych ward, the higher your chances later for killing > >>yourself, relative to non-admits, say studies. > > > Not that i have great doubts, but a reference would be nice > > on such a controversial statement. I think small neighbourhood > > clinics > > would be so much better. The PQ gov. in Canada set them > > up in its wisdom, but they are out-clinics. Maybe the US has > > something similar? HMOs? > > > Erin > > If the studies didn't control for severity of illness, the claimed > results wouldn't be a surprise. > > In the US, only the most severely mentally ill individuals tend to be > hospitalized in a psych ward. In many cases, the individuals are > admitted because they are a danger to themselves or others. > > The less severely ill, or persons who aren't a danger to themselves or > others, usually are treated on a out-patient basis. > > Given that the most ill and most dangerous are the patients > hospitalized, it wouldn't be surprising if, after release, they were > more likely to commit suicide. > > Nancy > Unique, like everyone else > > -- > Proud member since 2007, WWWSC #1 > Ann/Emma Anne #4- Hide quoted text - > > - Show quoted text - Needless to say, I cannot research it for references at the moment; but based on my memory (at one point in my life, I spent considerable seriously researching such issues for a book), there are controls that point to the conclusion that institutionalizating itself accounts for deleterious influence on survival. As for severity of illness an its association with incidence of admission, based on my experience in NYC, there are a variaty of random reasons for admission into psych wards, from .. * Bad experience on Cymbalta * Need for social services * Potential litigation * Primary care physician pressure * Cry for help vs lethal intent * Protect pt from potential adverse legal outcome * Patient pleading * Risk to others * Adverse home circumstances And more. Some of which truely benefit the patient -- if the diagnosis is not adverse to their health outcomes -- and are not a function of "severity if illness," but severity of circumstance.
From: Erin on 8 Apr 2008 14:23 Twittering One wrote: > On Apr 7, 5:22�pm, MothWrangler <mothwrang...(a)hotmail.com> wrote: > > Erin wrote: > > > > > Twittering One wrote: > > > > >>If admitted to a psych ward, the higher your chances later for killing > > >>yourself, relative to non-admits, say studies. > > > > > Not that i have great doubts, but a reference would be nice > > > on such a controversial statement. �I think small neighbourhood > > > clinics > > > would be so much better. �The PQ gov. in Canada set them > > > up in its wisdom, but they are out-clinics. �Maybe the US has > > > something similar? �HMOs? > > > > > Erin > > > > If the studies didn't control for severity of illness, the claimed > > results wouldn't be a surprise. > > > > In the US, only the most severely mentally ill individuals tend to be > > hospitalized in a psych ward. In many cases, the individuals are > > admitted because they are a danger to themselves or others. > > > > The less severely ill, or persons who aren't a danger to themselves or > > others, usually are treated on a out-patient basis. > > > > Given that the most ill and most dangerous are the patients > > hospitalized, it wouldn't be surprising if, after release, they were > > more likely to commit suicide. > > > > Nancy > > Unique, like everyone else > > > > -- > > Proud member since 2007, WWWSC #1 > > Ann/Emma Anne #4- Hide quoted text - > > > > - Show quoted text - > > Needless to say, I cannot research it for references at the moment; > but based on my memory (at one point in my life, I spent considerable > seriously researching such issues for a book), there are controls that > point to the conclusion that institutionalizating itself accounts for > deleterious influence on survival. > > As for severity of illness an its association with incidence of > admission, based on my experience in NYC, there are a variaty of > random reasons for admission into psych wards, from .. > > * Bad experience on Cymbalta > * Need for social services > * Potential litigation > * Primary care physician pressure > * Cry for help vs lethal intent > * Protect pt from potential adverse legal outcome > * Patient pleading > * Risk to others > * Adverse home circumstances > > And more. > > Some of which truely benefit the patient -- if the diagnosis is not > adverse to their health outcomes -- and are not a function of > "severity if illness," but severity of circumstance. I have been fortunate to acquire some education which enabled me to study my condition and psychopharmacology on the net. This has enabled me to help myself in times of severe pharmacologically-induced crisis. An example, would be if lithium goes toxic, or heat stroke on medication. I am not sure that if i had gone to the hospital i would have got better care than self-medicating. However, the initial depression and bp -- definitely helped me by going to the hospital. As things stand now, after many yrs. on the same medical balance, i would rather treat myself at home. Ideally, having a nurse come to my home would be the best, especially in older age. Character has to be taken into account -- i am very self-reliant and shy at the same time. So, hospitals might be a challenge for me. But I have never been in a hospital except to see a doctor for an appointment. Erin
From: Frank on 8 Apr 2008 19:25 "Erin" <squiggle(a)sympatico.ca> wrote in message news:1f3dd195-0bba-4c40-bbc9-543f9f1d6d83(a)8g2000hse.googlegroups.com... > > > marcia wrote: >> On Apr 8, 7:20 am, Erin <squig...(a)sympatico.ca> wrote: >> > Jan Drew wrote: >> > > "LostBoyinNC" >> > >> > Advocates of deinstitutionalization see the world >> > through rose-coloured glasses; completely blind to >> > the cruelty, humiliation and outcasting that society >> > throws on not just the mentally ill, but anyone who >> > does not fit in to their clique. That's why a lot of >> > mentally ill people who have no support end up on >> > the streets, in prostitution, abuse, or somehow taken advantage >> > of. For seriously ill people who need help, the solution is to >> > improve >> > hospitals, not to kick people out on the street. >> > >> > "Freedom's just another word, for nothing left to lose.." >> > >> > - >> > Janice Joplin >> >> You forgot to mention, "or in jail"--one of the more popular dumping >> grounds for deinstitutionalized mentally ill. > > True, in the States it's scandalous -- and what a horrible place > for the mentally ill. The shortage of beds and resources does > not allow for the long-term stay that used to be the case pre-50s > anyway. That goes for all hospitals now--- they would rather you > were taken care of outside somehow. > > Erin How quickly the tune changes. At one point people were getting lost in the system and could not get out. Some were retained against their will. Some never got their day in court. Before you all lament too much consider the other side of the coin and use that to make value judgments regarding the future. There is a huge amount of the mentally ill on the various forms of the internet.
From: Jan Drew on 9 Apr 2008 00:05
"Erin" <squiggle(a)sympatico.ca> wrote in message news:49094167-f6df-4153-bd3a-ab87b9c1fe65(a)m71g2000hse.googlegroups.com... > > > Jan Drew wrote: >> "LostBoyinNC" > > Advocates of deinstitutionalization see the world > through rose-coloured glasses; completely blind to > the cruelty, humiliation and outcasting that society > throws on not just the mentally ill, but anyone who > does not fit in to their clique. That's why a lot of > mentally ill people who have no support end up on > the streets, in prostitution, abuse, or somehow taken advantage > of. For seriously ill people who need help, the solution is to > improve > hospitals, not to kick people out on the street. > > "Freedom's just another word, for nothing left to lose.." > > - > Janice Joplin > > Very Well Said. |