Monday, December 17, 2012

An American Epidemic

I worked for over 20 years in the ER.
Not just 1 ER, but 2 of the largest in East TN, simultaneously for most of that time.

I can tell you I've seen dozens and dozens, probably hundreds, of extreme psychiatric cases during my career. I have definitely seen hundreds of people come in for various minor/moderate psych problems, the overwhelming majority of whom were being managed not by Psychiatrists or even Psychologists, but by regular medical Doctors with little to no business doing so.
We saw that every single day.
Every single day.


Because the Psych system is absolutely overwhelmed with cases.
There is so few inpatient psych beds that exist in this country, and particularly this area, I would say it was a joke, except that it isn't. It's a shame, a tragic problem that's existed for many years, but is now at an epidemic level.

So, people go to their regular Doc, and tell them their problems, and the Dr just writes them a script for one of the antidepressant, antianxiety, even antipsychotic meds that are out there, even though they have no real expertise in identifying people who have true clinical psychiatric processes going on. Many of them do it because they know these patients cannot get psych care.

Many times these people are on combinations of medications that actually 'work against one another' so to speak, and can cause unwanted psych symptoms themselves.

Listen to the TV commercials disclaimer on virtually all psych meds--they themselves can cause thoughts of, if not actual suicide and/or violent behaviors and personality changes.

Do I really want my Internal Medicine Dr. or Family Medicine Dr. prescribing me these meds? Do you?

Folks, the fact is that there is an epidemic of mammoth proportions going on in this country.
Untreated/undertreated/poorly treated mental illness has been on the rise for a good number of years.
There is little if any real treatment going on, because there just isn't enough inpatient facilities, and woefully little outpatient treatment either.

I cannot tell you how frustrated it feels to have a guy brought into the ER, who was waiting at home to kill his wife & kids, (his statement to me) but they knew something was wrong & wife called cops. Cops get to the house, they had to talk down, he had the barrel of a 30-06 RIFLE IN HIS MOUTH. They talk him down, bring him to the ER.
We do the protocol; alcohol/drug screen, etc. He of course has a psych history, depression, being medicated by his regular MD, with some outpatient treatment. They just have him in counseling, he goes about 2/3 of the time, diagnosis is major depression.
Gets into a spat with wife, decides to kill her & the kids (his statement to me). Thankfully, this time it was avoided.
He gets to the ER, and is going back and forth between anger & hyper-calm (bad sign). We have security on him of course, but the cops have as usual left him there with us-suicide/attempted is a crime, but they never, ever prosecute.
Anyway, we get him evaluated by psych, which takes hours.
They decide he needs to go to the ONLY local psych facility that takes unstable, violent patients. Well, they're full, and the Dr. there is giving us all kinds of grief. Bottom line, they agree to evaluate him and admit if they think he needs it.
Finally, we get him transported by the police to the facility. Cop arrives at psych hospital, and is met at the door by the Dr., who tells him not to leave, so he can take him back if they don't admit him.
They don't admit him.
The cop brings him back to us, and leaves him.
So, we get another eval on him, and finally get him admitted to an inpatient facility north of us, about 2 hours away.
This entire episode lasted over 12 hours from the time he first set foot in the ER.
He was "stabilized" and released after several days.
Upon his return home, his wife & kids had left the house.
Guy sets his house on fire, and shoots himself.

That was over just one case, over 10 years ago, and is but one of dozens and dozens, of stories I could tell, some with happier endings, most with tragic ends.

TELL ME the system isn't broke, I'll call you a fool to your face.

We  Americans have created this monster ourselves, with our systemic, liberalistic, 'everybody's a victim', 'everybody's entitled', "there's a pill for that" attitudes.

The fact is that some people are indeed mentally ill enough to need to be removed from the society they endanger.

I have seen many that I wish had been removed.
A lot of them committed suicide, many of them committed murder, a fair number of whom had been treated for mental illness, but allowed to walk among us.

There are far more of them out there than you know, or wish to know about. How long do we allow them to endanger the rest of us?

If my saying that offends anyone, I am sorry that you find it offensive, but I have seen more up close cases of people who are a danger to themselves and/or others than you have, unless you either work in mental health, or have been where I've been, worked where I worked.

Our society is broken.

Our mental health system is broken.

Evil is at play .

I guess the answer is that politicians will give speeches, and try to ban tools.
The media will try to sensationalize the events to swell their ratings.

Neither of these are in any way solutions to the situation, but it's all we're likely to get.



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