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We are failing our neighbors with psychiatric illnesses
Long waits, poor care affect the treatment received by patients
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Published: June 6, 2009
Your recent report "Hospital crisis: Wait of 8 days" (May 30) about the very long wait by a citizen for inpatient care has, I hope, startled your readers. Many of our citizens who experience a psychiatric crisis are not seen as a priority when it comes to timely (and preventive) care.
Unfortunately, this incident illustrates a lack of real concern for those with mental illness by the hospitals, the local public mental-health management and board, and our elected county officials.
This is raw, unabashed discrimination. A person with any other illness would not be treated this way. Even if the illness affects an individual's behavior, he or she is still in dire need of health care and hospital staff should be available to deal with such people. I know that as a nursing student and even as a nurse in a hospital, I was trained for crisis intervention with agitated patients.
Too many in our community make over-simplified and unfair assumptions. They assume that people with psychiatric disorders can be respected differently. They assume that they do not have other health needs for which they should be evaluated and treated, and that the availability of treatment should be based upon their ability to pay. Finally, there is an assumption also that all people in a life crisis who exhibit behavioral symptoms should be sent to the hospital -- or perhaps even to jail.
As an advocate, a person with clinical expertise, and as someone who also has a psychiatric diagnosis, I am dismayed and ashamed of what my fellow citizens experience at the hands of the community's mental-health care system. How have we let things get this far? We have allowed a system that we know is failing to get worse.
As we consider solutions, I recommend the following be considered as minimum standards for mental-health care in Forsyth County.
□ Services should be available and easily accessible for people before they have a crisis, and the caregivers should be respectful and welcoming. Relationships should be based on real engagement to improve clients' personal commitments to care.
□ After a crisis, there should be strict follow-through monitoring to ensure that the person is linked to services in our community. Again, relational engagement of community resources should be emphasized to foster helpful innovations.
□ CenterPoint -- our Local Management Entity tasked with developing and overseeing availability, access, and quality in our public system of providers -- should improve its community relationships and funding decisions, especially with regard to inpatient treatment settings. The LME must ensure that barriers to successful partnerships are studied and minimized.
Finally, we must all ask why our three inpatient settings are so lacking in their dedication to such a large group of people in this community. Our two very large hospitals are charged no property taxes in order to offset their costs for charity care, yet we feel that time and time again citizens with mental illness are refused services there. Our one privately owned clinic is able to specify who it will treat and does not offer the much needed medical services necessary. Often in the case of chronic mental illness, people have a higher rate of disease to heart, lungs and blood vessels.
They also have growing rates of diabetes, sometimes due to their medications.
It is time for a paradigm shift. Let's aim for a better-developed infrastructure of genuinely welcoming and accessible services so people do not end up in emergency rooms.
Let's make the measurement of real-life outcomes the objectives of how we monitor success. Let's tap into the resilience of our neighbors, even those with a psychiatric illness, to support prevention and recovery.
By managing resources and relationships wisely and by respecting all citizens in spite of diagnoses, we won't need so many hospital beds, handcuffs in emergency rooms, or long, insulting waits.
■ Laurie Coker serves on the North Carolina Commission for Mental Health, Developmental Disabilities, and Substance Abuse Services, and the Board of the National Alliance on Mental Illness (NAMI) in Forsyth County.
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