Long term housing of mentally ill people

[wyomingosualum]

I remember the highlights of an article I read maybe 20 years ago and recent events have brought this to my mind.

Back in the 1960s and 1970s, mentally ill people were housed long term in institutions run by the states. Many times, people were forced to live in substandard conditions. A flurry of lawsuits were filed, which led to a change in how mentally ill people were treated. Instead of keeping somebody institutionalized for their entire lives, the focus shifted to keeping people for shorter terms, giving them medication, and releasing them once they began to function at a more normal level.

Fast forward to today. The down side to this approach is that these people rarely stay on their medications once they are released from the state institutions. Medications have side effects, so the person decides they feel fine otherwise, so they stop taking the order to rid themselves of the side effects. And naturally, it doesn’t take long for the original mental health issues to appear again, many times to a greater degree than before.

And once the person stops taking their medication, the meds that once worked are now less effective or maybe even ineffective, period. This leads to the mentally ill person becoming more and more of an issue, not just to themselves and their families, but to society in general.

So here’s my question: Is it time to look at long term care for mentally ill people again? I’m not asking if we need to build country clubs to house them in, but is this something that we need to discuss and determine its feasibility?

 

[Medic007]

Fast forward to today. The down side to this approach is that these people rarely stay on their medications once they are released from the state institutions. Medications have side effects, so the person decides they feel fine otherwise, so they stop taking the order to rid themselves of the side effects. And naturally, it doesn’t take long for the original mental health issues to appear again, many times to a greater degree than before.

Not entirely true. Most people do stay on their medications provided they have access to them. The biggest issue is in the homeless mentally ill folks.

And once the person stops taking their medication, the meds that once worked are now less effective or maybe even ineffective, period. This leads to the mentally ill person becoming more and more of an issue, not just to themselves and their families, but to society in general.

Not true at all. Stopping a medication doesn't preclude its future use or effectiveness. Curious where you got this info.

So here’s my question: Is it time to look at long term care for mentally ill people again? I’m not asking if we need to build country clubs to house them in, but is this something that we need to discuss and determine its feasibility?

Long term care is still used for mentally ill people who are not functional in society. It just isn't done in "mental hospitals" any longer. Many nursing homes house mentally ill patients that are covered by Medicaid and Medicare. Others live in group home settings throughout the community. People that are functional are best cared for in an independent setting. The undiagnosed and incompletely diagnosed are the ones that we most often hear about.

 

[wyomingosualum]

Not true at all. Stopping a medication doesn't preclude its future use or effectiveness. Curious where you got this info.

It's what the doctor said about my wife’s nephew. He was in and out of mental hospitals in several western states for many years. He was committed countless times. And it was the same story every time. Fill him with meds and boot him out the door, which was quickly followed by his refusal to take the meds, which, according to the doctor, just made the problem increasingly worse.

He was bipolar and schizophrenic. Anyway, I speak of him in the past tense because he shot himself between the eyes a year and a half ago. I was involved in one of his involuntary detentions and it was a fight. Nothing says “I’m here to help” like pulling taser barbs out of somebody’s back. Thanksgiving dinner at my sister in law’s house a month after that was awesome....

Anyway, after many years of repeated interactions with the same people over and over leads me to search for a change in how we as a society deal with the issue. Open for suggestions.

 

[BIGOSUFAN]

In a state of acute psychosis, the brain is literally inflamed and without treatment grey matter is lost over time. As more and more grey matter is lost, people tend to become less responsive to medications over time. That’s why it is paramount for people to remain compliant with treatment once the first episode of psychosis ensues.

 

[wyomingosualum]

In a state of acute psychosis, the brain is literally inflamed and without treatment grey matter is lost over time. As more and more grey matter is lost, people tend to become less responsive to medications over time. That’s why it is paramount for people to remain compliant with treatment once the first episode of psychosis ensues.

Thank you for the down to earth explanation.

 

[anon_xl72qcu5isp39]

It's what the doctor said about my wife’s nephew. He was in and out of mental hospitals in several western states for many years. He was committed countless times. And it was the same story every time. Fill him with meds and boot him out the door, which was quickly followed by his refusal to take the meds, which, according to the doctor, just made the problem increasingly worse.

He was bipolar and schizophrenic. Anyway, I speak of him in the past tense because he shot himself between the eyes a year and a half ago. I was involved in one of his involuntary detentions and it was a fight. Nothing says “I’m here to help” like pulling taser barbs out of somebody’s back. Thanksgiving dinner at my sister in law’s house a month after that was awesome....

Anyway, after many years of repeated interactions with the same people over and over leads me to search for a change in how we as a society deal with the issue. Open for suggestions.

David foster Wallace went off his meds and they didn't work when he restarted them.

 

[wyomingosualum]

David foster Wallace went off his meds and they didn't work when he restarted them.

Another eventual suicide, I see. Are some problems just not solvable? Or is the eventual suicide of these people the solution? Talk about harsh....

 

[Medic007]

It's what the doctor said about my wife’s nephew. He was in and out of mental hospitals in several western states for many years. He was committed countless times. And it was the same story every time. Fill him with meds and boot him out the door, which was quickly followed by his refusal to take the meds, which, according to the doctor, just made the problem increasingly worse.

He was bipolar and schizophrenic. Anyway, I speak of him in the past tense because he shot himself between the eyes a year and a half ago. I was involved in one of his involuntary detentions and it was a fight. Nothing says “I’m here to help” like pulling taser barbs out of somebody’s back. Thanksgiving dinner at my sister in law’s house a month after that was awesome....

Anyway, after many years of repeated interactions with the same people over and over leads me to search for a change in how we as a society deal with the issue. Open for suggestions.

I'm sorry to hear about your wife's nephew. A neighbor I watched grow up across the street, a great kid, had onset of schizophrenia when he was 18ish. He did OK on medication but after leaving home, compliance was always an issue. He ended up homeless and found his way to Phoenix where he was ultimately killed by a vehicle while trying to cross a busy interstate at the age of 24.

I apologize for being so short in my previous reply. I've heard of the anecdotes that drug treatment becomes less effective, but have never seen any scientific evidence of that. I know there was a study involving discontinuation of lithium in bipolar disorder and it did not show less effectiveness once restarted. In all likelihood, the cause of observed deterioration in those that are non-compliant and stop taking the medication is that they are more difficult to keep on a medication regimen from the beginning and less likely to remain on one in the future, more so than the medication actually becoming less effective if taken as prescribed. If they didn't stay on the medication the first time, they aren't likely to do so in subsequent times.

Regarding what BIGOSUFAN posted, the inflammation and loss of cortical gray matter precedes the psychosis and is what triggers the psychotic conversion. I don't think the general public understands that schizophrenia is a progressive brain disease just like Alzheimer's and Parkinson's. It took medicine a long time to figure it out. The bad part about schizophrenia is that there are some that ultimately won't respond treatment. I don't think anyone has any answers on what to do with those folks, how to identify them early, and what a "successful" outcome should look like.

I'm throwing in a link to a study that is a meta-analysis and meta-regression of 30 years worth of research. It's a long read, but worth it if you're interested in the complexities of schizophrenia. Here's a very sobering passage from it...

"In fact, it is now well known that brain abnormalities are present even before the onset of schizophrenia, in the prodromal stage of the disease or in first-episode drug-naive patients4, 18 independently of drug treatment, and that these anomalies show progression over time even during the phase of transition to psychosis,104 again without or with little potential effect of pharmacotherapy. Alternatively, morphological abnormalities in the brain, and their progression over time, may represent a significant correlate of poor outcome of schizophrenia, for which a larger prescription and use of antipsychotic drugs may be considered an epiphenomenon. Early105, 106, 107 and more recent108 literature confirm that the most consistent clinical correlate of structural brain abnormalities and their progressive change is poor clinical outcome of the disease."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3565772/

 

[wyomingosualum]

I apologize for being so short in my previous reply

I didn’t read it that way at all. We are good, bro.

I don’t know what medication he was on. I do recall, though, that they put him on monthly time released implant of some sort. We thought this would be the answer to the lack of daily pill popping. Worked for a while, until he just skipped town for several months. It’s a long story and I’m leaving out a bunch of stuff for the sake of brevity.

Anyway, I understand that the local cops had many contacts with this Cruz guy in Florida. His lawyer said that Cruz has been mentally ill all his life. I tend to believe that. I am wondering if we will ever know how many of those contacts with the cops involved involuntary detention for mental health treatment and, ultimately, if the mental health system failed in this case as well as all the other things that went sideways.

 

[Medic007]

I am wondering if we will ever know how many of those contacts with the cops involved involuntary detention for mental health treatment and, ultimately, if the mental health system failed in this case as well as all the other things that went sideways.

I doubt we'll hear. The crossover from public info to protected info occurs once he became a patient if he was ever involuntarily detained in a psychiatric facility.

 

[Medic007]

I do recall, though, that they put him on monthly time released implant of some sort. We thought this would be the answer to the lack of daily pill popping. Worked for a while, until he just skipped town for several months.

That's the most difficult part of management in some. Short of institutionalizing them, it's difficult even for dedicated family to ensure compliance. The same thing happened to my neighbor. Once he started venturing out, the family's ability to help him help himself was gone.

 

[wyomingosualum]

I doubt we'll hear. The crossover from public info to protected info occurs once he became a patient if he was ever involuntarily detained in a psychiatric facility.

I suppose the defense could introduce this information at trial (if this info even exists) if they thought it beneficial to them.