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Reinventing the E.R. for America’s mental-health crisis

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Re: Reinventing the E.R. for America’s mental-health crisis

#101

Post by Timon3 »

NoZebra120vClip wrote: post #100
Timon3 wrote: post #97

Earlier quoted context omitted.

At the same time it would be interesting to know how many had these ideas before SSRI. If you've been feeling suicidal for a long time, and SSRIs haven't improved your condition, you might feel hopeless enough to commit the act - without SSRIs being any kind of cause.

The fact of having a prescription for psychotropic drugs is a knowable thing, albeit jealously guarded by HIPAA and lawsuit-averse manufacturers. Perhaps it is less knowable whether the victims were taking those drugs and had "therapeutic" levels in their systems at time of death. But it would be extremely unknowable whether or not they had experienced suicidal ideations, and how long they had had them. Because the m…

Then it seems like a pretty terrible idea to just assume they increase the likelihood of social ideation more than they prevent, no?

Re: Reinventing the E.R. for America’s mental-health crisis

#102

Post by NoZebra120vClip »

Timon3 wrote: post #101
NoZebra120vClip wrote: post #100

Earlier quoted context omitted.

The fact of having a prescription for psychotropic drugs is a knowable thing, albeit jealously guarded by HIPAA and lawsuit-averse manufacturers. Perhaps it is less knowable whether the victims were taking those drugs and had "therapeutic" levels in their systems at time of death. But it would be extremely unknowable whether or not they had experienced suicidal ideations, and how long they had had them. Because the m…

Then it seems like a pretty terrible idea to just assume they increase the likelihood of social ideation more than they prevent, no?

Tell that to the pharmaceutical manufacturers who ran clinical trials, received guidance from the FDA, and have been required to black-box-label the drugs according to the suicidal ideations which were scientifically proven to increase due to taking the drugs. I don't know where you got "assume"?

Re: Reinventing the E.R. for America’s mental-health crisis

#103

Post by NoZebra120vClip »

flangola7 wrote: post #28
bombcar wrote: post #20

Earlier quoted context omitted.

I wonder how much can be attributed to legalization/decriminalization of drugs. Because if someone is on drugs but that is “fine” now are the classified as a mental illness incident?

Have you actually googled this at all? This reads like a question made in total ignorance of legal recreational substances, as well as their effects. I'm trying not to be insulting, but as someone who's social circle nearly universally consumes recreational drugs (not counting tobacco or alcohol), this comment is cringe-inducing how out of touch with reality it is. To answer your question, 0% can be attributed to it.…

Psychotropic pharmaceuticals can have strong interactions with legal and illegal drugs alike. If you're taking most types of these, you won't want to smoke pot or drink alcohol. Also, since you can't depend on the ingredients and dosages of illegal or unregulated drugs, there is really no telling what drugs you could or couldn't take in concert with your psychotropics.

And then there are questions of whether you'll tell your psychiatrist. I've seen a quite accepting, non-judgemental attitude about recreational drugs, but can you count on this to be consistent? Do you want this on record in your medical chart? Do you want to try and consistently lie about activities quite germane to your mental health?

Re: Reinventing the E.R. for America’s mental-health crisis

#104

Post by harimau777 »

willcipriano wrote: post #51
harimau777 wrote: post #42

Earlier quoted context omitted.

Can you explain what policy you are advocating for? Asylums pretty egregious abuses of people's human rights; and that's to say nothing of instances where they were used to lock up mentally well but socially "undesirable" people. I'm guessing that you must have intended to advocate for something else?

Ok first check this out: https://www.dailymail.co.uk/news/article-12131455/Inside-Phi... That's about 40 minutes from where I live and I can say first hand it isn't a exaggeration, since the pandemic those areas have been growing. Would you feel safe walking at night there? Now consider that children live in those communities. Do you think they feel safe? I agree with you that many of the asylums were inhumane, shock…

Personally, the solution that I advocate is social reform to address root causes. Things like making healthcare more available, adopting harm reduction strategies, strengthening social safety nets, and building more housing to reduce costs.

Re: Reinventing the E.R. for America’s mental-health crisis

#105

Post by growingkittens »

fnordpiglet wrote: post #95
cat_plus_plus wrote: post #94

I have a feeling that future generations of doctors will look at today's mental health care in the same way as we now look at bloodletting. Belgian town of Geel has demonstrated that many mentally ill can lead content, functional life with a different attitude from society. Current mental health care emphasizes drugs with uncertain mechanisms of effectiveness and severe side effects, and Freudian style therapy that p…

Technically I think Freudian analysis is very uncommon in a clinical setting in 2023. Most often it’s some variant of CBT, and for some conditions DBT, that have more outcome oriented approaches and frankly can be more systemically applied by less skilled clinicians.

What the original commenter wants is called "occupational therapy."

CBT, in application:

- is focused on quick results

- does not evaluate the patient as a system

- does not enable practitioners to recognize the limits of their practice

- does not have a concept of trauma as a barrier to using CBT.

This references my experience as a complex patient: I have a childhood brain injury that went undiagnosed until age 30. From 0-18, my parent's negligence hindered diagnosis; from 18-30+ I ran into the limitations of medical professionals and the medical system. In addition, I have read hundreds of experiences across time and space that align with these statements.

I have noticed that experienced CBT practitioners have a habit of seeing "failure to respond to CBT" as a failure of the patient to use it correctly. Less experienced practitioners are not as confident, and actually more open to the idea that their technique is wrong for the patient.

Re: Reinventing the E.R. for America’s mental-health crisis

#106

Post by duped »

bordercases wrote: post #58
duped wrote: post #38

Earlier quoted context omitted.

> Suicide is an example. You can't "overdiagnose" suicide unless you outright lie that it happened. People have been outright lying about suicides for a long time.

If it's counted as an accident rather than a suicide then the numbers are still high. If it's counted as a suicide rather than an accident then maybe. I would then ask who is lying. If it's faking deaths then that's the coroner system which you would have to question.

Or we have gotten better about recording suicide today and they were under-reported years ago.

Re: Reinventing the E.R. for America’s mental-health crisis

#107

Post by duped »

hezralig wrote: post #40
duped wrote: post #38

Earlier quoted context omitted.

> Suicide is an example. You can't "overdiagnose" suicide unless you outright lie that it happened. People have been outright lying about suicides for a long time.

Do you mean in regards to under-reporting to save face?

Yes. Also if you put yourself in the shoes of a coroner/investigator, how do you determine if it's a suicide vs an accident? And would you get the context you need from the family/friends/colleagues of the deceased, keeping in mind they might not tell you, or lie because they don't want their loved one to be remembered as someone who lost their battle with mental illness?

It's kind of undeniable that there's a rising mental illness crisis in the US and undoubtedly more suicides, but keep in mind that suicide, like all symptoms of mental illness, is hard to track accurately. Especially as the stigma towards mental illness is starting to cede.

Re: Reinventing the E.R. for America’s mental-health crisis

#108

Post by stevenicr »

NoZebra120vClip wrote: post #89
noelwelsh wrote: post #86

Earlier quoted context omitted.

The root cause is, I think, inequality. See, for example, https://equalitytrust.org.uk/health "A much higher percentage of the population suffer from mental illness in more unequal countries; differences in inequality tally with more than triple the differences in the percentage of people with mental illness in different countries. Rates of depression in US states are associated with income inequality (after adjustin…

> income inequality Then is this the corollary to "Money Can't Buy Happiness"?

or maybe the opposite? Or maybe I misunderstand the statement.

A lot of money seems to buy happiness, and when that pile of money is used to raise the price of housing / food / transportation - then those who do not have the big pile of money feel like they are hopeless and are often treated as such which has secondary effects.

Re: Reinventing the E.R. for America’s mental-health crisis

#109

Post by wahnfrieden »

77pt77 wrote: post #15
wahnfrieden wrote: post #6

Earlier quoted context omitted.

those were prisons

Prisons were and are far better. Those were endorsed torture centers with zero accountability. Prisons don't even come close.

The well known colloquial name for Rikers is torture island

Re: Reinventing the E.R. for America’s mental-health crisis

#110

Post by willcipriano »

harimau777 wrote: post #104
willcipriano wrote: post #51

Earlier quoted context omitted.

Ok first check this out: https://www.dailymail.co.uk/news/article-12131455/Inside-Phi... That's about 40 minutes from where I live and I can say first hand it isn't a exaggeration, since the pandemic those areas have been growing. Would you feel safe walking at night there? Now consider that children live in those communities. Do you think they feel safe? I agree with you that many of the asylums were inhumane, shock…

Personally, the solution that I advocate is social reform to address root causes. Things like making healthcare more available, adopting harm reduction strategies, strengthening social safety nets, and building more housing to reduce costs.

Sure, but those kids don't have that kind of time. We need a solution with immediate effect now.
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