Since this blog focuses on reform, I would like to take a moment and discuss populations that never have a chance to be helped. I’m referring to children, geriatric patients, and those that are intellectually disabled (ID).
Before I get into specifics, allow me to clear up some misconceptions. First, a hospital will not raise your child, nor will it make up for poor parenting. Your child will not conform to whatever version of perfect you have concocted in your head in a matter of days as a result of being in a hospital. Second, those that are ID, actually have a higher rate of mental illness, so not every behavior can be attributed to them being ID. This does not mean a hospital will take them, it is just validating. Finally, an individual with Alzheimer’s will meet criteria to go to a hospital almost 99% of the time, but after a certain point it will do absolutely no good whatsoever. Best thing you can do is find a memory unit for your loved one so they can be cared for properly. If you’re concerned about losing the disability check from this happening, you’re a horrible human being.
Children have always been a challenge to the mental health system, and my theory about this is because there is a belief that everything is transient. That whatever Bubba, Jr is doing now, he’ll “grow out of”. Mental illness is rarely ever one of those things, with maybe the exception of a few cases of ADHD (which is because it is way over diagnosed). The sad truth of the matter is that genetically, a child may have a predisposition to mental illness, but it is environment that brings it out in them. Which means that whatever is wrong with Bubba, Jr, can a lot of times be attributed to Bubba, Sr and Mrs. Bubba. But we live in a generation where no one can be held accountable for anything anymore, so the decision has been made to hospitalize children at a enormous rate. One study that is slightly dated suggests that 1 out of 6 discharges are of individuals under the age of seventeen. In Virginia, there is a shortage of children’s beds, so the existing beds are always full. There is ONE state hospital that specializes in children, and it is always full. So what do we do with the kids? What do we do with Bubba, Jr when he doesn’t want to give up his cell phone and slaps Mrs. Bubba? Well, detention isn’t an option mainly because that system is not prioritized properly either. Besides, its easier to create a label for Bubba, Jr. than hold him accountable. With all the money that the state has placed in outpatient children’s services over the past several years, there have been many programs spring up, but no real progress has been made. We still have children born to families that never should have children, who abuse and neglect them. This is a societal issue that needs to be addressed before it is too late.
In 2012, the Department of Justice decided that Virginia was keeping individuals with ID institutionalized, and not offering them any services outside of that. Yes, I’m aware that institutionalization is something that we as a society supposedly decided was a bad idea. More on that in a moment. So, a result of this lawsuit is that the state would have to put more money in community programs, and close some of the training centers that have been operating for years. We also created a whole statewide program specifically to respond and answer any crisis intervention issues that arose with this population. Let me be clear so that there is no misunderstanding…it did not accomplish anything.
The problem with institutionalization is two fold. First there were no limits placed on it. Yes, someone who is severely mentally ill/intellectually disabled and who cannot function in society should be placed in an institution and cared for as long as possible. There, I said it. But, what we were doing was putting people in these “insane asylums” for really horrible reasons, where they were being mistreated and exploited. Treatment did improve slowly over time but the problem has always been that those in the field of psychology have all the power over someone who may or may not need that power lorded over them. What I mean is that if I label someone with a descriptor such as “psychotic”, a typical person will have no idea what that means but believe that I must know what I’m talking about because I do what I do. Since people believed this to be the case, it allowed for some really horrible experimentation on those that were mentally ill, most notably lobotomies, but at one point and time we thought dunking people in ice cold water or spraying them with fire hoses were a good idea as well. But society allowed us to do this because they did not know any better.
In the present day I think we’re better informed, but the stigma is still there. Enter the intellectually disabled, a population that is also misunderstood by the general public. Human beings tend to run away from or do their best to ostracize things we don’t understand as a protective factor. So given history it makes sense that we would be nervous at individuals living their lives in an institution. However, the difference is that we can actually quantify intellectual disability so that there is not a lot of ambiguity. We in the field of psychology though took that a step further and figured we could correlate quality of life with that IQ score. We got it wrong a few times, so once again we’re back to where we started. So now we’re placing these individuals in the community, and while we do a good job with wrap around services, we are still lacking in crisis intervention. There is a total of one hospital in the state that has perhaps two beds dedicated to the ID population. Otherwise, when hospitalization is necessary, they end up at a state hospital. Go figure.
Same is true for individuals that suffer from Alzheimer’s. These individuals become violent or do something unexpected, and we get called to put grandma in handcuffs, placed in the back of a police car, and ship her off to a hospital.* Then what? A psychiatric hospital cannot fix a chronic degenerative MEDICAL condition. But families where it gets to much to handle or assisted living facilities keep sending them. Then they refuse to take them back; which I think should be a felony (not that anyone asked). Of course, when that threat is leveled, I should probably just walk away, but I regard myself as better than the individuals that abandon them, and so I try to find a bed for them. Now, they also go to a state hospital more often than not, because even geriatric facilities do not take individuals with dementia.
So what can be done. Well, I think we have to stop using hospitals as a default location for people that we don’t want; or not. We have to decide. If institutionalization is a good thing, then we need to regulate it heavily and have oversight so we do not end up back where we started. If it is not a good thing, then we have to stop using hospitals as orphanages and nursing homes, and create alternatives that do more than just pay lip service. Finally, either facilities need to be established for these special populations that are accessible to people that do what I do for a living, or private hospitals need to be held accountable for not taking them. But, I don’t see the latter happening anytime soon since that makes too much sense.
*Note: Virginia does have a provision for alternative transportation which would eliminate the need for handcuffs. However, we still have not allowed billing for this and a lot of medical transport companies won’t do it for that reason.