No Place To Go

There is a fantastic article up on the New York Times website, coming out in print this weekend in the NYT Magazine, called When My Crazy Father Actually Lost His Mind, by Janeen Interlandi.  The author tells the chaotic story of how her family tried to get help for her 69 year old father who was ill with a manic episode.  In it, he bounces from hospital to jail to ER, to homelessness, over and over. She talks about the catch-22's with the legal/psychiatric system with a father who is dangerous enough for a restraining order to keep him from his family, but not dangerous enough for civil commitment, and she talks about stories of others families where awful things have happened.  Her love for her father comes through, mixed in with her frustration that there is no place or mechanism to help such people.  Ah, but the story has a happy ending.  It reminded me a lot of Pete Earley's book Crazy: A Father's Search Through America's Mental Health Madness.


Interlandi writes:


And so for weeks, we had been locked in a game of chicken: waiting for my father to do something clearly dangerous; praying like hell that it would not be his suicide or accidental death or the death of someone else. In the meantime, my mother had all but stopped sleeping and had started hiding the car keys and the checkbook. She would tiptoe around their one-bedroom apartment at night, waiting for him to doze off, then call my sister or me to unload her despair in a flurry of whispers. 

Oh, I can't begin to  do this article justice in a blog post, you'll just have to read it.

Shrink Rappers Set Bar High for NAMI Walks

4/24: $250 ~ 4/25: $295 ~ 4/28: $330

Click on image to donate!
See which Shrink Rapper has attracted the most donations.
4/28 (7%): thank you, Carol!
4/25 (6%): thank you Christina, Jesse, Abhishek!

The National Alliance on Mental Illness is the nation’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness. They provide education and training programs for consumers, family members, providers, and the general public. Their Family-to-family and Peer-to-peer programs have won awards for providing education, insight, and support to people and families affected by mental health problems. They have hundreds of state and local affiliate organizations to provide grassroots support to communities.

NAMIWalks, NAMI's annual fundraiser, raised charitable contributions to support their work. The Shrink Rappers are working to raise money for the NAMIWalks fundraiser on May 19 at the Baltimore Inner Harbor. All of the money goes to support the Anne Arundel County NAMI affiliate. We did this last year 3 days before the event and managed to still raise $750. We're shooting for $5000 this year.

Anne Arundel county has a population of 588,000 people. Anne Arundel county has 14 psychiatric beds to treat the portion of that 588,000 who require intensive inpatient psychiatric treatment. That comes to 2.4 inpatient beds per 100,000 people. The average number of psychiatric beds in the U.S. is 36 per 100,000 (most recently available data; see other psych beds posts for details). The average number of psychiatric beds in Africa is 3.4 beds per 100,000 population. Anne Arundel county has fewer inpatient resources per capita than Africa. They need our help.

So... I'm asking our dear readers to help out and pitch in. In the last month, we've had 22,000 unique visitors. If only one-fourth of you Shrink Rap visitors gave $1 to our fund-raising campaign, we'd have $5000 for the Anne Arundel county NAMI chapter, which they can put to good use. Please consider clicking the picture above to donate to this cause. Give $1, $10, $25, $50, or even $100... whatever you can. And it's all tax-deductible. (4/25: Sarebear said it won't take less than $10.)

To really sweeten the deal, we will give an autographed copy of our book to any person or organization that donates $250 or more. (Yeah, I know, big deal. Still, it's a token of our appreciation.)

And, if we manage to get any SUPER donations of $1000 or more (!!), we will place an image of your choice (tasteful only) for one month in a prominent place on our blog to celebrate your generous donation (or to advertise your organization), including a link back to your website, as well as four signed copies of our book. Note that we get about 40,000 page views and over 20,000 unique visitors per month -- that's ~2.5 cents per impression! (If we get more than one of these donations, we'll give each one it's own month, in order of receipt of donation, starting with June.)

"Roy, you've talked me into it. Enough already; where do I click!?"

Click right HERE to take you to our team donation page.  Or click on the image at the top of the post. I will change this image daily to update the progress you are making. You will be able to choose which Shrink Rapper you want to honor with your donation (a little friendly shrink competition).

I'll throw in one more thing. Whomever donates the most will get to also have a Guest Post on Shrink Rap, and we'll bring you on as a guest on our podcast, My Three Shrinks. (Can you tell I listen to a lot of public radio?)

Thank you for considering this worthy cause.
~Roy out.

PS: You can also JOIN our Shrink Rappers Team and raise funds yourself. We have room for 27 more "walkers", and you can either walk in person on May 19, or just in spirit (you don't have to be present to raise money, but I must tell you that Clink will be out of town, and Dinah is at best a maybe).

Where Did All The Psych Beds Go?

Roy likes to write about Emergency Departments and Bed Availability for psychiatric patients, but this one came to me, so I'll borrow the topic while he's away.


In the Observer-Dispatch in NY State, Andrew Coates writes in "Guest View: Psych ward closings require public discussions":


The pell-mell closures of inpatient wards at Mohawk Valley Psychiatric Center and at other Office of Mental Health (OMH) facilities around the state are unfair and unwise. The cuts will shift costs to localities even as they rob the same communities, especially Utica, of much-needed jobs.

New York state law formerly required a full year of public notification when OMH planned to close or downsize inpatient services.
But last year, Gov. Cuomo wrote into the state budget a provision that authorized ward closures on 30 days’ notice and facility closures on 60 days’ notice.
 
Coates goes on to say that the Governor has chosen "expediency over community needs." 

It may be politically expedient to turn a deaf ear and a blind eye to needs of patients with serious mental illness. (Patients who are not exactly known for lavish campaign contributions!)
Yet cutting services to vulnerable patients with no serious public discussion of the impact on our communities, with no regard for the human hardship upon patients and their families, is as irresponsible as it is outrageous.


 In the next day's (2/29) Times Union, Dr. Coates then shared a patient's perspective on the bed closures.  The patient wrote:


For many individuals in Mohawk Valley, no one is really sure where they are going. But they are leaving maybe the only home they ever knew. Maybe the only place they ever felt safe.

Mohawk Valley is not perfect but it’s certainly better than the streets. And now the system has failed them – the system itself is failing. The mental health system is stretched to the breaking point already in NYS. Closings are just going to make it worse. People are going to end up on the street.

 I'll leave the comments to you.  I probably would have found the patient's opinion to be more powerful if she had been previously hospitalized in the facility that is being closed.  


Thanks to Meg for the shout out on this issue!

Running Out of Psychiatric Beds

I read today that Eastern Ontario has started a bed registry to keep track of where open psychiatric beds are available. This is something I've long advocated. The United States now has less than 10% of the beds it used to have 50 years ago. Granted, treatment has improved and community resources are enhanced. But there are still areas that often do not have a sufficient number of hospital beds for folks needing acute inpatient psychiatric care.

The Ontario story described in the Ottawa Citizen states that six of the area hospitals have been connected to a computerized "bed board" that provides real-time information on who has an appropriate bed available. This saves time in the ER and gets patients to needed treatment more quickly. Otherwise, calls need to be made to each individual hospital, which is very time-consuming.

And it is not uncommon for all the beds to be full. Last July there was an EMTALA complaint against a hospital in Maryland because a patient sat in the ER all weekend, and this hospital said they had no beds to admit the patient to. The Department of Health and Mental Hygiene investigated the complaint and found that, indeed, the hospital was full that weekend. The ER's record indicated that all the hospitals (except the state hospitals) were called that weekend and all indicated their beds were full. So, DHMH visited every hospital (about 28, I think) thinking that surely one of them had an empty bed they were hiding. What they discovered was that every single psychiatric bed in the state was full.

Unfortunately, we have no way of determining how often this happens, but we know if happens often enough. A "bed board" like this would be very helpful in (1) quickly finding beds when needed, and (2) keeping track of the extent of this problem. Having patients wait in ERs for days is unsafe and is even discriminatory. How many people with stroke or uncontrolled diabetes sit in ERs for days waiting to find a bed for treatment? I'd like to hear others' thoughts on how this problem can be addressed.

[Note: my apologies to our readers for not blogging or commenting much over the last year or so. I plan to be more engaged again in Shrink Rap going forwards. I'll never talk as much as Dinah does, but I'll get some words in :-]