[tradika]

First of all, the question I’m about to ask is not being asked for research. We had a nice discussion about the healthcare system last night in chat, and it got me thinking about how the rest of PC handles the various problems they face with treatment.

My question is how do you think the healthcare system could be improved for the mentally ill? I’m curious to see in what areas you guys have personally experienced problems, and whether or not you have any creative solutions to solve those problems.

Okay, fire away!

[sideblinded]

Mental healthcare (if you want to call it "care" is way underfunded. It starts with our legislators. They have no clue and don't care about the mentally ill. They are rich and it is all about where money should go.

I have heard of so many mental health facilities being shut down in my state. It is so sad.

Mental illness still caries a stigma.

It is poorly managed and there is a shortage of psychiatrists who are willing to take the under advantaged population. For instance...Medicaid.

Insurance had to make Mental health a "parity law". It is supposed to be looked at as being equal to medical issues but it is not.

How do I think it could be improved?

If all of our legislators had a mental illness and knew what it was like to be poor.

Good luck. Mental illness and poverty go hand in hand. It is a proven fact.

I think it may never be improved on a fast track. I think it will take years and years for slow implements to occur. If I am a bit cynical, it is because I have lived it for so long.

Sorry that I couldn't be more helpful as I would like to hear some good remedies that are feasible and believable.

[tradika]

It is true that a lot of psychiatrist do not want to see patients on Medicaid. I am sure there is quite a bit of paperwork involved, and they have to see a much larger patient load to make less money. Some of them probably have a huge debt from medical school, and so the prospect of treating this population is much less appealing if they can just charge cash or patients with good insurance.

I think it is better when they use other types of healthcare professionals who require less school (and money) and get them trained to perform the basic duties people require such as prescribing medication. They would like to move some of those professions up to doctoral degrees, but at this time I’m not sure that’s a good idea. At least allow some of the master’s level professionals to continue to prescribe with a medical doctor or someone in their own field with a doctoral degree to supervise them.


I would love to see the break-down of each states budget on mental healthcare treatment care is allotted. Does anyone have this?

Hi tradika,

Mental Health Spending: State Agency Totals

I'm not really good with talking about things like this,

But I'll give it a go.

I feel like with mental health and the healthcare system, the big thing is, it's so expensive. I have no idea how we could make it less expensive, but if there was some way that the patients could afford medication, I'm sure it would improve the system.

That's really all I can think of right now. When I think of more, I'll definitely come back to this thread.

I will post a link that I believe answers your question, but first I will put my 2 cents (or sense?) in.

1) People with mental health issues must "come out of the closet." It is a fact that there is nothing more powerful than a personal testimonial. That's not my opinion, that's a fact. When a person puts a face on depression, anxiety, bipolar, schizophrenia, etc., the public changes their views on mental health. This is so much more powerful and effective than any amount of data in a book. And it destroys stigma and stereotype.

2) After we do this, we will be in a position to, once and for all, end the false dichotomy between physical health and mental health. Hospitals should be for healthcare. Period. Separation is inherently unequal. Yes, I'm advocating for the elimination of psychiatric hospitals. I want mental health in hospitals. So if you have cardiac arrest, stroke, diabetes, cancer, depression, psychological issues, or schizophrenia, you need to go to the hospital.

Here's a link that provides a more complete answer:

Improving Mental Health Care

[kim_johnson]

I live in NZ so our health system is different from the US one. They say that there 'aren't enough doctors' and I do think that the main problems I've had with my healthcare have been due to clinician's having too many people on their books and being overworked / burned out. I don't know whether the problem is that there aren't enough suitably qualified doctors to fill advertised positions or whether the problem is that there isn't the money for another position / another doctor to join the team to take up some of that caseload. I suspect it is mostly the later.

The best health care I've ever had has come from people who worked part time. 3 days per week. I finally felt heard. I finally felt cared for. I finally felt like they had the cognitive resources to see me and accept me as an individual rather than rushing me quickly into some preconceived box / schema.

I think that medicine is very 'old school' in some ways. Slow to change. Part of it is about public acceptability. Sometimes... People really do want Superman. I don't want to know that I have the trainee surgeon who has never done that particular operation before and who has trouble suturing a pigs foot... I want to believe that I have the very best surgeon that there is. Calm assuring confidence is important in some settings, for sure. But I do think that medicine has been slow to... Look out for it's own (in truly psychologically health ways, I mean, clearly it is good at closing ranks). Perhaps because of the huge numbers of people queuing to do it there is this idea that people in training are really expendable. For every medical student who burns out there are 4 or 5 more (who would all go on to be competent, likely enough) queuing to take their place...

I think things are starting to change. But slowly, yeah.

I am finding a lot of inspiration from some of the stuff that is coming out about flexible workplaces. In particular, the idea of job share. I am fairly sure that studies show you get about 3/4 of the full time work equivalency out of a person who is employed for 1/2 of a position. I know from my own experience that studying part time is about 3/4 of the workload. And so very (very very) much more enjoyable and interesting and so on for only being part time. Manageable. Competence. Etc. Great for my own psychological health. Great for the psychological health of the people I'm working for / with.

Something has happened here with GP's where they seem to have the power to work part time. And a lot of them are doing it. And I think that quality of care has improved because of it. I'd like to see this transition more broadly through to other areas of medicine. Especially something like psychiatry. Halve the caseloads.

I suspect the problem is that it is the student doctors (years 5 and 6) who are doing the bulk of the (unpaid or grad stipend equivalent) work. Since they are unpaid already we can't really pay them 1/2 for doing a part time workload (thereby achieving 1.5 labor output equivalence). Anyway... This is the kind of thing I am thinking...

I suspect... The real resistance comes from senior clinicans / consultants. Who feel they have worked freaking hard to get into positions they are currently in - of part time workloads at 2 or 3 or 4 or 5x the salary that anybody needs to be paid for a decent quality of life...

I don't know... I need to learn more.

[tradika]

In NZ do you have other types of health professionals that can take some of the strain off the medical doctors?

[kim_johnson]

Originally Posted by tradika

In NZ do you have other types of health professionals that can take some of the strain off the medical doctors?

Absolutely. The government is doing what it can to encourage people to go to nurses as a first port of call, for example. I am actually currently working with a community mental health nurse for my psychological support. She's every bit as helpful to me with respect to my needs right now as any psychiatrist has ever been. And the government pays her a lot less than they would be paying for me to similarly see a psychiatrist.

I think the division of labor between medicine and allied health really does need to develop. I am particularly interested in developing physiotherapy so as to prevent hip replacements. Standing on a wobble board: Silly. Teaching people how to fall safely: Priceless. Little things... How abdominal activation can pull your back pain (your joint compression) right out... Catching joint instability early and teaching people to use their muscles in order to save their joints... Exercise... Nutrition... Not just telling people what they know already 'you need to eat better and exercise more' but professionals (personal trainers etc) actually getting in there and walking people through life changes until the changes become part of... Who the person is... Much cheaper than a lifetime of diabetes meds for... How many generations? Surely...

Part of the problem is that allied health fields have a long way to go in their professional development. It is only fairly recently that nursing has developed a professional identity. In the US physiotherapy is a PhD level, graduate program. In Commonwealth Countries (UK, Australia, NZ) physiotherapy is a 4 year undergraduate degree. It is more... Massage therapy (not much knowledge of anatomy / physiology) than something that is really in the position to be working closely with orthopedic (respiratory, etc) surgeons. The journals need to develop etc. I was very upset to learn that physiotherapy in this country is going more the way of hairdressing or beauty therapy (a consumer pays 'feel better' service) than trying to align with health and get some of that health funding to develop more empirically effective treatments.

Part of the problem... Is this view of medicine as the 'elite' field. Partly it gets this reputation from being most competitive to get into so this idea that it gets the 'best' (the smartest, the hardest working) students. And the medical program is 6 years whereas most other fields require significantly less years of study. So then this idea that medical doctors are 'better' (smarter, more knowledgeable, more hardworking) than allied health professionals. So... Some people would rather see a doctor than allied health.

On the other hand... Medical doctors are pretty out of touch. I was having a discussion with a medical student the other day and it emerged that she believed that plumbers make more money than medical doctors do. Medical students don't represent the communities they are expected to serve with respect to major demographics. Socio-economic background etc. They don't know what it is like to be stuck in some horrible dead-end job with no forseeable way out... They don't know what it is like to be living on welfare struggling to feed their kids... They don't know what it is like to be the victim of racism... They don't know what it is like to be struggling with disability...

I am kinda wary... I mean... I didn't get along so well with AA / NA. But they were consumer empowered rah rah. Just because you have been there... Doesn't mean other's experience is the same as yours, or that only people who have been there can be in the position to help.

Anyway... Things are developing, for sure. In my lifetime (36 now) I think that psychiatry services have gotten better. Sometimes it has seemed a bit like things have gone backwards... But I think overall there has been some kinda progress...

[possum220]

Get people to care about other people..............

A statement like "mental illness has had a detrimental impact on my life" creates absolutely no change in public opinion in regards to mental health. And it's not because people don't care about other people; it's because that statement doesn't touch a person's heart. For example, look at reply #9 to this thread. When kim starts saying "they don't know what it is like" I began caring.

The focus should be on public opinion, for if you change that you change the government (legislative, executive, judicial); the healthcare system will change, big pharma will change, etc. The public needs to know how mental illness has affected your life. Has mental illness had any impact on your employment? If so, how? Any impact on education? If so, how? Any impact on relationships? If so, how? The more details the better. I wrote a reply to a thread about indifference (Current Events forum (The Cost of Not Caring by H-H-H-H)). It is a statistical thread, but I decided to reply with a personal experience. I received two virtual hugs from a statistical thread.

Here's a similarly-situated issue: Same-sex marriage. Just 15 years ago, 60+% of American citizens opposed same-sex marriage and it was illegal in the USA. Today 60+% of American citizens are in favor of same-sex marriage and it is legal in 70+% of the USA and may become legal in the entire USA by this June. How did an issue with a huge stigma go from less than 20% support to over 70% support in less than 15 years? The LGBTQ community and their allies took a two-pronged approach: Stop the militancy movement and start emphasizing similarities; and advocate for a constitutional right to marry.

Let's take a similar approach in regards to mental illness.

[Lady Courtesan]

The intellect and wisdom displayed in this thread give me hope. I have always recognized that 'ordinary' folk fear us-as if mental illness were catching. And I believe that every person has a place inside themselves that could erupt with rage and make them 'crazy' and it scares them silly.

For that reason, I do not believe we will ever be accepted. I do not believe most people understand the kind of money (read power) the pharmacuitical companies hold in this country. It's not about our military presence or fuel-it's about people who make medications that cost pennies and charge hundreds of dollars for them.

Shakespeare said 'kill all the lawyers'. When I was unfairly incarcerated, I asked the shrink if he knew the first four words of the Hypocratic oath.
He didn't and when I told him he shrugged it off as if it were meaningless.

FIRST, DO NO HARM. And perhaps that is the heart of it. We have all had those who care and treat us with compassion-and those who believe we are the lowest form of life on the planet. Crazy and lasy-living off the government so we don't have to support ourselves. Content with a life of poverty that must be lived to be undestood. (As one poster noted.)

The solution that made the most sense to me was to begin a program for those who specialized in taking care of the mentally ill-who did not have to endure the punishing years of medical school, perhaps only going for two years. Perhaps lessening the burnout and leave the core of caring that brought these individuals to this field in the first place.

We live in a world of such self doubt and such pain, abandoned by God and left to carry a burden that is often just to heavy to bare. So it all comes back to kindness. You can leave your caretaker's office with a little bit of hope, feeling a bit better about yourself-or you can leave filled with doubt, convinced the judgemental and snide remarks that leave you feeling worse about yourself just might be true.

In the beginning I said that this thread leaves me with hope-hope that we can continue to find the courage, not only to deal with whatever issues we face, but also the courage to continue to fight a system that doesn't play fair.

[Fuzzybear]

[kim_johnson]

Originally Posted by Lady Courtesan

The solution that made the most sense to me was to begin a program for those who specialized in taking care of the mentally ill-who did not have to endure the punishing years of medical school, perhaps only going for two years. Perhaps lessening the burnout and leave the core of caring that brought these individuals to this field in the first place.

What kind of program would that be, though? I mean... I know that in the US there is this program / job description 'physician assistant'. Every now and then people come over here and try and persuade us to introduce the program. There has been a lot of resistance to this idea. From nursing, especially. They keep asking 'what can physician assistants do that we can't?'.

So, if there were to be a program that was focused on care for people who are mentally ill... Well... The education people (with their counseling qualifications) and the nursing people and the occupational therapy people etc etc etc will all want to know what this new program / qualification can offer that they aren't capable of doing already.

So then I guess we get to 'well, why aren't they'. Doing it, I mean.

Partly it is about $$$$$. They say here that there are a shortage of nursing home / aged care workers. But then they advertise nursing home / aged care jobs as something approximating minimum wage. The workers they get are run off their feet... Burning out... Similarly for care of disabled. People with autism or downs syndrome or whatever whatever who need varying levels of care... Over 200 pounds of three year old hurling things out the window because he didn't get his gold star...

I don't think very many people go into medical school with the intention of becoming psychiatrists. There has been some discussion... That medical schools are more likely to be wary / suspicious of students saying that they have a special interest in psychiatry. They worry that the student won't be interested in anatomy and more traditional (most of the rest) of the areas of medicine. Psychiatry... Is one of the easiest areas to match into... Aka... It has a tendency to pick up the doctors who are only there because they failed to get into the program they really wanted.

I think this is perhaps partly why the scope of psychiatry has become more and more limited over the years. Health insurers and governments are only really willing to pay psychiatry for a 15 minute medication consult. Forget about psychoanalytic talk therapy or discussion on housing or... Allied health: Much cheaper.

[Nammu]

Ok, I'll give it a go.

First step is to stop making hospitals the main entry into getting treatment. Start thinking in terms of what is scientifically viable not just approach MI with drugs, but look for a holistic whole person solution. Cover more alternative choices( that cost less and treat a person as a person rather than an illness) form like minded groups for those that need a social aspect to healing, ie more social groups for higher functioning people with MI. Cover talk therapy, and other none drug treatments as a first choice before using drugs. Gym memberships and transportation should always be offered. Just becouse someone does have a car doesn't mean they are going to be able to get to treatments if they are in a bad place.

Stop calling us clients....does anyone call cancer patients or those with disabilities clients instead of patients? I believe this change has lead to a negative change in how MI is seen by doctors and others especially in a hospital setting. They don't see a person they see a series of negative symptoms that need eliminating, not a patient needing treatment and care.

Need media headlines that are positive and informational not just pointing out the tragedies. Most people with MI are victims not doers of evil.

Help to find decent housing and jobs without penalizing. If someone is trying to work don't take away healthcare or suport. A job, full time, part time or occasionally is not going to magically cure a MI.