[costello]

Not sure what to make of this editorial. Is he hinting we need to go back to more hospitalization?

I'd never heard of that book he mentions. I looked at the reviews on amazon, and they seem to indicate the author lays some blame on the parents for their daughter's condition. I'll have to get a copy and read it.

Last week, one of the landmark nonfiction books of the last 50 years was reissued by Vintage Books. “Is There No Place on Earth for Me?” by Susan Sheehan began in 1981 as a four-part series in The New Yorker; in 1982, it came out as a book, winning the Pulitzer Prize.

“Is There No Place on Earth for Me?” is about a woman who suffers from severe schizophrenia. In the book, Sheehan calls her “Sylvia Frumkin,” a pseudonym meant to protect her privacy; her real name was Maxine Mason, which Sheehan divulged after Mason died, at the age of 46, in 1994. She was overweight and overbearing, a difficult person even in the best of times, but also, Sheehan told me recently, “bright and articulate” — when she wasn’t delusional. The book’s title was a question Mason “had first asked her mother in an ambulance transporting her from one hospital to another in 1964,” as Sheehan wrote in an essay published after Mason’s death. (It is included as a postscript to the new edition.) Mason was 16 at the time.

I have no idea what moved Vintage Books to republish “Is There No Place on Earth for Me?” but I’m glad it did. The story Sheehan tells is a terribly sad one, and not just because of the flashes Mason shows of what she might have become if she had not suffered from mental illness. It is also appalling to see what she goes through as a mental patient: the hospitals that overmedicate; the misdiagnoses by doctors after the briefest of examinations; the lack of any kind of safety net when she is not hospitalized. But here’s the worst part: Even though the story Sheehan tells is more than 30 years old, there is only one real difference between then and now for the mentally ill. It’s worse today.

The deinstitutionalization movement was well underway when Sheehan was doing her reporting. In the 1960s, during the Kennedy and Johnson administrations, the federal government passed a series of laws designed to liberate the mentally ill from the acknowledged horrors of mental hospitals, where they were often confined for decades. The idea was that with the introduction of powerful new antipsychotic drugs, people with schizophrenia could live outside a mental hospital — and that hospital stays would be much shorter. The federal government gave money to communities to set up local mental health centers as well as housing for the mentally ill.

In 1975, this trend was affirmed by the Supreme Court, which ruled that the mentally ill had a right “to live in the least restrictive setting necessary for their well-being,” as Sheehan writes. By the time Sheehan met Mason, in 1978, the average stay at Creedmoor — the New York psychiatric hospital where much of the book takes place — was 38 days. Some 67 percent of the admissions were people who had had previous stays at Creedmoor.

On the one hand, many mentally ill people were able to lead fuller, richer lives thanks to the deinstitutionalization movement. But as Sheehan’s book illustrates, there were also many people for whom the drugs did not have a pronounced effect — or who stopped taking the drugs as soon as they left the hospital. Yet there were no longer enough hospital beds for them, hence the need for hospitals to drug them up and move them out.

E. Fuller Torrey, perhaps the most vocal critic of the current mental health system, says that before deinstitutionalization there were 312 public psychiatric beds for every 100,000 people. That was clearly too many. But today there are a paltry 14 beds for every 100,000. Torrey estimates that we need at least 50 beds per 100,000.

Meanwhile, what happened to patients once they left the hospital was often horrendous. State mental hospitals would release patients with little idea where they were going. They often ended up on the streets, or in prison, which have become today’s de facto mental hospitals.

In one sense, Maxine Mason was lucky. Though she had enormous difficulties with her parents, they clearly loved her and tried, as best they could, to help her. Her sister Trudy did the same after her parents had died, pulling strings to get her into the kind of outpatient housing that was envisioned when the deinstitutionalization movement began. The problem was that Mason was simply too sick to last long in such an environment. She needed to be in a hospital — a humane hospital where she could get the care she needed. It never happened.

I remember thinking when Sheehan’s articles first came out in The New Yorker that someday we would look back in horror at the way our society treated the mentally ill. Thirty three years later, that day still hasn’t come. But it will.

http://www.nytimes.com/2014/01/25/op...p&rref=opinion

[beauflow]

I took from this that things have gotten worse, not that they need to hospitalize more. It mentions these days the jails are filling beds with ones with issues . I'd have to agree and I'd have to agree it's not the proper place for treatment with mental illness. That's not saying to hospitalize everyone in these cases, its asking to provide the correct and though treatment that should be given for one with difficulties to live a better life.

Perhaps I'm missing something, it is after all the end of my day.

[Turtleboy]

hmm a strange one to be sure, it does seem to suggest that the author would have the old ways of long term hospitalization.
A sad case to hear about for sure, and i do believe that somethings have not really changed,
i.e the lack of aftercare for extreme cases and and sufferers not taking their medication.
It does bring up a point that should be noted i think, that we don't always get the care we need, but to say it's worse than it used to be imo is just not true,
I came through pretty bad psychosis but if this were the early 60's i would probably have spent years in a ward and not gotten the modern treatment i did. pretty scary when i think of it that way to be sure.
thanks for the article it was an interesting read

[avlady]

i know from personal experience that in the last year or so only have things changed for the better, maybe because the hospital stay i last had a few months ago was better than any other one i've had, i was in hospital pshyc wards several times fro 1980's to 2013. I have to say i am now clear headed enough and realized i really needed it. I am doing so much better now. I still have my good days and bad days. i hope everyone here can come as far as i have i couldn't have done it without my doc and t although. i would like to thank everyone that had helped me throughout the years too.

[Sometimes psychotic]

I think this is an incredibly difficult thing to deal with....clearly there are people who don't need to be in the hospital who probably were....for example this woman who was depressed because her son was killed was involuntary held inpatient even in today's climate...

Grieving mom is held against her will, but still billed

I can't help but wonder if there are more long term hospital beds then they will be filled whether necessary or not...certainly it's easier to warehouse people than to actually care. At the same time 30% of people with sz don't respond to meds...what to do...I simply cannot believe hospitalization is the right approach because meds are not the correct approach for this group...what I would like to see is communities of people living independently but with community support...why not give people apartments...their own space but with proximal meal services and basic cleaning services with day programs near by all for some rate which can be afforded by someone on disability....I'm talking basic human services not medication management. Considering the rate for intensive nursing and the cost of meds I actually think this non-medicalized support model would be less expensive than more hospital beds. Have these kinds of communities spread across the country in both urban and rural areas so people have a choice of their preferred location. But the only locks will be the ones you personally close to keep the world out for a time.

I debated whether to add this or not but I think one additional clause might be something along a three strikes policy for drug use resulting in a ban unless rehab is completed. There is apparently a sub-population of people that have been diagnosed with sz that are heavy drug users....the bulk of violence associated with sz patients is in fact due to dual diagnosis of drug abuse and sz....people with sz are not statistically more violent on average but when you add drug use it is three times the baseline level(28%). In order for such centers to thrive in decent neighborhoods I think drug users would have to be excluded from this type of low intervention facility. There is also a much greater stigma to drug use so community acceptance would be even lower...it seems heartless to me because they too have a problem but I imagine there are other interventions which might be more appropriate more along the lines of a rehab facility which should also be supported. So that is what I would do...and the money for this should be taken from medicare/caid because it is cheaper to house and not hospitalize and uselessly treat.