System for mentally ill spurs worry

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I told a friend that I would be posting about people expressing their opinions during this presidential election…because, I guess, I’ve been getting fed up with some of the comments I’ve heard about the candidates.

However, I saw this article in the East Valley Tribune, and it kind of stirred something up in me.

The article talks about how care for the mentally ill in Maricopa county has deteriorated. About a year ago, Magellan was awarded the contract by Maricopa county to care for those people suffering from a mental illness, replacing the previous provider, Value Options. Because of my ex-wife, I had a lot of experience with Value Options, but I have no experience (or opinion) about Magellan. But it sure sounds like little has changed. Overwhelmed case managers and doctors, lack of treatment and followup still seems to be the status quo. I wish I had an answer for this, because lack of care for SMI individuals is absolutely unacceptable.

But the author of this piece also briefly touches on what I perceive to be a bigger issue: the rights of mentally ill patients versus society at large. Two cases mentioned involved patients who had either assaulted or murdered innocent victims shortly after receiving care and assessment. This is such a tough subject to tackle. People should not lose their basic civil rights based solely on the fact that they have a mental illness; but the question could also be posed about society’s safety.

My ex-wife has borderline personality disorder. This psychiatric illness often results in cutting and suicide attempts. I’ve seen research that claims a mortality rate as high as 10%, meaning that as many as 1 out of 10 people with BPD are successful in their suicide attempt.

As a spouse, here’s some of the fun I got to deal with: assault (I still have physical scars), emotional blackmail and manipulation, loss of friends, battles with healthcare providers to get proper care and medication, many calls to 911, and a constant vigilance to keep her from killing herself. Now, if you know me, I’m definitely not the smallest guy out there, and while I won’t be enrolling myself in any boxing matches, I think I can handle myself under normal circumstances. But the ex turned out to be a challenge I should have never signed up for. I remember one time that she attacked me so fiercely that I had to bend her arm behind her back and smother her face into the bed until the cops got there. At that point, I was prepared to go to jail because I just didn’t care; I had to do what I needed to do to protect myself. Fortunately, the police had been there enough to know that I wasn’t the one assaulting her. In fact, because of the path of destruction she left in the house, they told HER that SHE was the one in danger of being arrested for domestic violence.

The interaction we had with mental health providers, and the system that was established to balance her rights with everyone else’s, was often a real source of frustration. The worst times came when she was in crisis mode, threatening to hurt herself or others. Under Arizona law, this is defined as danger to self (DTS) or danger to others (DTO). I can recall multiple times when she would tell a police officer that she wanted to kill herself or others. When an officer hears that, they have no choice but to ensure that the consumer gets help. If she refused to go for help voluntarily, she was literally handcuffed and transported to what is more or less an emergency room for DTS/DTO individuals.

More than once she was taken to this center, only to be released several hours later. The last incident I experienced involved her swallowing a bottle of meds, producing a reaction that made her heart stop twice in the ambulance on the way to the hospital. She spent 3 days in ICU getting rid of the drugs in her system…and after that was transferred to a psychiatric center for evaluation. It took them 6 hours to come to the conclusion that she was no longer DTS/DTO, and needed to go home. I got the phone call at 2:00am to come get her. How can anyone really say that someone is no longer a danger to themselves less than 4 days after swallowing a bottle of pills?

The reason for letting you into this piece of my life is this: while I know that anyone suffering with a mental illness is in an extremely difficult situation, I also know all too well that the suffering extends into everyone else surrounding that person. That means family, friends, coworkers, and for that matter, anyone that crosses that person’s path.

The battle to balance the rights of the mentally ill with the rights of society in general is a fragile balance. It used to be that consumers (one term used for mentally ill individuals) were institutionalized for life, a practice that was used as recently as the mid-1970s. Most people would agree that approach is wrong for many reasons. But what’s the balance? How do we prevent someone from walking out of their psychiatrist’s office and assaulting someone less than 4 hours later?

The answer is not to blame Magellan, Value Options, or whatever mental health provider happens to be at the helm. While I personally believe that they share some responsibility for the welfare of consumers, the real problem is that the laws do not seem to strike that balance between consumers and society. I don’t have the solid gold answer, and I haven’t met anyone else that does. But instead at pointing fingers at providers, someone needs to take a good, hard look at the legal balance of rights between these two groups…and determine what changes are needed.

It’s broke. Let’s fix it.

One comment on “System for mentally ill spurs worry

  1. Hey Scott,

    I actually agree with you wholeheartedly on this point. I wrote a paper in my ethics class in graduate school on a similar subject, and in my practice, I have had patients that I, as a licensed clinical psychologist, believed to be DTS, released from the crisis unit at the local hospital. I’m just damn lucky that they stayed safe.

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