Doesn’t shock me tbh. The “deinstitutionalization movement” was a fucking joke all they did was dump people out on the street so they could use their 0 community living skills to go get their mental Healthcare from prison instead, and now that people are getting sick of being screamed at on the street by homeless schizophrenics on drugs (not like there’s anything better for them to do) they want them locked up again so they can make health insurance companies money instead of doing literally anything to actually heal their communities. I have an entire nursing theory and set of practices just for this specific population because we’ve just completely fucked so many of them up, probably most of them permanently. And I’ll say it until I’m blue in the face but housing is the #1 driver of the American mental health crisis. They joke about “what radicalized you” and it’s 8 fucking years of working in psych hospitals even when I’m proud of the care I’m giving just watching the system as a whole is killing me. What I do should be considered ICU level psych care for that handful of people who are actually actively psychotically tweaking so why are all of the units I work mostly full of not even depressed but just understandably sad homeless people?
This is not really even about that because yes, people are being held in these places involuntarily, but a lot of people voluntarily check themselves in- Acadia even works on propaganda to get them to do it- and then can’t leave. People who want things like an evaluation for bipolar disorder or an adjustment in medication or just plain old therapy.
No that’s 100% exactly what I’m talking about because no one should be going to psych hospitals for any of those things, and the fact that we’ve not allocated the resources to treat those things in the community (which would actually be cheaper) is the entire failing of that “deinstitutionalization” movement. It was supposedly going to be a whole movement where we shifted to community care models but they never actually allocated proper funding for that so it became just another way to fuel the prison industrial complex.
I’ve never even worked a psych hospital that did proper 1:1 talk therapy on the regular. I as a nurse working a 12h shift with 6-8 patients and also being responsible for equipment checks, groups, checking on all my patients at least hourly etc am often the closest thing some of these people get to a therapist. At the absolute MOST most of those things should be being treated at a CSU which is a type of voluntary stepdown unit that usually has 1 nurse on-site continuously and that does a cursory belongings search and NO body searches. Most of them function like rehabs but do other mental health services as well as detox. I shouldn’t be being asked to strip search depressed people, but I also can’t risk one of them being dumb enough to bring a proper sharp or ligature onto my secure unit for people who genuinely can’t be trusted not to shank or garotte a bitch. Ffs one time the ER just didn’t even check at all and an actively psychotic pt rolled onto the unit with a loaded fucking gun in their bag that my tech just happened to find during a routine belongings search and I’ve found all kinds of other weapons on people. My unit is tightly controlled for a reason and most people receiving psychiatric care don’t need it and therefore should never gave to experience it.
Almost none of the people you’re describing should be setting foot on even the classier units I’ve worked, and they wouldn’t have to if proper community resources like medication management, talk therapy, and even CSUs were more available. I remember reading at one point that there was like one psychiatrists office serving like half of Montana at one point. The lack of those services (and particularly the lack of adequate insurance reimbursement for those services - those professionals still need to feed and house themselves and their families) are a very intentional component of this fucked up orphan crushing machine.
In my town at least, we’ve got it right, that is if we could get more funding and help everyone.
The system that I went through has tiers, and it’s mostly drug addicts, but man I’ve seen it turn people around completely.
If a person ends up arrested because they’re tweaking, paperwork is immediately filed to get them into a specialized local hospital. It’s very small, but the people involved really do work hard to get things moving.
Once the person is in the hospital, they keep them until withdrawal ends or psychosis subsides. Then they enroll them in a very strenuous program that pretty much takes up their entire life for a bit. They try to get the person on Medicaid, but if they don’t qualify the hospital actually has a fund to pay for their treatment. They are provided with a ride to drug classes and group therapy multiple times a week and drug tested daily. If they fail a drug test they take them back to the hospital, unless they’ve been charged criminally, then it’s back to jail first, but ultimately they’ll end up back in the hospital.
Assigned case managers will visit them at their home at random daily. If the person doesn’t have a home, we have several “sobriety houses” in the area where folks are sent until they can get on their own feet.
Their case worker files applications for low income apartments and other programs like HUD. The person will ultimately end up in a home if they work the program.
In my time with the program I seen way more success than failure. The only failures I seen were those people who just made criminality their entire life. I’m talking drug dealing, robbing, constantly fighting. There are some people you just can’t help. I might be wrong there, but I seen a personality type that didn’t seem like it could be helped anyway. It was those folks who found their source of pride in a criminal lifestyle.
I probably do have some bias on the success of the program because they stick you with people who have progress similar to yours. If you’re a success in the program, you’re generally going to have appointments scheduled alongside people who are doing at least roughly as good as you are.
When I left the main program in 2020, I always had my appointments with the same people. We were the “no failed drug tests in years” group. Several of those people were homeless but they aren’t now.
Yes that’s ideal. I would argue most of the “lost causes” you’re describing are victims of the current system and we owe then something akin to long-term secure units until they’re sick enough of the restrictiveness of even a non-abusive containment system to put in the work to recover, but that’s semantics. At the end of the day everywhere should be doing it like that and housing and rehabbing these people, emphasis on the housing since it’s a prerequisite to the rehab.
Yeah. And they’re volunteering to risk something that’s at least horribly traumatic and at worst just a straight up human rights violation because they don’t have any better places to go and that’s by design.
Doesn’t shock me tbh. The “deinstitutionalization movement” was a fucking joke all they did was dump people out on the street so they could use their 0 community living skills to go get their mental Healthcare from prison instead, and now that people are getting sick of being screamed at on the street by homeless schizophrenics on drugs (not like there’s anything better for them to do) they want them locked up again so they can make health insurance companies money instead of doing literally anything to actually heal their communities. I have an entire nursing theory and set of practices just for this specific population because we’ve just completely fucked so many of them up, probably most of them permanently. And I’ll say it until I’m blue in the face but housing is the #1 driver of the American mental health crisis. They joke about “what radicalized you” and it’s 8 fucking years of working in psych hospitals even when I’m proud of the care I’m giving just watching the system as a whole is killing me. What I do should be considered ICU level psych care for that handful of people who are actually actively psychotically tweaking so why are all of the units I work mostly full of not even depressed but just understandably sad homeless people?
This is not really even about that because yes, people are being held in these places involuntarily, but a lot of people voluntarily check themselves in- Acadia even works on propaganda to get them to do it- and then can’t leave. People who want things like an evaluation for bipolar disorder or an adjustment in medication or just plain old therapy.
No that’s 100% exactly what I’m talking about because no one should be going to psych hospitals for any of those things, and the fact that we’ve not allocated the resources to treat those things in the community (which would actually be cheaper) is the entire failing of that “deinstitutionalization” movement. It was supposedly going to be a whole movement where we shifted to community care models but they never actually allocated proper funding for that so it became just another way to fuel the prison industrial complex.
I’ve never even worked a psych hospital that did proper 1:1 talk therapy on the regular. I as a nurse working a 12h shift with 6-8 patients and also being responsible for equipment checks, groups, checking on all my patients at least hourly etc am often the closest thing some of these people get to a therapist. At the absolute MOST most of those things should be being treated at a CSU which is a type of voluntary stepdown unit that usually has 1 nurse on-site continuously and that does a cursory belongings search and NO body searches. Most of them function like rehabs but do other mental health services as well as detox. I shouldn’t be being asked to strip search depressed people, but I also can’t risk one of them being dumb enough to bring a proper sharp or ligature onto my secure unit for people who genuinely can’t be trusted not to shank or garotte a bitch. Ffs one time the ER just didn’t even check at all and an actively psychotic pt rolled onto the unit with a loaded fucking gun in their bag that my tech just happened to find during a routine belongings search and I’ve found all kinds of other weapons on people. My unit is tightly controlled for a reason and most people receiving psychiatric care don’t need it and therefore should never gave to experience it.
Almost none of the people you’re describing should be setting foot on even the classier units I’ve worked, and they wouldn’t have to if proper community resources like medication management, talk therapy, and even CSUs were more available. I remember reading at one point that there was like one psychiatrists office serving like half of Montana at one point. The lack of those services (and particularly the lack of adequate insurance reimbursement for those services - those professionals still need to feed and house themselves and their families) are a very intentional component of this fucked up orphan crushing machine.
In my town at least, we’ve got it right, that is if we could get more funding and help everyone.
The system that I went through has tiers, and it’s mostly drug addicts, but man I’ve seen it turn people around completely.
If a person ends up arrested because they’re tweaking, paperwork is immediately filed to get them into a specialized local hospital. It’s very small, but the people involved really do work hard to get things moving.
Once the person is in the hospital, they keep them until withdrawal ends or psychosis subsides. Then they enroll them in a very strenuous program that pretty much takes up their entire life for a bit. They try to get the person on Medicaid, but if they don’t qualify the hospital actually has a fund to pay for their treatment. They are provided with a ride to drug classes and group therapy multiple times a week and drug tested daily. If they fail a drug test they take them back to the hospital, unless they’ve been charged criminally, then it’s back to jail first, but ultimately they’ll end up back in the hospital.
Assigned case managers will visit them at their home at random daily. If the person doesn’t have a home, we have several “sobriety houses” in the area where folks are sent until they can get on their own feet.
Their case worker files applications for low income apartments and other programs like HUD. The person will ultimately end up in a home if they work the program.
In my time with the program I seen way more success than failure. The only failures I seen were those people who just made criminality their entire life. I’m talking drug dealing, robbing, constantly fighting. There are some people you just can’t help. I might be wrong there, but I seen a personality type that didn’t seem like it could be helped anyway. It was those folks who found their source of pride in a criminal lifestyle.
I probably do have some bias on the success of the program because they stick you with people who have progress similar to yours. If you’re a success in the program, you’re generally going to have appointments scheduled alongside people who are doing at least roughly as good as you are.
When I left the main program in 2020, I always had my appointments with the same people. We were the “no failed drug tests in years” group. Several of those people were homeless but they aren’t now.
Yes that’s ideal. I would argue most of the “lost causes” you’re describing are victims of the current system and we owe then something akin to long-term secure units until they’re sick enough of the restrictiveness of even a non-abusive containment system to put in the work to recover, but that’s semantics. At the end of the day everywhere should be doing it like that and housing and rehabbing these people, emphasis on the housing since it’s a prerequisite to the rehab.
They were tricked into going there. You seem to be missing that. That isn’t legal. Most of the things in the article aren’t legal.
Yeah. And they’re volunteering to risk something that’s at least horribly traumatic and at worst just a straight up human rights violation because they don’t have any better places to go and that’s by design.
Here in the UK there was a former inpatient who was released during Thatchers deinstitutionalization in 80s and within weeks he killed his doctor.
Maybe that’s due to how badly he was treated by that doctor in the institution…the abuse at those places js why patients avoid them