The country that closed its psychiatric hospitals

[Hoopoe]

Mezzina, originally from Bari, told me he had never used restraint on a patient during his 41-year psychiatry career in Trieste. This is striking if you consider these violent techniques were used at least 97,000 times in English mental health hospitals in 2016/17, injuring 3,652 patients. “We do not use restraint,” he said. “We have approved, people-centred plans that are based on negotiation – sometimes very exhaustive negotiation. You have to listen to patients and understand them. If a person wants to go then we must convince them to stay since there are no locked doors. We must eventually convince them to take medicine but within a range of other care offers. This is all based on principles to respect people if they are in a state of severe suffering, just as if they had cancer.’”

This should not be a radical approach. Partly it is based on ideas of destigmatising mental health by treating it like any other form of illness. Yet it felt inspiring to hear after listening to so many awful stories of British citizens locked up and abused in grim secure units.

https://members.tortoisemedia.com/2...-health-institutions-ian-birrell/content.html

 

[Snowdrop]

This woman’s recovery is testament to supportive mental healthcare. I met her on a trip to Trieste prompted by insights I gained into Britain’s increasingly-coercive psychiatric services during a year-long investigation which became a campaign to stop the abusive detention of people with autism and learning disabilities.

Not just Britain. Famously, at least locally, a man was tasered to death at Toronto International Airport because he was agitated. He was frightened, alone and couldn't speak English.

Just in my opinion but all of this horror stems from a simple axiom gone to far. Time is money. There is no time to deal with things that take time and some effort to deal with in a reasonable way. A little compassion wouldn't go amiss either. Easier and simpler to put the boot to someone and pretend it's compassion and effective (in a humane sense).

Many are held by inadequate private providers that have muscled in on this lucrative sector, with some families even silenced by court-imposed gagging orders.

This is happening in seniors care homes as well. Family members are given restraint orders from the private care home owners. This suggests to me that there needs to be some intervention to strengthen and enforce laws around human rights issues in these settings.

Mental Health under Simon Wessely's tender care:

I fear he is right: stripping human beings of rights and then locking powerless people in secretive units can foster abuse, especially in a society so contemptuous of things such as autism, dementia, learning disabilities and mental illness. This underlines the need to be wary of such situations. Instead, we see rising reliance on coercion in our mental health services: 24,576 involuntary hospital admissions in England in 1988/89 rising to 43,356 cases a year by 2007/08 and then 63,049 cases in 2015/16.

But keep up the pretense of destigmatising mental health issues. Ending stigma means treating the mentally unhealthy with respect not just telling people to stop stigmatisingMH by denouncing they have mental health issues because it stigmatising.

Finally, many of the changes that were made as stated in the article were social changes. There is no reason why some of the wealthiest nations with some of the brightest minds cannot manage to accomplish something better than the clusterfuck that exists now in some areas of mental health and diseases of unknown etiology that have been swept up in the blitz. Apparently people aren't worth it. Time is money after all.

 

[Hoopoe]

Supposedly this way of doing things greatly reduces the cost because there are no guards.

 

[Snowdrop]

Supposedly this way of doing things greatly reduces the cost because there are no guards.

Interesting. I missed that point. I would have thought that all the time spent with the patient added up to more.

Maybe Italy could get interested in exporting consultants to other countries on how to save money this way.

 

[Amw66]

This reminds me of an article I read late last year/ early this year.

A psychiatrist was tasked with introducing antidepressants into areas of Vietnam.

He met with a " village head " to explain how lives could be improved and was taken aback when told categorically that pills were not needed He simply could not believe this.

The village head introduced him to a villager as an example. This poor man had lost the lower part of one leg and had been a rice grower. Working in paddy fields had made him more and more miserable.

The community noticed this, had a meeting with the man, offered full support and the solution was found- he became an animal farmer ( cow/ pig) . No more wading in paddy field water, and his depression resolved.

We have lost sight of so much.

 

[Arnie Pye]

Some articles on the subject of mental health provision in the UK and elsewhere that are alarming to say the least :

https://www.cchrint.org/2017/01/16/...on-fraud-abuse-buys-uk-behavioral-facilities/

Despite multiple U.S. Federal and state investigations into potential billing fraud or patient abuse, the largest psychiatric hospital chain in America has been approved to expand its behavioral health business in the United Kingdom. The mental health watchdog, Citizens Commission on Human Rights International (CCHR), charges that this could put UK patients at potential risk and needs investigating. Universal Health Services (UHS) completed its acquisition of Cambian Group, PLC’s Adult Services Division in December 2016, which added 81 behavioral facilities to the Cygnet psychiatric hospital chain UHS bought in 2014. It now owns 102 facilities in the U.K.[1]

The acquisition was approved and finalized despite a December 7, 2016 BuzzFeed News exposé in the U.S. reporting that “current and former employees” in UHS’s behavioral facilities said they “were under pressure to fill beds by almost any method—which sometimes meant exaggerating people’s symptoms or twisting their words to make them seem suicidal—and to hold them until their insurance payments ran out.”[2]

https://www.cchrint.org/2017/06/05/uhs-under-investigation/

The fact that UHS is allowed to acquire or establish any new psychiatric facility while under federal investigation is astonishing, CCHR says. It has also been allowed to expand its behavioral empire in the United Kingdom, where it acquired the Cygnet psychiatric hospital chain in 2014, then completed its acquisition of another chain, Cambian Group, PLC’s Adult Services Division in December 2016. UHS now owns 102 psychiatric facilities in the UK. In November 2015, CCHR wrote the UK Competition and Markets Authority (CMA), the National Health Service (NHS) and the Care Quality Commission (CQC) warning about the allegations against UHS’s psychiatric operations in the U.S.

https://www.grandviewresearch.com/industry-analysis/behavioral-rehabilitation-market

The global behavioral rehabilitation market size was valued at USD 188.1 billion in 2015. The growing prevalence of behavioral disorders and increasing awareness of the available therapeutic options are major driving factors for the market. Rising government initiatives, such as Substance Abuse and Mental Health Services Association grants and The Affordable Care Act, to increase investment on programs to eliminate substance abuse is expected to boost the market growth during the forecast period.

Change in perception regarding behavioral rehabilitation has proven to be the most vital factor associated with the steep rise in demand for behavioral therapies over the last decade. Societal acceptance of behavioral disorders is encouraging the patients seek appropriate treatment. The recent incidents of shooting at public places and mass murders highlight the need for better diagnostic therapeutic options for behavioral disorders. In addition, categorization of mental health treatment into essential care benefits in the Affordable Care Act is expected to facilitate a large number of patients opting for these therapies. Along with increasing demand, institutes that offer these services are strategizing mergers and acquisitions as well as regional expansions, thereby promoting growth over the forecast period.

There is also this link but I think it is only available to people who subscribe :

https://www.economist.com/britain/2018/04/19/an-alarming-rise-in-mental-health-sectioning-in-britain

The number of detentions under the Mental Health Act in England rose from 43,463 in 2009 to 63,622 in 2016. The process requires two doctors and one approved mental-health professional, like a social worker or nurse, to agree that a patient needs hospital treatment for a mental-health disorder, and that they may pose a danger to themself or others.

Experts admit it is impossible to know whether the increase is justified or not. But many are alarmed by its sheer speed. Some also worry that those with only minor conditions are being swept up in the rise.

 

[erin]

I believe the best way of controlling people is accusing them that they might be mentally ill. Then your life is taken away from you. But real nut cases are out and they are actually ruling us, doing all murdering, pillaging, robbing etc.

 

[rvallee]

The global behavioral rehabilitation market size was valued at USD 188.1 billion in 2015

Well, that explains a lot. And almost nothing to show for it while common sense alternatives would be significantly cheaper. And this is while the thing is being massively expanded despite consistent evidence showing it amounts to basically nothing.

So $1T wasted every 6 years, and all because people don't want to spend hundreds of millions to low billions in research. That's super smart use of money. Great economics.

Other things aside, it's clear that psychiatry needs it coercive powers to be revoked. The profession cannot handle the responsibility, has made that very clear. It has its own problems but nothing that compares to the disaster of this much completely unaccountable power in the hands of people who value their personal opinions above objective reality.

And that's even before people understand how people's rights, even their agency, can be yanked away without zero process, zero oversight, on mere implication, with no paper trail, from small samples in highly biased settings that basically assume millions of people can be ignored and everything we say dismissed with prejudice. Beyond the official process of institutionalization, there is a much broader problem where nearly the same thing happens without any of the process and on mere whims.

 

[Sly Saint]

it seems that not all MH patients are that keen on psychiatrists either

 

[rvallee]

it seems that not all MH patients are that keen on psychiatrists either

I love that the statement itself is entirely meaningless: "the modern world is toxic for our health". What does "the modern world" stand for here? Many of us literally live in the safest, most prosperous, most educated and healthiest period in the whole of history, aside from pollution but then that can of worms is always rejected by psychs since it impinges on their turf and falsifies their beliefs about magical psychology as the alternative explanation to basic common sense.

This trope of "the modern world" being too fast on "weak constitutions" has been going for so long it's almost right up there along with "the youth are degenerates", which also means nothing and goes back all the way to antiquity and possibly beyond. It's literally a running gag at this point.

Pollution is indeed toxic. Literally. Linked to all sorts of health problems, from cardiovascular to respiratory and most likely explains a huge chunk of the remaining chronic illnesses that psychiatrists hold in a stranglehold, unable to progress. The link from pollution to depression is getting very hard to continue to deny, and it even explains many of the socioeconomic associations with chronic health problems, since poor people always live in more polluted areas.

So to Wessely, a meaningless comment that is so banal it's basically a trope is "SPOT ON!". Figures. Right along there with his shilling for Eysenck's cancer-personality link and how 9/11 health-related problems are mass hysteria. The guy truly has a natural talent for being wrong.