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The orphans of medicare

From Tuesday's Globe and Mail

Patients with mental illness — unwanted and forgotten — account for an astounding one-third of all hospital time ...Read the full article

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  1. Harold A. Maio from Ft Myers FL, United States Outlying writes: Asylums phased out When it comes to care, mental health has always been the poor cousin of physical health. This is partly due to a legislative anomaly: Half a century ago, when medicare was created and Ottawa started funding hospitals, asylums for psychiatric patients were excluded. 'Asylums' is an anomaly in language, a word which became its own antonym - a place of safety, its original meaning, and a place of horror, the meaning it came to have through mental institutions. It is also archaic. Institutions is accurate. Then came the civil-rights movement, coupled with the advent of effective drug treatments, which led to policies of massive deinstitutionalization. Is not a factual statement, 'Deinstitutionalization' is a Reaganism, a euphemism for closing institutions to remove their costs from California's state budget. Reagan was not called the 'great communicator' for nothing, he could communicate meaning to words that people then mirrored, as you have done here. His policy spread rapidly, the costs removed from one budget appearing obviously in many others. ON the positive side, closing the institutions, breaching their walls, making the problems of mental health care public, put the issues in the public eye, which is one reason the Globe and Mail is running this series. Stigma and discrimination are also commonplace The word 'stigma' is contained in the word discrimination, it is one of many. It is like saying 'pneumonia' and illnesses, 'apples' and fruit. It appears out of habit, poor habit, like 'asylum,' above. Harold A. Maio Advisory Board American Journal of Psychiatric Rehabilitation Board Member Partners in Crisis Former Consulting Editor Psychiatric Rehabilitation Journal Boston University Language Consultant UPENN Collaborative on Community Integration of Individuals with Psychiatric Disabilities Home: 8955 Forest St Ft Myers FL 33907 239-275-5798 khmaio@earthlink.net
  2. Emma Hawthorne from Canada writes: Politicians like to spend large amounts of money, outcomes be damned. Sure they could hire a certified psycho-social worker to travel between a cluster of six homes housing mentally ill persons, or create a group home to house six seriously mentally ill in a standard residential dwelling with staff 24-7 but that would cost only between $8,000 and $15,000 per person per year for staff, plus about $6,000 each in living costs. Keeping even one patient in a hospital with less than ideal care, as this story shows, could let politicians spend a million, nearly ten times as much!
  3. Bert Russell Paradox, BC from Canada writes:
    We have spent billions on Aids and Cancer ... mental illness tends to be sluffed onto family care and Doctors who go the maintenance route if one has any support behind them. Drugs and mental illness often coexist ... when mental illness is not properly addressed it become a cycle of Doctor/Hospital Emergency/ back out. The people who have the problem and live in our streets know that going to a Dr. is pointless, so when they become desperate or violent, the Police transport them to hospital emergency etc., who re cycle them back out.
    This whole cycle repeated constantly by the Police and Agencies involved is no cure, is very expensive, it puts stress on the whole system.
    We need research, medication and therapy to be effective and to relieve the constant drain on each system used.
    Right now we recycle, what goes around, comes around.
    Right now we use excessive amounts of money for Health care, no follow up and trained Police to accomodate mental illness/drugs/crime.
  4. Mindfully Partisan from Ottawa, Canada writes: Try building a group home for people with mental illness in any given neighborhood. They tried that near where I lived a few years ago and they had the NIMBY people out so fast. Though they seem to be perfectly okay with having mentally ill people live in their gutters.
  5. ellen m from ontario, Canada writes: I am getting really discouraged with reading up on the mental health crisis here in Canada.( 'I am sure I am not alone in thinking this way')
    I have been being dealing with trying to get the proper help for almost two yrs!!
    it seems as though. there are time giving up would be easier.....
    like why should I take the time to care about myself when The proper help isn't there. I struggle with the thoughts of death every day, it is a struggle to ignore that.

    don't really have the support of family and friends. I really am feeling defeated.
  6. Lillian Drysdale from Canada writes: Ellen, I'm sorry and I hope you find the help you need...
  7. Timothy Nessus from Somewhere, Canada writes: Meanwhile...... in a different planet.... they will be spending 450 BILLION dollars on Armed Forces.

    Oh.... wait.... It is NOT a different planet... is CANADA!!!

    Oh cr*p!!!
  8. Lorne Craig from Vancouver, Canada writes: As one of the 'Family members' left to pick up the pieces in this mess, I have an idea.

    A class-action lawsuit against the government, claiming unpaid wages for the ad-hoc medicare support system we are running at our own expense.

    Any other families of mentally ill people out there want in?

    Any lawyers out there want to take this on?
  9. whatevah D from Canada writes: ellen m from ontario, Canada writes: I am getting really discouraged with reading up on the mental health crisis here in Canada.( 'I am sure I am not alone in thinking this way')
    I have been being dealing with trying to get the proper help for almost two yrs!!
    it seems as though. there are time giving up would be easier.....
    like why should I take the time to care about myself when The proper help isn't there. I struggle with the thoughts of death every day, it is a struggle to ignore that.

    don't really have the support of family and friends. I really am feeling defeated.

    Hi Ellen,

    I feel for you. I suffered from severe post-partum depression and anxiety. I was having weird thoughts and took myself to the hospital. It was going to take me six weeks to find a psych or get into a support group--and I had a newborn to take care of! I couldn't believe that with the severity of my situation they couldn't get me in to see someone right away. Thankfully my family doctor had an in somewhere. Hang in there. Once you find the help you need (and the right help), it will make a world of difference.
  10. whatevah D from Canada writes: John Doucette: Please take your flippant attitude elsewhere. People like you promote stigmatization against mental illness!
  11. E W from Canada writes: There should be more services tailored to the mentally ill as a way to decrease the burden on the healthcare system. If the asylum model doesn't work, something else needs to take its place. The facility described in this article sounds like an excellent place to start. Dumping people on the street to fend for themselves is neither a just nor a moral decision.
  12. B Reynolds from Kingston, Canada writes: If you were to substitute the word 'diabetes' or 'epilepsy' for mental illness in this article, particularly as it relates to wait times for treatment, the entire readership would be outraged.

    As it is, mental illness is still widely seen as something people should be able to rise above with enough intelligence and self control - which of course is ridiculous. It's a medical condition. No more, no less.

    Scientists are now saying that 50 percent of the population will have to deal with mental health issues at some point in their lifetimes. Can we really afford to keep looking at this topic as if it's someone else's problem?
  13. Jan MacLean from Toronto, Canada writes: Dealing with a parent with mental health isssues has been very discouraging.My mother was able to exist very well at home on her own until her 80th year, then circumstances triggered a breakdown and she was admitted to the hospital. It took 3 months to adjust her medication so that her paranoia was under control. Then there was no support available to possibily let her go back home because months of inactivity had left her legs unable to operate properly. Now she has been admitted to a nursing home where she was isolated the first week because of a virus she had picked up in the hospital. That fed back into her paranoia so that she slipped right back to her previous state and it took almost 3 weeks for the psychiatrist to visit her. My sister was even told when she called the home that my mother had to be on a waiting list for her doctor to see her. This whole process has really taken a toll on our families.
  14. elaine Berns from Toronto, Canada writes: I worked in the Mental Health Industry for over 20 years and I call it an industry on purpose because that is what it felt like to me! Most of the women and men I worked with and tried to help were mostly victims as much of the system as their diagnoses! It was almost impossible to get caring care where someone didn't just hand out pills and send them on their way - no housing, no help with disability, etc.
    I managed to assist many people to get affordable housing and sometimes even decent therapy and other supports, but it took its toll on me and mostly the people I worked with! Many of them were sexually abused as children and often by the system that was supposed to help them!
    I read these articles (which I commend the Globe for writing) and it seems that not much has improved since I retired and in some cases even has gotten worse!
    These problems are worse for those who are poor and who are at the mercy of finding psychiatrist who will listen and not just hand out pills. They can't afford any other kind of help that may be better or even feed themselves. I challenge anyone to try and live on the amount of $ one gets on disability without support and a subsidy, etc. I know because I found myself in a similar situation for a physical disability that is barely recognized and has little Dr's who can help and of course there are always long waiting lists.
    We, as a country should be ashamed of ourselves - it is outrageous and the next time you see someone who behaves in what you think is a strange way - just stop and think for a moment that it could be you or someone you love.
    Most people suffer silently and alone without support and decent housing and since they don't have voting strength - the politicians rarely think of them.
    It is a closet that is shut more strongly than being gay or most anything else these days and needs to be ripped open and see the the light of day!
  15. The Work Farce from Canada writes: Society spares no cost to scare the work force into submissive wage slavery. In the War on the Poor, the so-called mentally ill are the prisoners of war. The authorities in this piece say all the right things that people want to hear, but the realities are very different. Politics plays a giant roll in who gets treated well and who gets locked away indefinitely as fodder for the system. Once the rebellious daughter, the difficult son, the inconvenient spouse, the malcontented worker is locked away, an iron curtain descends between doctors, nurses, orderlies and the patients. Somebody ought to check with the Geneva Conventions because some of the 'treatments' still being practiced should be condemned as torture. Our adverserial punitive economic system is maintaining a punitive adverserial mental health system that is more about punishing the malfunctioning slave wage workers than helping them. Deinstitutionalization was originally said to coincide with subsidized housing and various supports within the community. But, oops, subsidized housing was - at that same time - cancelled. It was planned that way. To create homelessness, scapegoats, fodder for the pharmaceutical business, guinea pigs for the psychiatrists to experiment with new drugs, new ECT techniques, new lobotomy procedures. In a word, to punish the poor and scare workers into line. Why do you think Canada is the only industrial nation without a subsidized housing program and is the most psychiatrized nation in the world? That's the way it was planned. No cost is spared to 'grow the economy'. And now, along with war, oil and tourism Big Pharma is one of the top five businesses in the world.
  16. gordon foster from Canada writes: There is subsidized housing in Toronto. I know, because I was on the 'waiting list' for three years behind what I was told were '10 000 other families'. Now just that little tidbit of information might be enough to trigger anyone who is homeless and prone to 'episodes'.
  17. ellen m from ontario, Canada writes: thanks for the words of encouragement. I have One more thing to say,
    I had known before this series it was hard to get any help. but the thoughts I had are validated.
    I had been in the hospital twice in a year....I commend nurses and any practitioners who have worked in the field of mental illness and with the patients that have these issues. they cared for their patients and made people feel cared about.
    John, I hope you were not saying that too me, I will just say this if you were. think about this. I didn't ask to have these mental issues. for me the simple thing as STRESS was my trigger. and you know what,
    some people have a HEARTATTACK. Believe me I would of rather of had a heart attack. because at least there is immediate help for people then. I am sorry but it is the people like you who give it the bad name......
  18. Graham Brown from Sarnia, writes: My brother suffers from a mental disease, and it has been very hard on our family at times. My parents care for him, and help is difficult to come by. I will point out that the system is broken, not only in hospitals and the like, but in other institutions too. Case in point - the local College (Lambton College) offers assistance to disabled students, but only those physically disabled. Not with mental disabilities, and let me tell you, based on the statistics in this story, those with physical disabilities are greatly outnumbered. Where is the logic in that? It is extremely frustrating to deal with.
  19. E. S. from Canada writes: My question is how do we balance the 'rights of the individual' to determine/decide on treatment with getting the care required? My mother-in-law is schizophrenic, but refuses to take any medication. Do we have the right to force her to take medication that we believe will be good for her? This question obviously doesn't address the shortage of funding or lack of an integrated plan, but it is one that I've wondered about.
  20. Cheap Skate from Vancouver, Canada writes: Harold A. Maio from Ft Myers FL, United States Outlying writes: Asylums phased out When it comes to care, mental health has always been the poor cousin of physical health. This is partly due to a legislative anomaly: Half a century ago, when medicare was created and Ottawa started funding hospitals, asylums for psychiatric patients were excluded. ----------------------------------------- Sorry Harold, the reason Asylums were phased out are twofold. First what replaced them was supposed to be a lower cost, more effective alternative. A community service with as many people cared for at home by relatives as possible. But this only works when the appropriate services are provided. Once you provide the services, the costs skyrocket! Without the services, there is no care! As a result, the service never was a lower cost alternative, nor does it provide real care! The second reason was to remove the opportunity for advocates to band together to demand services. Remember in the sixties about how bad the asylums were and how many people were mistreated? Once the asylums closed everyone had to fight for their own services again and again. Just like in the eighties when people were forced to bid for their own jobs. Remember that fun time? What happened was that the people who were supposed to provide funding became really good at selecting those who were deemed worthy. As a result the funding became less and less. Here's another point to consider. Why are the mentally ill not considered as part of the health service? Sit and think on this for a while. Consider the number of times you have heard the comment that someone who is depressed needs to pull their socks up, or that the homeless don't deserve support, or that autistic children need disciplining. We have for many years considered those unable to help themselves as unworthy of our support. After all, if I can get a job why can't they?
  21. John Smith from Canada writes: Cheap Skate from Vancouver, it would be appreciated if you could provide evidence for your statement 'Once you provide the services, the costs skyrocket!'

    I cannot think of a single jurisdiction, provincial or international, where that statement holds true for costs of community-based care.
  22. Emma Hawthorne from Canada writes: I think poor persons short shrift from society bercause they are seen as a drag on resources. However, the truth is that they paid up front in the poor upbringing, lack of proper psycholgoical assistance and the lack of proper social serrvices, all of which have robbed them of much of the quality of their lives and allowed many tens of thousands of dollars to be poured into raising more advantaged children. Althought the advantaged and favoured middle class has a moral duty to pay up, and they do pay ample taxes that are actually about double what they would be if Canada was properly governed and had no debt, why is so much of the money wasted on poor quality unexamined routines and treatments? Canadians foolishly spend more than most any country on earth for medical care, but we don't even make the top 30 on delivery. The poor and mentally ill suffer most from out disoraganized, imprudent health care system and its complete lack of assessments for efficacy and proper spending.
  23. Emma Hawthorne from Canada writes: Given that lobotomies and electro-consulvive shock are out of fashion and rarely used in any event, why are psychiatric patients being housed enmasse in mental hospitals and even in psychiatric wards of general hospitals? The institutional environment shatters their personality over time as personal history and individual pstychological make-up is disregarded. Records focus on drug regimes and nurse's notes with the occasional discharge report. Other then being warehoused, which could be accomplished more humanely and just as effectively in a group home, what value is there in being in hospital with all of its iatrogenic effects? The Europeans don't do this.
  24. ellen m from ontario, Canada writes: ES from CANADA--last week was my last session with my therapist because she is retiring after 40yrs. well I do not have a replacement. according to her I am not suffering bad enough to have a replacement.
    little does she realize she didn't even touch on my past and all the abuse. I was very upset. she said, the people that are critical get first attention.

    to me I need attention because I am going on two yrs and nothing has gotten better. at the moment I am on 2 new meds and I feel worse.
    bipolar depression is back....yippi...wondering how long I am going to have to deal with this.. I feel I am a rapid cycler. In one day i could go back and forth.
    I hope I was able to shed some light for you. I am with an online support group. It has really helped me. since I don't have any other support. www.findthelight.net It is 5 dollars per month. but well worth it. family members can also join. it is a small, well monitored, private, and safe environment.
  25. ellen m from ontario, Canada writes: Emma- I came from an upper-middle class family and my parents provided everything I need. I have Been it the hospital twice in the last year. but that is due to poor treatment due to not enough doctors for the amount of people that need help. being In the hospital was a very good experience for me. I actually felt that I mattered during that time.I found my stay very helpful for myself. now that is the hospital in my city.
  26. The Work Farce from Canada writes: Gordon Foster from Canada: Three years waiting for subsidized housing in Toronto? You can wait 10 years in Vancouver and Victoria and still not get a subsidized apartment because those who have one are staying forever. That's part of warehousing the poor. Emma Hawthorne from Canada: ECT and lobotomies WERE out of fashion in the 70's thanks to the liberating influences of the baby boomers; but they are back in fashion now. Another example of the WW II generation still being in control. We need a culture that values family and community before economy. Workaholism is the scourge of post-modern society. Children need full-time mothers. And fathers would help too. People need families. They need mentors. They need community.They don't need the burden of working two jobs just to pay the rent. We have lost community replaced by dog-eat-dog individuality. And individuality is only a disguise for mass conformity. Step out line with a different look, a different idea or a different act and you're scapegoated.Freedom to be a carbon copy of the next person isn't really freedom. It's a totalitarianism similar to the Soviet Union. So much of what passes for 'mental illness' is mere political scapegoating. Until we take away the profit motive from the pharmaceutical companies, the power motive from the psychiatric industry, and the political scapegoating motive from society at large, the number of people having difficulty coping with life problems will skyrocket. And most will not get the help they need. Just like marijuana or cocaine are not a quick ticket to paradise, psychiatric drugs are not a quick fix for abnormal thinking or abnormal behaviour. We need a complete overhaul of our value system and our code of ethics.
  27. urban ranger from Vancouver, Canada writes: The Work Farce above says among other things 'Children need full-time mothers'

    Oh right, like that is going to solve anything. When in doubt, blame women for wanting a life outside the home. Children need caring parents who have healthy lives of their own. But even that does not guarantee them from developing a mental illness.

    Much, if not most, mental illness is biologically based and can be treated pharmaceutically with success. It is not caused by parental neglect any more than is diabetes or cancer.
  28. whatevah D from Canada writes: urban ranger from Vancouver, Canada writes: The Work Farce above says among other things 'Children need full-time mothers'

    Oh right, like that is going to solve anything. When in doubt, blame women for wanting a life outside the home. Children need caring parents who have healthy lives of their own. But even that does not guarantee them from developing a mental illness.

    Yeah, I agree. One of my friends had a mom home full-time and she was mentally ill. Think about how that might have been.

    ellen: I'm sorry your therapist kicked you out. I know how you feel in a way because when I went back to work after six months, I got kicked out of my post-partum depression program even though I wasn't ready and hadn't worked through everything. I too have stuff from my past to work through. Do you have a family doc and can you get them to refer you to someone else? You could always call the Ontario College of Surgeons and Physicians and get them to refer a psych who specializes in bipolar disorder and ask your doctor to get you a referral with such and such a doc.

    I'm sure you've thought of all this, but I know how frustrating it can be! Good luck!
  29. Tara Lene from Toronto, Canada writes: Work farce, people do need families and a sense of community, but there are other ways to do this besides enforcing gender stereotyped roles and encouraging people not to pursure their interests. (Some people actually LIKE working!) Further, I'm a little alarmed at the misinformation you are spreading about invasive medical treatments. One of the reasons psychiatrists and medical professionals are so willing to prescribe drugs is because they can easily be discontinued if they are not successful or if the side effects are too difficult to deal with. Medicine is the *one* of the least invasive of available therapies (and yes, conveniently it is also the cheapest). I have heard of ECT being performed on patients where no other intervention was successful. ECT IS A LAST RESORT, and the patient often goes through a round of consultations with health providers before engaging in this treatment. And what are you talking about 'lobotomies?' This simply isn't done any more. If you are talking about invasive brain surgeries to treat epilepsy, and neurological pacemakers to treat depression, these are not the same thing. Furthermore, brain surgery is considered the most invasive of all treatments, is considered an extreme last resort, and is not conducted unless there is full consultation with the patient (and the patient's family if applicable). The lobotomies of the early 20th century were gruesome experiments indeed. They basically amounted to a doctor taking an ice pick and poking it through someone's eye cavity to reach the brain. Then they'd wiggle it around a bit and wait to see what happened after the patient woke up. Do you honestly think, with the sophistication of brain imaging techniques that we have today, that our procedures are still so heinously barbaric? I think a little skepticism goes a long way to keeping us on our toes as citizens, but I think there is a not so fine line between skepticism and a conspiracy theory.
  30. The Work Farce from Canada writes: Tara Lene from Toronto, Canada: Tra la la la to you too. Whatever gets you through your life. To each her own delusion. Let me, however, be the first to disabuse you of the notion that the psychiatric industry exists for the convenience of people having problems dealing with an increasingly punitive, violent and cruel life or that rats in a cage are there for their own good at the behest of the Human Rights for Rats Association.
  31. Tara Lene from Canada writes: Work Farce: I'm sorry, I hadn't realized my tail was showing! Darn that thing, I must make a stronger effort to tuck it into my skirt whilst I go about my daily travails!!!!

    Note to self: The tail may only be exposed in private so that NO ONE WILL CATCH ON!

    Scurries away from the computer to eat some delicious cheddar and gorge herself silly on peanut butter.
  32. Miss Piggy from Canada writes: Tara Lene, don't you go hiding your tail on us!!! It's a lovely one, and a smart one. Hope you enjoyed the peanut butter and cheddar. I went for the chocolate tonight.
  33. Cheap Skate from Vancouver, Canada writes: John Smith from Canada: then you haven't had to pay for services out of your pocket. Nor have you seen services provided by the government for your child taken away because the principal decides that the school policy is to share resources because they have other children that the government won't fund.

    Community care costs more because you need more people to provide the same service. Otherwise you are reducing the amount of service provided. If I can house twenty people in one place then it costs less than having twenty houses in which to house people.

    Please do not think that I believe that institutional care is the right or wrong approach. I am simply pointing out that the cost is always greater for community care.
  34. Graham Brown from Sarnia, writes: The Work Farce is a troll. Don't feed him and he'll go away and be bitter and recriminating somewhere else.
  35. ellen m from ontario, Canada writes: thought I would share this:

    28 Jun 2008


    with in the mind
    Category: Writing and Poetry

    Having no desire in this world we live,
    the hurts and pains that come along.
    feeling alone, in having to cope, hidden away
    we all feel, hurting and feeling where is the care?

    push away, in the darkness I go, holding on, and to
    what maybe left. searching for help. search for understanding.
    searching for someone to show they care!

    feeling paralized deep inside not being able to move and
    throw it aside.
    feeling alone and to deal with this by myself, I stopped talking because
    nobody wants to hear.
    so here I go just existing to live. the thoughts go threw my head.
    of wanting to be dead.

    A constant struggle with in my mind, give me a reason to keep with
    the flow.
    the desire for people to understand and care. they will never know what I go through unless they have been there.
  36. Alastair james Berry from Nanaimo BC CANADA, Canada writes:
    We need a return to asylums............. An asylum in today's world need not be a duplication of the 1700's 'BEDLAM'..........BUT THEY ARE JUST AS NECESSARY!!

    Open asylums for those in need...........Closed Asylums for those who endanger the public..........Hell's bells we do it already for DRUNK DRIVERS - we lock them up!

    The confused, the elderly indigent, the simple minded, the imbeciles all need the care and protection that can be provided by an INSTITUTION.

    Our present system has them in acute care hospital beds police cells or prisons at enormous expense and very poor results.

    And for those who object, I recommend they visit the institutions on a regular but ramdon basis, to see that the inmates are being treated fairly and humanely.

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