Adjusting antipsychotics in a short term mental hospital or at home?

Psych ward

If a seriously mentally ill relative is a danger to himself or others then the authorities must be called very hopefully a team trained to deal with mental health emergencies will answer the call.

Strange is not necessarily dangerous. Giving the seriously mentally ill individual some space can solve a whole lot of problems.

In short term mental hospitals given the diagnosis is schizophrenia and the individual is over 25 basically the only goal of the hospital is to get individuals stabilized on medications. The dosages will be high. There really are no other goals other than med stabilization.

The point is that in short term hospital meds are being adjusted and not much else. If the authorities had to be called the experience will be profoundly traumatic for the entire family including the ill relative. Despite the trauma if the seriously mentally ill relative is a danger to himself, herself or others the authorities have to be called.

That there are not more long term beds in hospitals is a good thing but even if this was a bad thing still there are no long term beds in mental hospitals available. The authorities are not coming to take the ill relative away for more than a few weeks. The ill relative is likely coming home after a very traumatic experience.

Meds can be adjusted at home. The key to an ill relative taking medications is the ill relative deciding to take medications. Giving the ill relative a lot of decision power over what meds he takes and at what dosages increases the chances he will take medications. Safe for himself or herself and others even though still strange even quite strange has to be viewed as a win when the diagnosis is schizophrenia. Low dosages are much better than no dosages. Keep the ill relative from posting on the Web.

Giving the ill relative as much decision power as feasible and giving the ill relative space in which he could be strange is the optimal strategy. Will this work every time? No.

The sensible old days when there was a continuum of care for the mentally ill

Parts of the continuum of care provided to the mentally ill prior to de-institutionalization. That dastardly President Kennedy undermined the continuum of care for the mentally ill when he signed the Community Mental Health Act.

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Apparently a sauna room

Theory of mind in schizophrenia

Various psychologists hold that individuals with schizophrenia have difficulties with grasping mental states of other individuals which goes under the rubric of theory of mind (ToM). This is not correct.

Individuals with schizophrenia are thinking about everything all the time. For the most part other individuals do not want to talk about everything all the time.

What individuals with schizophrenia have difficulties with is grasping what is in the attentions of other individuals. By and large conversation resides around what is in attentions and this is where individuals with schizophrenia have difficulties.

There are so many difficulties in schizophrenia that separating out the difficulties presents difficulties. Disorganization can be prominent in schizophrenia and one could hold with this disorganization that individuals with schizophrenia have very rudimentary ToM, however, the disorganization can be widespread. There is zip specific to ToM to this disorganization.

Individuals with schizophrenia can hit some sore spots with other individuals when talking about everything all the time. Individuals with schizophrenia then can become paranoid about what other individuals are thinking. The fails are not fails in ToM but rather in schizophrenia conversations are warped away from useful, pleasant or routine.

If someone were to say to President Biden, who by the way I think is doing a terrific job, that ‘politicians are the problem not the solution’ then future conversations with President Biden would be warped away from conversations that went anywhere. However, over the last few decades, there has been political gridlock in the US which President Biden is certainly aware of. The problem would then not be strictly fails in ToM but rather that conversations are warped away from useful, pleasant or routine conversations. The warping away from useful, pleasant or routine conversations in schizophrenia are not fails in ToM but rather is due to the setting up of paranoid feedback loops which basically arise due to individuals with schizophrenia wanting to talk about everything all the time rather than talk on what is in attentions.

Employment rates of individuals with schizophrenia

Individuals with schizophrenia can not even make it into the unemployment line.

A Nation-Wide Study on the Percentage of Schizophrenia and Bipolar Disorder Patients Who Earn Minimum Wage or Above

“The percentages of patients with only 1 admission who were earning minimum wage or above in December 2010 were as follows: 10.6% of patients with a diagnosis of schizophrenia; 21.6% of patients with a diagnosis of nonaffective psychotic disorders; and 24.2% of patients with bipolar disorder. The percentages of patients with multiple admissions who were earning minimum wage or above were as follows: 5.8% of patients with schizophrenia; 11.2% of patients with nonaffective psychotic disorders; and 19.9% of patients with bipolar disorder.”

Individuals with schizophrenia have to give up every hope they had for the future. Medications do not deliver a ‘normal life as long as medications are taken’.

Relatives of the seriously mentally ill must protect ill relatives from the mental health system

Police shooting of mentally ill man who was holding a screwdriver (not a link to the video)

One of the key jobs of relatives of the seriously mentally ill is to protect mentally ill relatives from the mental health system. Relatives of the seriously mentally ill must ask themselves honestly ‘is my ill relative disabled?’ If the answer is ‘yes’ the mental health system is used for medication trials. Getting an ill relative on the best medication possible is key. After that the mental health system is very frequently more of a liability than an assistance.

If an ill relative enjoys visits to the mental health system clearly that is a good thing. Very frequently they won’t. Mental health administrators tell legislators that they can get individuals back into the labor force. Mental health administrators then tell their medication prescribers ‘with that prescription pad and other billable services which we provide we have the tools to get individuals back into the labor force. Use that prescription pad!’ They are paid to believe the drugs are very effective and they do so believe. They have zip for negative symptoms.

When an individual is not safe for himself and others then the proper authorities must be contacted. The mental health system is also very helpful in finding the right medication regime, which will be not too much medication and not too little medication. Rarely someone with a serious mental illness who is disabled will find a mental health professional that he or she clicks with whom he or she can talk comfortably with about his or her difficulties. That would be rare but that would be a good thing. Other than that avoiding the mental health system is the optimal strategy for someone who is seriously mentally ill which relatives should be very supportive of.

Primary responsibility for care of seriously mentally ill family members resides with families not with the mental health system.There are many, many newspaper reports of parents of the seriously mentally ill complaining about the inadequacies of the mental health system. These reports are almost always reports of major disasters. These parents rely heavily on the mental health system and there are major disasters. The two are connected.

There are 3,870,000 results on Bing for ‘police shoot mentally ill relative on front lawn.’ Now the police could not have shot more three million mentally ill individuals on front lawns but by page 11 the mentally ill are still being shot by police. Here is a not atypical headline Man shot by Portland police was legally blind, suffered from schizophrenia …

Ending the Medicare and Medicare exclusions for long term mental hospitals

Over and again on the Web there are calls for more long term mental hospitals whose costs would be covered by Medicare and/or Medicaid, which do not pay for long term hospitilizations now.

Individuals in mental hospitals do not hold long term mental hospitals are asylums but would rather be Anyplace But Here, which is the name of 1979 documentary by Bill Moyers. Moyers investigates a long term mental hospital is 1979 which is not one of the snakepits of the first half of the 20th century still no one wants to be there. The hospital is overcrowded and underfunded. Patients can be attacked both by other patients and by staff. There is no freedom. Indivduals in long term mental hospitals become totally dependent on the hospitals. The Moyers documentary is fair and does not present then available community treatment programs as anywhere near perfect.

Medical costs keep growing and growing in the US. Costs of long term mental hospitals would be a lot, lot more now than in 1979. There will be huge budget deficits for the foreseeable future. Cost savings are said to obtainable by cutting programs for the ‘worried well’. These programs are not going to be cut. Given that Medicare and/or Medicaid paid for long term hospitilization costs would rapidly balloon as there would be massive attempts to place individuals into long term care. Advocates argue than only the sickest individuals would be placed in long term care but who is the ‘sickest’ would depend on family dynamics, different allowances between jurisdictions for strange behavior, whether corporations could be reimbursed where corporations would have armies of attorneys arguing corporations should be reimbursed and that two or three years in a ‘caring community’ could be bring lasting change, the personal predilections of psychiatrists sitting on boards deciding as to long term hospitilizations, whether or not patients take to the total treatment programs of mental health clinics etc. Simply due to terrific cost increases there is a high probabilty that ending the Medicare and Medicaid exclusions for long term mental institutions would result in the return of the snake pits of the first half of the 20th century which the taxpaper would foot the bill for.

Homelessness is a huge problem for individuals with major mental illnesses. Housing First is a solution that works. Housing First is the low cost solution and is good for individuals with major mental illnesses. Individuals with major mental illnesses who reject treatment may not so much be rejecting medications, which are the cornerstone of treatment, but rather could be rejecting the more or less total loss of control that can come with being in the belly of the mental health system. With housing and some gain of control individuals with mental illnesses could be more accepting of parts of the mental health system that work for them such as medications.

What is the best mental health option for someone with a psychotic disorder?

A psychiatrist in private practice by far. There are some large difficulties with this option. First of all there are not a lot of psychiatrists in private practice. If some one with a psychotic disorder is very disruptive the psychiatrist will refuse to see the patient. The treatments provided will be limited which is a feature not a bug. Both too much treatment and too little treatment can have very negative consequences. The treatment that a psychiatrist in private practice gives should involve talk and medications where the patient basically talks about anything the patient wants to talk about that relates to how the patient is doing. A psychiatrist in private practice should be willing to talk to individuals which is not a given. Some psychiatrists see themselves as pharmacologists. A psychiatrist in private practice can call things by their true name. If someone is disabled due to a psychotic disorder the psychiatrist in private practie can state flatly to any funding authorities and to the social security administration that the patient is disabled due to a psychotic disorder. At mental health clinics there is lots of pressure to say individuals can work when this is not so. The mental health clinics will get paid either way as the patient is disabled and needs medical care.

A relative with a psychotic disorder who sees a psychiatrist in private practice will appear to be just running in place and not getting anywhere but the alternative is to fall off the treadmill at a mental health clinic with very serious consequences. Family would be very important as the ill relative is going to be quite isolated.

The Goldilocks Solution to mental health care treatment

Goldilocks prefers porridge that is neither too hot nor too cold, but has just the right temperature. The best treatment for major mental illnesses is just the right amount of treatment which is not too much treatment and not too little treatment. Hidden Valley Road documents instances where there was way to much treatment resulting is deaths and/or zombiehood. The right amount of treatment in all probability will not cure major mental illnesses but rather will allow individuals to manage their major mental illnesses. The right amount of treatment could very well leave individuals with such illnesses strange and disabled but individuals will be safe for themselves and others.

An almost invariable aspect of tales of disaster in regards to individuals with major mental illnesses is that relatives state that they tried absolutely everything and nothing worked. Police were always being called, mental hospitals were always being called, numerous mental health professionals were consulted etc and then the patient is either shot on the front lawn by police, dies in prison or commits suicide.

Wrongly or rightly individuals with major mental illnesses hold that they have legitimate points of view. Also total treatment programs, which are more about generating billable hours for clinics than providing assistance that resonates with patients, can result in losses of autonomy which are very, very upsetting to individuals with major mental illness as losses of autonomy are very upsetting to all individuals. The patient managing his or her illness is always to be preferred to a team managing a major mental illness.

Parents want cures where chemical imbalances are righted and children are put back on track for normal lives. The Goldilocks solution is not a cure. Part of the Goldilocks solution is that mentally ill children must be safe for themselves or others. Authorities are appropriately called when children are not safe for themselves or others. Some individuals with major mental illnesses appreciate a lot of services then, of course, parents should support such children in using a range of mental health services. For optimal treatment the viewpoints and desires of individuals with mental illnesses must be taken into account.

External points of view and the treatment of psychoses

Psychological treatment of psychoses is very counterproductive. Individuals with psychoses are already too much in their heads. Treatment that assists patients take external perspectives on their illness can be very helpful. With external perspectives patients would be looking at how aspects of the world negatively or positively affect his or her illness. Patients can learn that by taking medications that patients can be safe for themselves and others which is very great relief to patients. Patients can learn to watch out for stressors that negatively affect his or her illness.

Family members not trying to get into the heads of mentally ill relatives would contribute a lot to the treatment of ill relatives as ill relatives appropriately take external perspectives on their illnesses. Familes could learn that invasions of personal spaces of individuals with can negatively affect illnesses of individuals.

Patients taking external perspectives on their illlness is not a cure for psychoses but rather is a way to manage psychoses. Patients in their personal spaces could still be dealing with the liminal in ways that would not stand up to rationale criticisms. As long patients are safe for themselves and others and are handling stressors appropriately that patients still can be strange is not to the point.

Only patients can address the liminal. Psychological explorations of the liminal of patients by therapists are very counterproductive. Therapists should take external views on how patients are handling their illnesses. How the liminal is addressed by patients can be very important for patients but explorations of the liminal must me taken alone though amidst such journeys patients must always be safe for themselves and others.

Patients need not always be addressing their illnesses from external perspectives. Friends and family should listen to viewpoints of individuals with mental illnesses. and be accepting of some strangeness of individuals with psychotic disorders. Lots of what ill relatives and ill friends say should not be charged to mental illness.

In sum in terms of treatment taking external views of major mental illnesses is always to be prefered to internal or psychological treatments of major mental illnesses. However, the mentally ill amidst treatmemts, which look at what is external, will very frequently be on Secret Journeys.