Silver Lining Playbook: Well Worth Seeing
A big thank you from me to Dinah Miller, Xavier Amador, Chrisa Hickey, Tracey Skale, and Erika for offering advice last week to A Concerned Parent during my week-long WE’VE LOST HOPE series. Each of them did an excellent job. I devoted a week to answering a single letter because it was representative of the heart-breaking emails that are sent to me. On the same Monday when the series began, I received this email:
“Son had a psychotic break in 2010 stabbed step-father. found not guilty by reason of insanity due to phentermine and chantix given to him by a general practitioner who knew he was bipolar and on meds. after jail stay of 2 years, son put in transition home where he sat and did nothing. psychiatrist saw him for 15 minutes while talking on the phone the entire time. changed meds that worked to cheaper drugs that didn’t work. sent to hospital, discharged to street with no money or id. case manager from transitional home “forgot” to take son to medicare appointments or inform them of his hospitilization. all benefits cancelled. case manager fired. son no benefits at all. in shelter, mandated court order states he must have supervision for meds, he doesn’t,
cannot live with parents, attorney doesn’t want judge or da to know. son had never been violent. had benefits for 10 years, now gone. living in a violent area told not to leave the property because of drug dealers, murderers, prostitutes. son 27 and considered slow. mental health system total failure. he is now considered indigent. we pay copay for meds and initially cost for all drugs. so much more info but sounds unbelievable as it is so bizzare. i am a social worker, retired, but cannot even help my son. i have been lied to by more mental health professionals than i can count.i guess you can believe this as you have heard many stories.
what to do?
I suggested the parent read the advice being offered during the week. I hope it helped. Letters such as these and my own experiences are evidence of how people are suffering because of our faulty mental health care system that too often fails our loved ones despite the best efforts of dedicated professionals.
The only way to solve these issues is by shining a spotlight on the problems and advocating for meaningful change!
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On a lighter note, my son, Kevin, and I saw the movie, Silver Lining Playbook, and thoroughly enjoyed it. The movie’s main character is a young man with bipolar disorder who has been released from a mental hospital. He returns to his highly dysfunctional family and eventually finds balance in his life. The scenes that depict mania were painfully realistic to any parent who has had to deal with an adult child who refuses to take medication and is convinced there is nothing wrong with their behavior or demands. Two unrealistic moments came when the audience was told that Pat had been in a mental institution for eight months (if you are involuntarily committed in Va, the average length of time is five to 30 days – at best) and when he later is seen engaging in therapy with his psychiatrist. Okay, I know that happens, but too many doctors today spend about 15 minutes with patients doing med checks and leave it up to social workers to handle the rest.
Despite my picky points, this movie does a good job portraying mental disorders without stigmatizing the characters.
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I didn’t realize I had a TWITTER account until last week when my son, Evan, who runs my website, mentioned it. Even more surprising, I discovered I had some 200 followers. Evan taught me how to tweet so I have decided to begin sending out more of them. Most will be about articles that I have found worthwhile. Please join me on twitter – just don’t ask me how you can do that! Evan also suggested that I begin posting a blog each Friday from my archives because of a much appreciated jump in new readers who might have missed older posts. Stay tuned for From the Files Fridays!
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Kudos to Trudy Harsh, the housing activist I’ve written about previously. Trudy recently won another well-deserved award, this one is called the Good Neighbor Award. It got her an appearance on our local Washington DC area FOX News station. You might recall that Trudy grew tired of endless meetings where people complained about a lack of housing in Fairfax County but did little to address the problem. Using her knowledge as a realtor, she launched the Brain Foundation. To date, it has purchased six homes and offered 24 persons with mental illnesses housing.
Trudy continues to be an inspiration, giving all of us HOPE and reminding us of the power of a single individual to change lives!
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Another tragic story. I am very concerned about how frequently phentermine is prescribed by primary care and “weight loss docs.” It is not at all an innocuous medication. We have patients come in all the time jittery and manic and we we try to determine what happened, all too often we find out that the person had received phentermine or some other diet product. And phentermine and Chantix together?!? Would definitely require some very close monitoring.
The part about psychiatrists spending 15 minutes is a dangerous trend across the country that is driven by payor sources. Several years ago, a non-clinical consultant advised our agency that “you don’t need so many psychiatrists and really can’t the psychiatrists just spend about 10 – 15 minutes every 3 months or so?” My response to that was “NOT while I am Medical Director.” I’m pretty good at what I do at this stage of my career and I cannot give the care I need to provide which includes developing a therapeutic relationship in 10 – 15 minutes. We need NAMI and other advocacy groups to fight against shifting all care to providers who are deemed less expensive than psychiatrists. We (psychiatrists) have medical training to rule out, think about other conditions affecting mental status as well as psychopharmacological considerations with other medications. Also, we are trained in the therapeutic relationship and therapeutic techniques. We WANT to spend time with our patients. Luckily at my agency, we still spend hour long Intakes and half hour follow ups. But, the payer sources don’t always support how much it costs to staff agencies. If the doctor is considered to spend “too long” the agency loses money on that visit. Conversely, places that do 10 minute med checks one after the other, could make money. I cannot imagine being able to provide high quality care without enough time to get to know my patient and what is really going on with a holistic view. We need time for the entire bio-psycho-social approach.
Adding to Tracy’s comment, I also think that many people still hold the myth of “Doctor as infallable” in their minds. We learn it as children – when you’re sick and your mom doesn’t know what’s wrong with you, you go to the doctor. Mom never questions the doctor saying you have strep throat or a cold, and never questions the medication the doctor prescribes.
I know when we started out on this ‘adventure’ with Tim, we didn’t question psychiatrists or therapists, ever. Then one told us to relinquish custody of Tim to the state to get him the treatment he needed. It was very likely the first time I ever told a doctor, “no.”
It’s exhausting to try and find a doctor that 1) takes your insurance, whatever that is, 2) knows how to work WITH YOU not against you.
After reading your post on the Silver Lining Playbook, I watched a trailer of the movie on Utube. It caught my interest. Currently, the movie isn’t playing in the Syracuse area movie theaters. Hope I haven’t missed it.
My family found the We’ve Lost Hope series insightful. Bart forwarded 2 of the stories in the series to NAMI Cayuga County members last week. Thanks Pete.
Terri
In response to Tgskale –
I am in complete support of every patient w/ mental illness having a psychiatrist as primary therapist. I say this because it was a psychiatrist who initially treated me, in the days before effective medicines,and it was his expert knowledge, caring, intuition and extroardinary insights into healing, that laid the groundwork for me to become well. Weekly or bi-weekly hour long sessions that fell under the heading of therapeutic medical treatment. Virtually impossible to find nowadays, as social workers ask required questions and give scripted rote answers, then bill the patient for ‘therapy.’. It is no wonder so many mentally ill who could be getting better with good medical care, are instead forced to become part of a managed group.
Mental illness is such a personal disease that it requires a trusted one to one relationship with an authentic, schooled, and caring health practitioner. It makes no sense to me that ones who study for 13 or more years to learn how to best alleviate the painful conditions of seriously mentally ill people, are asked to stuff their conseling and healing skills, and simply pass out pills.
A trained psychiatrist working regularly with a patient is synomonous with antibiotics to an infection. Or the difference between a mother’s care, and an uninvested day care worker. A psychiatrist who understands the unique effects an illness has on his patient, is in a position to treat them, AND educate the patient on techniques he/she will need to learn. A social worker isn;t trained to do that.
There is no magic pill either, only medicines that may help lessen the symptoms of the illness.
I hope that more and more well mentally ill will speak up on the invaluable treatment they have received from therapeutic psychiatry. For every mentally ill person who seeks full psychiatric care and is denied, is another example of criminal stripping of the human right to pursue health. If only mental illness mimiced other conditions, like heart disease – then we could sue for malpractice!
If coronary care units were run like mental health centers, with aides doing surgery while surgeons stood by – just like social workers standing in for psychiatrists…
Accountability has to begin somewhere…
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Excellent insight!! I have an adult child for whom I have been advocate, caregiver and personal nurse for over 20 years. Lack of public funding help has kept me responsible for hanging on by a thread! All I can say about the mental health system is that the first priority of any system is to PROPOGATE itself. The bureaucrats need to keep their salaries coming in ~ main priority!