How would you feel if you checked into a hospital for emergency surgery and after the operation was successfully completed, you were told that you couldn’t go home?

“But how long do I have to stay in the hospital?”  you might ask.

“Maybe weeks, maybe months, or even longer.”

For patients with severe mental illnesses in Virginia’s state mental hospitals this is not a theoretical  question. It’s what is happening every day across the state.  It also appears to be happening in other states, as well.

A new investigative report by Douglas Bevelacqua,  the Inspector General for the Virginia Department of Behavioral Health and Development Services, found that 70 patients in state mental hospitals were ready to be discharged.  But they couldn’t be released because there was no where safe for them to go!

The primary problem was a lack of affordable supportive housing. The next roadblock was a lack of community based treatment services, especially for elderly patients, those with co-occurring disorders, or those with such severe mental disorders that they require specialized care.

This bottleneck wastes tax dollars.  The average cost of keeping a patient in a state mental hospital is about $590 per day or $215,000 per year, according to the Virginia IG. The average cost of supporting that same patient in a community setting is about $120 per day or about $44,000 per year.  It doesn’t take a math wizard to see the savings. Taxpayers are shelling out $15 million for services that could be obtained for $3.3 million. That’s a staggering savings of nearly $12 million!

Bevelacqua also notes that keeping patients, who are ready to be discharged, in state hospitals takes up beds that are desperately needed by sick patients waiting to get help.

“It doesn’t make any difference which door is closed,” Bevelacqua said. “…If the hospital’s full, people can’t get in the front door. And if the community’s full, you can’t get out the back door.”

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People who are in the midst of a psychotic break often do not think anything is wrong with them. In recent years, this lack of insight has been described as anosognosia (a word that does not roll off the tongue easily.)  It means that a person isn’t aware that he/she is sick.

Two years ago, there was a push to add anosognosia to the the APA’s  DSM which is currently being revised. I wrote about that campaign on my blog and it attracted a number of divergent comments.

The Treatment Advocacy Center, which lobbies for passage of Assisted Outpatient Treatment laws, has released a video this week about anosognosia.  Dr. E. Fuller Torrey argues that anosognosia is a key reason why it’s important for family members and mental health professionals to be able to intervene when someone — who has a history of going off their medications or a history of violence — begins showing signs of psychosis. 

Critics argue that anosognosia isn’t a real medial condition and that most people are capable of making their own decisions without intervention even if they have a mental illness and may be in the midst of a breakdown. 

What do you think of anosognosia and this new video? I’m especially interested in personal stories.

Thank you for sharing your experiences and thoughts.

 

 

Yesterday’s announcement that the global pharmaceutical giant Abbott Laboratories had agreed to pay $1.6 billion to state and federal agencies in criminal and civil fines made me furious. This is not the first time that a large drug manufacturer has been caught illegally promoting unapproved uses for one of its medicines.  But the Abbott case is especially egregious because it executives  exploited two vulnerable groups: persons with mental illnesses and the elderly.

The settlement ends a four-year investigation into a wide number of calculated moves by the Illinois-based company to push sales of its neurological drug Depakote into so called “off label” markets where it didn’t belong.  One of the more scandalous admissions was that executives created a special sales force to promote Depakote in nursing homes.  The sales force was told to push Depakote as a substitute for proper staffing since one of its side effects was turning grandma and grandpa into compliant zombies thus reducing the need to hire employees and provide decent care.  “Abbott essentially preyed on…the most helpless patient populations,” one attorney noted.

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