Search This Blog

Friday, May 24, 2019

From Massachusetts to Idaho: An Advocate Reviews Breakdown: A Clinician's Experience in a Broken System of Emergency Psychiatry (Guest Blog)

I finished reading Breakdown: A Clinician's Experience in a Broken System of Emergency Psychiatry, by Lynn Nanos. The opening page of Breakdown quotes Dorothea Dix: “…I come as the advocate of helpless, forgotten, insane, and idiotic men and women….” Like the Civil War era Dorothea, Lynn Nanos is a Massachusetts woman and tireless advocate for people with serious mental illness. 

As a parent of a thirty-year participant in the mental health system, I found Breakdown informative, comprehensive, well-researched, and thoroughly-referenced. Practical advice and familiar vignettes weave through the narrative as only someone who has been on the front lines of psychiatric emergencies can document. Each of the twenty-two chapters is focused and does not shy away from difficult issues or controversial positions. Nanos’ experiences as a clinician in Massachusetts document the roles, laws, and regulations in that state as I ponder my state of Idaho. For instance, what is a Roger’s Monitor in Massachusetts and how does this compare to Idaho? This is a court order for patients to receive antipsychotic medication regardless of whether they want such medication. Many people with mental illness do not adhere to treatment recommendations because they lack awareness of being ill. 

Nanos tells stories of individual crises, which she skillfully uses to document the complex problems surrounding the personal and societal costs of mental illness. I am intrigued by her ability to tell the stories of countless individuals from her perspective as a professional clinician in an urban setting. By contrast, I am one family member, an artist and knitting machine educator by trade, with one long story, in rural, north Idaho. My personal experiences include every topic and every chapter in Breakdown, supporting my daughter as best as I can. My tenacious efforts have partnered and often struggled with doctors, nurses, social workers, hospitals, living situations, guardianship proceedings, Social Security, Medicare, Medicaid, the Department of Health and Welfare, law enforcement, Crisis Intervention Team (CIT) police, and the National Alliance on Mental Illness (NAMI).
The complex mental health system is far removed from Dorothea Dix’s advocacy efforts. But, how much better off are people with serious mental illness, no longer shuttered away and forgotten in insane asylums? Today medications replace straight jackets while the Institutions for Mental Diseases Exclusion law did away with 400-bed hospitals, which in turn led to homelessness, violence, victimization, addictions, inadequate resources, best-guess medication practices, revolving door social services, fatigued families, and abandonment. What we have here is a multi-faceted “Problem Pile-Up.”

Geographic population densities differ. Massachusetts has 839 people per square mile while Idaho has nineteen people per square mile according to United States Census Quick Facts. A great source to compare individual states is the Treatment Advocacy Center (TAC), which reports that in Massachusetts with a population of 5.5 million, 60,000 people live with schizophrenia. In Idaho with a population of 1.3 million, 14,000 people live with schizophrenia. The TAC statistics reference United States Census statistics. Coincidentally, one percent of the population of each of these states live with schizophrenia, which begs the question…where do these facts originate? Are the solutions the same in both urban and rural America?
While statistics and anti-stigma campaigns are useful to start conversations, CIT may save lives, NAMI classes educate family members, Mental Health Courts and Assertive Community Treatment teams may restore some people to better lives, my humble opinion is that these noble and worthwhile efforts are but band-aids on our society which is bleeding out. No one sets out to be homeless, incarcerated, hospitalized, die by suicide, or face an accidental early death. Policy makers need the education to give priority to the people affected by serious mental illness, the most difficult task. To be trite, an ounce of prevention is worth a pound of cure. There is no one-size-fits-all solution. There is a giant elephant in our living room and there isn’t a circus tent big enough to house her ill body. Together, one bite at a time, with a dedicated commitment to constancy, structure, encouragement, and acceptance, we can make changes that would make Dorothea Dix proud.

I have yet to personally meet authors Lynn Nanos, E. Fuller Torrey, Pete Earley, DJ Jaffe, Robert Laitman and others. Their writings and advocacy work through books and social media are enabling me to be a more knowledgeable advocate for my daughter and other people who are so disabled that they can’t speak for themselves. I hope that you will join our efforts!

Gini Woodward,
Mother of a fifty-year-old daughter with schizophrenia
Bachelor of Arts in Social Sciences

Past Experience: 
NAMI Family-to-Family Educator
NAMI family support group facilitator
Idaho Region 1 Behavioral Health Board member and State Hospital North Advisory Board member