The system is broken- big time. That premise is proven each time a seriously ill patient does not receive care or receives inadequate or inappropriate care.
Here are a few case studies that provide the evidence.
case study 1: A 26 year old schizophrenic decided to stop taking his medications. He was lost to followup. No one was monitoring him. Once he went AWOL and stopped his medications, he became paranoid. That is what paranoid schizophrenics do when off their medications. He chose to arm himself with a knife. He went out into public and was screaming at the demons inhabiting his mind. The police were called. They confronted him. He refused to put down his knife. He was shot and killed by the police officer.
The system failed this young schizophrenic man.
case study 2: A 49 year old woman was a shut in. Her apartment was full of mobility devices including at least 4 wheelchairs and many walkers. She was convinced that she needed ten surgeries on her various joints to fix the problems. She had had more than 50 MRIs and CTs of her joints. They did not show any major problems. She insisted on her need for the surgery to control her pain. She refused to take pain medications. This woman had a delusional disorder.
She was encouraged to go to the hospital for admission to psychiatry. She was taken to the emergency psychiatry unit by the police under a form 1. She was assessed. The diagnosis of delusional disorder was confirmed. She was held overnight. Then the next day, she was released as long as she agreed to go to the outpatient clinic. She went home and never went to the outpatient clinic. The system failed this woman who likely has a treatable problem but will remain a delusional shut in for life.
case study 3: A 38 year old woman had been well on her regular mental health medications. She was being treated for a bipolar mood disorder. For some reason, she stopped her medications. She quickly unravelled and became manic and then fell into a deep depression. She was obsessed with thoughts of self harm.
We encouraged her to go to the emergency psychiatric unit. She wanted to be admitted for treatment. The doctor at the hospital recognized the problem but suggested that she could go to the outpatient mood disorder clinic.
I said to the doctor at the hospital that I did not want to go to her funeral. He admitted her for treatment. She did well with the treatment within the hospital.
Unfortunately, not everyone has an advocate on their team. Maybe each mental health patient should be represented by an advocate with mental health training? Maybe mental health care should be delivered in the home and in the hospital? Maybe psychiatrists should be encouraged to see the most urgent cases and not just the worried well? Maybe the psychiatrists should be monitored based on customer feedback and on outcomes? Maybe the most urgent cases should be monitored closely to avoid having them fall between the cracks? Maybe the mental health courts should be integrated with teams of mental health care providers? Maybe the police should have mental health care workers on their teams to help manage EDP’s ( emotionally disturbed persons)? Maybe we should change the SYSTEM? It is broken.
It is very sad to see these patients losing the battle with their mental health problems and not being able to get the mental health care that they need and deserve.