January 2016
I’m not much of a psych guy, but in some respects, I am. My first experience with psychiatry was my medical school rotation. I was assigned to a Veteran’s Administration lock-down ward in 1985. It was basically one big scam. The patients scamming the system to get $3000/month disability income from Social Security and Veteran’s benefits. To qualify they just had to act out enough once every 1-2 years requiring hospitalization.
The unit was a drug cabal of Houston. The orderlies would smuggle drugs into the patients, who would then sell them to other patients and staff. The attending’s evaluation of me at the end of that 2 months said, “Student Ward was provocative.” He didn’t mean that sexually, but that I was prone to provoke conflict and argumentative discussion constantly with the staff because I wouldn’t just go along with the status quo. I’m surprised I passed. Fast forward to the rest of my career. Emergency Departments see a fair amount of psych patients on a daily basis (for instance, I have 3 in the ED at the time of this writing). And it’s getting worse.
Patients that have a mental health or substance abuse diagnosis at discharge from the ED.
2000 5.4%
2008 10%
2011 it was up to 80% in some states.
In a Washington state survey in July 2014, mental health patients wait for their assigned bed in the ED 3.2 times longer than patients being admitted for a non-mental health diagnosis.
Why do I mention this? Because of the movie, One Flew Over the Cuckoo’s Nest with Jack Nicholson. Sometime in the 1960s, our liberal friends decided that too many people were being deprived of their “rights” by being institutionalized in psychiatric institutions and subjected to torture and inhumane treatment. Doubtless, there were occasions of this, just as there is a bell curve for any institution, industry, or process. But along came Ken Kesey. He wrote the book One Flew Over the Cuckoo’s Nest, from which the screenplay was “adapted”.
The movie plot involves the main character, McMurphy (Jack Nickleson), who has a criminal past and has once again found himself in trouble and is sentenced by the court. To escape labor duties in prison, McMurphy pleads insanity and is sent to a ward for the mentally unstable. Once there, McMurphy both endures and stands witness to the abuse and degradation of the oppressive Nurse Ratched, who gains superiority and power through the flaws of the inmates. McMurphy and the other inmate’s band together to make a rebellious stance against the atrocious Nurse. Through the notoriety of Jack Nicholson (and editorial abuse), the movie became the hit of 1975, grossing $112,000,000 (USD).
Kesey’s plot was to expose the plight and mistreatment of Native Americans more so than the mental health issues. The director and Nicholson saw a better public outcry if the plight of the mental health issues were exposed. Guess who won. Don’t get too teary eyed over the loss of fame for Kesey. In the 1960s, Kesey became a counterculture hero and a guru of psychedelic drugs with Timothy Leary of LSD fame. Kesey has been called the Pied Piper, who changed the beat generation into the hippie movement. At a Veterans’ Administration hospital in Menlo Park, California, Kesey was a volunteer experimental subject, taking mind-altering drugs and reporting their effects. The experiences as a part-time aide and subject at a psychiatric hospital, LSD sessions and a vision of an Indian sweeping the floor formed the background for One Flew Over the Cuckoo’s Nest. When the film won five Academy Awards, Kesey was barely mentioned during the award ceremonies. He made known his unhappiness with the film, his dislike for Jack Nicholson and the script and he sued the producers. The actor, William Sampson played Chief Bromden (also in Outlaw Josey Wales, 1976). In the book, his character narrated the story and was symbolic of Native Americans as a group. He died June 3, 1987 in Houston, Texas. He was a full Muscogee Creek Indian who supported Native American rights and culture. He was mute in the film and the character as the narrator was mute in the book (although he talked to the reader but not to other characters in the book). Sampson was one of the first patients to receive a heart-lung transplant but died of complications from the procedure. I took care of him while on my internal medicine rotation in residency.
Why all this insanity (pun intended)? Well, Congress passed laws and liberals pushed the agenda to close mental institutions in an effort to get these patients out of the hospital and “home.” Let’s look at where that effort has left us/them.
In 1950, there were 500,000 mental health patients in hospital beds.
In the 1970s, there were 680 mental health beds for every 1 million population in the US. Now there are 34/1 million. One doesn’t have to wonder for long why it takes 3.2 times as long to find a bed for a mental health patient.
In 1985, a study showed that the problem was due to funding, bed availability, adequacy of staffing and infrastructure support, in that order.
In 2012, for 1507 mental health inpatient beds, 181 beds are in a psychiatric hospital, 577 beds in a private non-psychiatric hospital and 749 beds in a State psychiatric hospital.
In 2014, of 590,000 mental health patients, there were 108,000 beds available. There were 200,000 mental health patients that were homeless, 356,000 mental health patients in prison and 34,000 mental health patients that had committed suicide.
In 2015, a study showed the same problem and same hierarchy.
A review by Health Care of Vermont revealed that the cost of treating a mental health patient who was arrested was $30,258, who was hospitalized was $ 31,623 and who was living at home was $ 31,280, essentially the same.
The 1985 study that showed that the problem was due to funding, beds availability, adequacy of staffing and infrastructure support, in that order has been repeated and still holds true.
Some of the “inhumane” treatments, such as drug therapy, electroshock therapy and lobotomy, are still in use today.
Mental health patients have liberal idealism to thank for dying of cold or heat on the streets, for being abused, neglected, robbed, raped and killed on the streets and in prison.
Progressivism to die for.
More musings from your grumpy Uncle/Brother Dave.
Bibliography
1. Psychiatric Boarding in Washington State, Lecture presentation,
Stephen H. Anderson, MD, FACEP, 12//20015, Maui, Hi
2. DSHS, Washington State Institute for Public Policy, legislative
Evaluation & Accountability Program Committee;
3. One Flew Over the Cuckoo’s Nest. Directed by Milos Forman, performances by Jack Nicholson, Louise Fletcher, Michael Berryman, et. al.,Fantasy Films and United Artists, 1975.One Flew Over the Cuckoo’s Nest,
http://www.imdb.com/title/tt0073486/?ref_=fn_al_tt_1
4. ebook download and read online
http://www.ebook3000.com/One-Flew-Over-The-Cuckoos-Nest_1604.html
5. From a book review
https://www.goodreads.com/book/show/332613.One_Flew_Over_the_Cuckoo_s_Nest
6. Jeffrey Swanson and Marvin Swartz, Duke Univ, Fletcher-Allen
Weary