Guest opinion underscores need for mental-health facilities

BY GUEST OPINION | JULY 29, 2011 7:20 AM

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Monday's guest opinion by D.M. Seay poses many troubling questions. It does a great job of raising the issue about the treatment of the chronically mentally ill and the aging mentally ill — not only in Iowa City, but across Iowa and all over the United States.

Seay addressed what he felt was a lack of response to his situation by the UIHC emergency-room personnel when he came in after seven months off of a medication cocktail.

One has to ask, of course, why he had been seven months off his medications. Many patients stop because of the extreme expense, not to mention the nasty side effects of so many of these drugs. He said that he spoke with a medical doctor, psychiatrist, and a social worker and the decision was to release him to spend the night at the Shelter House. Chances are very good that there were no psych beds available, because there are far too few of them. Additionally, Iowa has a shortage of mental-health professionals.

I'm a retired RN, and I spent my last days in nursing at a clinic for people with schizophrenia, schizo-affective disorder, bipolar spectrum disorders, and addiction issues, whether to street drugs, alcohol, food, or sex. This was the sort of place that is sorely needed all over the United States.

Because the patients we saw were all private-pay, they either had had trust funds set aside for their care, came from well-heeled families, or in some cases, Medicaid.

These were seriously ill people, some of who had been in the criminal-justice system (which did very little, except allow them to deteriorate further). They were on a supervised regimen of medications, group-therapy meetings, and lessons in simple things, such as how to practice good hygiene or how to balance a checkbook. Some could go on to college with proper treatment, group meetings, and follow-up care. At night, these people were transported to supervised group homes. My job was to be available to these people who needed someone to tell about their delusions or someone with whom to share good experiences. This facility should be a prototype of what is needed all across the nation.

These facilities are also necessary to support aging caregivers, who support and help their mentally ill adult children. Some have lost their children to suicide, when those afflicted could no longer live with the demons that occupied their brains. One woman I know told me that she lives in fear and sadness that when she dies, she wonders what will become of her child. She said her middle-age child does OK as long as she sees that he takes his meds and keeps him on a structured path that keeps him out of trouble. She is worn out, but she perseveres each day because she has no choice.

We have to recognize that we have to invest in the building of safe havens for these mentally ill people, and we must educate the people to care for them. It takes years to become a psychiatrist, and now most nurse practitioners and physician's assistants entering any phase of medical practice are going to be required to have a doctorate — a huge debt load for the students. It's only reasonable to acknowledge that these people are going to have to be decently compensated.

Please recognize that people don't "get over" disorders such as schizophrenia or bipolar disorders or the many awful disorders mentioned in the Diagnostic and Statistical Manual of Mental Disorders, a thick book of all kinds of brain disorders. But they can be helped, and they can be of service in the community, and their aging caregivers can rest a tad easier.

Bobbie Paxton is a retired nurse who lives in Iowa City.

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