This, I Believe . . .

[twoapennything]

. . . to steal a phrase from NPR. This I Believe.

First, thank you to everyone who e-mailed me and pinged me yesterday after I posted about Ariel -- it really meant more to me than you will ever know. I think this is the first time I've even shared about Ariel and her disabilities. I would hope it goes without saying that of course I love my precious daughter, no matter what, but you know? Screw Holland. Right melusinahp? Screw HOLLAND!!!!

ME & MY LIFE

It looks easy, but it's not . . .

Anyway, I want to talk about something else, really. On Monday, one of my clients was released from jail after being incarcerated for over two months. Long story short, my client was an unmedicated Schizophrenic who began to experience command voices and impulses to hurt other people. Oh, I really like this client so much - seriously. He has absolutely no criminal history, aside from the present crime that got him onto probation, and I'm convinced his crime was likely a manifestation of his emerging illness. It's not illegal to be mentally ill, and it's extremely difficult to hospitalize a mentally ill adult against their will, even when it seems extremely obvious that the person is 1) in the throes of their mental illness's symptoms, or 2) actively delusional or hallucinating. The terms and conditions of probation when someone is placed under mental health supervision includes compliance with mental health treatment, including medications if recommended by a psychiatrist. Now, people can refuse to take meds -- we deal with this on a case by case basis. If someone's generally compliant with probation, but prefers to take, say, homeopathic remedies and use exercise/talk therapy to deal with depression, I will absolutely work with them on that, as long as there is a psychiatric safety plan in place. But, command voices telling you to kill someone? Yeah, not going on a field trip to Wild Oats for that. Nope.

So, my client was released from jail on Monday and the jail bus brought him to the probation department and dropped him off. I had been informed he would be coming, so I had prepared all his referrals, cleared his vouchers for treatment, troubleshot his meds with two separate mental health agencies, and had his treatment plan organized and ready to go.

He has no meds. The jail released him without any meds, which is typical, but they also didn't provide him with a prescription to take to a pharmacy. I had anticipated this might be a problem (because the Denver County Jail is notorious for releasing mentally ill prisoners onto the streets without meds, although they do provide them with medications while they're in custody), so I had set up what's called a "bridge prescription" through a private agency. They need a list of my client's meds, though, before they can fill the Rx. I called the jail and spoke with the psychiatric nurse -- she informed me that the doctor there could fill the prescription, but I would have to allow up to 24 hours. Not great, but what could I do? I'm not a physician and I can't write Rxs myself. I got the client set up for an appointment the next day with MHCD and figured we'd have meds the next day.

Tuesday morning comes and I call King Soopers pharmacy and identify myself, and inquire whether the client's prescription had been filled. OF COURSE NOT! So, I call the psych nurse back and she informs me that she gave the client's info to the doctor that morning, but the doctor had to leave unexpectedly for a family emergency (which, okay, that happens and is understandable). I asked if she could get the information for me, explaining that I had a private agency that could call in the prescription, but they couldn't do that without a list of the client's medications and the dosages. She told me, No, she had given the doctor the client's file. At this point I'm thinking to myself, Can you not go into the doctor's goddamned office and OPEN THE FILE AND WRITE DOWN THE MEDS FOR ME? Dudes, I know a blow off when it hits me. No, she could not do that, she said. Sorry.

Great. I call every single direct number I have at the jail until I reach the most incredibly nice records clerk -- named Rachel, btw -- who finally, FINALLY, says, Sure, she can help me. She'll pull my client's meds list from his records. I could have kissed her! She was so unbelievably helpful and I was very grateful. She was unable to locate the meds list during business hours, but she assured me she would try and get it to me by the next morning.

Wednesday morning -- my client has been off his anti-psychotic medication for almost 48 hours. I receive Rachel's faxed list of my client's meds, and in turn fax it to the private agency. They call in the prescription. Relieved, I called my client's father and let him know the prescription was filled. I tell him to let us know if the prescription is too costly, that we have some monies available for emergency meds. He's elated that the prescription has finally been called in, and I'm relieved.

Thursday morning -- there is a voicemail from my client's father. The prescription is -- wait for it -- $496.00. No, that's not a typo. Four-hundred and ninety-six dollars. For a thirty day supply of pills. So, I tell them to come into my office and we'll do a voucher for emergency funds. We completed the voucher with my client's father putting in $100.00. We fax the voucher to King Soopers.

Thursday afternoon -- my client's father calls again. The voucher is at the King Soopers at 13th and Speer. The medicine is at the King Soopers at 14th and Krameria. *sigh*

Thursday afternoon, late -- SUCCESS! The prescription is filled! My client has been off his anti-psychotic meds for almost four days. Having experienced him both while medicated (I visited him in the jail after he began Risperdal and Cogentin) and while not, I know that the meds had worn off by Thursday morning when he came to see me.

Friday morning -- Voicemail message from my client's father: Client is taking his meds as prescribed. *WHEW*

And we wonder why we see people wandering the streets muttering to themselves, obviously severely mentally ill. We wonder why so many mentally ill end up living on the streets and self medicate with alcohol and/or illegal drugs. Vodka and crack is more cost-effective than controlled, prescription medications. And you know what? That's wrong. It's unconscionable, it's wrong, it's inexcusable and it's vile. The pharmaceutical companies are one of the biggest political lobbying forces in D.C., and, as is the American Way, capitalism prevails -- it's all about the money. Don't even try and tell me that it takes $500 to make 30 days worth of Respirdal, yet you can get 30 days worth of Vicodin or Eurythromycin for a-dollar-effin-fifty. What does Respirdal have as a special ingredient? Some kind of rare, funky Dr. Suess ingredient that can only be harvested from Salamasond during the Ides of March? WTF, is the secret ingredient Oobleck or something?

It's wrong.

Regarding deinstitutionalizaiton, I'll just quote directly from the Wiki: In the early 1960s in U.S., amid public images of mental hospitals as sites for horror movies, a deinstitutionalisation movement caught hold in many states. At the time, mental hospitals were viewed as the least desirable solution to the problem of mental illness, both from a humane point of view and an economic one. California, for example, began to scale back its large mental health system in favour of community-based care, whereby smaller clinics would provide care. Although many facilities were emptied, outpatient services proved severely inadequate, a disaster according to some, which has only recently been addressed with the enactment of the California Mental Health Services Act. Popular books and movies such as One Flew Over the Cuckoo's Nest and Zen and the Art of Motorcycle Maintenance painted very unflattering portraits of mental hospitals as torture chambers run by sadistic staff, contributing to the deinstitutionalization movement.

The negative stereotypes (and an undercurrent belief that patients were "entitled to think what they wanted", rather than accept societal norms) continued to promulgate, however, and went even further in the backlash against social welfare policies in the 1980s, which lead to massive deinstitutionalisation and funding cuts. These changes led to the closing of many mental hospitals and the further reliance on local community care. Many former patients, instead of reintegrating successfully into society or receiving community treatment, simply wound up as homeless persons.

Let's repeat: Many former patients, instead of reintegrating successfully into society or receiving community treatment, simply wound up as homeless persons.

I believe that everyone has the right to basic medical care and that basic medical care should be provided by our government. I believe that "basic medical care" varies from person to person, and while one person's basic medical care will include only yearly health exams and the occasional round of antibiotics, another's might include the need for anti-psychotic medications, so that they may lead a valuable (to them, and what constitutes "valuable" will also vary person to person - value is a subjective concept) life. It's wrong that pharmaceutical companies profit gluttonously at the expense of ill people, whether those people are suffering iwth a mental illness, HIV/AIDS, a congenital heart defect or diabetes.

Mental illness is an organic illness that just happens to manifest in the mind. It's no different than diabetes or asthma or migraines. No one has ever asked to be mentally ill. It's not a character defect, although it is often perceived as a character defect by many people: Just snap out of it already. The lack of access to affordable medications and treatment exacerbates homelessness, addiction to alcohol and illegal drugs, and perpetual victimization of the mentally ill by criminally-oriented individuals. Certainly the institutions of yore weren't ideal -- often they were downright cruel and unbearable. Yet, there needs to be group homes, or modernized psychiatric institutions or living communities, where the chronically mentally ill can live and be cared at whatever level they need. Some would need ongoing intensive care for the rest of their lives, but it is truly amazing how stability, good medical care and quality mental health treatment can propel a person struggling with a mental illness to success and engagement in life and the community.

Our deputy chief sent out the budgets for May and June (end of the fiscal year) and we have $5000 in our unit to last through July 1, 2007. How far does that go? Well, we have a total of about 600 probationers who are being supervised in the Mental Health Unit right now -- that's about $8.50 of treatment funds per person, for the next two months. And you know how much funding the regular (non-specialized) units get? About $500.00. Denver Probation has approximately 4800 active probationers at any given time.

Statistically, the most availed gateway to mental health treatment (and substance abuse treatment, as well) is through the criminal justice system, and that's wrong. It shouldn't take a person being arrested and possibly being convicted of a felony in order to receive mental health treatment. Some local (Colorado -- statewide) legislation I've been following this year:

- HB07-1058: Juvenile Justice Mental Health Process

- HB07-1064: Find/Save Programs - Cognitively Disabled

- HB07-1082: Prohibit Individual Microchip Implant

- HB07-1089: Mental Health Providers Report Cards

Oh, I want to list them all, but Hunter wants to snuggle and it's not like most people enjoy reading house bills, right? Right!

On a final note, please consider your investments carefully -- pharmaceutical companies show massive profits, but at an intolerable human price. I'm all for ethically sound investing.

• Schizophrenia: A psychiatric diagnosis that describes a mental disorder characterized by impairments in the perception or expression of reality and by significant social or occupational dysfunction.

• Delusion: A fixed false belief.

• Hallucination: Sensory perceptual distortions, for example seeing (visual), hearing (auditory), smelling (olfactory), feeling (haptic, tactile), or tasting (gustatory) sensations that others would not sense and do not exist outside one's perception.

• Derailed or Disordered Thought: In which the idea changes spontaneously to another idea that is unrelated or only distantly related. Also known as "tangential."

• Blunted Affect: Outward behaviors, including but not limited to facial expression and vocal modulation, which express emotions. The comic Stephen Wright's deliver style would be considered blunted affect.

• Alogia: Speech, and presumably the thinking that underlies it, is brief and limited to a few words.

• Avolition: Absence of initiative or motivation to begin and maintain behavior in pursuit of a goal.

• Bedlam: Bethlem Royal Hospital of London, which has been variously known as St. Mary Bethlehem, Bethlem Hospital, Bethlehem Hospital and Bedlam, is the world's oldest psychiatric hospital. The word Bedlam has long been used for lunatic asylums in general, and later for a scene of uproar and confusion. The pronunciation comes from the Cockney accent, when saying Bethlem -- instead of "Bethlem" it came out "B'dlam."