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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Phillipa on November 4, 2008, at 0:46:19
Says psych hospitalizations account for longer stays and more admissions to hospitals in a year average stay 8 some odd days and physical symptom diseases have a psychiatic component in many. Do you agree or disagree? Seems to me 8 days can't do that much to help a person stabalize or even see if the meds will work. Short. Phillipa thought it was interesting as the new law affects it.
Mental-Health Hospitalizations Longer, More Common, Than Others
October 31, 2008 In the United States in 2006, more than 20% of all hospital stays were related to mental health, a new report from the Agency for Healthcare Research and Quality shows.During that year, 21.3% of hospital stays had either a principal or secondary diagnosis of a mental-health condition. Furthermore, the average length of stay for hospitalizations for mental health was longer than all other stays (8.2 days vs 4.6 days).
Overall, in 2006, there were 8.5 million hospitalizations involving patients with mental illness. Of these, 7.1 million patients had a mental disorder in addition to the physical condition for which they were admitted, and 1.4 million were admitted primarily for a mental illness. Of the admissions for a primary health disorder:
Nearly 730,000 were related to depression or other mood disorders, such as bipolar disease.
381,000 were related to schizophrenia and other psychotic disorders.131,000 were related to delirium (which can cause agitation or inability to focus attention), dementia, amnesia, and other cognitive problems.
76,000 were related to anxiety and adjustment disorders (stress-related illnesses that can affect feeling, thoughts, and behaviors).
Roughly 34,000 were related to attention-deficit disorder, disruptive behavior, impulse control, personality disorders, or mental disorders usually diagnosed in infancy or later childhood.
Report author Dani K. Saba and colleagues point out that untreated mental illness is more likely to result in hospitalization. They note that the "recent passage of mental-health-parity legislation for private health-insurance coverage should increase access to mental-health care in the United States and help mitigate the far-reaching effects of mental illness on social relationships, employment. and quality of life."
The authors have disclosed no relevant financial relationships
Posted by yxibow on November 4, 2008, at 1:14:55
In reply to Psych Hospitalizations Agree or Diagree?, posted by Phillipa on November 4, 2008, at 0:46:19
Unless you're in dire straits and have an actual plan to commit suicide, the psychiatric ward of a hospital is not the best place to be therapeutically.
It's not just whether there is enough nursing staff to attend to your needs or the quality of the place, although those are variables -- its that you're taken from a familiar environment and placed in a situation where you feel even more like a patient than someone working with their limitations and solving ways to cope with an illness.
You don't have much access to family, which if you aren't estranged from them is an important part of the healing process, any friends you have, the views of the city you live in, depending on whether they have a typical program of exercise and arts and crafts, etc.
It may be a place where medication management that can't be done by several psychiatrists that you've already seen to be adjusted but that's about the extent I would say.
And of course the state 14 day holds and the like, there's nothing you can do about that, but that's mostly about appeared agressive behaviour on the streets or attempted suicide.
And attempted suicide does not always end up in a ward anyhow if you are determined not to be a harm to yourself and are released after being seen because it can just be ideation.
The days of long stay state hospitals in the US ended in the 60s and 70s.
What I had for treatment for severe OCD would not be possible today, not just for insurance reasons which is a major one still, but the length is just not seen.
Which is why -- and I don't like to single out people, I am surprised at the 120 day stay that Jeroen is experiencing in a Western country. But it may be different in Europe.
Schizophrenia and related disorders are ones where you do see longer stays -- generally more at Veterans' Hospitals I think, I'm not sure.
The cost of housing someone who can't afford it (i.e. someone homeless on the streets) would be similar to any hospital day rate, which can be up to $5k a day, depending on whether the person also has to spend time in the ICU for methanol poisoning.
And then once the "danger" is over, you see people back out on the streets and the same people are seen back in the hospital again some day later. This is something pretty common in this area, its sad to say. There are pilot half way apartments that have been tried with some success but people have NIMBY attitudes of them being built next to them.
-- Jay
Posted by jnew12 on November 4, 2008, at 1:37:18
In reply to Psych Hospitalizations Agree or Diagree?, posted by Phillipa on November 4, 2008, at 0:46:19
I had a very bad responce to a hospitalization.
I got real, real sick and had diahera , and vomiting at the same time over, and over again. I told the nurse, and he wanted me to show him the puke, and when I did it was clear from throwing up so much, they think everyone is nuts, he told me it was just water. I was severly ill.. and asked him to call the doc. He told me the only doc he was going to call is a psychatirst, Once again he thought i was nuts.
Then I woke up the next day and had a very high temp, something like 103.
They finally believed me because it was not just me that was sick, like 5 other people had a high fever..the idiot finally called a doctor.
Then I asked a nurse when I get to leave because they were not treating me right, there was no trained psychologist, mostly just body guards witbhot degrees, following you around taking note of everything you say, and constinatly asking, DO YOU STILL WANT TO KILL YOURSELF. It was embarresing. When I asked her when I got to leave, even though i was the voulantary, but still treated like dirt, and my roomate had psycosis, it was not a good experience. She lied and told me that my mom called and they were sending me somewere long term, which she never said she was just lieng to get me angry.
I was constantly harrased by some overweight guy because I had substance abuse problems, they acted like that was my main reason, but it was not it was extreme anxiety, and mental breakdown.
Then, I think I caught hep C there, it was very nasty, and the nurses kept sticking me with needles.
My liver enzymes were rising to a extreme level, specially because I was on depakote.
But I had hep C, and they knew but they were trying to keep it secret for some reason.
Then, they were rushing me out because my insurance no longer wanted to pay, and some doctor from the bottom floor came up and yelled at the nurse, and said he wanted to talk to somebody who was treating this patient. He was furious. I wsa right there and I thought something was major wrong by the way he talked, he did not know i was standing right there.
Before I left the doc from the down floor and his other assoociates came and felt my belly and said I might have some kind of hepatits. But he said don't jump to the conclusion that is C, it could be med related.
He gave me another doctor to follow up.
I went there for six months ever 3 weeks, my liver enzymes were up every single time. He did not know what was causing it, then after six months he said I was fine and I had no hepatis or anything, i was free to go.
Bad news for me, a year later, I had a episode where I was hospitalized and they said my enzymes where up again. I finally got a test for Hep C, and I came up positive.
I don't know how somone could check my liver for six months, and not find something.
I think they were hiding it.
They were a bunch of bafoons.
I was hospitalized again for depression same thing, not as bad, but all we did is do art, and play three year old games..no real thearpy, just meds, and a ticket to leave in 4 days. How can you get better if you can only stay for 4 days I dont understand?
Posted by Phillipa on November 4, 2008, at 19:18:58
In reply to Re: Psych Hospitalizations Agree or Diagree?, posted by jnew12 on November 4, 2008, at 1:37:18
Hence eight day stays I got 30 days when had the chronic lymes as they were also treating it. Agree home is best. When I did the psych nursing small hospital and all patients complaints were taken very seriouly and many consults called. Now it's 8 days. Or I guess the state hospitals? Phillipa
Posted by JadeKelly on November 5, 2008, at 1:37:49
In reply to Re: Psych Hospitalizations Agree or Diagree?, posted by Phillipa on November 4, 2008, at 19:18:58
As a last resort. In my experience, they don't treat, they just wait it out a week or so until the individual is "not a danger to himself or others". Meds are changed or added that turn patient into zombie, then its up to outside Pdoc and family to figure it all out and get appropriate meds on board.I wouldn't be surprised if a week long stay gets a patient 2-15 minute visits with PDoc. No real therapy.
Secondly, a serious detox sitution calls for, in my opinion, close medical supervision, even tho its a psych hospital. Too dangerous for a family with no medical/psych training to handle at home.
Lots of visits required from family to make sure patient is being treated well, correct any screw ups, etc. I've seen horrible care in top notch hospitals known nationwide. Can't figure out why these patients aren't treated as well as any medical patient. Its a system that needs a lot of work. Subsequent outpatient care is a joke from what I've seen.
I'm sure its not always this way, just what I've seen.
And I agree, its got to cost the state a lot more money to put homeless people or patients that are obviously emotionally unstable, back on the street witout a plan in place.
I've never even heard of a 4 month stay. Is that more like a halfway house, or an actual psych hospital? I can't imagine that long stay being healthy for an individual but don't know the circumstances. Can they do this against will of patient? Only thing I can think of is private pay.They like that. and boy, when insurance says its time, better have those bags packed.
Again, just what I've seen
Jade
Posted by Racer on November 6, 2008, at 22:20:56
In reply to Re: Psych Hospitalizations Agree or Diagree? » Phillipa, posted by yxibow on November 4, 2008, at 1:14:55
While much of what you've written is spot on, I do think there are many more situations in which the hospital is the best place for someone, and longer stays are more beneficial.
I don't have the energy right now to go into all my thoughts on this, but essentially:
1. Many times, removal from a stressful environment will be therapeutic. And sometimes (often?) the family dynamics are the cause of much stress. In that case, hospitals can provide a safe place to be, while easing some of that.
2. In Anorexia Nervosa, recovery rates were far, far better in the late 1970s -- back when hospitalization and residential treatment in specialized facilities were the rule, stays in these facilities were far longer than they are now, and (perhaps most importantly) discharge weights were proportionately higher. Again -- partly removal from the stressful environment, but also a stronger base of recovery, more practice tolerating both eating and weight gain, etc. And much of the most helpful treatment for AN kinda requires residential -- too painful O/P, for one thing -- and the presence of others who really and truly do empathize with you, because they're in the same facility, for the same reason.
And no, I've never had residential treatment, although it was recommended quite strongly. My insurance company said I should be fine OP -- despite the fact that the program they recommended to me wouldn't take me, because my weight was too low...
For many, though, you're right -- hospitals are not great places to be.
Posted by manic666 on November 8, 2008, at 5:00:31
In reply to Re: Psych Hospitalizations Agree or Diagree?, posted by Phillipa on November 4, 2008, at 19:18:58
i was in hospital 8 days after the nut shrink F.D up my meds , an its not a place to be . the night staff look at you like scum an totaly ignore you get minimum skills from untrained docs who experiment with you, you may see the consutant once in your hole stay.if i had strenth i would have taken out side an battered 2 of the night staff thats how bad they were,my wife ask constantly what are you doing for my husband . an was met with blank looks.the only decent people in hospital are the pationts.i bluffed my way out or they could have done me some serious harm.your a number an thats all. i am worse for the experiance.manic666
Posted by yxibow on November 9, 2008, at 3:06:27
In reply to For once I disagree with you! » yxibow, posted by Racer on November 6, 2008, at 22:20:56
A disagreement is fine, that's what conversations are about.
Perhaps I was projecting my own views that I have had a relatively positive relationship with my parents.
I know for some on here and not on here that family either does not understand one's woes or mental illness grinds against the family and arguments are a part of such a relationship. NAMI wouldn't be the first to know about this.
I guess I'm just saying that it is frightfully expensive, insurance does not pay for things well, staff are not always the best in non-academic, state hospitals, which largely don't exist any more, not here at least, except for the criminally ill.Becoming a ward of the state is not a great thing to be and that is one reason to struggle to achieve. Its something that I worry about, I know I project to the infinite future at times and all we can work on is the present and worry about how the next steps unfold. Anyhow, I think I'm diverting from the conversation.
As for anorexia nervosa, I have no experience on that so I can't say anything about it other than it is one of hundreds of diagnoses and can be treated in an outpatient way successfully. It may require strong will, intervention from friends, etc. Just like any other condition, you could create scenarios, something I do too much about myself. Okay, so now I'm projecting again -- well I think we all project.
Anyhow, let's just say I was lucky to have what care I could have in a hospital that does no longer exist in that capacity or financial ability in the 21st century. And there was an incident that made me very angry and violated, which I won't go into at this point.
So that's my take and you can have yours.
-- tidings
Jay
Posted by Racer on November 9, 2008, at 10:41:03
In reply to Re: For once I disagree with you! That's fine » Racer, posted by yxibow on November 9, 2008, at 3:06:27
> A disagreement is fine, that's what conversations are about.
It helps that you respect other views than your own. I appreciate that.
>
> As for anorexia nervosa, I have no experience on that so I can't say anything about it other than it is one of hundreds of diagnoses and can be treated in an outpatient way successfully.Actually, Anorexia Nervosa is one of the few that probably is best treated in a residential setting. Not necessarily a hospital -- in fact, probably not a psychiatric hospital, but a residential facility specializing in eating disorders. (Then again, for those who require significant refeeding, that really does require very intense, specialized medical care. Refeeding syndromes are fatal for a fair number of patients.) Then again, it's also a very different sort of disorder than many of the others, for a variety of reasons.
And it really doesn't apply to most of what you're talking about.
> So that's my take and you can have yours.
>For the most part, I agree with your basic premise -- most psych wards at this point are not healthy places to be. My only real disagreement with any of it relates to the fact that some people just don't have the social supports necessary for outpatient treatment of acute symptoms. For those people, in an acute crisis state, no matter how bad hospitals might be, they may still be the best choice out of a lot of bad choices.
Some of this is based on my own experiences, by the way. I've been mostly in pretty terrible places when I've been hospitalized. In fact, I've only been in one place that wasn't very much like a snake pit. Nonetheless, at the times that I've been in the hospital, it's often been a life-saver. Even the two weeks I spent in one terrible, terrible place -- their HVAC was broken, so it was about 45 degrees the whole time I was there; there was nothing like actual treatment; and I didn't eat for days on end and no one noticed -- was better than what I had to go home to. I know my situation has never been as bad as many people experience, but there's no hierarchy of suffering and it was bad enough. So, we're both projecting.
I guess my fundamental premise is about what one might expect from me: Psych hospitals are not places to go for a vacation, but there are times when they're still the best place for someone to be.
And, like any other hospital, don't go if you don't need to be there...
Peace.
Posted by Phillipa on November 9, 2008, at 18:48:06
In reply to You're so civilized! » yxibow, posted by Racer on November 9, 2008, at 10:41:03
Around here can't be admitted unless suicidal, psychotic, bipolar mania. Used to let people in for med changes no more. I do have to say that the psych hospitals I was in and worked in gave excellent care. Patients were so relieved to be with us. One nurse used to play her guitar and get singing going with patients on weekends. We all loved our jobs and the patients knew it. Sadly things have changed. Heck even surgery is now outpatient. Oh well. Phillipa
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