Health care

[Marocc]

21 minutes ago, eyeball said:

People like you make me puke.

A bit of an exaggeration, but okay. Good luck creating the first Orwell land.

[eyeball]

5 minutes ago, Marocc said:

A bit of an exaggeration, but okay. Good luck creating the first Orwell land.

Honest politicians = Orwell land?

Have you checked the definition of exaggeration lately?

Edited January 4, 2020 by eyeball

[Yzermandius19]

18 minutes ago, eyeball said:

Honest politicians = Orwell land?

Have you checked the definition of exaggeration lately?

You want free speech banned dude, because politicians lie. Complete clown show, even if you made such a ridiculous law, it would not result in honest politicians, just selective enforcement against political opponents. Dumbest plan ever.

Edited January 4, 2020 by Yzermandius19

[eyeball]

13 hours ago, bush_cheney2004 said:

Same reason the left hasn't done so.

So the implication that the right is no better remains standing.

Cool. Feels like I'm finally getting somewhere.

[SpankyMcFarland]

12 hours ago, Marocc said:

What promise, exactly? UK has a pretty impressive psychiatric treatment system. Scandinavian countries and Baltic countries have also made great progress with deinstitutionalization in the last decades.

Shortage of beds is probably a problem everywhere. In psychiatric treatment it may be part of the deinstitutionalization precisely. The amount of beds are decreased since the amount of admissions decreases. There remains the decision of who gets the available bed. That's for the psychiatrist to make.

If there is a big problem with a shortage of beds in one hospital or one ward, it doesn't automatically mean it is the same in other hospitals and other wards.

You'd have to read the community care literature to see what I'm talking about. I can certainly dig them out. After the antipsychotic medication chlorpromazine arrived, utopian predictions were made about caring for nearly all psychotic patients in the community.

https://en.m.wikipedia.org/wiki/Chlorpromazine

Most of the advocates were well-intentioned but government bean counters saw an opportunity to close the asylums, many of which were awful, and spend the money on politically more popular projects. 

The UK has a national shortage of psychiatric beds. It closed too many since the Fifties. I think there's an article by Green on that which I will post. I can assure you that both Canada and Ireland also have serious, chronic, national problems with this issue and we can see on our TVs what the US is like. As I noted earlier, I have been listening to complaints by psychiatrists for over thirty years on this issue in Canada. The only comparable problem elsewhere is the growing demographic timebomb of care for the elderly. No other specialty has been so short-changed. 

 

Edited January 5, 2020 by SpankyMcFarland

[SpankyMcFarland]

Here's that article by Green. These three sentences drily sum up his thinking on bed closures and community care:

Quote

The reduction in beds and organisation of community teams is largely based on philosophical ideas ¹⁷.The physical alteration to services of bed closures is thus conducted on a philosophically weighted and relatively evidence-light basis. This could be characterised as a brave, uncontrolled experiment, but one conducted without the involvement of a research ethics committee, and the absence of any patient consent.

 

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http://www.priory.com/psychiatry/Decline_NHS_Inpatient_Psychiatry.htm

Quote

Doctor Pangloss was a character in Voltaire’s satire Candidewho espoused a particularly flawed, but admirably optimistic philosophy. Essentially Panglossian philosophy was that all was for the best. Typical Panglossian logic is exemplified by this quote: 

 

‘It is demonstrable, ‘ said he, ‘that things cannot be otherwise than as they are; for as all things have been created for the best end. Observe for instance, the nose is formed for spectacles, therefore we wear spectacles’.

 

The received political wisdom is that the massive investment in home treatment teams for ‘severe and enduring mental illness’ including assertive outreach, early intervention and crisis intervention teams has allowed a reduction in hospital admissions and thereby prompting mental health beds to be further reduced. 

 

Quote

The reduction in beds and organisation of community teams is largely based on philosophical ideas ¹⁷. The physical alteration to services of bed closures is thus conducted on a philosophically weighted and relatively evidence-light basis. This could be characterised as a brave, uncontrolled experiment, but one conducted without the involvement of a research ethics committee, and the absence of any patient consent. The overall intentions may be laudable, and the eventual outcome could be good, but there is seemingly no will to co-ordinate measurement of the effects of the experiment before and after the intervention. The reduction in beds is, for now, seemingly irreversible and for the next decade at least the mentally ill patents of the NHS must make do mainly with community care. Even so, the jury on community care is still out. Evaluative papers on community care even now stress their preliminary nature ¹⁸, but the policy has already been implemented in the UK. 

The most recent Cochrane review of crisis intervention for severe mental illness concluded that there were few studies that met their inclusion criteria and that although home treatment and crisis intervention were possible management strategies some 45% of patients eventually required admission ¹⁹. Crisis intervention is unsuited to un-cooperative patients and patients at risk of self neglect ²⁰. The Cochrane team concluded to that ‘If this approach is to be widely implemented it would seem that more evaluative studies are still needed’ ¹⁹.

Here's are a few articles from the papers on the beds crisis in the UK:

https://www.theguardian.com/society/2019/nov/06/hundreds-of-mental-health-beds-needed-to-end-shameful-out-of-area-care

https://www.theguardian.com/society/2018/jul/21/mental-heath-crisis-beds-shortage-detentions-soar

Half the beds in the NHS were once psychiatric beds. Given their progressive disappearance, it's hard to believe that now. Here's a recent official report on bed occupancy. It's rather polite on the subject of community care but you can read between the lines:

Quote

This report reviews the pressure on inpatient psychiatric services, building on the work of the 2015 independent Commission chaired by Sir Nigel Crisp.

The headline conclusions are clear. Pressures on psychiatric beds are mounting. This appears to be forcing up admission thresholds, driving inappropriate use of out-of-area placements, and the use of general acute hospital beds for patients with mental health problems. There is some considerable regional variation in pressure on inpatient beds and the resource levels and efficiency of these services.

High levels of bed occupancy place significant pressures on staff working in both inpatient and community mental health services, compelling clinicians to manage higher levels of risk. A range of approaches and services are being developed to manage these pressures, and whilst some show promise, it is clear that no single approach will be sufficient. The vast majority of Royal College of Psychiatrists’ members believe that the solution to pressure on inpatient beds lies in increasing the coverage and resilience of community services, but this will take time, and in many areas the pressures are reaching critical levels.

Whilst there is some good evidence to suggest that early intervention and talking therapies might reduce pressure on inpatient beds, the evidence base for crisis resolution teams and primary care mental health services needs to be strengthened. 

https://www.strategyunit.co.uk/sites/default/files/2019-11/Exploring Mental Health Inpatient Capacity accross Sustainability and Transformation Partnerships in England - 191030_1.pdf

 

A letter to the Lancet makes similar points. Note how low our per capita Canadian bed numbers are in the graph:

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“Four legs good, two legs bad”, bleat the sheep in unison in George Orwell’s Animal Farm to drown out intelligent criticism whenever it is raised.1 “Community good, hospital bad”, has been a similar ideological mantra for the past 60 years in psychiatric services. It was appropriate when we had bulging mental hospitals in which many patients were merely warehoused, but it has gone too far. We have forgotten the hospital component of a community health service, even though it is essential to good practice.2 While much has been made of innovations in community and extramural care, most observers have barely noticed the steady reduction in bed numbers, particularly in the UK (figure).3 

...So why is the apparently relentless attrition of psychiatric beds continuing in the face of this accumulating evidence of failure? In our view, it is fuelled by two factors: money and ideology. Inpatient care is expensive: for example, the average cost of an acute inpatient stay in the UK acute psychiatric unit is £11 500 per patient.5 Bed reduction remains attractive, despite the clear evidence available beds are now too few, and formal enquiries fail to recommend an increase in bed numbers.5 

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(17)30149-6.pdf

 

Edited January 5, 2020 by SpankyMcFarland

[SpankyMcFarland]

We have the same problems in Canada but they don't seem to attract as much coverage. Here's one article. Again, note the international comparisons on bed numbers:

https://vancouversun.com/news/local-news/mental-health-gap-in-b-c-psych-beds-dwindle-as-community-supports-struggle-to-keep-up

Falling number of psychiatric beds in B.C. hospitals

2006-07: 1,305 beds or 30 beds per 100,000 population

2008-09: 1,239 beds or 28 beds per 100,000 population

2010-11: 1,273 beds or 28 beds per 100,000 population

2012-13: 1,242 beds or 27 beds per 100,000 population

2014-15: 1,219 beds or 26 beds per 100,000 population

Source: Canadian Institute for Health Information (CIHI)

Comparable international rates:

The Netherlands: 137 beds/100,000 population (includes beds not counted as psychiatric in other countries)

Norway: 89 beds/100,000 population

United Kingdom: 58 beds/100,000 population

United States: 34 beds/100.000 population

New Zealand: 21 beds/100,000 population

Source: Mental Health Atlas 2011, World Health Organization

Edited January 4, 2020 by SpankyMcFarland

[SpankyMcFarland]

I think many of us have a fear of being dragged off to the asylum one day. In my youth I saw an old movie, The Snake Pit, and it greatly disturbed me. 

https://en.m.wikipedia.org/wiki/The_Snake_Pit

Of course, psychiatric wards aren't like that any more but it's still an unsettling subject to consider, which is one reason of many why funding for mental health needs to be ring-fenced. 

 

Edited January 5, 2020 by SpankyMcFarland

[Argus]

3 hours ago, SpankyMcFarland said:

A letter to the Lancet makes similar points. Note how low our per capita Canadian bed numbers are in the graph:

About half as many as the UK, maybe a third what Germany has.

But it's OKAY! We still have more than the Americans! Yay us! Everything is FIIIINE!

Edited January 5, 2020 by Argus

[Argus]

2 hours ago, SpankyMcFarland said:

I think many of us have a fear of being dragged off to the asylum one day. In my youth I saw an old movie, The Snake Pit, and it greatly disturbed me. 

https://en.m.wikipedia.org/wiki/The_Snake_Pit

Of course, psychiatric wards aren't like that any more but it's still an unsettling subject to consider, which is why funding for in-hospital psychiatric care needs to be ring-fenced.

Well it's not going to be. Canadians evidently don't care about health care, much less mental health care. We just had a federal election and no one even brought it up. We had a provincial election in Ontario last year and no one brought it up.

[eyeball]

6 hours ago, SpankyMcFarland said:

I think many of us have a fear of being dragged off to the asylum one day. In my youth I saw an old movie, The Snake Pit, and it greatly disturbed me. 

https://en.m.wikipedia.org/wiki/The_Snake_Pit

Of course, psychiatric wards aren't like that any more but it's still an unsettling subject to consider, which is one reason of many why funding for mental health needs to be ring-fenced. 

More often than not the world outside a psychiatric ward is even more of a Snake-Pit.  Another reason why funding is so scarce.

[SpankyMcFarland]

4 hours ago, Argus said:

About half as many as the UK, maybe a third what Germany has.

But it's OKAY! We still have more than the Americans! Yay us! Everything is FIIIINE!

Making international comparisons on per capita psychiatric beds in general hospitals, mental hospitals and community facilities is a murky business. Suffice to say, if we are even ahead of the Yanks, it ain’t by much: 

http://apps.who.int/gho/data/node.main.MHBEDS?lang=en

And we are way behind many European countries. 

Edited January 5, 2020 by SpankyMcFarland

[SpankyMcFarland]

37 minutes ago, eyeball said:

More often than not the world outside a psychiatric ward is even more of a Snake-Pit.  Another reason why funding is so scarce.

True enough. I had to read that twice to see what I think you were getting at. Chronic schizophrenics often have no jobs, few friends and not much in the way of family connections. I’d say they vote less often than the average punter as well. It’s easy to see why politicians prefer to be opening facilities that care for breast cancer patients or kids. 
 

The whole hospital/community care debate in psychiatry is weird if one views the brain as just one more organ that can go wrong and compares care of it with other specialties in that light. For example, patients with heart failure should be cared for at home as much as possible but hospitalization is also occasionally necessary. This obvious truth also applies in neurology, the closest specialty of all to psychiatry. 

Edited January 5, 2020 by SpankyMcFarland

[Rue]

On 1/4/2020 at 5:01 PM, SpankyMcFarland said:

I think many of us have a fear of being dragged off to the asylum one day. In my youth I saw an old movie, The Snake Pit, and it greatly disturbed me. 

https://en.m.wikipedia.org/wiki/The_Snake_Pit

Of course, psychiatric wards aren't like that any more but it's still an unsettling subject to consider, which is one reason of many why funding for mental health needs to be ring-fenced. 

 

The Charter of Rights makes it very improbable psychiatric  care can be imposed on you. Very few people are forced past 48 hours under psych observation where it was forced on them.

[SpankyMcFarland]

12 hours ago, Rue said:

The Charter of Rights makes it very improbable psychiatric  care can be imposed on you. Very few people are forced past 48 hours under psych observation where it was forced on them.

I was talking about the fears people have about psychiatric institutions. However, some people are involuntarily detained longer than that:

 

Quote

The detention may be for no more than 24-96 hours, depending on the province. In British Columbia, the person may be detained for up-to 48 hours for examination and treatment before admittance. In Manitoba, New Brunswick, Nova Scotia and Prince Edward Island a patient can be detained for up-to 72 hours, and in Alberta and Saskatchewan, not longer than 24 hours. Within that time, a different physician must assess the condition of the patient, and complete a medical certificate in order the patient to be detained for a further period, which can range from 14-30 days depending on the jurisdiction. 

https://www.legalline.ca/legal-answers/involuntary-hospital-admission-of-mentally-ill-people-and-length-of-stay/

Such legislation has to exist in some form for psychotic patients who are a danger to themselves and others. There’s a natural tension between safety and liberty here; relatives and communities are focused on safety while the patient is more concerned about liberty. 

 

Edited January 6, 2020 by SpankyMcFarland

[Argus]

Before we talk about forcing people to get the mental health treatment they don't want we should at least have enough doctors to treat the people who do.

[cannuck]

On 1/4/2020 at 6:09 PM, Argus said:

Well it's not going to be. Canadians evidently don't care about health care, much less mental health care. We just had a federal election and no one even brought it up. We had a provincial election in Ontario last year and no one brought it up.

Not at all true.  During the entire Federal election period, I repeatedly pointed out to anyone and everyone that one would have to be crazy to vote for the Liberals and Trudeau.   Obviously, it must be the lack of mental sick care that resulted in the government we have.

[Argus]

8 hours ago, cannuck said:

Not at all true.  During the entire Federal election period, I repeatedly pointed out to anyone and everyone that one would have to be crazy to vote for the Liberals and Trudeau.   Obviously, it must be the lack of mental sick care that resulted in the government we have.

Let me rephrase it then to say nobody in media or politics spent any time on the subject.

[SpankyMcFarland]

On 1/7/2020 at 4:45 PM, Argus said:

Before we talk about forcing people to get the mental health treatment they don't want we should at least have enough doctors to treat the people who do.

Involuntary detention of dangerously disturbed patients would still have to exist no matter how many psychiatrists we had in the country. Other countries also struggle to fill these posts - the work is distressing and, despite the many vacancies, the pay remains poor because of our system’s bias towards procedure-related specialties. 

Edited January 11, 2020 by SpankyMcFarland

[Argus]

36 minutes ago, SpankyMcFarland said:

Involuntary detention of dangerously disturbed patients would still have to exist no matter how many psychiatrists we had in the country. Other countries also struggle to fill these posts - the work is distressing and, despite the many vacancies, the pay remains poor because of our system’s bias towards procedure-related specialties. 

Yes, but we don't have enough mental health care professionals to even treat those who desperately try to get treatment. Nor enough doctors for other ailments, for that matter. Nor do we have enough facilities for addiction.

But people don't care or they'd be pressuring politicians to do something about it, and they're not.