*DISCLAIMER: I am not a doctor, therapist, or health professional of any kind. I’m sharing things that I have been taught that have helped me (or not). This is my experience.


Wednesday, July 11, 2012


Today I found out that I am not under court committal.  When I was talking about being discharged from the facility I was in they assured me I would be on outpatient committal, and that it would include having services.  By services I mean SCL (Supported Community Living) and IPR (Intensive Psychiatric Rehabilitation) services and in order to have those services you have to have case management.

SCL services can include any range of things including rides to appointments, making sure medication is refilled on time, etc.  It's all based on your personal needs.  IPR, although it sounds like a deep serious thing, it comes down to using small steps to complete a long-term goal having to do with education, financial, social, or transportation.  Case management basically sets up these services and is available as a resource.

I don't think these services are a bad thing, don't get me wrong.  SCL and IPR services were very helpful and I enjoyed working with the workers I had when I was living in a city where I knew no one.  It was good for me to have someone checking on me a few times a week.

I spent time and was stressed out about getting these things set up so I could leave.  What makes me angry is that I was given the impression that I was not given a choice about having these services.  I have been dealing with people in these services in the area that I live since I got here.  I have been basically teaching them about my illness and what the court advocate said I needed from them to prevent relapse.  These people, my case manager here and the SCL worker, know very little about mental illness, in particular schizophrenia and schizoaffective disorder.  They do not have IPR in this area yet.

After putting all this effort into trying to be sure I was meeting the court's idea of keeping me from relapse, I find out that it was a wasted effort.  I am very upset that the court didn't notify me that my committal was dropped when I left the facility, not to mention that they made me believe that these services were required.

I am seeing a therapist that has 30 years of experience in mental health that I didn't have explain what my illness is defined as, that I believe is a much more beneficial than any of these services I have in place.  I agree that it's good to have someone to check in with me regularly, but if those people are uneducated in what to look for when problems come up is pointless.  In this area services are more geared toward those who are intellectually challenged than the mentally ill.  I feel confident that seeing my therapist once a week is enough.

I am relieved that I am not under court committal but I am still worried that not if but when I relapse, I will end up back in placement.  I think that it's ridiculous that when I go into the hospital I am asked what I did wrong to end up there.  I have a chronic mental illness.  I should be able to go to the psych ward when I am in crisis.  It makes me angry that instead of trying to help me, they're asking me what I'm doing to make myself relapse.  You don't ask someone with alzheimers why they keep forgetting things.  When we were meeting in the facility about my discharge they were saying the same thing, "What can YOU do differently to prevent hospitalization?"

It all boils down to money.  They don't want to spend the money to help me (and others with mental illness), they would rather punish me for coming to the hospital.  My point is that I come to the hospital when I have no other choice, when I'm so depressed or psychotic that I want to die and could act on those impulses.  There are times when I can't get into my psychiatrist for three weeks and I need a med adjustment NOW.  I shouldn't have to compete with substance abusers and the homeless for a psych bed when I need help.  There should be emergency beds at substance abuse treatment centers for people who OD on illegal substances or alcohol.  Instead they take up beds in the psych ward which are supposed to be meant for people who are mentally ill.  They're not meant for people who don't have a place to go, they should be taken to shelters or a church.  I have a chronic mental illness and depending on the day of the week that I go to the ER I could be sent across the state to some tiny shithole of a psych ward because there are no beds anywhere else.

Instead of funding research for finding better medications and solutions for people with severe mental illness we focus on cancer and depression.  Very seldom is there any substantial research on things to help the truly mentally ill.  Take schizophrenia for example:  Schizophrenia usually starts in early adulthood, where most people start paying their debt back to society.  Think about it, we pay taxes to pay for them to go to school for 13 years before most of them start paying social security income taxes.  Then when they have their onset so many are completely disabled, some for the rest of their lives.  We pay these people SSI payments and give them Medicaid because they can't work.     You tell me what illness costs more.  Not to mention the heartbreak schizophrenia causes.  When people get alzheimers most have worked many years before the government has to start taking care of them.  And yet we spend so much money on finding cures for everything else.

Then there's the system of sending patients to RCFs (Residential Care Facilities).  It costs the state a lot of money when you're in the hospital if you have medicaid.  They want you out of there as soon as possible and if you're not making progress you will be sent elsewhere.  Think about this:  The med changes are not working, you're still suicidal, you don't have anyone to take care of you to the extent you need.  They are still going to get you the hell out of that hospital.  In an RCF you see a psychiatrist every three months and are barely observed by a staff that has little to no education or experience in mental health.  In an MHI (Mental Health Institution) you see the doctor much more frequently and are almost always observed by people who have both education and experience in handling all kinds of mental health scenarios.  Where are they going to send you?  To the RCF.  Why, when you need medication changes and observation, would they send you to a place that does none of those things?  Because the federal government does not reimburse the state any of the money they pay for you to be in an MHI.  At an RCF the rates the state pays are much lower and they are mostly reimbursed by the federal government.  MHI stays are much shorter than RCFs and people who receive SSI and SSDI have to pay for part or all of their fees associated with the RCF.  I paid $861 out of my $956 check, every month.  That doesn't include you pharmacy bill.

To put it simply, the mental health system is totally fucked up.  The mentally ill are far from the top priority.  I know in some areas of the country there are respite centers but where I live that would be a dream come true.  Psychiatric professionals are scarce in a lot of places (including here) and many choose to practice privately so they can be selective of their patients.  Some outpatient psych treatment centers have policies that if you see someone outside of their clinic, you can't come back.

I never want to go into the hospital again because I don't want to get stuck somewhere for doing the right thing.  Everyone sees a hospitalization as a negative thing.  But I see it as a situation where I could have committed suicide, but instead I got help.  That sounds like a positive coping skill to me.

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