(6-18-21) How long does it take for someone with a mental illness to become stable enough to be discharged from a hospital?

Roughly 30 percent of Virginia residents are discharged within seven days, according to a report. The others are discharged within 30 days.

Henry Johnson, the chair of Alexandria’s Community Services Board (which oversees mental health services in the county) said it took him 11 months.

He is urging Virginia Governor Ralph Northam to use state money to purchase one of the oldest hospitals in Virginia and convert it into a new state mental health hospital. INOVA has announced that in 2028 it will close its 318-bed Alexandria Hospital, which has operated for 149 years, and build a new complex in a former, large shopping mall that closed in 2017. It wants to raze the older hospital and sell the land  to housing developers.

It remains difficult in Virginia on some days to find available beds.

In addition, Johnson is calling on legislators to create a new classification that would make it tougher for hospitals to discharge psychiatric patients. Before a patient could be discharged, Johnson would require them to be able to advocate for themselves, have insight into their illness, and be willing to cooperate with a treatment plan for at least ten days.

In a recent letter, Johnson wrote: 

“This would be a huge step towards the long term health of the chronically mentally ill, and I believe would reduce crime, reduce recidivism, reduce overall cost of mental health treatment by making recovery achievable for all, and likely have profound effects on chronic homelessness in the Commonwealth.”

The anti-state hospital movement of the past is being challenged more and more, with several states expanding and building more hospitals. What do you think about Johnson’s call for more longer term beds and tougher discharge criteria? What do you think about using the INOVA hospital for mental health rather than high end housing? Tell me on my facebook page.

Here is a copy of Johnson’s recent letter to Delegate Charniele Herring, the majority leader in the Virginia House of Delegates.

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“We reaffirm that we are committed to the mental health and well-being of all individuals, that we are committed to healing and recovery for all those who seek it, and we are committed to inclusion and equity for all people. All those we serve, and all of us,” – incoming MHA president and CEO.

(6-15-21) Schroeder Stribling has been named President and CEO of Mental Health America, the nation’s oldest advocacy group for individuals living with mental illnesses. She replaces Paul Gionfriddo, the parent of an adult son with a mental illness, who has run the organization since 2014.

According to a press release, when she was introduced last Friday at an annual MHA conference, she said her experiences as a gay woman helped form the basis of her commitment to social justice issues.

“While my primary experience as a gay person has been one of acceptance and inclusion, this wasn’t the case for my biological father who himself was gay and who grew up in a very different time and place…his personal journey was difficult, he struggled mightily with depression and substance abuse.

“In my late teens and early twenties, I cared for him—as best I could at the time—while he was dying of AIDS…As you might expect, the experience was also traumatic for me—it overwhelmed my 20-year-old capacity to absorb the impact and led to anxiety and depression of my own. It took me many years afterwards to find the help and healing I needed to unwind the long tentacles of trauma. Three decades later now, my lived experience and that of my father, is the basis of my personal case for hope and my commitment to social justice.”

Mental Health America was founded in 1909 by Clifford W. Beers, who launched the group after being abused in both private and public mental hospitals. Historically, it has been the voice of individuals living with mental illnesses, although the larger National Alliance on Mental Illness, which was started in 1979 by parents, has recently expanded its membership to draw from that same base. A marked difference between the two groups is that MHA has traditionally opposed Assisted Outpatient Treatment while NAMI has endorsed its use as a last resort.

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(6-11-21) This is the third and last in a series of guest blogs written by Los Angeles Skid Row doctor Susan Partovi about Patty. As with all guest blogs, the opinions expressed are those of the writer. Please post your thoughts on my facebook page. What do you think about Dr. Partovi’s actions?

“Treatment First, Housing Second”

By Susan Partovi, M.D.

I hadn’t seen Patty for several weeks.  I had made a very difficult decision. If she came to me for help, I would only put her into a hotel if she agreed to begin taking a long acting injection version of the antipsychotic she had been trying to take orally. I struggled with this decision.

Am I manipulating her into taking her medications? Am I using a human rights need as a carrot in order to persuade her into taking her medications? 

No.

The only way she could stay in a hotel without destroying it or getting kicked out was for her to be mentally stable.  Otherwise we would just be wasting our grant money. Yes, she was safe when she was in a hotel, but her behavior was so unpredictable that she would continue to get kicked out.

It was a very difficult decision.

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(6-9-21) This is the second installment of a three part series about Patty as told by Los Angeles’ Skid Row doctor Susan Partovi. You can read part one here.  As with all guest blogs, the opinions are that of the writer.

Marinating

By Susan Partovi, M.D.

I wasn’t going to give up on Patty.

I began putting her in motels paid for by Homeless Health Care LA while waiting for her to get into interim housing. She stayed in one for a month but eventually was kicked out due to damaging the TV and having “inconsiderate” friends.

She tracked me down and I put her back at the original hotel where I’d housed her. I didn’t give her any antipsychotics this time, due to me being too tired and thinking if she wasn’t using, maybe she wouldn’t act out. Five days later I received a call from the manager saying she was “crazy,” but he didn’t speak English very well, and I didn’t take the time to try to understand what he was saying.

The next day he called me again, saying she had to leave. I said that I would get her in the morning. When I arrived, her door was open, her bed and bed frame were on their side, there was trash everywhere, the TV was shattered, the pictures were off the wall and destroyed; it was a disaster zone!

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(6-7-21)  This is the first of three articles this week written by Los Angeles Skid Row doctor, Susan Partovi. As with all guest blogs, the opinions are that of the author.

I Meet Patty

By Susan Partovi, M.D.

“I’m your new assistant,” Patty announced one day in 2006 when I arrived at the Homeless Health Care LA’s (HHCLA) Needle Exchange clinic in skid row, now called the Center for Harm Reduction.

She was short, soft spoken and a fast learner who could anticipate my needs in LA’s skid row. I was “the doc” who treated heroin injection users. Each week, dozens would arrive for help with skin infections and chronic wounds.

“That used to me,” Patty confided one day. “I was addicted to crack and was homeless on skid row.”

It was hard to imagine this bashful woman as a hard-core drug user. She would talk about her kids, especially her son.  When you work together helping the most difficult patient population, you form a bond. Kind of like war buddies. I remember one day, a regular came in with scabies….again. His hair was long and stringy. He was skin and bones. We stripped him down and Patty and I slathered the anti-scabies cream all over his body.

“You look like a wet puppy,” Patty kidded, causing all of us to laugh.

Another day, we saw a patient with a foot infection. He was a diabetic, but he couldn’t afford his medications. He was crying because he was in so much pain.

“Quick Patty, get me a basin with water and Betadine,” I said after he took off his shoe. We placed his disintegrating foot swarming with maggots in the tub as Patty proceeded to dash out of the room holding her hand over her mouth until she got to the restroom to throw up.

Like I said: we were war buddies!

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(6-3-21) When it comes to employee happiness, the federal agency responsible for mental illness and substance abuse programs has historically ranked at the bottom of federal polls – even years before COVID. A SAMHSA officials says it will be up to middle-management to find ways to boost morale. As with all guest blogs, the opinions are solely those of the writer. 

SAMHSA’s Important Work Can Be Strengthened with Cultural Change

Guest blog by Mitchell Berger

For a decade the Substance Abuse and Mental Health Services Administration (SAMHSA), an operating division of the Department of Health & Human Services (HHS), has ranked near the bottom of the Partnership for Public Service’s Best Places to Work in the Federal Government which is based on data from the annually administered Federal Employee Viewpoint Survey.¹

Currently, with the 2020 results pending, the Agency ranks number 417 out of 420 among Agency components and subcomponents.²

The federal government’s lead organization for mental health and substance use disorder must be at its best to effectively serve the vulnerable and traumatized populations that are the central focus of its mission. ^3,4

In my view, the ultimate key to potential improvement at SAMHSA lies with its ‘middle management’ layer– the branch chiefs, team leads, office directors, special experts, senior advisors and division directors, and their equivalents — that layer of management which is most numerous and comprises those with whom SAMHSA staff most typically and frequently interact. ^5,6

It is to these mangers whom many staff look day-to-day for guidance and leadership.

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