We the people have spent way too much time lately listening to health care reform debates. The discussion has ranged from Cornhusker Kickbacks to Louisiana Purchases. The unions were bribed by exempting their cadillac plans from taxation until Obama is safely out of office. The elimination of preexisting condition exclusions was the only positive point that was offered. It was moved far enough into the future to be of no help to those of us that need it now. The one thing that was made clear was that neither side understood what was broke about the system. Let’s take a closer look at the system through a trip to a midwestern town on a Friday evening. The people and places we will meet and see are entirely fictional.
It’s Friday night in Strangeville, Anywhere. At the local college, the football team is playing its archrival, Bizarre U. After the game, the victorious visiting team is celebrating. The visiting cheerleaders and some of the girls traveling with the team as trainers have been planning their revenge for the previous season loss and subsequent fight. They jumped the home team cheerleaders behind the refreshment stand and tied up Buffy, Jill, Mindy, Brandi, and Brooke. They gave the girls a beating, getting the uniforms and boots muddy as they pushed and rolled the girls around and made them eat a dirt and worm concoction with tabasco sauce and raw eggs. They finished it off as kids will with an internet video making the girls bark like dogs and eat the concoction. For treatment of their injuries after the girls got loose, where did they go? They went to their local emergency room.
The emergency room was well lit and full of people as the girls entered it. A nurse took down their complaints and got admission and billing information. Then they were processed by a triage nurse and told to take a seat. Brooke and Buffy had had their hands tied behind them and their legs tied together as were the other girls. They had been bound back to back and had no real injuries, just acute indigestion and ropeburn on their wrists and thighs. They were in for a long wait. Jill had a fractured wrist from the fight when Carla had twisted her wrist behind her back. Mindy had a sprained ankle and a rash from the ropes on her wrists and arms. Brandi had been wrestled down and hog tied. Her knee had been dislocated in the process and was swelling up rapidly. Jill and Brandi were seen immediatley. They were both taken to x-ray and the put in booths in the back. They each saw a Doctor and had their injuries explained to them. The nurse gave them pamphlets on bone and joint injuries and even gave them tips on how to clean their uniforms and boots. Mindy had her ankle wrapped and was given a set of crutches. Buffy and Brooke got seen last, with a nutritionist advising the girls about the hazzards of too natural a diet.
Each of the girls were seen and treated according to the severity of their injuries. Pamphlets and information were available for the girls to read. Compassionate nurses and doctors were in and out of the booths. A specialist in physical therapy came in to check the dislocated knee and put it back in place. Other people came in to the emergency room as well. Agatha came in with a stroke. Sam was brought in with a heart attack. Bonnie was brought in after a serious car accident. Each person and their families were treated competently and compassionately. Pamphlets and information about the illnesses and course of treatment were available. Doctors and specialists saw the patients and families. The patients who would be admitted were taken to their new ward or the ICU. The patients and their families knew what would be happening to them. Sam had to be transferred with his heart attack. The doctor and a staff cardiologist treated him and briefed him and his wife on the illness and a little background information about the cardiac ward at the university hospital that had taken him. Once again, information and pamphlets were available as was the cardiologist.
This emergency room has treated everything from rope burn and indigestion to a cardiac arrest case. Everyone has been treated with compassion and the families have been kept informed as have the patients. This is great for physical injuries and diseases but where do people go with another type of problem? Where do people come when they suffer from mental illness? Now lets put a curve ball into the situation. Let’s meet a woman named Theresa and her husband Tom.
Theresa is a slender brunette in her mid forties. In high school and college she had been a cheerleader and prom queen. She and her friends had experimented with alcohol, pot and other recreational drugs as part of their social life style. Later in life she had two marrriages and numerous relationships under her belt. She had remarried husband number two, Tom. She has attended a lot of 12 step recovery programs and has been as addicted to them as she is to energy drinks and all the other highs she had experienced. Let’s see what happens when she goes to the emergency room.
Theresa called Tom at work and sad he needed to come home quickly. She did not elaborate but was crying. Tom arrived at the house to find Theresa writing notes and taking pills. He called an ambulance and got the pills away from her and scooped up all the empty bottles. The ambulance arrived and loaded Theresa and took her to the emergency room. Here Tom and Theresa start learning about the response to mental illness.
Theresa is treated kindly and compassionately by the nurses. They put her in a secured booth by the nurses station. Her clothes and possessions are removed and Tom is given them as he helps put a gown on his wife. The pills are starting to wear off as her body convulses again and again as pains rip thru her. Tom and the nurses hold Theresa down and put restraints on her wrists and ankles so she can’t hurt herself as she starts screaming in agony. Tom can only sit and hold her hand and wipe her forehead for what seems to be an eternity. At last her pains ease up and she goes to sleep. Tom is able to stay with her and answers the MD’s questions about what she took and how much. A psychiatric nurse interviews Tom with some inferred questions about abuse in the home. Tom lets her know that there is no abuse, physical, mental or emotional, in the home.
Tom has been asking questions about what made his wife do this, and who will treat her and where she will be treated. No one has any real answers. All he can be told is that she will be sent to icu and then a medical ward where she will be evaluated and stabilized. She will probably go to the psychiatric ward for a week or so afterwards. No one has any convenient pamphlets or any real understanding of how to prepare a patient and their family for what will happen or what a psychiatric ward is really like. There are very few facilities in the state set up to treat mental illness exclusively and fewer with the capability and bed space to handle walk ins. Patients like Theresa with no insurance and no money are at the mercy of facilities that can treat them with public funding.
Theresa is finally moved to icu, then to a ward. Tom still has not met the treating psychiatrist and he inquires about having his wife moved to a more suitable mental health facilitry. He then gets a shock as he is told that Theresa cannot leave the hospital without approval of the psychiatrist treating her or a judges order. Theresa finally gets a bed on the psychiatric floor, a small 24 bed ward with locked doors and restricted visitation. Tom brings her the personal items she is allowed to have and visits her nightly. Tom finally meets the treating psychiatrist the night before she is released and finds out she is bipolar and has been started on medicine accordingly. He picks his wife up with no real preparation or idea what to expect other than a nurse telling them both good luck and to bring her back if she relapses. No family counselling has been done and Tom still knows next to nothing about his wifes illness.
This scenerio is played out daily in hospitals across this land. Theresa and millions like her slip thru the cracks in our healthcare system. Theresa can’t go on a drunken rant and then sign herself into rehab. These are the people who can’t afford a private psychiatrist or therapist to listen to them whine about driving last years luxury car or wearing the same dress twice. Mental illness is still a dirty little secret in our society. Insurance caps, pre-existing condition clauses and very limited public funds and limited facilities condemn Theresa and those like her to care that is marginal at best. Her psychiatrist that is assigned to work with her after she is released sees her once a month for 30 minutes via sattelite tv. He disagrees with her diagnosis but is leaving her on the medication the hospital prescribed. No one follows up and makes sure she is taking her medication or keeping her counselling appointments. No one even follows up to make sure she can afford her prescriptions.
To date, Theresa has relapsed 3 more times. She has been thru 3 hospital emergency rooms, 2 trips to a psychiatric hospital and another stint on her local hospital’s psychiatric ward. The psychiatric ward has dedicated nurses and a doctor caring for everyone from Theresa and a few others with depression, a paranoid schizophrenic, a few geriatrics from local nursing homes being treated for dementia and alzheimers and a few others with drug issues and fried circuits.
We have committed a trillion dollars to health care reform but the real needs that are out there have not been met. Real, up to date mental hospitals and clinics need built and funding approved to train psychiatrists and nurses to meet this need. More funding is needed to pay for the poor and moderate income people to receive treatment. How a nation treats its poorest, weakest and most helpless citizens is, in the end, how that nation is judged.