@ProPublica Noem might be untrainable in the ways of ethics.
@ProPublica From the article: “financial incentives may drive for-profit hospitals to turn away more complicated patients… hospitals can save on staffing and other costs if they admit healthier patients and avoid patients with the most severe psychiatric needs — a tactic she called “cream-skimming.”Although I had not seen it called “cream-skimming” before, this is a practice that is acknowledged even by some physicians and therapists. It’s a practice not only motivated by financial considerations, but also by a desire to see patients get well and the difficulty of trying to help patients who may never get well. Some physicians, knowing they are dealing with an illness, have admirable patience and longterm commitment; others do not. A therapist one of my children saw accidentally included my wife in an email she sent to her business managers explaining that she thought our challenging child was not a good candidate for continuing services. There is an inside joke among providers that if a potential client calls to seek treatment for a personality disorder, the right answer is that the practice is not taking any new patients. It is also a problem that patients experiencing a psychiatric healthcare crisis are often unable to effectively communicate or advocate for themselves, perhaps because their thinking is very disorganized from delusions or they are overwhelmed by a generalized psychic burden such as in the case of major depression. If they don’t have a family member to advocate for them they may be at the mercy of doctors who know little about them and are practicing in an area of medicine that may be more difficult than any other—the human brain is the most complex known object in the universe. And, even if a patient has a family advocate, there are HIPAA (Health Insurance Portability and Accountability Act) legal concerns that can be obstacles to communicating. This is especially true if there is a suspicion that family members are the underlying cause of the problem and they may not have the patient’s best interests in mind.
@ProPublica These are complex issues with concerns about costs of psychiatric care, high rates of treatment that is ineffective or only marginally so, high relapse rates, civil liberties concerns, and stigma. Most readers with an interest in mental healthcare will not like the content of your article and this is why: Since nearly 40% of individuals are expected to have some kind of diagnosable (but maybe never diagnosed) mental health issue in their lifetime but less than 5% of the population experiences serious mental illness, the majority opinion among those with an interest under the gigantic umbrella of mental healthcare focuses on civil liberties and stigma which are highly pertinent issues to those with milder and more treatable conditions who never experience the kind of emergency situations that you describe. Meanwhile, the less than 5% who have serious psychiatric illnesses are often treatment non-responders or only partial responders. It is the <5% who can become the “frequent flyers” that are fully disabled and abandoned to homeless, entangled in the criminal justice system, or dead. This happens partly because psychiatrists and hospitals are unable or unwilling to help them, partly because less seriously ill persons in the “recovery movement” are embarrassed by their behavioral symptoms and want nothing to do with them, and partly because civil rights advocates for taxpayer-supported groups like Disability Rights and private organizations like Scientology are often anti-psychiatry and advocate for the right of seriously ill persons to reject treatment while seldomly if ever advocating for their right to receive treatment even after they have lost the agency to make rational decisions about their own healthcare. Civil rights advocates go silent about involuntary treatment after a serious crime when prosecutors seek to restore competency so persons with serious psychiatric illnesses can be tried and punished for their symptoms. By then it is too late. What is needed to overcome the impass between advocates for and against treatment of serious psychiatric illnesses is an acknowledgment that what works and is appropriate for less serious illnesses does not always work for serious illnesses, like skin lotion works for many dermatological conditions but not for melanoma. Psychiatric hospitals need to become far more pleasant places with adequate beds so that more patients will voluntarily seek care and those traditionally opposed to involuntary care due to civil rights concerns will reduce their ideological opposition and accept that it is necessary under rare circumstances without waiting for a serious crime, homelessness, or death.
@Swede1952@universeodon.com Well, you’ve crafted in lovely prose a mental picture of that abandoned house and the dense vegetation engulfing it. 🙂
@Swede1952@universeodon.com He was dreaming of you each night while you were gone.