In the aftermath of a rampage by a psychiatric patient who killed a nurse and three patients at a Port St. Lucie, FL psychiatric hospital with his bare hands, a Florida co-conspirator, commenting in part,
“I’ll bet if this had happened in a media capital, the care of
psychiatric patients and the funding of the psych-care system would be a
prominent topic of conversation. People would talk about it on Sunday
morning talk shows. George Will would say that you have to expect a few
deaths on psychatric wards and it would be ridiculous to waste money making
them safer,”
send me this link to a Palm Beach Post feature on psychiatric nurses’ fears of violent patients. I’m of two minds about this. Psychiatric patients are already treated with enough irrational, xenophobic fear and stigmatization by the public that they don’t need anything that’d detract further from the compassion with which they need to be treated. But on the other hand, while statistics used to demonstrate that the mentally ill population is no more violence-prone than the general population, this does not appear to be the case any longer. I blame it mostly on global changes in the delivery of healthcare over the last decade, which can be neatly summarized under the rubric of “managed care. “
The upshot is fewer services, less continuity of care and less familiarity with the patients on an outpatient basis; and shorter lengths of stay and less thorough inpatient treatment when hospitalization occurs. Patients are sicker, and more apt to have been off necessary medications for longer, when they are admitted. A less thorough history to familiarize caregivers with the patient’s issues is available on admission or thereafter. The hospital units are less well-staffed, more chaotic and crowded, than they should be or had been in the past. The stresses of working under such conditions mean that veteran staff are more prone to leave the field, leaving care in the hands of generally less experienced and less well-paid nurses and mental health workers. Hospital administration has increasingly fallen into the hands of fiscally, but not clinically, sophisticated bureaucrats making decisions without firsthand knowledge of mental health care. Clinically astute caregivers such as psychiatric MDs are increasingly marginalized because of their intolerable agitation for quality-of-care measures with less concern for costs. Inpatient and outpatient services are more likely to see themselves as finger-pointing adversaries, pitted against each other competing to do more with fewer and fewer resources, than collaborators. Consolidation of health care delivery has meant that decision-making is more centralized, more removed, more corporate, less local, less responsive. And although this translates into more danger in treatment settings, the patients are largely the victims.
