Friday, July 1, 2011

And Medication for All?

At a time where justice seems to becoming more myth than reality I have been following the proceedings related to Jared Loughner, the young man accused of shooting Congresswoman Gabrielle Giffords and 18 others. He has been diagnosed with schizophrenia and in May the courts decided he was not competent to stand trial for the 49 counts against him, including the deaths of 6 people. He was transferred with little fanfare to a federal facility in Springfield, Missouri in June and since the 21st has been receiving psychotrophic medications against his will.

His attorney's argued that the federal facility did not provide enough evidence or reasons for medicating Loughner and that he should not be forced to continue the medications without a judge's approval.  Wednesday, Federal Judge, Larry Burns ruled in favor of the doctors treating Loughner,"I have no reason to disagree with the doctors here," Burns said. "They labor in this vineyard every day."  Amen brother, amen.

I admit to being conflicted about how we care for a man in Loughner's condition. I am too well aware of how limited mental health services are in the U.S. and how easy it is for someone with a severe mental illness to spiral out of control when they are off of medication. I know also, how these medications can impact a person's daily life and the plethora of symptoms the medications cause while treating the voices, tics, visions, and panoply of misery that is schizophrenia.

Long before my nursing degree I worked with adults with mental illness who were on parole for the Texas Department of Corrections, the vast majority also had a substance abuse problem due to their years of self medication to cope with the aforementioned mental illness. My job in a nutshell was to act as their guide back into the land of people who take care of themselves outside of an institution. How to ride the bus, buy groceries, take medication on time, go to AA, and meet with your parole officer were all part of our lessons, as well as reminders like, "Have you bathed this week?" and "No, you cannot wear that shirt again unless you go to the laundromat."

I did home visits to check up on their self care at everywhere from seedy motels, homeless shelters, the Salvation Army, boarding houses, group homes, and occasionally squallid apartments that would make sex offenders hope for death. I went with my clients to their parole appointments, to apply for social security benefits, and to get blood pressure medicine or teeth pulled. What I learned every single day in that job was that no matter how shitty I thought my life was...I had nothing to complain about.

The few clients I had who still had family members actively engaged in their lives were either ill themselves or looking to "borrow" money from them. Most reported their family members were dead, or simply did not want anything to do with them any more. Their families were fed up, tired, emotionally and/or financially exhausted and when the clients ended up in the pen, that was it.

The bulk of the individuals I worked with ended up in jail because they were accidental criminals. A prime example was a lovely gentleman named Wilbert, he was in his mid sixties, had been diagnosed with schizophrenia for all of his adult life and lived with his mama on the north side of Fort Worth, quietly tending her tomatoes, going to church with mama twice a week, and
staying away from alcohol and drugs.

Then his mama died, and Wilbert inherited her home. Not too long after he stopped taking his medicine and the neighborhood crack dealer offered up friendship as well as crack cocaine to calm his new buddy's voices and lickety split Wilbert had a new best friend. Fast forward six months and Wilbert's house was now the neighborhood crack den and when the police arrived everyone was smart enough to get out except... Wilbert.

By the time I met him, Wilbert had served three years in prison for dealing crack cocaine even though he could not tie his own shoelaces, manage his medications, ride the bus independently, or smoke a cigarette without setting the couch on fire. Quite the criminal mastermind.

Wilbert was fairly mellow when he took his medications, when he didn't he became very paranoid and hid from the world. He was never violent. Many of the people I worked with could become very violent when they became paranoid or heard voices and for my part I had no trouble imagining feeling pretty violent myself if I heard someone repeatedly calling me names or singing nursery rhymes, or thought I could hear my dead baby crying all night.

There was a constant pendulum swinging in the lives of the people I worked with between medication and non medication and sometimes over medication. They clients I worked with had limited education, less than limited insight, and getting them engaged in the process of finding just the right dose of medication was a battle punctuated by frustration on their part as well as that of their psychiatrist.

Day in and day out I saw that even though these people were legally adults they were not capable of making healthy choices for themselves on a consistent basis and while that was certainly their choice the consequences were shared by the entire community around them. No antipsychotic medication for some of these people meant public drunkeness, robbery, violence, and further costs to everyone for medical care and legal interventions. How does a community balance freedom from medical intervention with the need to provide a safe healthy community for the rest of its' citizens?

Jared Loughner is mentally ill, and absolutely no one denies it. Neither the prosecution nor the defense has debated his need for care or debated his inability to stand trial for his devastating actions. Rather the debate is about how much medication and what kind of evaluation is thorough enough before medications are forcibly administered to an incompetent adult.

Loughner's attorneys have stated that the physicians at the federal facility medicated him without a full and proper evaluation and that he is being overmedicated against his will. Here's the kicker though-how do you evaluate a man you have only just met, who has reacted violently to his own attorneys and family members and can't or won't assist in his own care? At some point, push has to come to shove, and prescriptions are written. So much of working with these patients is based on observation before and after medication and developing a plan of care that results in optimal health and behavior.

What would be the best possible outcome for this whole sorry mess is if our elected officials, people who vote and love those with mental illness, and budget bureaucrats would come together and realize that there will be more mass shootings and forced medications, suicide attempts and psychotic episodes, jail time and institutionalizations if we do not stop treating mental illness like the common cold.

Major mental illness does not blow in and stay for a week or two of misery. Major mental illness is not "the blues" or "feeling down." Major mental illness effects every single part of a person's life and therefore it effects every single person they come in contact with, every member of their family, workplace, school and it must be managed daily just like diabetes and hypertension. People with major mental illness deserve and require daily support to maintain their health, to stay on the proper dosage of medications, and to prevent harm to not only themselves, but to their communities. That harm isn't just physical, it's financial, legal, and emotional and the cost in dollars and cents is astronomical.

Case management works, there are multiple examples of ACT (Assertive Community Treatment) teams that work providing daily medication monitoring and support for people. The only problem is that these programs work so well people are able to hold down jobs and manage large portions of their lives independently-so they no longer qualify for the services that helped them get better. Surprise, surprise months later many are off medication, hospitalized, or in jail because they no longer had the support they needed to stay well and the cycle begins again. Except this time they have to recuperate or rehabilitate to a lower level of functioning because their brain has been even further impaired by mental illness.

Case management is expensive-but far less costly in money and human lives than this repeated roller coaster of mental health devastation. Time and again we are presented with an opportunity to change business as usual. When will enough be enough?

Read more:,8599,2080687,00.html#ixzz1QnBakmAz

Judge: Loughner Can Be Forcibly Medicated

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