Saturday, January 16, 2010

"He missed taking his meds several consecutive days this week."

Forced medication. If we just made that one simple reform, most of the problems of the severely mentally ill would be solved.

A patient who is taking his anti-psychotic medications (most of the time) does not have to be in a mental hospital. He can be a productive citizen and live integrated in his community. However, every patient with severe psychoses must have someone looking after him, such as a member of his family or a public guardian, to ensure the patient is taking his medications.

If the patient refuses to take his meds or "decides" to go off them for awhile, the guardian must be able to call authorities and have the patient involuntarily admitted to a psychiatric hospital where he will be medicated and where (hopefully) his mental health will stabilize. His release then will be on condition that he continues to take his prescriptions. If he stops, his guardian must then call authorities again and the process starts anew.

This mechanism would stop complete breakdowns in mental health and prevent the spiral into madness, homelessness, self-destruction, victimhood and violent criminality.

A good question is why so many mental patients refuse to take their medications, if they do so much good?

The answer, strangely, is that many people with severe mental illnesses have a secondary brain dysfunction called anosognosia*, which makes them unaware that they are sick. This explanation comes from the Treatment Advocacy Center:
Impaired awareness of illness (anosognosia) is a major problem because it is the single largest reason why individuals with schizophrenia and bipolar disorder do not take their medications. It is caused by damage to specific parts of the brain, especially the right hemisphere. It affects approximately 50 percent of individuals with schizophrenia and 40 percent of individuals with bipolar disorder. When taking medications, awareness of illness improves in some patients.

Impaired awareness of illness is a strange thing. It is difficult to understand how a person who is sick would not know it. Impaired awareness of illness is very difficult for other people to comprehend. To other people, a person’s psychiatric symptoms seem so obvious that it’s hard to believe the person is not aware he/she is ill.

Yesterday in Woodburn, Oregon -- a town near Interstate 5 about halfway between Salem and Portland -- a mentally ill man who stopped taking his medications (and was not forced to resume taking them), presumably because he also has anosognosia and is unaware that he is sick, drew the attention of a host of personnel from the local police and sheriff's department, including a SWAT team, when he went "crazy." Ultimately, all of the violence he committed was directed against himself:
A SWAT team with snipers was called to a Woodburn residence Friday morning after a man with a history of mental illness was reported as “out-of-control” and throwing things.

Woodburn Police Department (WPD), Marion County Sheriff’s Office (MCSO), Woodburn Ambulance Service, and Woodburn Fire District responded around 8:30 a.m. to the residence of Jeremy Baesman, 32, who had barricaded himself inside his home.

According to WPD Capt. Doug Garrett, Baesman then began turning his attacks inward.

“He had knocked out at least three of his teeth with a hammer on his own,” Garrett said.

“He had also … it looked like he had some self-inflicted lacerations on his legs from either a knife of some sharp instrument.”

Garrett said Baesman was “obviously extremely injured,” with dried blood on his face and both hands swollen. The police captain said he thought he’d broken his hands, likely from punching walls or other hard surfaces.

He had a previous arrest record involving an assault-related incident in Woodburn. In that incident, he was hit with a taser multiple times.

Garrett said family members were aware the man was on medications for a mental health illness, and thought he had missed several consecutive days this week.

*Anosognosia is pronounced: ə-nōˌsŏg-nōˈzē-ə or uh-NO sog-NO-zee-uh.

No comments: