Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists. A place to talk; no one has to listen. All patient vignettes are confabulated; the psychiatrists, however, are mostly real. --Topics include psychotherapy, humor, depression, bipolar, anxiety, schizophrenia, medications, ethics, psychopharmacology, forensic and correctional psychiatry, psychology, mental health, chocolate, and emotional support ducks. Don't ask. (It's not Shrink Wrap.)
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I thought people might be interested to know that the Associated Press just updated its style manual to give guidance to journalists writing about people with mental illness. Besides the obvious advice like "don't use words like 'crazy' or 'nuts'" (and it's sad they'd really have to tell someone not to do that), they also advise journalists not to automatically attribute the behaviors they're covering to mental illness: "Avoid interpreting behavior common to many people as symptoms of mental illness. Sadness, anger, exuberance and the occasional desire to be alone are normal emotions experienced by people who have mental illness as well as those who don’t." Writers were advised that violence alone is not solely a sign of mental illness and to avoid relying on bystanders' statements that the subject of a story is mentally ill.
This is good. Now the American Psychiatric Association needs to put together a style manual for talking head mental health types. If you go in front of a camera or behind a microphone (or keyboard) to comment on someone in the news and their alleged mental problems, you should know your professional and ethical limits. I've written about the problem of mental health professionals in high profile cases before over on Clinical Psychiatry News.
This is not to say that mental health professionals shouldn't be involved in the media. They can provide a broader context for a story, correct inaccuracies and give an 'insiders' view of a story that may help the people get a better handle on what's going on. But, this should be done responsibly.
On CBS news yesterday I saw this report about mentally ill people who end up in jail. The sheriff of the Cook County jail complained that psychiatric patients who don't take their medication become criminals and added, "We're not a mental health facility. These people should not be here.''
Simultaneously this week in the Baltimore Sun we have this story, where hospital workers complained because malingering criminals were being held at their facilities.
This week's news is a terrific example of what I call the Reese's Peanut Butter Cup problem of forensic patients. (I put up the old commercial for reference.) Each side is basically complaining that they have to provide care for someone. Nevermind that people can't be cleanly divided between the "mad" and the "bad," or that people who "only" have personality disorders can still die from those disorders. We waste a lot of time and energy arguing about who should be where and who should be doing what.
The bottom line is that we have to figure out how to deliver the right care to the patient regardless of the setting. Forensic patients require treatment as well as security. That sheriff needs to realize that his facility will always require a psychiatric infirmary and mental health services and that he's not going to be able to "clean house" off all the psych patients. Similarly, hospital workers can't write off every assaultive patient as being "just a sociopath."
We need to beef up hospital security so everyone, patients and staff alike, can feel safe. And jails need to be given enough mental health staff so the administrators won't feel like they're being overrun with chaos.
Getting rid of the patient is never the right answer to a health care system problem.
Over on the Clinical Psychiatry News website, I have posted the testimony I gave at the legislation hearings in Annapolis on Friday. It's a open letter to any legislator, in any state, who is thinking of following suit after New York's SAFE Act which requires mental health professionals to report patients who may be dangerous.
“If any Shrink Rapper ever has the time and inclination it would be interesting to read about what you would do to fix the mental health system, particularly the issue of involuntary hospitalization, if you had unlimited funds and political resources. You've been in the trenches, it would be great to hear your thoughts.”