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What is the most important factor in treating mental illness? Competence.

It’s been nine years this week since my late husband David died by suicide. Everything about this time of year releases a cascade of emotion that is unbearable, the softening of the light, the gold and amber in the leaves, the heat during the day dissipating to cold nights. There is a vivid memory of David’s state of mind, a cold, agitated horror at his state of being. Even breathing seemed to be an effort that exhausted him.

At a time when we needed the very best care we could get, we experienced a system that retraumatized David to the point of hopelessness. An initial misdiagnosis, a prescription that pushed David over into a state of akathisia and suicidality, a lockup care center whose contracted doctors made money– not by helping people– but by admitting as many patients as they could squeeze into a bland and hopeless enclosure. We knew it was oppressive when we were in it, but, in insight, it was also a shameful failure of care.

Currently, there is no standard of education for a diagnosis. Many people treat depression, including family practitioners and social workers, and the varying degree of competence is maddening for families who are desperate for quality care. Families seeking help find professional camps divided between psychopharmacology and psychotherapy. And often, medications compound the suffering. Caught in the middle, patients are dying.

This year marks the tenth consecutive year our nation’s suicide rate has increased while outcomes for heart disease, diabetes, and cancer are improving. Half of those who died by suicide were under the care of a general practitioner. One-third of those who died by suicide were under the care of a psychiatrist. As one doctor told me, “It’s time to put the head back on the body.”

We demand excellent outcomes for every other major disease. We track success rates for heart surgeons. We compare and contrast survival rates for cancers. Why has the treatment of mental illness in our country been so lacking that many inpatient psychiatric centers don’t even bother tracking the outcome of their patients? David’s doctors didn’t realize he’d killed himself just one day after his release!

We could be saving lives by coordinating patient care- sharing essential treatment information, scheduling and tracking referrals, and providing proper follow-up care. With today’s technological advances, a fully coordinated system of care is possible, and is even being practices in some parts of the country with very good outcomes.

I’m just one survivor. But for every death by suicide, the National Institute for Mental Health suggests eight people are profoundly affected. Last year, 41,000 Americans died by suicide. The toll of grief, confusion and chaos impacts hundreds and thousands of people every year.

What is the most important factor in treating mental illness? Competence. We should demand it.