All the Things We Never Knew

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.

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2 replies
  1. Phil Evans
    Phil Evans says:

    Amen Sheila! Competence is essential. Another important factor in treating mental illness is Coordination of Care. It seems simple enough; but all too often fragmented systems of care leave the most vulnerable patients falling between the cracks when the system is not equipped to share essential treatment information, schedule and track referrals, and provide the proper follow-up care. The fact that David’s doctors didn’t even know of his death is the tragic evidence of a lack of some basic coordination.
    With today’s technological advances, a fully coordinated system of care is possible, and is even being practiced is some parts of the country with very good outcomes.
    Thank you, Sheila, your advocacy, and that of other powerful voices like yours, will make a difference!

    • Lisa
      Lisa says:

      Omg. I have been pushing this same thing with my husband now for two years. He had a major trigger and started drinking. A lot ! He has moved away from me and our children. This seems to have started back 5 years ago with a gastric bypass which altered his absorbsion rate. So none of his meds work. He has thyroid condition and he has gained a lot of the weight back. He has bipolar disorder and he needs coordination between all of his Drs to even start to have any hopes of recovery. His liver was so enlarged at the time of gastric bypass and I’m sure with all the alcohol it’s worse. My suggestion to him was to go to a place like Mayo clinic where there many specialists. I am sure that is the only way he can get coordination of treatment. It is imperative that people with mental illness have a support system in place. My husband has so much memory loss that he goes to the dr and doesn’t remember any of the important information to give the Drs. So no one can really help him. Laws keep me from getting him help. I am so frustrated. Thanks for working to help this situation.

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