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walkitoutA recent episode of Last Week Tonight with John Oliver was about mental health. John Oliver is substantially younger than me, and this episode made me even more bitterly aware of that than episodes of his show usually do. The degree of outrage at the difficulty of accessing mental health care that he is capable of feeling is, honestly, astonishing.
It was _great_ to hear him acknowledge that, you know, we used to _have_ inpatient beds and we got rid of all of them. He blames the problem on the failure to provide in community care that was promised with getting rid of the inpatient beds. However, when he describes an insurance company that pre-authed paying for a residential stay and then cut it short (or maybe denied it entirely — it was not clear), and he also describes teens and other young people stuck in emergency departments for a month or more because there are no beds available in psychiatric hospitals, I’m just sitting here thinking: well, what kind of community care did you think was promised that was going to provide residential stay? When Republicans wanted to privative / get rid of Medicare / Medicaid / welfare / social security and leave it up to families and communities, everyone clearly understood: Nope. We do not want grandma back or disabled uncle back or whatever. We want grandma and uncle to get round the clock skilled nursing care in an appropriate facility. There was some debate on the details and we worked it out, so now, if someone wants to stay in a home and receive care there, that can be paid for; if they want to be in an institutional context, that can be paid for. Obviously, there is never enough money and nothing is never as good as one wants it to be because obviously we all want grandma to still be young and spry and able to babysit the grands, and we wish disabled uncle wasn’t disabled and blah blah blah. But we said absolutely NO to that nonsense. But we said yes to getting rid of psychiatric facilities across the board. That was fucking stupid and we need to revisit that decision and start building more. We can make them better. We can make it so people can stay in when they need and can be in the community when that is working for them. We can make sure that we monitor for abuse and bad care and neglect and someone lying to commit someone who does not need to be committed or whatever it was that worried people so much that they okayed getting rid of all the psychiatric beds.
But Oliver is not there yet. Which is simultaneously enraging and devastatingly sad, and I just can’t with those emotions at the same time in an unending way so I just laughed hysterically instead. It doesn’t really matter if you think that makes me crazy; no one locks anyone up for that anymore anyway.
I am still so angry that my aunt was de-institutionalized. There is such a straight line between sending her back to live with her aging parents and messed up older brother and her death a very short period of time later. Failure to provide residential care for people who need it because of mental health problems kills people. Sometimes that’s an accident. Sometimes that’s a suicide. Sometimes that is being homeless and dying of exposure, or being the victim of some other person’s violence which in turn of that other person’s mental health challenges. Sometimes that’s a result of police being surprised or confused or just plain awful and murdering them. People would live a lot longer, and be a lot healthier, and might actually get _better_ if we were willing to provide residential psychiatric care with compassion and generosity, instead of saying, oh, well, someone did something one time that was awful so no more residential beds for anyone ever.
It was _great_ to hear him acknowledge that, you know, we used to _have_ inpatient beds and we got rid of all of them. He blames the problem on the failure to provide in community care that was promised with getting rid of the inpatient beds. However, when he describes an insurance company that pre-authed paying for a residential stay and then cut it short (or maybe denied it entirely — it was not clear), and he also describes teens and other young people stuck in emergency departments for a month or more because there are no beds available in psychiatric hospitals, I’m just sitting here thinking: well, what kind of community care did you think was promised that was going to provide residential stay? When Republicans wanted to privative / get rid of Medicare / Medicaid / welfare / social security and leave it up to families and communities, everyone clearly understood: Nope. We do not want grandma back or disabled uncle back or whatever. We want grandma and uncle to get round the clock skilled nursing care in an appropriate facility. There was some debate on the details and we worked it out, so now, if someone wants to stay in a home and receive care there, that can be paid for; if they want to be in an institutional context, that can be paid for. Obviously, there is never enough money and nothing is never as good as one wants it to be because obviously we all want grandma to still be young and spry and able to babysit the grands, and we wish disabled uncle wasn’t disabled and blah blah blah. But we said absolutely NO to that nonsense. But we said yes to getting rid of psychiatric facilities across the board. That was fucking stupid and we need to revisit that decision and start building more. We can make them better. We can make it so people can stay in when they need and can be in the community when that is working for them. We can make sure that we monitor for abuse and bad care and neglect and someone lying to commit someone who does not need to be committed or whatever it was that worried people so much that they okayed getting rid of all the psychiatric beds.
But Oliver is not there yet. Which is simultaneously enraging and devastatingly sad, and I just can’t with those emotions at the same time in an unending way so I just laughed hysterically instead. It doesn’t really matter if you think that makes me crazy; no one locks anyone up for that anymore anyway.
I am still so angry that my aunt was de-institutionalized. There is such a straight line between sending her back to live with her aging parents and messed up older brother and her death a very short period of time later. Failure to provide residential care for people who need it because of mental health problems kills people. Sometimes that’s an accident. Sometimes that’s a suicide. Sometimes that is being homeless and dying of exposure, or being the victim of some other person’s violence which in turn of that other person’s mental health challenges. Sometimes that’s a result of police being surprised or confused or just plain awful and murdering them. People would live a lot longer, and be a lot healthier, and might actually get _better_ if we were willing to provide residential psychiatric care with compassion and generosity, instead of saying, oh, well, someone did something one time that was awful so no more residential beds for anyone ever.