That Horrible Thing on Everyone’s Mind
I have been consciously avoiding the news this weekend. I understand and am deeply saddened by the events in Connecticut like everyone else. Sadly, there is nothing that I can do. One more card from a stranger isn’t going to ease the burden of a small town that experienced 28 senseless and violent deaths in one day. The pain is unimaginable and the fact that we can’t do anything about it frustrates us.
The truth is, when we focus so intently on a single thing, everything else in our lives is pushed to the shadows. The Sandy Hook shootings are very important. Make no mistake. There are lessons to be learned and studies will take place and hopefully policies will be changed. But not tonight and I am pretty sure the real lessons will not come from people on the news channels shouting over each other about gun control, access to psychiatric services, etc.
If you are reading this, you are likely a healthcare worker or work closely with health care workers. As such, we are in a unique position to take the information we already have and put it to use in very important ways. As a professional, you can even make it a point to learn more about mental health issues.
We talk about healthcare politics a lot. Gun control seems to be a very popular topic. We talk about access to mental health care. But what I have noticed in my work lately, is that we ignore mental health.
I see Zyprexa in a med list with no psychiatric diagnosis. I see patients assessed as having no signs and symptoms of depression in the past 14 days even though they have just been released from the hospital status post open heart surgery. If I am reading charts in areas I frequent, I will notice that a young person is living in an assisted living facility and ask why?
Sometimes I see reference to ‘drug seeking’ behavior as though the patient isn’t behaving properly. I see enough written skillfully to read between the lines when a patient’s medications are being stolen by relatives.
These issues are not grounds for denials and I cannot recall any state deficiencies related to lack of a diagnosis related to Zyprexa. I would certainly see a denial if a patient with high blood pressures went an entire episode without them being addressed.
So, it isn’t just ‘us’. We have a culture that overlooks mental illness as being unimportant. There is no lab test for it. Patients with mental illness are often on Medicaid and we all know how undesirable a boatload of Medicaid patients are. The interventions for psychiatric conditions are vague and the language used to describe psychiatric symptoms is strange to us.
Our patients are hardly likely to go on a shooting spree. That is not the point. My point is that if we, as health care workers, do not recognize, acknowledge and do our very best to treat mental illness, we are failing the patient. That is true even if you are not a psychiatric nurse. Patients admitted for any reason should have their primary diagnosis plus all diagnoses that affect their ability to participate in or respond to their plan of care addressed.
I’ve started you out by uploading some ideas taken from the internet on rational behavioral therapy that you can discuss with your patients who are depressed. It sounds much more complicated than it is. Don’t get me wrong – I love a good antidepressant as much as the next person but it is not enough to simply ignore depression while you wait for the meds to kick in.
As long as we continue to pretend psychiatric illness does not exist, we can hardly complain when others do the same.
You with me on this one?
I noticed one outstanding headline as I browsed the unthinkable in today’s headlines. “Conneticut mother keeps daily struggles with mentally ill son undisclosed.” Those are not the exact words, but something to the effect that she TRIED to deal with a mentally ill loved one alone and without help. Did she do this because she was ashamed or because the system is inadequate. I’d say both. There is still much stigma attached to mental illness and there is a tendency for the healthcare professions to prescribe a pill and be done with it. What makes people like Adam do the unthinkable? We’ll never know what made him do what he did; he is gone. Some say, “Good riddance.” I say, “Another tragedy.” Could he be helped? Maybe, maybe not. But, he was once a 6 year old child sitting in a classroom; the same classrooms where he indiscriminately killed innocent children. Was he once an innocent? Yes. He didn’t wake up Friday morning and say, “I think I’ll go kill a bunch of kids at my old elementary school.” What did we miss in the last 14 or so years since he was among the innocent? And who today is among the innocent sitting in some elementary school class room who might do the unthinkable in 14 years? The news today is heavy with other shootings and killing. Others who feel they have no recourse, but to act out violently. A gun in MY hand (which is not likely to happen) will do no harm. But, in whose hand will it kill or maim? That is what we need to know; to answer that question before there is more tragedy and pain and grief.