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Violence and the mentally ill: the myth of the hospital as a protective fortress

Posted Dec 01 2011 10:00pm

I went to a meeting today with the East Tennessee legislative delegation about mental health in Tennessee. Among the other people there was the commissioner of mental health and many people associated in one way or another to the mental health system.  The upcoming closure of Lakeshore Mental Health Institute was the central topic.  One theme seemed to predominate.  It was brought up in several different ways but the message was the same throughout.  They talked about public concerns and questions, but it came back to one subject.  “If Lakeshore is closed who is going to protect from the violent crazy people?”

The question was asked in all kind of different ways.  One administrator of another hospital asked whether or not there was a plan to deal with the disruptions in the emergency rooms caused by violent acting out people who were defecating on themselves that they would be unable to find placement for.  What he didnt seem to know was that there would be no sudden surge of violent defecating people in the ER.  Whether or not Lakeshore is open or not is irrelevant to the violent, defecating problem.  The ER is the entrance point for many people in to the mental health system.  It has been that way for a long time.  It will remain that way.

There is no horde about to be unleashed though.  There are a little over 1 million people in East Tennessee.  If you have any faith at all in current predictions about the frequency of  mental illness 306,000 of them will need mental health treatment in any one year.  Lakeshore has about 75 patients most of the time.  90% of them are released within 7-9 days.  They are the same people in and of other psychiatric hospitals.  The only difference is that they are poor.  They have no insurance.  They are not more severe.  They are not more violent.  The are much more poor.

There are about 40-45  people who Lakeshore has been home for.  They have been there many of them for years and there is no place in the community for them.  The superintendent of Lakeshore spoke in the meeting to that issue.  All we need he said is money.  About 38 of these people can make it in the community with support and help.  “There are about 8 people we are not sure of,” he said.  There are currently 7 other people who are forensic patients who are guilty of violent crimes and may be dangerous.  There are about 1100 admissions a year at Lakeshore.  The deeds of 15 have tarred the picture of all.

What I wanted to say to the hospital administrator was that if the mental health system of the poor and uninsured actually included enough community resources and supports to help them maybe his emergency room wouldnt be so full.  I confess to being extraordinarily cynical on the subject to but I had to wonder whether or not violent defecating people with private insurance had different results than those without insurance.

Another very nice lady wondered whether or not all the violent people might spoil the atmosphere on the psychiatric wards for the depressed people.  The commissioner pointed out that perhaps an inpatient psychiatric ward was not the best place to treat someone with depression, but I am not sure whether she heard that or not.  I know you can ask anyone who has ever been on a psychiatric unit and he will tell you one of the first things you learn is that the staff expects you to be “good.”  Rather it spoils things or not for “the depressed” it makes it much more difficult for the staff when people are troublesome.  To my knowledge every psychiatric hospital in this area has had at least an informal “do not admit list.”  One almost certain result of Lakeshore closing will be the death of the “do not admit list.”

There are neighborhoods in Knoxville that are much more dangerous than Lakeshore even on its worst days.  Study after study has shown the idea of violence and mental illness being closely related are a myth.  One study is linked below.  People with mental illness are far more likely to be the victim of violence rather than the source of it.  The myth of the mentally ill violent person and of the psychiatric hospital that acts as a protective fortress for the larger community is one of the greatest injustices done in the entire mental health system.

Someone in the meeting used the phrase “Not in my back yard.”  It is time for segragation to be a thing of the past for everyone.

There was a police officer there listening to the meeting.  I talked to him after the meeting and asked his opinion.  He shook his head.  “The real problem is not those people at Lakeshore.  I dont worry about them.  The real problem is the people out here.  Those are the dangerous ones.”

Amen.  Amen and Amen.



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