When patients in crisis came to our hospital, we worked to stabilize them and then plan for an optimal discharge plan, as long as it took. The team included psychiatrists, nurses, occupational therapists, psychologists, social workers, and mental health counselors who met daily to discuss patients’ progress and plan for their ongoing care.
The hospital programs included an emergency system that would direct patients to appropriate community treatment. If hospitalization was needed, there was a locked inpatient unit, an unlocked inpatient unit, a day hospital for transition to the community, and outpatient therapy services.
We worked with the state hospital in the region if long-term care was warranted and with community housing and day programs and state agencies that coordinated work programs. The patient was included in the planning, and family members were engaged in the process.
If patients had periodic episodes that required rehospitalization, they would return to the same system and to providers who knew them and cared for them.
Today, that continuity of community care doesn’t exist. Local hospital beds may not be available, and patients often wait in emergency rooms. Patients are discharged before they are ready and left on their own to organize treatment and ongoing care and support, often when they are least able to do so.
Our reliance on a patchwork of public and private medical insurance is no substitute for a coherent, consistent universal health care system that treats everyone.
We have a sick, ineffectual, and callous mental health system that works well for very few. It is an outrage in this wealthy land.
Marilyn Levin
Arlington
The writer is a former psychiatric occupational therapist.
After discharge, patients are met with a thorny outpatient care system
Madeline Lambert’s Ideas piece about her episode of manic psychosis is spot-on in describing the bewildering and demoralizing experience of the acute phase of this kind of major mental illness (“America doesn’t know what to do with mental illnesses like mine,” Nov. 9). It also captures the fragile state of mind that follows discharge from inpatient treatment. This is when a patient attempts to enter the early phase of recovery through an outpatient care system that is difficult to navigate, all while trying to avert relapse and the need for rehospitalization.
In many parts of the country, a successful transition to outpatient care is often thwarted by the lack of adequate post-hospitalization treatment programs that are accessible and affordable. This includes partial day hospitalization as well as wraparound interdisciplinary mental health teams based in community mental health centers, which include a medication provider, a psychotherapist, and a case manager.
Hospitals that offer inpatient mental health care should be strongly encouraged to also offer post-hospitalization partial day programs. Additional funds need to be allocated to support the expansion of interdisciplinary teams within community mental health centers.
Jerrold Pollak
Portsmouth, N.H.
The writer is a clinical psychologist and neuropsychologist.
Writer’s own story gives hope to survivors of acute mental illness
I am so grateful to the Globe for presenting the thoughts of someone who has experienced psychosis.
Madeline Lambert’s piece provides a rare opportunity to be able to read the words of someone with lived experience. It gives me hope that those of us who have survived acute mental illness and, with treatment, now live productive and often joyous lives will be listened to and respected.
Linda Larson
Cambridge