The behavioral health place she was at was not perfect, but she would not be where she is right now if it weren’t for her having to be there.

For years I have told myself that if I somehow become wealthy, I will spend my time and money improving mental health resources in my area. After hearing her stories about the place she was at (one of a couple hundred owned by a public company), I wish I had the resources to start a place that did everything right.

I’m sorry you had a bad experience. It’s really messed up.

Schools too. My mum spent two decades as a primary schol teacher, and it's an open secret in that industry that Ritalin and other behavioural drugs are, at least in some cases, administered for the benefit of the teacher and other students in the class - not necessarily for the child receiving it.

Not necessarily does not mean never, so be careful of a claim like that, and maybe back it up. I have a daughter, now an adult, which Ritalin and/or Adderall provided real benefit. The only thing in question was how to find the right one and right dosage to minimize the side effects )lack of appetite and sometimes stomach aches). The difference was very clear, and was exhibited multiple times. For example when we let her go off it at her request during the middle of her sophomore year in high school, and she went from getting B's and C's to getting flunking a quarter of four of six classes, and then going back to not flunking anything and getting mostly B's by the end of the year when she went back on the medication. This was not an isolated incident, it happened 2-3 times over junior high and high school.

That's the thing about medication. Different people respond to it in different ways. That's why studies look for statistical significance, not "guaranteed to do what it says".

Edit: The language of the original comment has since been softened to no longer imply that's the only or main reason, which I appreciate.

I'm sorry to hear that. I believe that's why we had mandated psychiatric visits while my daughter was on the medication. We couldn't get refills without meeting with the doctor to discuss how it was going. It definitely sounds like it wasn't working well for you, either because of how the medication expressed itself in your case or your specific school situation, or a combination thereof.

> Maybe we could re-evaluate the school system instead of drugging kids to be more scared and spineless?

While I'm not going to argue that school couldn't do with a bit of change, I'm not sure it's fair to extrapolate what everyone's experience is from what happened to you.

As an example, I remember an incident early in seventh grade there was an incident in gym class when we were being taught the fundamentals of wrestling, where after one match and unfortunate classmate earned himself the nickname 'boner' and the ridicule to go with it, which lasted a few years. This undoubtedly made his life much harder. A number of lessons could be taken away from that situation, but "we should stop teaching wrestling in gym class" is probably not one of the better ones.

Should we stop medicating students? Maybe. That probably depends on quite a lot of factors, most of which I don't know enough about. But I would hope that a better solution where those that the medication helps take it and those that it doesn't or the problems associated with it are enough to make it a bad choice don't is an achievable outcome that we should strive for.

But the problem is generic. USA schools have all the code smells: employees who are “just doing their job Ma’am”, or reacting knee-jerk, politics being involved leading to no solving issues but communicating a lot on them; no-xyz policies (replace with any CNN topic of the time) which leads to extreme response to normal youth events (overreaction to suicide or misbehavior, police in schools, searches come to my mind, but there is worse), competition between children, not only in curriculum but also in who’s the most popular and the most bully, drugs… And finally, the prevalence of psychologists compared to other countries, but psychologists that prescribe Aderall (US schools are world-famous abroad for threatening to curb energy with drugs on, mostly, boys) instead of working with teachers to better alternate recess/manual classes/theoretical lessons.

Of course it’s easy to tell from abroad that something is wrong, but less easy to tell how to setup different social dynamics that would result in a better system (and France certainly has its own problems with schools). It might even be as subtle as too much sugar in kid’s food, which changes behaviors a lot.

For many people, d-amphetamine or cannabis are better treatments with less side effects.

Yes, they are not related, but both are taken for their dopaminergic effects, though they achieve this by different methods (reuptake inhibitor vs agonist).

Generally, in the course of treatment for ADHD, patients will get to try both to see which one they respond to better. They often exhibit strong preference for one over the other (personally, dex does nothing for me, even at recreational doses of 50mg).

Their risk profiles are very similar, and one cannot be said to have "less side effects", unless referring to a specific individual's response.

Are there similar studies regarding the ADHD meds?

Ah yes gen z are the only ones... the only ones to be sad and mad. Never mind the generation having to be drafted and die in Vietnam. Never mind the generation having to fight in WW2. Never mind the generation having to take care of your ass.

I had breakdowns from social anxiety everyday in 7th grade in 2003. I got nothing. I would have rather have drugs.

the zoom zoom is showing. Go to bed please its past your bedtime.

Take an example of someone who posts solely facts in a controversial topic. Folks that disagree with the direction the facts point will ascribe all manner of negative projection to said poster. But does that reflect on the facts-poster, or on the interpreters?

Online communication is such an odd thing.

It's not about saying it's not possible, it's about setting expectations, and scaring people away from a medication which may be helpful.

>> Ritalin and other behavioural drugs are administered for the benefit of the teacher and other students in the class - not necessarily for the child receiving it.

That clearly states the reason it's administered is not primarily for the child's benefit. While it doesn't discount that the child may benefit, it clearly sets the expectation that it's not the child's well being that's being considered. The natural extension of accepting that is to wonder if there's any actual benefit to the child or if that part is just in service to "the secret".

Implying that the reason a specific medicine is prescribed is not actually for the benefit of the patient might have real repercussions if it scares away someone that it could have haloed. At a minimum, I think a statement like that should be backed up in some manner.

A single mom, exhausted with 2 part time jobs and 3 young kids put them in front of tele tubies all day long. Is that for her own benefit or for the benefits of the children? We don't even have clear evidence of the overall impart of such educating programs on child development. But we have to use common sense and agree it benefits carers if they want to get more time for themselves. It doesn't imply careless attitude, or consciousness of the motive, the kids appear to enjoy anyway. I think the comment was made out of common sense: attention deficit of just one student can cause serious classroom management issues, it isn't naive or prejudicial to point out what we don't hear very often: the prescription isn't for the child own' benefit.

I held off a long time. But finally relented. Night and day difference. Rolling around on the floor endlessly to top of class.

I haven’t found one my body can tolerate for long. But it was so weird to feel normal and not this horrific agony at trying to stay on task.

I do have an actual diagnosis and doctor for ADHD

You can be a horribly depressed empty shell pf a human, but still "function" in society.

That's definitely correct. It can be a great help for some children, and some teachers (maybe even the majority) do make carefully considered decisions where the primary concern is for the welfare of the child receiving the drugs.

Other times, though, they just want some ratbag kid to STFU so they can get on with their job.

I distinctly remember overhearing a conversation where a teacher wanted to (in her words) "sedate" a problem child so that they don't disrupt the rest of the classroom.

In the United States, teachers do not prescribe medications. They may make a recommendation that parents seek the guidance of a doctor, and a qualified medical professional (usually a psychiatrist) will diagnose the child, and the parent may choose to pursue medicating or not. In our case, we had regular checkup appointments with a psychiatrist where our daughter and us were present at the same time, and a later point in the session where the parents were asked to leave so the psychiatrist could speak with her privately.

> I distinctly remember overhearing a conversation where a teacher wanted to (in her words) "sedate" a problem child so that they don't disrupt the rest of the classroom.

Unless the laws have changed since then in Australia, Ritalin is a controlled substance, according to this, and it's not even guaranteed a general practitioner can prescribe it, and a psychiatrist is preferred.[1] Maybe you misheard, or maybe the teacher misunderstood what their capabilities were?

1: https://www.health.nsw.gov.au/pharmaceutical/patients/Pages/...

Just like in the US, teachers here can make recommendations for parents to seek medical treatment. Said recommendations can include comments like "I suspect your child has ADHD". While nothing is guaranteed, if the parent follows up on it there's a good chance the child will be medicated.

You say that, but we went through three recommendations over 5 years or so and following doctors visits where we were told initially that it was hard to tell because she was young, and that she might grow out of it, and the doctors did not recommend medication at that time (so we didn't, until on the last one where that diagnosis and recommendation changed based on her age and behavior).

The problem with statements like "there's a good chance" is that it's likely based on your understanding of things and not actual statistics or hard data, and meanwhile I have my understanding of things based on my singular experience (anecdote) that's also not based on hard data, so without any of that data all I'd agree with you on is that sure, some parents might end up with medicated children that don't need it based on a teacher recommendation, but I'm not sure whether it's a "good chance" or not, and unless you have more info you haven't disclosed, I'm not sure whether you know that either.

That's a fair comment. I'd be interested to hear directly from someone who does have hard data, or at least a teacher who's actually done this multiple times.

Sounds like the system works then!

It makes me sad to read comments like this.

My takeaway - don’t just stop taking these even if you think it’s just for adults benefit - there has to be a way to come off them more slowly

In more brutal prior days, they'd be expelled and become the parent's problem. Now, they get medicated into compliance. It isn't fair to anyone, neither that child nor the others, that they get streamed in with everyone and everyone has to figure out how to cope.

I don't know what the right answer is, but pretending there isn't a problem in the first place is definitely not the beginning of an answer.

Personally, I’ll take the memories of violence over being medicated for life any day of the week.

Oh, and it generally worked - fear of retribution is quite the motivator.

Having spent my formative years being motivated by avoiding beatings, rather than seeking praise, made it very difficult to adjust to adulthood in a world that relies on positive reinforcement for motivation.

For every "...and I turned out just fine", there are many who didn't. Your "memories of violence" aren't the alternative to "being medicated for life", they're often the very cause of it.

Not that current time is perfect, but statistically it has better results.

Hard to judge quantitatively - but TBH as fucked up as my childhood was I wouldn't want to grow up in the modern system and working with the zoomer generation I'm not impressed with the outcome.

> if your only goal is to prevent negative outcomes might as well put everyone in a coma and tube feed them - bound to get 0% crime, violence, addiction.

This is fairly absurd jump.

Also, beating kids into obeisance makes them more likely to beat others onto obeisance. Which has no repercussions if against a kid, but has large ones if against adults. And even if not physical, leads to bullies. The more authority they get, the more coercive bullying happen.

But my point was more about comparing generations, I feel like a lot of struggles like having to learn how to control your temper or focus, are wiped away with drugs, and in general society is very good at removing historic hardships you had to overcome. On the flip side a lot of artificial stress and challenges are introduced with modern life (grade chasing since preschool, social media) - I don't feel like this would have felt meaningful to me so I don't envy the current generation of children.

It is harsh, but clearly trying to integrate all of them to general population is not working for anyone, but administrators...

Let's keep treatment focused on healing the individual, not drugging them into compliance. We are talking about kids here.

Be sure to consider the age which the treatment starts. A major aspect of concern for all drug use is how it affects developing minds.

I worked with the same group of students for a 2.5 year period of pre-K and kindergarten. Low self esteem, anxiety and depression and to a less extent conduct disorder were plain to see in the majority of the low executive function students by the end of Kindergarten. I saw these negative outcomes develop as a direct consequence of difficulty managing behavior in class and keeping up with peers.

Particularly for kids with combined inattentive hyperactive ADHD symptoms it's nearly impossible for them to get through the day while keeping up academically AND keeping their behavior inside the realm of "acceptable classroom behavior". Lacking a robust support system for students with extra needs (think an additional teacher or teaching assistant in classroom at all times) there is a very finite limit to how much you can assist without creating issues for the progress of the class as a whole.

The reason that I am careful to use low executive function (EF) as the label at this age is that even for experts in this area it's incredibly difficult to predict who will "grow out" of their lower than average EF issues and who plateaus with maturity.

I think the current consensus that diagnosis and especially medication for ADHD is too difficult prior to 6 or 7 is correct. I've seen too many students have seeming miraculous gains in EF and catch up with peers in a matter of weeks to think that preschool is the appropriate time to diagnose and treat ADHD.

The students who continue to lag behind in EF are substantially behind in basic grade level knowledge when they set foot in primary school. The amount of catch up they have to do is substantial even for neurotypical students by time that a formal diagnosis and medication is an option.

Now add in the fact that a large portion of the parents of ADHD kids have a parent with ADHD or less than average EF skills. They are less able than most to give their children the extra out of classroom help they need.

Getting kids on medication ASAP once a diagnosis is confirmed and a well tolerated treatment is found is a no brainer. By the time that this comes into play you are already in educational triage. We're talking about 1st graders that can't read simple consonant vowel consonant words in some cases.

The obvious solution is putting in a low EF safety net in pre-k and kindergarten. Extra teachers in classrooms, extra help with literacy. Making sure all parents are aware that their child is has an elevated risk for ADHD diagnosis later down the road, so they can familiarize themself with the diagnosis and treatment options-- and more importantly so that people are assessing and testing to see if they catch up in EF function.

My brother got an adult diagnosis and would have benefitted a from a child diagnosis

I agree that it is wrong.

But the protection of other students is not a bad thing in principle. It is a thing that is often missing. Yes the school should help problem kids. And absolutely, the school should make sure other kids don't get victimized in the process.

This ADHD epidemic is localized in the US, so either people there are being overdiagnosed for the sake of sinplicity, so they can just be drugged; or there is something horribly wrong, causing all those children to suddenly develop ADHD.

My money is on the former explanation.

It's important to take ideations seriously but as someone who struggled with that at points in my life I never felt completely safe about discuss it.

I'd expect the quality of a party you're allowed to leave to be higher than one you're not.

There is no strong evidence that suicidal people have a genuinely held belief that they wish to stop living, as opposed to a psychiatric episode that once passed does not reflect their actual world view. This, in part reflected in the fact that one of the riskiest periods for clinically treated depression is shortly after anti-depressive medication is started, since depression manifests in large part as a lack of motivation, and the first effect of treatment tends to be to allow people enough action to actually attempt suicide. But again: this is episodic.

Note that this is entirely different to terminally ill people seeking euthansia, who amongst other things will pursue the goal for years if necessary i.e. it is a strongly held belief of a rational mind.

Though finally I'd note I don't know what you propose "challenging" society is meant to mean here. A therapist isn't there to sign off on you killing yourself, nor is that ever required. That option, especially in the US with the absolutely minimal checks on firearms ownership, is constantly available and has exactly one outcome. Dead people don't feel, or have to justify, anything to anyone.

[1] https://en.wikipedia.org/wiki/Suicide_attempt

> There is no strong evidence that suicidal people have a genuinely held belief that they wish to stop living, as opposed to a psychiatric episode that once passed does not reflect their actual world view.

I would argue that there is an overwhelming amount of evidence that suicidal people have a genuine held belief that they wish to stop living, in the form of genuine and sometimes successful suicide attempts. To redescribe it as a "psychiatric episode that once passed does not reflect their actual world view" is to simply negate the validity of the belief by viewing it through a medical rubric which affirms suicidality as something pathological. This is a value judgement. Compound with the complication that, as described through the comments on this post, any discussion of intent towards suicide can have severe consequences and therefore suicidal people will necessarily be coerced into denying their true beliefs of things, and must acknowledge the consensus view that their desire to kill themselves was in fact not "a genuine beliefe". That they may come at some point (possibly much later on) to have genuinely changed their mind not to kill themselves or to have kill themselves may be great but does not invalidate their previous belief at the time they were suicidal.

For comparison, imagine a society in which intent towards abortion was viewed as a pathological state of mind, and any talk towards such was met by extreme force from the state similar to that which it is for suicide, to wit: forced imprisonment, pharmaceutical intervention and koshing of a person until they no longer expressed (openly) a desire to have an abortion. A statement like "There is no strong evidence that these women have a genuinely held belief that they wish to not have their baby, as opposed to a psychiatric episode that once passed does not reflect their actual world view." may sound valid to people living under such a value system but we might recognise something more going on here.

Step 2) call police

Step 3) enjoy

Wow so easy to take down your political enemies huh

No consequences for the guy, of course.

My buddy got arrested, restrained to a hospital bed against his will, was given a cocktail of drugs, and had to stay there multiple days while getting a 'wellness check' every fifteen minutes where a nurse shakes you awake.

To top it all off they sent him home with a $60,000 medical bill.

Not a great way to treat someone who's going through a hard time. I definitely learned never to call the police unless someone is literally getting ready to jump off a building.

This is an important lesson. Do not call the police unless you literally just want them to remove a nuisance and you don't care what happens to the person or how they are dealt with. Even then, police are just a wild card with the potential for life altering outcomes.

My brother called the police once because his then girlfriend was acting really crazy/violent after a night out drinking (not the first time) and they almost arrested HIM.

The way people are treated by the police is actually cruel. If you dug into it you would be ill.

If it's inconvenient to you then you always have the option of checking out of the hospital whenever you want: you are always (except in psychiatric hold cases) able to sign a form saying you understand it may be Against Medical Advice and want to leave.

There are other ways; they are more expensive, less accurate, and possibly more dangerous to the patient, but they exist.

But if you go back and read my comment again, you'll see that I'm talking about the popular belief that losing consciousness is detrimental to the patient. It isn't; it is beneficial. The doctor may have good reason to keep the patient awake anyway, because, if the patient suddenly starts to die, he might be able to do something about it.

But if you are not in that situation -- if there's nothing you can do if your injured friend suddenly starts to die -- then you should not be trying to keep your friend awake.

This is where calls for defunding the police come in. Take some of the money spent on using physical force on those whose thoughts do not conform to social norms and use it on a more appropriate agency. We no longer regularly physically restrain and torture the mentally ill in treatment settings. Why do we insist on funding other institutions to do so?

Political abuse of psychiatry in Soviet Union has its own Wikipedia page.

Any ideas of how to fix it?

Make it contingent on prompt medical evaluation. The current timeframes for involuntary commitment in certain states can leave people confined on a Friday afternoon and waiting to be evaluated until Monday morning. If it's urgent enough for involuntary confinement it's urgent enough to have a medical professional oncall for prompt evaluation.

The medical necessity of all involuntary medical treatment should have to be substantiated in front of a judge, even if the patient is released before statutory deadlines would have required a judge to approve continued involuntary commitment. The medical facility should have to explain their actions e.g. "On Feb 12th at 5:12AM patient started scratching the skin off of their left arm (Exhibit A) which necessitated the administration of 10 mg of Midazolam intramuscularly". Any medication should also be limited to the shortest duration feasible until a court order is issued, no depot injections of Haldol that will last a month.

No financial liability for the patient. The state doesn't have to foot the bill for all of it, you could mandate that insurance picks up the tab and leave the state to pay for only the uninsured. It's profoundly unjust to not only deprive someone their bodily autonomy but also saddle them with a mountain of debt with no recourse even if the involuntary commitment turned out to be unjustified. If it came out of municipal budgets maybe police departments would be more diligent about making sure that involuntary commitment was necessary instead of using it like a blunt tool to pawn off a tiresome person onto someone else.

Perhaps where you live. The legal system I live under has strong protections for freedom of speech that ensure that such a statement cannot be criminalized.

Not trying to pick on your post or anything just thought it is a good example to say that it's maybe not as easy as it may seem to decide who gets admitted/committed, and the dichotomy in this thread shows that point.

Regarding potential overuse of sedation (benzos) or antipsychotics in nursing homes, it's easier for a nurse to push a doctor to prescribe meds to "snow" a patient than to spend time in the room and try to reorient a sundowning delirious dementia patient.

Of course the topic of involuntary committal and people’s rights and prevention of abuse is extremely difficult, and that is why the pendulum swings back and forth. I just think it might be at or nearing the other end of the swing.

Falling out with your business partner? Want to get rid of your wife, so you can move in with your mistress? Your kid came out gay, or atheist? Dad has money, and you don't want to wait for him to die? Involuntary commitment was a fantastic solution for all of these problems.

If you weren't crazy before you get sent to a mental institution, you almost certainly would be after you involuntarily spent some time in one.

Let's say you were wandering the streets of a major city, looking very odd to everyone else and muttering to yourself (likely someone you'd see on a drive who is "obviously mentally ill"), but otherwise very happy and not breaking any laws, would you want the police to be able to snatch you off the street and involuntarily lock you away?

Likely not, and this is why the laws in some countries like the US are the way they are.

This is obviously not the case with a sizable portion of the people wandering the streets. An ideal world is nice to theorize, but practically, there will always be type 1 and type 2 errors.

Transparency and other efforts to reduce them should of course be a never ending goal, but abandoning a problem completely because it cannot be done perfectly is not a long term solution either.

> Likely not, and this is why the laws in some countries like the US are the way they are.

I think the laws are the way they are because it was cheaper to simply dismantle whatever existed of the mental health care system rather than invest in improving it. And it is still cheaper to ignore it on the federal level while the rich people cloister themselves in affluent suburbs and gated communities.

I'll bite.

Give me an example of someone who fits your definition of someone who should be forcibly taken under the wing of mental health treatment (whatever that entails) who isn't breaking any laws. Putting someone into a mental institution strips of them of all rights and requires convincing a judge to ever get out.

This logic essentially wants to "arrest" people without "arresting" them because they aren't doing anything illegal. That requires a very precise definition of the conditions under which you can do this.

Very much like a law.

I did not suggest involuntary committal for those not breaking laws. I wrote a sizable portion of those who need mental health treatment are breaking laws (more importantly, they are behaving in a manner that is destructive to other members of society - littering, biological hazards, fire hazards, property crime, etc). Whether it be for schizophrenia, meth and drug addiction, or some combination thereof that make involuntary mental health treatment the only option.

The incentive systems have yet to realize that there needs to be some balance in bad outcomes to support the good ones. It results in a system where any mention of self-harm is taken extremely seriously, even at the cost of a larger treatment plan.

I can understand that but involuntary institutionalization should be implemented only if there's an immediate danger to someone's life.

A currently euthymic person mentioning casually there were times they wished they were dead is not cause for institutionalization.

A depressed person who not only thinks about taking their own life but has made plans for it and has the means to execute that plan is in great danger and in need of immediate help.

"freedoms can be taken away so dubiously even when not charged of a crime nor arrested in a system that exists outside the criminal system"

I'm sorry this happened to you.

Not defending it, but I don't think it's fair to say your experience represents some runaway extra-judicial outcome.

For better or worse, in the US, a judge's approval is required to detain someone in a psychiatric facility beyond an initial period (in my state it's 24 hours).

This is more or less the same standard we apply to people arrested for crimes, no?

I.e. you can be detained involuntarily for a bit, but they have to put you before the court or let you go.

Being involuntarily committed makes you a "prohibited person" and includes a lifetime ban on owning a firearm.[1] It wouldn't surprise me if there were other strings attached to having that on your record too.

[1] https://uclawreview.org/2021/08/18/pulling-the-trigger-on-am...

[edit responding to your edit] you were responding to the tone of my original comment, which I softened while you were responding, so sorry for the original combativeness. For what it's worth, holy crap does what you described suck. i would have done exactly what you did. no amount of knowing that it's not "indefinite" would have made it any better. the circularity of being falsely accused of something, and then having your (justifiable) non-compliance used to justify threats of further force, is blood boilingly unfair. sorry my apology sounded insincere. i sincerely feel that your experience should not be minimized.

https://en.wikipedia.org/wiki/Baker_Act

"There are many possible outcomes following examination of the patient. These include

(1) the release of the individual to the community (or other community placement),

(2) a petition for involuntary inpatient placement

...

(3) involuntary outpatient placement (what some call outpatient commitment or assisted treatment orders), or

(4) voluntary treatment (if the person is competent to consent to voluntary treatment and consents to voluntary treatment)."

[Numbers mine]

So assuming #2 and #3 are the "bad" outcomes: both seem to require a judge's order within 72 hours?

Unless the definition of "stable" has a wiggle room I am not appreciating? Or some other practical nuance?

https://law.justia.com/codes/arkansas/2018/title-20/subtitle...

> (a) An individual with a behavioral health impairment who is admitted to a psychiatric emergency service under a crisis intervention protocol under this subchapter shall have a final disposition within a maximum of seventy-two (72) hours or be released from custody.

> (b) If the individual with a behavioral health impairment cannot be stabilized within seventy-two (72) hours of entering into a crisis intervention protocol, a participating partner may institute commitment proceedings as authorized under § 20-47-201 et seq.

> (c) An individual who has been released from custody and has chosen to stay at a crisis stabilization unit voluntarily under § 20-47-804(c) is not bound by the seventy-two-hour maximum time of detention under this section.

> (d) As part of the discharge process after the seventy-two-hour hold has expired and the individual is being released from custody, and subject to the consent of the individual no longer in custody, a crisis stabilization unit may provide the individual with a follow-up treatment plan and a request that the individual utilize the treatment plan, including subsequent appointments with a mental health professional.

Sounds like you're talking about (b), but I wouldn't really assume we're talking about children (as in America they don't really have rights).

“Stabilized” indeed… (rolls eyes completely around head.)

In contrast working as a contractor, intentionally contributing to more than one job per year, taking a big salary hit to be on a cool project with cool people are all things that are completely and utterly insane. No reasonable people would do such a thing.

And one of my side project was a mini MPORG with no combat, just some puzzles. Obviously no one can make good money providing something like that, and turning such a thing into a good job opportunity is not possible.

Take your meds and get a steady job at a big company, or better yet the Federal Government.

It is kind of surprising to me that this is considered so odd. Have any long time tech workers here tried to explain how their work is organized to anyone who has worked for the federal government for a decade or two? Maybe I was just lucky.

I know a few and they really, really, really hate how the system & law forces them into this corner, to the point where they actively try to avoid suicidal patients, because they don't want to report them. There is a similar dynamic with being a mandated reporter for children when giving them therapy.

Even for those who dearly love and care for their children, it's not a great feeling knowing that the slightest misinterpretation _requires_ that health / mental professional to refer you for prosecution. Instead of helpers, doctors and therapists have to be viewed as threats.

The road to hell is paved with good intentions.

[1] https://en.wikipedia.org/wiki/%C3%89lan_School

https://elan.school/

IMHO, the system errors too much on the side of caution when it comes to psychiatric holds and ignores history of repeated hospitalizations.

So? If they wanted to die, that's what they wanted. Do we have to forcibly be required to live in a mental institution, pumped with drugs, for the benefit of others if we don't want to be here anymore?

People who are suicidal with a plan are not generally thinking clearly and are happy that they received care once they've been treated. We take people who are acutely intoxicated or unconscious to the hospital all the time and have no qualms about that.

Regarding being "pumped with drugs", I can only speak from experience rotating for 6 weeks at two different psych hospitals, but the only people who I saw forced to take medication were acutely psychotic, manic, or incredibly agitated. The schizophrenics that are picked up and brought to psychiatric hospitals generally are so psychotic that they would not be able to care for themselves - risk of harm to themselves. Same thing with acutely manic bipolar patients.

As if preference on this is always treatable. For example, what kind of treatment do you give a person who wants to die because they have no support network and had a stroke which rendered them disabled and homeless? What realistic treatment is going to give them hope? A bed in a state funded nursing home surrounded for the rest of their days by untrained, uncaring people who are just there for the low wage paycheck?

I respond to these comments because I don't want people to hesitate to call for help if someone they know reaches out in need because of what a bunch of software engineers on HN who've never seen the inside of a hospital have to say about psychiatric care.

[1] https://news.ycombinator.com/item?id=28497547

Haldol is a typical antipsychotic. If the patient has no symptoms that indicate its use, they should absolutely not be taking it. There's a lot of side effects. Some may even persist after the medication is discontinued.

One of these side effects is that it can be sedating. I've been on the patient side of a misapplied antipsychotic myself. They can make you very tired and cause you to feel "drugged". This is not the same as a drug being a "powerful sedative". Words mean things. Words in a medical context have specific definitions and nuance. If you're reporting on medical malpractice, it's important to get the vocabulary correct so that the way you word something represents the truth rather than a sensationalized version of it.

I can definitely believe that these people were medicated in ways that were dangerous to their health for the convenience of the staff. However, when you call Haldol a powerful sedative, I have to assume you're either trying to make the situation sound as horrible as possible or you have no idea what you're talking about.

I mean, it actually sounds like you don’t really know what you’re talking about. It’s not quite in our ‘take down’ class of drugs (think meth patient in the emergency room) but it sure as hell knocks patients out in IV/IM administration.

Which should definitely not be the administration in aged care, but even in oral form it is used unfortunately in a long term role as a sedative (which is not what it is indicated for), which is basically what the article is about

Warfarin is a blood thinner. Warfarin was originally used as rat poison. If a nurse gave it to someone they didn't like to increase their risk of internal bleeding, would it be more accurate for a journalist to say that the nurse administered a blood thinner that was not appropriate or rat poison?

If you give Warfarin to somebody at the dosages used to poison rats, it'll probably kill that person, too. I think I get what you were going for with the comparison, but all medicines are very light poisons at the dosages in which they are administered (all substances in general are poisons at the right dosages, really) but Haldol is a strong sedative at the dosages at the dosages in which it is administered.

And can we really say categorically that we aren't actually using the sedation itself (to some degree) to calm the schizophrenic?

The other day I read an article in the paper about a woman’s journey with uterine fibroids and how it had affected her life. It contained a large amount of misinformation that my partner (obs and gynae doctor) objected to strongly but at the end of the day it’s been published and that’s that. But in this case what you’re objecting to isn’t even incorrect information.

I mean, the first typical antipsychotic, Thorazine was literally called ‘a lobotomy in a pill’. The trade name, Largactil, is because it was ‘large acting’ in basically turning the patient into a walking vegetable.

This is at a point in the history of psychology when asylums were being shut down and over the next few decades the large numbers of people who had previously been held in often awful conditions were released into society, and despite the literal sledgehammer effect of these ‘typical antipsychotics’, any side-effects we’re considered mild in comparison to not having them. Until the extrapyramidal effects started showing up.

Haloperidol acts on the same system as Thorazine.

When said patient regains control of their faculties they are often confused and angry as a day is missing from their memory.

The regular nurses who had completed the state mandated training did not usin this combination of drugs on patients.

I think psychiatrists have moved away from haloperidol and the internists or family doctors in nursing homes haven't caught up yet. Not that there's going to be much practical difference between Geodon and Haldol. Of course psych ED is a much different situation than on the floor of a nursing home where it might be more appropriate to use a low dose of Seroquel for delirious patients.

The issue is as you note in this instance, their use for something otherwise, that is, to force submission to make others' lives easier. It is not just in care homes that they are used for this purpose. Psychiatry as is practised within institutions such as prisons, schools, or care homes, serves as a way to legitimize dealing with difficult people using forced or coerced drugging, something we would not otherwise accept on the face of it. I don't see any good solution to this issue, especially not in the case of a care home where many residents will be deemed by all to not have capacity. Oversight can only do so much and when there are loopholes like the three excepted diagnoses mentioned in the article being exempted from public tallies, incentives will do the rest to close it.

EDIT: I'd like to add I have considered a bit more about other people I know who have taken or are taking antipsychotics (voluntarily), and they have never expressed extreme distress at their side effects. So I should have said 'can have' rather than 'have', my initial wording being influenced by my own experience.

Modern antipsychotics are useful for conditions beyond schizophrenia. Seroquel is commonly prescribed for insomnia at doses lower than those used for Schizophrenia. Adding Abilify is a common second-line strategy when first-line antidepressants aren't giving proper results. Certain patients with bipolar disorder benefit from antipsychotic medications, particularly in the therapeutic delay before traditional mood stabilizers can kick in.

Like you said, the drugs themselves shouldn't be demonized. They're not perfect, but when used appropriately they're often far better than the underlying conditions being treated.

However, if doctors are simply making up diagnoses in order to prescribe the drugs, that's obviously not appropriate treatment.

The second generation "atypical antipsychotics" are really not much different from antidepressants. They just typically contain an additional dopaminergic effect (e.g. modulation). As someone else pointed out in this thread, Abilify is prescribed for depression and anxiety.

I have an autistic child and I get so much pain thinking along the lines of what your grandmother went through.

The fact that some people were prescribed haloperidol as the first line of treatment instead of a newer, safer antipsychotics also blows my mind.

I'm terrified of growing old in this country.

unfortunately there are a lot of ppl in a situation where they did not declare that in time and we can't assume they would.

Over prescription of antipsychotics is still common in US psychiatric facilities, and even if not there are alternatives, like very high dosages of SSRIs or other specific medications with complacency as a side effect.

But it is really difficult staying enthusiastic about treating someone, long term, who is never going to repay any extra efforts. Caring for the elderly/infirm is a really gruelling experience.

It seems quite likely that there physically are not enough doctors who have the mental stamina to do that. The options the average person faces if they can't care for themselves are going to be doctors who don't really care, or nothing.

I can see that in the facility where my parents live. Overall the place is fine but it's constantly understaffed and people aren't paid well. This is a way harder job than my much better paid tech job. I can slack off for days when I feel like it whereas the care personnel never can escape the grind.

It's sad that these people get paid so little considering how psychologically strenuous their work is and how much human benefit comes out of it.

This article strikes a chord with me. After a long hospital stay, I sent my father to inpatient rehab (aka "nursing home") for two weeks. Before he went, they told me I could do daily visits outside his window. After he was there, they made me schedule visits ahead of time with their "activities coordinator" who told me I was lucky to get twice a week. They didn't bother to make him do any of his therapy, rather they just let him lay in bed the whole time. They put him on a bunch of new meds to make their job easier, double dosed his biannual medication, etc. It was of course impossible to get anybody on the phone to talk about any of the details of his care (and not for a lack of trying). I only discovered the meds after the fact when I requested the records (which was also its own ordeal, and they're not even complete).

Administratively though, they were on the ball. The intake paperwork pushed me to sign him up for a long term stay (complete with "sign here" highlights on patently unnecessary forms; I rejected them), and they wasted no time switching his insurance billing address to their own address. His stay ended abruptly one (early) morning, when they punted him back to the hospital with a dubious story. I believe it was because they knew his Covid test was coming back positive but didn't officially "know" yet, and this way they could keep their numbers down.

After the second hospital stint, I just took him home despite the extreme burden. I hired some private helpers and between them and myself being extremely involved with the visiting nurses/rehab, he did much better. I would have paid for more bona fide sessions of rehab if I could have, but that's our inflexible system.

If you have a good relationship with your family and one of them is in the position of "needing" a nursing home, it behooves you to save them from these horrible institutions that are mainly geared to milk their insurance. Even at decent hospitals and not during Covid, if someone else is not there and continually advocating, their care will be overlooked.

I don't believe that it affected his care. There were a fixed number of hospitals, inpatient rehabs, and visiting nurse associations, and they all took his plan. And I can't possibly see their behavior being different for a different payer - the incompetence was intrinsic to their deliberate bureaucracies. The only way to rise above would have been to find providers that didn't take "insurance" at all, such that the actual customer was the patient rather than another bureaucracy.

The Medicare rules were limiting by fixing the amount of rehab sessions he got per week. The length of his care would have been limited too (discharge rules), but I advocated to extend him within the system. But any bureaucracy is going to be similar, and thus the only way to fix that would be neutering the whole "insurance" cartel and forcing the industry into radical price transparency. Which is basically the line I was straddling with the private pay helpers.

What Medicare really helped with is making his copays sane and giving me solid footing to push back on billing fraud. For instance, one equipment supplier sent me a bill for 50% more than it should have been, and then shamelessly stood by their story on the phone ("you owe us this amount, so you need to pay"). I presume they successfully defraud many people that way.

I agree with the principle behind your other points though, in an ideal world we would not prescribe these medications to the elderly to ‘aid in management’

I don't know why this is, but dementia is often a continuum, and the decision making that people make seems to change in early dementia.

Unless you are proposing that others get to make this executive decision that people with dementias lives aren't worth living, this solution is not practical.

More practical would be to accept that we are far better off over-medicating with pain meds to "keep people comfortable" with the implicit idea that it will shorten their lives. Everyone can pretend we're doing it for pain. Effectively it's like what you said but with some face-saving bullshit where no-one has to admit we're killing grandpa/grandma over the course of a few months. I'd much rather a few months on opiates at the end of my life than a few years on Haldol (JFC). Ugh.

Is it really demented thinking to want to avoid approaching death? I am there right now with my mom, and if she wants to press on, who am I to argue?

On Monday I will be an Intel Principal engineer again - but there's some Monday where I may need someone else's help to get the shit off my bum. From the perspective of that next Monday the indignity of the latter one is astonishing and humiliating, but there will be many intermediate stages where I get used to the idea that I am not what I was and to see that life is still quite pleasant.

If it's reasonably certain that I will die soon or there is no chance for recovery I would like to try all kinds of drugs like heroin, cocaine and others. Why stay sober?

More likely it is that theoretical death sometime in the future is something much different then real death sometime soon. Which is much different to actually doing it and following up.

The exact same thing happens in physical danger situations. People are brave and daring and when faced with actual situation, the start making real decision differently.

Personally I think I would prefer euthanasia if I knew I was developing dementia and likely to end up in a care home similar to the one described in the article, or even one much better than that, so perhaps selfishly I would prefer a society where such is legal even though there would end up being abuses like you describe.

We can think of care homes as like suppliers in a captive market, and we are the consumers - but it is even worse that a captive market in the sense that at least in a captive market you have the option not to buy, whereas we will be forced to. The existence of assisted dying as an option may even economically incentivize the care industry to improve.

If they are fabricating schizophrenia dx, then they would also likely to fabricate medical cause for euthanasia.

Antipsychotics are supposed to be the last resort in geriatric care due to obvious effects on patient quality of life and functionality. Not even sure they're approved by the american FDA for such uses. If they must be used, pretty much anything will be better than haloperidol.

Reminds me of lobotomies of old. "Make the patient easier to care for."

I feel like this industry for the care of elderly in this country just bears 0 responsibility.

I developed tardive dyskinesia from use of antipsychotics over a period of 8 months. It's been over 6 years since I've taken them, but it still has not gotten any better...

You can still develop TD regardless of the drug, given that pretty much any dopamine antagonist can cause it in the long term.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5958944/

"Haloperidol is relatively inexpensive, being up to 100 fold less expensive than newer antipsychotics"

This is what convinced me to have as many children as possible. Hopefully at least one of them will care about me enough to not let this sort of thing happen to me.

If your kids aren’t suicidally depressive but also don’t love you enough to take care of you in your old age, there’s probably something else they resent you for other than being born in the first place. Which isn’t necessarily your fault—some people are just irrationally resentful. But that is probably the bigger risk to worry about. It’s just that, compared to trusting nursing homes not to become abusive, it’s still a better bet.

It’s also not necessarily about obligation, at least not in the negative sense of the term. I took care of my father during the last year of his life, not out of obligation but out of love. (One might define love as the act of willingly accepting the obligation to care for another, but a willingly accepted obligation is not really the same kind of obligation.)

In any case, the goal is to go into old age having people in your life who are capable of taking care of you and who will choose to do so out of love. Having kids and maintaining a strong relationship with them gives you a good chance of reaching that goal. Institutions, on the other hand, will never love you and will instead just fuck you up with psychoactive drugs for their own convenience.

This is a common misconception, and completely incorrect. https://en.wikipedia.org/wiki/Antinatalism . This is a possible valid philosophical judgment that implies nothing about depression.

It's kind of funny, my wife's mom abused her horribly and is now upset my wife and I won't take care of her. Treat your investments better lady.

If you’re not abusive children tend to remember the 18 years you gave them fondly and provide assistance for your last few years.

I’m bullish on that strategy, even if there is no contractual guarantee that those kids will return the favor.

Others consider bearing children a gift of life.

That's right - it cannot be given.

Life expectancy is a bit of a misleading metric in that regard, since life expectancies are just averages. If a population has a life expectancy of 50, that doesn’t necessarily mean that 50-year-olds are dying of old age and no one makes it to age 80. It could mean that there are a lot more children and young adults dying and bringing down the average. So if you’re living in a society with a life expectancy of 50 years and you turn 50, your personal life expectancy is probably going to be closer to 70-80 because you’ve already managed to survive the causes of death that affect younger people.

And you may very well develop things like dementia. The concept of people becoming elderly enough to lose their mental faculties isn’t some unprecedented 20th century discovery. It is becoming more common, but that’s just because deaths from childhood illness, infectious disease, violence, and occupational accidents are becoming less common.

I'm seeing a lot of bullshit on all these threads from people who are doing the whole "fake bravery about how they would just be euthanized" in this situation, and how life isn't worth living if you're demented, etc.

Here's how life goes for a demented person close to me:

A "fulfilling life" with dementia isn't that different from one without. You wake up, someone makes you a nice meal, you read the papers, shuffle around a bit, get helped to take a shower and dress, watch a movie (which you won't really take in, but it's some nice pictures), get a call from your daughter (who either lives down the road or thousands of miles away, depending on what you're remembering today), etc. On some days your carers will take you for a drive to look at the ocean, or out to a dinner.

You might dream that you went on an exciting adventure down the California coast and tell everyone about it; surprising that an 80-year-old man who can't walk unaided can take a sailboat out by himself. Everyone you talk to will enjoy your story and no-one will try to tell you that you are deluded.

Some days will be better than others, which is the same for anyone.

That's 24 hour home care - and it's not cheap. Neither is living at a facility at this stage. Often the money spent on medical heroics would be better spent on quality of life. Of course, packing folks off to a facility is necessary for some (in this case, we're talking about outright home ownership plus a modest level of wealth). And then a lot of other people frankly want to put hands on grandpa/grandma's money and/or house which is tricky if they are still living in it.

Why don't they just eat cake?

This is the good end of the spectrum. The other end is that the patient lives alone, soils his clothes and doesn't change them for months/ gets lost and becomes homeless, gets infected and dies an animals death. Most of the patients live closer to the bad end.

First of all, a lot of the grandiose claims here about how "if I was demented I would just get myself put down" are coming from tech people who could afford this end of the spectrum.

Second, 24 hour home care - or 'family care plus a certain amount of professional relief' is, while expensive, not much more expensive than medicalized fulltime care in a lot of facilities. You're not paying the overheads of a bunch of salaries and potentially the profit margin.

At the lowest end of the spectrum, things are indeed terrible. Aside from fairly extreme small government people, I think most people would want the state to step in. A lot of the places that are over-medicating their patients are collecting vast amounts of subsidies and pocketing the improved profits that come from getting to run staffing levels as low as they can get away with.