August 29, 2008
Dear NC Senator Martin Nesbitt:
I read w/ interest your statement to the Raleigh News & Observer for the 8.29.08 edition pertaining to the investigation of Cherry Hospital by the feds which may very well put their ability to have Medicare/ Medicaid patients----if not more than this----at risk.
And all of this means, once again, as took place at Broughton Hospital in western NC, as per its loss of fed funding for a year, something which just ended, and which was paid for by NC tax payers to the tune of $1.5 million/ month-----only to have its JCAHO accreditation removed a week ago---and so that the tax payers now pick that up again.
This is a never ending set of problems which require a bigger vision and stepping back.
You stated, Mr. Nesbitt:
"I'm not sure we had people involved who care about the patients," said Sen. Martin Nesbitt, an Asheville Democrat and committee co-chairman. "That is a systemic problem I don't know how to fix." Senator Nesbitt
I am sure you have had your fill of advice from every psychiatrist, psychologist, mental health technician, hospital director, and newly created division in order to investigate problems like this. This is a systems issue and while as psychiatrist Harold Carmel maintains, ‘there must be accountability’, I would like to add that a step back----in order to overview the components of this system---- provides the answer. And the right answer is reflected when one asks the question, “Who maintains power here?”
It is, I think, a red herring to think that the people who work there do not care about the patients and those people should be fired, no questions asked. Certainly, in every worksite in the world, there is a range of people as associated with how they do their jobs. I am sure that you probably are familiar w/ this information:
“More than 1,000 workers are put out of work due to injuries each year. Since December 2000, at least 82 patients have died in ways that raise questions, including homicides and suicides. Workers are incredibly underpaid, with health care technicians, the bulk of the front-line workers, earning on average less than $24,000 per year and forced to work incredible amounts of overtime in unsafe and understaffed conditions to pay their bills......”
On May 29th, more than 200 workers attended the UE 150 Mental Health Workers Public Hearing. Before the hearing, workers held a public rally to expose the conditions at the state hospitals, demand Dix hospital stay open at least one year longer and demand a Mental Health Workers Bill of Rights.
WW photo: Dante Strobino (World Workers)
Many people might dismiss the above as associated with anarchists, commies, or unions-----all equivalent in the South. However, facts is facts.
Difficulties in working w/ the population w/ mental health challenges is evidenced also by March, 2008 NC DHHS Crisis Intervention Team training which advances the notion of ‘expertise training’ which should be part and parcel of the training of every person working in a psychiatric hospital. (see http://www.dhhs.state.nc.us/MHDDSAS/consumeradvocacy/
The people who work in public mental health hospitals are embedded in a social milieu which supports the very observeable fact, as per the staffing when the feds are not sniffing around, that no one cares about them and therefore why should they knock themselves out to care for the patients?
Let me explain. Have you ever been a patient in a mental hospital?
I imagine you have not; neither have I. However, I worked at Bryce Hospital, the state mental hospital in Tuscalossa, AL, as an intern, a person of no ‘power value’ and therefore was able to observe----as if a fly on the wall----the behaviors of both the staff and patients. Indeed, it was an assignment given to me by my supervisor.
What has been taking place at Cherry Hospital, Broughton Hospital, in Georgia at GMHI, and indeed, around the world is not unique. There is not something so terribly wrong and different about the NC mental health system. I believe that the media is all over this as associated with years now of mental health reform coverage and that every episode creates anew a sense of a system that is rapidly devolving. It may be worse than it was, but I am betting that if the records could be combed, that many episodes of mistreatment of patients would be turned up and I personally know of some of them myself.
Here is a statement randomly picked from google.com utilizing the descriptors “mental hospital patient what it’s like to be.”
The example is associated with a mental hospital in Finland. The Scandanavian countries, I maintain w/ some evidence, are more consistently progressive in terms of social issues:
“The closed institutional care used in mental treatment is suffering from extremely negative attitudes. The exercise of power in those wards is partially distorted, reminding of the abasement of mental illness compared with other diseases.”
When I was an intern at that mental hospital, second only in size to the Pentagon in its heyday, this is what I witnessed and it is not different than what has taken place in any public, as well as many private, psychiatric hospitals in the US.
When a patient walked up to the nurse’s station, it was common for them to stand for a very long time without even being able to get the eye contact of the nurse or technician.
If you were to go to a store, and you needed something from the person on the other side of the counter, and they continued to stare down at their paperwork, ignoring you, how would you feel?
If you are like me, and like most fully functioning American adults, you would feel perturbed and righteously angry. You would ask for someone to help you; you would start to sigh and make loud noises in order to get someone’s attention.
The patients have no magical way of getting rid of how they feel in these situations. They may try to escape using the laundry hole, as at Cherry Hospital; they sit quietly in their chairs, hour after hour, like the man who recently died there.
People in mental hospitals would not demand that the nurse looking down at his or her work pay heed to their request. If they did this, they would find themselves labeled as ‘angry’ and in need of medication which would be watched as you swallowed it----to make sure you would not have another episode like this. For, you see, this is not a luxury hotel where the staff’s desire is to cater to your whims. This is a place where you have been sent because there is nothing else to do w/ you. This is a place where you take your medication and do what you’re told or there will be ramifications and punitive actions.
Your eye glasses will be with-held from you, as for one of my patients who was in a public psychiatric hospital. You will be buggered by the orderlies, late in the night, when no one watches-----as happened to another client of mine. Your husband will ask you what happened that you are so red in that area. Another client: the sheriff will run into your house in order to drag you off to the mental hospital, throwing you to the floor and dislocating your shoulder. Another client: you will pee in your pants if the deputies come to take you away. Another client: you will sleep on a bed w/ no sheets so you cannot hang yourself and threaten the psychiatrist that if she tries to commit you again, you will take everyone out with you. Thus, you will hide your psychotic depression rather than be humiliated again.
I do not believe that enough ‘accounting’ is available in order to monitor every egregious circumstance. This is the argument of ‘lets just have some more police.’
When you are a patient in NC public mental hospitals, when you take a shower, someone stands in the door in order to make sure you do not do something weird-----if you are on suicide watch----which is a common reason for admission to a psychiatric hospital. There is no privacy. People in mental hospitals, as much as they are able, keep their heads down and do not complain.
They are more like prisoners than patients.
You may say that this is necessary in order to protect them from themselves and this is partly so. However, the unwitting cost of that is the creation of a social setting associated with one set of people in control and the other set of people not in control.
Phil Zimbardo, a Stanford psychologist who did the Stanford Prison experiment in the early 1970’s, which, along w/ psychologist Stanley Milgram’s work, has indicated in his widely disseminated work, that in situations in which there is a distinct difference between the rights of one set of people and another, lack of caring and even violence WILL take place. The people who are the staff are not ‘bad’ people. The patients are not beserk loonies who will bite, scratch, kick and generally tear down the house.
Dr. Zimbardo has continued to work on this matter as pertaining to what has taken place in Guatanamo Bay as re: the behaviors of military personnel who acted in a manner which was in keeping with the social milieu of the prison but which was out of keeping with the (some of) the expectations of the military. In other words, Zimbardo is, best I understand, maintaining that people are social creatures who respond in a particular PREDICTABLE manner given social situations in which the distribution of power is vastly different for one group versus the other. People respond in predictable manners to social situations. It is the social situation which shapes communal behaviors.
I am advancing the notion that the mental health technicians, nurses, psychiatrists and psychologists are not people who do not care about the patients that they are assigned to.
Also, I am advancing the notion that the patients do not, without provocation in the form of dehumanizing treatment, kick, bite, and generally aggress against the mental hospital staff.
I am submitting that accountability MUST be coupled to a recognition of the demoralizing impact of understaffing, which seems to be the most distinct problem at the state mental hospitals. This means that the NC State Legislature has to make available MORE MONEY for funding. That is the first priority.
The second agenda item is that accountability include the concept of dignity and that the concept of dignity be enshrined throughout the mental health system.
Both staff and patients should be treated w/ the dignity that they need and deserve.
People are social creatures; they react to egregious circumstances by engaging in behaviors that reflect their core feelings about matters e.g., the staff sits and plays cards while the patient sends hour after hour in his chair, unattended.
If the powers that be understand that this is not an issue about ‘bad apples’ e.g., ‘there are no people who care about the patients’---the argument that Carmen Hooker Odom attempted to launch at the Endorsed Provider companies upon seeing her Service Definition of Community Support fully utilized-----that indeed the problems take place because of the social milieu in which the MH workers and patients find themselves embedded.
IMO, it is not a matter of there being no people who care about the patients but rather there being no underlying sense and demands that the staff and the patients be treated w/ dignity.
THIS is the leap that should have been taken rather than privatization back in 1999 and prior to the development of mental health reform which saw as a panacea the privatization of mental health care rather than a re-invention of attitude with which to shape efforts.
Thank you for reading this, Mr. Nesbitt. I know you are vastly overworked. Me too.
Marsha V. Hammond, PhD
NC mental health reform blogspot:
Cc: Janowsky; Insko; Stratus; Wainwright; Benton; Raleigh News & Observer; Harold Carmel; MH advocates throughout NC; madame defarge blogspot: http://madame-defarge.blogspot.com/