I heartily agree with Dr. Henry Nasrallah’s stance about the treatment of chronically mentally ill individuals, specifically those with schizophrenia. I recently completed my psychiatry residency in Virginia. In addition to the consequences Dr. Nasrallah outlined in his editorial, I have identified a few additional disastrous effects of transferring care of severely mentally ill patients from state hospitals to the community service boards (CSBs).
Working in a hospital affiliated with a medical school meant that we took care of all indigent patients who were admitted. It is heartbreaking to spend weeks stabilizing a very ill patient and then send him or her back to the disastrous circumstances that often lead to the initial hospitalization. I saw patients discharged with appointments to CSBs that they had little chance of finding, getting to, or even remembering. These patients often were prescribed medications that I could not afford even with health insurance.
Discharged patients don’t fill prescriptions or they can’t remember medication schedules because they are too busy trying to survive. People who most need effective medicines have long ago become nonresponsive because of repeated periods of non-compliance.
Severely mentally ill persons do not have lobbyists in government; they are not likely to organize a march on Washington, DC. They have no voice, which is why their whimpers go unheard and unanswered.
Erica Bradshaw, MD
Staff psychiatrist
Inpatient psychiatry
Houston Veterans Administration Medical Center
Houston, TX