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Old 12-28-2019, 08:11 AM   #1 (permalink)
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87: Take Your Pills, Psychopath! Episode 3: Bipolar Versus Schizo-Affective

John opens this episode talking about a Tinder date whose "Psychopath" status totally blows him out of the water. He also delves into how when manic he tried to track down Esme Weijun Wang, the author of the brilliant, vulnerable and eye-opening book, "The Collected Schizophrenias." The heart of the episode is an earnest attempt to explain the difference between Bipolar, Schizo-Affective and Schizophrenia. Also, yet even more songs John thought were written about him.

Guests:
Andrea Allan


John F. O'Donnell



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Old 01-10-2020, 09:05 PM   #2 (permalink)
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Iím about halfway through this episode and really enjoying it. I appreciate Andrea saying that the notion that schizophrenics are violent is not true and that it is rare. I too had that notion at first because of how badly the media has portrayed schizophrenia.

When I was a brand new social worker, I got a job with the county outpatient mental health department in the older adults section. We treated people with severe mental illness and addictions, most of the time they were dually diagnosed. During my time there I found the people with schizophrenia to be some of the sweetest people to get along with. People with borderline and dependent personalities were some of the more challenging people to work with. I learned early on to set strict boundaries with them.

The study that found that at least 80% of people with mental illness are homeless is very accurate. Part of the problem is that the mental hospitals shut down, giving them no where else to go. Due to the nature of their illness, they couldnít hold jobs for long, often have extensive criminal histories and estranged families. Treatment is very difficult to obtain, part due to cost and part due to the illness making some of them believe that they donít need treatment or have a paranoia that the government is trying to poison them. Plus they donít have documentation needed to get on welfare and it is a pain to navigate the system-and I have a masters degree.

Cost of medications can be astronomical. One of the nurses told me one of the shots she gave to someone cost $1000. Also, these medications have awful side effects. The risk of getting tardive dyskensia gets higher the longer you are on some of these anti-psychotics.

Once people are put in jail due to their illness causing behaviors that land them in jail, a lot of times their sentence gets extended because when they act out, they get more time added on. Some prisons have developed mental health departments that are state of the art for their state.

Also-for those who are on Medicaid-if they try to leave the hospital AMA, they lose their Medicaid and are responsible for the entire bill. When I was inpatient psych January of last year, I witnessed someone lose their shit when they got their bill. One of the staff members ended up getting bit. Inpatient stays are expensive. With my insurance covering 60% I owed over $3000. I was only there for 3 days.

Another problem with the system is retaining people. When I was at the county mental health department, even with my Masters degree I only got 28k a year. I had asked for $32k and was told no. I had to use my own vehicle and phone. They would pay mileage but some people were lying about how many miles they were going so they started scruntinizing our logs and randomly reducing them because they decided we should have taken a different route, not taking into account traffic, school zones, construction etc. we also had strict productivity measures we had to meet. Even though they would deny it, that was their main focus. Not on the quality of our work, but how much we could pull in. I was asked to do some shady shit which I refused because it was my license and they would have thrown me under the bus so damn quick. I loved working with my patients. But I couldnít afford to stay so when a spot opened up at the VA I had to take it. My salary literally doubled, almost tripled.

Many places donít know how to handle people with mental illness, especially nursing homes. I had to fight nursing homes several times because they would keep sending one of my guys with schizophrenia for suicidal ideation because he was hearing voices telling him to jump off a building. They would then load him up on seroquel which is pretty much a chemical restraint. When I talked to him he said he was still hearing the voices but wasnít going to act on them. And there was no physical way he would have been able to do so. I had to tell them they were inappropriately using a chemical restraint and that I would report them if they continued doing so. They said they their policy states they have to send a patient in anytime they express any kind of suicidal ideation. I had to provide a lot of education to get them to understand. He didnít have any family involved and was assigned a state guardian. If I hadnít had him on my caseload and took the time, a lot of which was not billable since he was in the nursing home, god knows what would have happened to him.

We are long overdue for mental health reform. I think we need to start education about it in elementary school. It should be part of health class.


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