A team of 12 mental health professionals all met in the consultation room to kick off their discussion on the cases and meetings with their patients after the rounds at 8:30 am every morning. This was how my day would start at the LSU behavior health unit for adults in New Orleans, Louisiana (in the spring-summer of 2012). I was an exchange social work student at the Tulane School of social work and placed at LSU in the psychiatry facility for adults for my field work.
Each team at LSU was headed by a senior psychiatrist. The team consists of a tech-nurse, a social worker, a resident psychiatrist, student Interns, a recreational therapist, an occupational therapist, a detox therapist, a psychologist, a head nurse on duty and 2 other temporary staff including myself. This was like a personalised battalion each patient had to help deal with their mental illness. It was exciting for me to learn that recreational therapy and occupational therapy were two different forms of therapy and they consisted of much more than stitching and embroidery. (Unlike back home) even if a person is suffering from a mental illness then also both genders can interact with each other (and do not always need to be kept separately, unless required)
I spent two months in the United States at LSU behavior health unit for adults and the experience was truly enriching for me. In contrast to LSU, back home in India, we only have 200 staff members in total (5 psychiatrists and support staff like nurses and psychologists) for an inpatient facility of over 800 patients.
I was so impressed with what I observed (I hope you are able to relate why I was so excited and impressed to be at LSU as a student social worker!) and had decided I wanted to come back to this country and learn more. I wanted to learn new skills, acquire some tools and techniques that would help me work more efficiently back home.
Now I am back in the United States, in my quest for knowledge but somehow things look different, than the last time I was here. I have started observing things that I did not during my previous short trip. I see more homeless people on streets with mental health issues in every state I have visited so far. However I am optimistic and want to understand more about tackling mental health issues, I regularly attend seminars and sessions to satisfy this thirst for knowledge whenever the opportunity presents itself.
Two weekends ago, I attended a conference on ‘Healing Hearts, Minds and Bodies’. The conference focused on the keys to emotional and mental wellbeing, and pathways to getting there. The conference provided me with a deeper insight into the mental health and psychiatric arena in the United States, from a new perspective (so different from what I had seen during my last visit). I interacted with Psychiatrists, Physicians Counsellors Social Workers, Therapists, Survivors, Mental Health advocates and many people more outside a hospital setup. Learning from their experiences in the field, I am exploring new avenues in mental health that will enable me to be a better programme implementer in the field back home.
‘My opening question to all the participants was; despite the world class facilities this country has to offer in the field of mental health, the number of cases is only on the rise and most of these patients are homeless, WHY??’
I got many different perspectives on why this situation exists. I found one answer in particular to be the most powerful statement and that communicates it all. “Mental health disorder labels often act as a cover for societal and situational problems. This paradigm is encouraged and exacerbated by powerful financial interests”. Until now I have always focused on looking at mental health from one tangent of health but never from a socio-economic perspective.
For those who are on medication or had access to the facilities, most of these medicines have many side effects that are never discussed by their doctor (I do recall at LSU we would ask the patient if there was some problems after taking medication but I am not sure if this specifically discussed the side effect, management and long term effects of the medication).
In many cases incorrect dosage prescription only heightens the problem. The mental health patients often lose their rights and are picked up by the police and kept in detention centres or jails. They cannot apply for jobs or take up housing, their entire existing structure has collapsed by now, and instead of coping up with the illness they need to cope up with a lot of other issues. In most of the cases the situations are complex and a patient in absence of any support structure is unable to successfully come out of what was originally only one illness. They fall in to a vicious trap.
“My next question to the specialists in the field was if there is something that could be done differently?”
I understood that long term support structure play a key role in helping a patient successfully manage their mental illness and live a longer life. This is generally not possible with conventional form of treatment as if not supported by insurance in US, hence looking at economically sustainable alternative methods for management of illness (sometimes combined with conventional form for keeping the under medication for small interval if required) is something a lot of professionals associated to field are exploring.
My aim for this trip is to not only learn from success stories but also from the failures. India still is in the process of developing our approach in this domain. We need to further explore, learn from existing examples across developed countries and develop an effective path that works for us and does not lead us to where the USA is right now (that is people with mental illness end up on streets)
 Source: Rethinking Psychiatry: http://creatingcommunitysolutions.org/event/rethinking-psychiatry-portland-or