To the editor:
I think it is important that the psychiatric community respond to the latest report on Rawson-Neal Psychiatric Hospital, the Las Vegas mental health facility (“After busing, Rawson-Neal patients saw trouble,” Dec. 16 Review-Journal).
The problems described face not just Rawson-Neal, but all mental institutions that treat the uninsured, homeless and indigent. Many patients who are admitted for evaluation and treatment do not suffer from what we call the serious mental illnesses, the list of which usually includes schizophrenia, schizoaffective disorder, bipolar illness, major depression, post-traumatic stress disorder or obsessive-compulsive disorder. Rather, they exhibit the effects of intoxicating substances or are looking for a place to settle down and get help with numerous social problems, including evading the law — which of course they never acknowledge.
The article describes The Sacramento Bee’s investigation of a list of presumably recently discharged patients after cross-referencing it against criminal databases, then following limited trails and ultimately relying upon the former patients and family members for information.
No psychiatric hospital would share the diagnoses without a court order or a patient-signed release. Thus, the reporters are probably following the trails of antisocial personalities who hide out periodically in the hospital. Antisocial personalities usually do poorly in a psychiatric hospital, because they do not follow rules and they disrupt the environment, and they usually discharge themselves when they find the situation too confining.
At the Veterans Affairs hospitals where I worked, it was always a dilemma when we had suspicions of criminal conduct of whether we should check if the patient was wanted. Generally, we decided that confidentiality and the desire to treat those suffering won out, unless the patient started to cause significant trouble on the ward, such as destruction of government property or assault on patients or staff. Until laws are passed that protect psychiatric staff from liability for calling in law enforcement when suspicions exist, I expect psychiatric facilities will continue to provide shelter for this group.
This article and many others have made the assumption that a patient who has been prescribed psychiatric medications has a serious mental illness. While such medications have been designed and developed, and then studied in clinical trials with patients diagnosed with such illnesses, once released they are prescribed for many symptoms in individuals. Why? Because they work in quelling symptoms such as hallucinations, paranoia, anxiety, depression and irritability, which occur in individuals with other problems such as drug intoxication, delirium and diagnoses we used to call the neuroses.
We should leave the decision of whether appropriate care is being provided at Rawson-Neal to the experts, such as the Joint Commission and Medicare Surveyors.
LESLEY DICKSON, M.D.
The writer is executive director of the Nevada Psychiatric Association and former inpatient psychiatric chief at the Las Vegas and New York City VA medical centers.
Standing up to A&E
To the editor:
This Christmas season, let us remember the real reason the pilgrims came to America. It was not to go Christmas shopping or mug the mall, but to preserve the real values of religion.
That is why I support “Duck Dynasty” standing up to cable channel A&E’s attack on religion. Catering to a small interest group should not infringe on the rights of the majority who have real values. Rights of a minority do not mean tyranny by a select few, however out of touch they are.
Let us remember the courage of the solidarity movement of Poland in overturning the Stalinist regime. I call on people who value things other than the almighty dollar to join the boycott of A&E.