The Medication of the Mind

In 1985 I graduated from a nursing school as a Registered Nurse. I was in my mid 30s and my intention was to become a psychiatric RN. I had volunteered for a few years at a local mental health center and found great satisfaction working with the group of mostly paranoid schizophrenia diagnosed patients of the center. My wife had been a psychiatric nurse for ten years at that time.
I almost immediately hired on with Ft. Logan Mental Health Center, a state funded psychiatric hospital. I was hired to be a RN on a high risk assault team. Sounded dangerous but it wasn't. At least for me. Guess since they weren't shooting at me it really wasn't all that dangerous.
I liked being there. I enjoyed working with the men and few women who were patients on the unit. Granted, they could be very volatile but it also felt they needed human contact and a compassionate ear to hear them in the tortured state of mind they often seemed to be in.
At that time RNs were therapists, ran groups and took part in the therapy of our patients as well as the medication part of treatment. We were skilled at listening and picking up cues from our patients when they needed help. Our co-workers, a group of very skilled mental health workers, social workers, recreational therapists and psychiatrists valued us for our therapeutic skills and our medical skills related to the treatment of mental health patients.
As the 20th century ended and the new one began, mental health changed dramatically. It was the medical model in charge of treatment. HMOs, and managed care took over. The bean counters took over. Instead of a combination of therapy and medication to treat our patients, medication treatment became paramount. The pharmaceutical industry had discovered psychiatric care  was a gold mine. Psychiatry was an area of medicine with many unproven and unknown theories that could be exploited by the pharmaceutical companies for huge profits.
New antidepressants, antipsychotics, antianxiety medications were developed and old medications repackaged and sold as "cures" and best treatments. Scientific studies were done to show how drugs targeted certain areas of the brain that were alleged causative factors for schizophrenia, mood disorders and anxiety disorders. Childhood mental health problems suddenly appeared with dramatic frequency. The diagnosis of childhood and adolescent problems exploded onto the the scene at rates unheard of in the history of mental health treatment. And the pharmaceutical companies had medications ready to treat the kids.
Suddenly, the use of medications first and minimal therapy was the treatment of choice. Registered nurses saw their skills of therapist taken away and became pill pushers and vessels of the psychiatrists under the influence of the drug reps from the pharmaceutical companies. Samples became the backbone of many mental health centers' treatment. And when new drugs were put on the market, the samples of the older medications dried up. So either the doctors ordered the newer medications or patients were faced with possible shortages of drugs that seemed to help them. Nurses were left justifying medications not on a certain HMO formulary. Congress allowed Medicaid and Medicare to be taken over by private HMOs to line the pockets of their private contributors.
Along with the pharmaceutical dominance of mental health treatment came a new type of nurse manager. They weren't valued for their skills as a mental health professional. They were valued for being able to manage nurses away from using therapeutic skills to focus only on pushing medications and billing for as many client as they could see.
And where do the clients (changed from patients) fit in this grand scheme? They don't other than to be seen as "billables" and money makers. Public mental health has begun to move away from the local clinics spread throughout a metropolitan area. Now they want to centralize and make it more difficult for some clients to reach the reduced number of clinics.
Mental health clients are seen as the pariah of health care. They enter an ER and they're seen only as a diagnosis, a GOMER, a nut job or loonie. Their physical distress is often ignored or medicated without consultation with the psychiatric provider. More and more the mental health client is prescribed narcotics for pain. They end up on a cocktail of narcotic, benzodiazapines, antidepressants, mood stabilizers and antipsychotic. And then medications for side effects.
Case managers are supposed to care for 20-40 clients on their caseload. The squeaky wheel gets attention and the poor isolated client often slides away into a drug induced oblivion.
Nurses are expected to see one client every fifteen minutes and told not to get into therapy discussions by alleged nurse managers. The first line of advocacy once expected of RNs and other nurses has eroded. Nursing professionals are now the drug procurer, the shot giver, the robotic pill pusher. The conversations asking the client about their lives and their emotional state are to be limited. The important information once obtained by the one time nurse caregivers is lost. Like a client saying they are being beaten by a spouse. Don't have time for that. Move on. Get the next patient going.
Where the client does fit is in the profits gained by the pharmaceutical companies. Today more psychiatric drugs are prescribed in the US than at any other time. Every American is a potential user of a psychiatric medication. We have to diagnose children for being children. School teachers are on watch for a rebellious kid and often suggests parents get them medicated.
Mental health treatment is a joke. Skills and experience are rejected as old fashioned and the managers of clinics and inpatient sites are only interested in getting the patient in and getting them out on medications. In some sites the old drugs causing tardive dyskinesia are prescribed because the drugs are cheaper. It is no coincidence these facilities often times hold the Medicaid contracts for the region. The contracts for managed care are structured so the contractor gets a flat yearly rate to provide care for patients having Medicaid in a designated region. The unspoken motto is " less is more". The less care given and billed to Medicaid, the more left over for the contractor as a profit. There isn't an incentive to provide good treatment as much as there is to provide less treatment.
Case managers and nurses are expected to make progress in the care of patients by reducing the need for care. The more they can get patients receiving less care the better. Often times patients needing a higher level of care are pushed into categories where they will receive fewer visits to doctors and therapists. The less care needed the more successful a contractor is seen to be. This would be a good measure of therapeutic success if it wasn't such a sham in which the therapy team is bullied into saying clients need less care when it isn't true.
Even the doctors have become just another vessel to make profit on the backs of psychotic, depressed, manic and anxious patients. They are often over booked with appointments. Their days are back to back with patient appointments and the opportunities for therapy other than prescribing drugs are much less now. The mental health centers and inpatient units are advertising themselves as recovery centers, wellness centers and places of excellent care. They spend great sums of money to tell the public about their wonderful care and seldom give their workers wage increases that keep up with the cost of living.
Mental health treatment is a joke. We've lost the human touch. We treat the patients like cattle pushing and shoving them into things they don't want to do. The patient has now been trained if in distress surely there is some pill they must take. While we deinstitutionalized the mental health patient from locked state hospitals, we've continued to institutionalize them using medication. The constant refrain is about medications. Emotional distress is treated by ignoring it by using techniques of coping that represses the past. Don't have time to discuss the pain of trauma. For years and years trauma in a psychotic or anxious patient was glossed over. The PTSD diagnosis was completely scorned and ignored. The phrase, "we don't want to open that can of worms" was common when it came to PTSD. Now with wars and returning combat veterans regularly having PTSD and drug companies "discovering" new ways to treat it, the PTSD diagnosis is common. One more pill to add to the bunch.
There is no where else in the world having the extent of mental illness as in the alleged richest and freest nation in the world, the US. No other nation uses medications for mental illness as much as the US per person. Emotional and mental health has become medicated. No therapy required.

Since 1985 this writer has worked in both public and private areas of mental health care. He has worked in emergency care and directed a mental health emergency department for a large private hospital system. He has been a nurse manager in a public mental health hospital and also worked in outpatient mental health. Most importantly.....this writer is a combat veteran that has been in treatment for PTSD and is in recovery using psychotherapy and medication treatment....the type of treatment studies show to be the most successful in the treatment of mental illness.