72 Hour Hold and the Struggle of Mental Health - Essay Example

Prof’s 72 Hour Hold and the Struggle of Mental Health Mental Health is, as it has always been throughout its history, in a paradigm flux. When serious mental health illnesses were first diagnosed around the turn of the century, standard procedure was to institutionalize masses of people against their will. In recent decades, however, the pendulum has swung the other direction, recognizing that civil rights of patients are being violated when they are institutionalized against their will, and sharp constraints were put on the process of doing so. The novel 72 Hour Hold documents the challenges facing families navigating this situation with people who are mentally unwell and not taking care of themselves. The novel tells the story of Trina, a young woman diagnosed with bipolar disorder shortly after her 18th birthday, and her mother who will do anything to try to get her the care she needs. The fundamental conflict in this narrative revolves around Trina’s unwillingness to take medication that will help her control her mental illness, her mother’s inability to fully care for her when suffering from symptoms of bipolar disorder, and the struggles in dealing with institutions which, through a combination of lack of funding and strict regulation, make it almost impossible to admit patients against their will, and absolutely impossible to do so for more than a 72 hour hold. The mother, Keri, caught in this incredibly complex situation, is unable to do anything but look outside the official framework to care for her daughter, which eventually leads to her making contact with a group that is vaguely modeled on the Weather Underground. While Trina and Keri’s situation is far from rare, it does illustrate some gaping holes in the continuum of care for severely mental unwell patients who are not willing to consume their medication. In an ideal situation, Keri and her daughter would have access to a continuum of care that would ratchet upwards or downwards to meet their needs: when Trina is a real danger to herself or others, (IE could seriously harm, murder someone else or commit suicide) then she should be placed in a psychiatric hold of some sort, but she should also have a range of other care available to her when she does not meet this qualifications, things like community mental health centers, in home-care when necessary, psychiatric counseling and so on. Trina’s actual experience, however, is quite fractured. She is either under extensive supervision, removing all of her agency (including the choice whether or not to take drugs) or under no medical supervision of any kind, and remanded entirely to her mother’s care. This creates situations where Keri is forced to do anything she can to try to convince hospital staff that Trina is a danger: recounting the times Trina hits her (Campbell 2005, 152), only to be told that administrators “can’t justify taking” Trina into care (Campbell 2005, 152). One particular monologue by Keri demonstrates the extreme frustration: she must constantly “wait … call again … and hope” that everything in the system works, that people observe her daughters dangerous behavior, that doctors will do the proper paperwork, and so on (Campbell 2005, 163). This novel demonstrates the significant problems in the current fractured care systems that exists for mental health patients. There are many examples of patient advocacy in this novel. They show, however, that there are often cases of missed advocating, and in other cases advocates that in attempting to advocate for their patients actually do them harm. One of the most telling moments in the entire novel is when Keri, who genuinely loves and cares for her daughter, admits that she hopes that patient advocates “are lazy” so that they will not attempt to defend Trina’s rights (Campbell 2005, 163). This shows how fundamentally broken the advocacy system is, when advocates, in attempting to ensure that patient’s rights are not harmed, put patients in dangerous situations: situations where they could harm themselves or others. Continuously throughout the novel advocacy tends to focus more on supporting the community mental health system as it currently stand than ensuring what is right for the patient or for her family. Throughout the novel Trina and Kerri also come into contact with many professional counselors in non-emergency and emergency situations. They have a couple of distinct roles. One of them is to do entrance evaluation of Trina in emergency situations to determine if she warrants further psychiatric care, and can be held against her will. The other is to ensure that Trina receives ongoing care, for issues such as substance abuse, and ongoing care that each of them needs in order to cope. The problem, however, is the fractures between these two systems: counselors with more experience on Trina have less to do with her care than entrance counselors at hospitals, and the communication between them is virtually nonexistent. An oft used phrase in the novel is the fact that counselors “have their hands tied,” and are unable to provide any care other than basic guidance (Campbell 2005, 121). The counselors have to balance the requirements of their work situation, their ethical obligation to protect Trina’s rights, and the needs of someone who is obviously gravely ill. These often conflict to the degree that they lead to paralysis, a situation that helps no one and has serious potential to harm. On a cognitive level, this novel demonstrates something that many health practitioners already know: that a highly fractured continuum of care, weak and confused advocacy, and conflicting counselor roles lead to massive holes through which people slip, unable to receive the care that they need. It also demonstrates that there are some relatively simple fixes that could help to mend this broken system. This novel’s affective impact on me, however, was much stronger. As a care provider, you often only see small snippets of a person’s life – but to see these snippets strung together into a narrative, from that person’s eyes, is a powerful reminder of the power and responsibility inherent to such a position. Works Cited Campbell, BM (2005). 72 Hour Hold. New York: Knopf. Appendix B: 72 Hour Hold Book Critique & Discussion Board Rubric (20 points) 3 2 1 0 Content Section 1: Brief Summary of the Novel Basic story line of the novel is clearly, but succinctly summarized. Summary includes key themes from the novel. Basic story line of the novel is summarized. Summary includes one theme from the novel. Ideas are thorough, but excessively verbose. Basic story line has large sections omitted. Content and/or themes are incorrect. Section 2: The Continuum of Care in CMH Community Mental Health services within the Continuum of Care that are utilized within the novel are clearly labeled, with examples cited. Section describes effective and ineffective aspects of each of these services. Section clearly incorporates course material, showing depth of understanding and application. Community Mental Health services within the Continuum of Care that are utilized within the novel are named, with examples provided. Section describes effective and ineffective aspects of some of these services. Section incorporates course material. One or two Community Mental Health services within the Continuum of Care that are utilized within the novel are named. Few to no examples from the novel are provided. Section describes either effective or ineffective aspects of these services, but not both. Section loosely incorporates course material. Some Community Mental Health services within the novel are named, but no examples are provided. Services do not relate to the course material or the Continuum of Care. Evaluation of effectiveness or ineffectiveness of services is omitted. Section does not incorporate course material. Section 3: Advocacy Advocacy opportunities and processes that could be explored for characters in the novel are clearly labeled, with examples cited. Section clearly incorporates course material, showing depth of understanding and application of advocacy processes. Advocacy opportunities and processes are named, with some examples cited. Section incorporates course material. Reference is made to advocacy processes, with some examples cited. Section loosely incorporates course material. Reference is made to advocacy processes, but few to no examples are cited. Section does not incorporate course material. Section 4: Professional Issues The role of the professional counselor working with Trina and Keri is clearly defined. Ethical, legal, and multicultural issues are defined as they affect this counseling process. The role of the professional counselor working with Trina and Keri is labeled. Ethical, legal, and multicultural issues are loosely incorporated. The role of the professional counselor is omitted. Ethical, legal, and multicultural issues are omitted. Section 5: Personal Reactions Personal reaction to the story is clearly delineated, and includes cognitive and affective responses. Section includes specific examples of what you would do if your child were experiencing Trina’s symptoms. Personal reaction to the story is described, including the affective component of how you would feel if your child were experiencing Trina’s symptoms. Unable to articulate a reaction, or to self-apply the content from the novel. Or, personal reaction is omitted from the paper. Writing Style Read More