tag:blogger.com,1999:blog-7772182113499451603.post5801976166344333858..comments2024-03-27T10:50:53.692-05:00Comments on Real Psychiatry: Minnesota's Suicide Prevention PlanGeorge Dawson, MD, DFAPAhttp://www.blogger.com/profile/03474899831557543486noreply@blogger.comBlogger4125tag:blogger.com,1999:blog-7772182113499451603.post-69840432936469896542016-09-25T01:11:41.155-05:002016-09-25T01:11:41.155-05:00To clarify - I don't believe that zero suicide...To clarify - I don't believe that zero suicides is possible. I know for a fact that the prescribing patterns for patients with terminal illnesses have changed considerably over the past 30 years. Some of of that prescribing results in medications with no upper limit. I think that is a way around a formal euthanasia law and I defer to the experts in that area as to how it is handled.<br /><br />My job is much different - and even though it consumes much of my time both in the office and sitting at home thinking about things - I will concede that there is no current way to prevent all suicides in otherwise healthy individuals. That doesn't mean that you can't save almost all people but with the current fragmented system - even standard care is difficult.<br /><br />Thanks for your extensive comments and experience in this area. George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-5456987050553192222016-09-25T00:55:05.852-05:002016-09-25T00:55:05.852-05:00I'll offer a few tidbits of thought, as a mult...I'll offer a few tidbits of thought, as a multiple firearm owner, current (recent) opioid user and chronic pain patient.<br />First, I'd be the happiest man in the world if a black box warning were included with firearms. Most of my firearms were inherited and are of historical note, the rest, tools and if I have a warning about how dangerous a circular saw is, I really should expect a similar warning with a handgun, shotgun or rifle.*<br /><br />Second, we do need to re-examine our means of addressing our opioid usage and abuse issues. Far too many times we leave chronic pain patients in the dust in our zeal to eliminate abuse, equally often, we ignore abusive prescribing. As a layperson, I'm starting to lose faith in self-policing of our medical community, but also fear political involvement.<br />After all, if one wants something seriously fouled up, leave it to a politician. Rule by focus group, rather than competence center tends to foul up badly. See the mess of our mental health care system as a prime example of that level of ineptitude. <br /><br />Finally, you've entirely avoided one sensitive topic - a topic abandoned by most of the medical and lay community, end of life care.<br />Do we honestly want zero suicides, despite what a dying patient is experiencing?<br />While I'm a layperson, I am also a former SF medic and my clinical rotation involved an oncology floor. Some of what I saw there marked me as much, if not more, than actual combat conditions!<br />People dying, in horrific pain, pain beyond the ability of our technology to mitigate, zero hope for survival and only months of more pain in store for them and no option for them.<br /><br />That said, I also advocate for more in-patient care. Far too frequently, we briefly hospitalize an out of control patient, initiate medication, then release them and hope that the medications work.<br />Just today, I had my wife's antidepressant D/C'd, due to suicidal ideation. The medication being off label prescribed to stimulate appetite and help control neuropathic pain. If we weren't so open in our communication, I shudder to consider what might have happened with her access to my firearms and her access to her morphine sulfate tablets!<br />I suspect that the root cause is liver dysfunction and an interaction with gabapentin, but that's a guess based upon pharmakinetics and frankly, a guess that's far outside of my lane of experience. But then, my pharmacology knowledge is quite extensive, I never worked with a drug until I knew how it worked, its metabolism, excretion, etc.<br />That also means, I know precisely when to call doctor. :)<br />As, I'm not a medical professional, these days, I'm an information security professional, who happened to provide advanced EMS services to our special operations community (and especially loved operating small clinics in remote locations for small villages), knowing when to seek professional guidance is important. <br />Most lay lack that resource of knowledge.<br />Addressing that need also is critical. Dane County seems to be slightly addressing the issue (closing at 23;00 isn't exactly an optimal address, it ignores sundowning and similar issues). But, funding, funding, funding...<br />Still, as mom once said, a half of a loaf of bread beats no loaf at all.<br />But, we really do need to do a *lot* better. Nationally, our mental health care system is a disgrace.*<br /><br />*Please excuse any logic flow lapses, I was in the middle of lunch and lamb chops can be a bit messy and labor intensive in an office environment.Wzrd1https://www.blogger.com/profile/11709454392659584792noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-79717258104161388952016-09-13T10:02:24.487-05:002016-09-13T10:02:24.487-05:00Thank you for your comment and I agree completely ...Thank you for your comment and I agree completely on the issue of more psychiatrists speaking out against these practices. A person should not have to meet some business or government idea about how desperate they need to be in order to access the appropriate level of care. I have compared this to any middle aged person in the US (and presumably the UK) with chest pain. They uniformly receive an intensive level of care whether they are having a heart attack or not. With depression and suicidal thinking a person's distress needs to match somebody else's idea of what is an appropriate level of distress in order to access care. That does take superhuman perseverance and in most cases people just give up. Much better treatment is possible but only if the selective rationing of mental health services is exposed and corrected. George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-64817998951753722602016-09-13T08:23:53.625-05:002016-09-13T08:23:53.625-05:00I am in the UK but this sounds so familiar. The su...I am in the UK but this sounds so familiar. The suicide prevention c**p that gets wheeled out completely ignores the fact that getting treated for a mental illness takes superhuman perseverance. Getting an admission requires risk so high that it is a miracle you are still alive. Getting a long term admission is even harder..... And in the mean time people are encouraged to download apps, phone a friend, tell their GP ( who won't be able to do anything) , go to their local ED who also won't be able to access any help...... and heaven help you if you are diagnosed with a personality disorder, when you will be left to self harm in the interests of learning to take responsibility for yourself. I wish more psychiatrists would speak out. Anonymousnoreply@blogger.com