Definition of a Patient

Psychiatry is the only medical specialty that refers to their patients as "survivors," "people with lived experience," "clients," and "consumers."  Are these alternative titles of recipients of mental health treatment really helpful to those with mental illness? The title "survivor" suggests that the recipient of mental health treatment was traumatized from being involved in the mental health system. The title "person with lived experience" suggests that the recipient of mental health treatment was never really mentally ill. Using these titles when referring to recipients of mental health treatment upholds anti-psychiatry groups' belief that mental illness is not real. 

Schizophrenia, severe depression, severe anxiety, and bipolar disorder are real illnesses. Referring to these as "conditions" is disrespectful to psychiatry. Doing this gives psychiatry a pseudo-scientific appearance and undermines positive progress. For decades, psychiatry has had a reputation in the medical community as being less than medical, or even unworthy of respect in some instances. Psychiatry and its strides, albeit slower to come by than other medical disciplines, does not deserve a pseudo-scientific reputation. Organizations dominated by peer specialists (people with a history of emotional distress expected to help patients) rarely refer to recipients of mental health care as “patients." It is not stigmatizing to use language that accurately reflects the relationship between those giving and receiving care.

The titles "client" and "consumer," suggest that recipients of mental health treatment are self-directing their treatment courses. These terms especially isolate those people with mental illness who lack the capacity to direct their treatment plans. When I authorize an involuntary transport to a hospital for someone, I view this person as a patient who is unable to make the appropriate choice about her or his own treatment. 

I will refer to those I help as “patients” in this book to accurately reflect my work. I will do this to give psychiatry, and its recipients of care, the respect that they deserve. 

Mentally Ill? Barely.

I've touched upon the subset of the mentally ill population whom I believe is most impaired. On the opposite end of the spectrum there are those who pretend to be mentally ill. They are referred to as malingerers. They pretend to be sick for secondary gain, that is, hospitalization or a crisis unit stay. Although the most common reason for this is to secure "three hots and a cot" because of homelessness, there are other reasons. For instance, they might have just encountered a drug-deal-gone-wrong and now are in danger of getting killed, thus need to hide out. Or, they might want to build a case to try getting financial benefits from the government.

I want to give attention to this population not because I believe they deserve to occupy my brain space. It should be shouted from the rooftops that they are part of the problem. They occupy precious and limited bed space. They waste health care resources. They waste our tax dollars.

How prevalent is this problem? I haven't found any state specific or nationwide statistics when I searched for this. However, I tracked one hundred cases in a row randomly dispatched to me in order to see what percentage of these were malingering. The results were alarming.

In graduate school at Columbia University, the possibility that patients could lie about their mental states never crossed my mind. When searching for continuing education courses to take in order to maintain my license, I've never come across this topic. When clinicians are educated about how to identify malingering, they are better prepared to show them the exit door rather than enable them.

Underserved Population

The purpose of writing these blog posts is to spread the news about developing this book. These blogs will hint about what will eventually be self-published. In my first post, I began to describe my work as a mobile psychiatric emergency clinician. I will expand on this a bit.

The majority of clinical cases at my current place of employment have involved mentally high-functioning patients. However, I have felt most satisfied when working on the most complicated, most acute cases involving the most mentally impaired patients. My fascination with this population relates to how grossly underserved they are both in the mental health system and the legal system. This subset of the mentally ill population is more impaired than higher functioning subsets. Therefore, it's ironic that they don't appear to be prioritized by many societal entities.

I became alarmed at the extremely high rates of readmissions to the inpatient psychiatric units that I worked on. While emergency work has involved observing patients functioning outside of hospitals for many years, this has sometimes felt like long-term care because of the astronomically high rate of patients returning to the emergency setting.