Breakdown: A Clinician’s Experience In A Broken System Of Emergency Psychiatry by Lynn Nanos (book review).

When I was first asked to review this book, I got the impression that it would be full of interviews with mental health patients on how they were treated in the USA. Actually, it isn’t, mostly because most don’t even believe they are ill, although their mental conditions are serious and how they are treated by the system.

Author Lynn Nanos is careful to change names and such so they aren’t readily identified. What she is more concerned with and from her personal experience as an emergency psychiatric clinician in Massachusetts is in the failings of mental care over there. She is one of the few clinicians brought in to assess people with mental problems who are arrested. Even when she has to section or confine them, many are released back onto the streets, often with no care whatsoever.

I presume she is seeing people who are brought in without concern to whether they can pay medical bills, more so as many of these people are brought in for assessment or help and many are actually homeless. Worse, a lot of them aren’t aware that they have mental problems until assessed and not even then. These same people, because of human rights issues, are just as likely to walk out when left unsupervised if left alone. When you consider some are hearing voices urging them to kill, well, we’ve seen the outcome of that.

No one can even check if they are taking medication and unless they are formerly signed up to a particular drugstore/pharmacy will find their prescriptions thrown away which is a complication when patients are released early. Mentally ill people are also treated as criminals than people needing care. The more you read, the more you will realise that there is something seriously wrong with how American treats its people.

4% of the USA population has serious mental problems but that looks like a small number until I put it in terms of people. Now, currently, they have a population of 328,900,709 and that makes 1,315,602. That’s still a significant number of people and I assume this is based on those who have been recognised as having problems and so presumably must be more whom the system hasn’t caught up with. 29% are known to kill family members and 7% of the general public. The prevalent conditions is schizophrenia, mania and depression. Of 62 mass shootings, 38 were committed by those displaying mental delusional illness.

Nanos also points out that there are few people in her line of work because it does not pay as much as other parts of the medical profession and the number of beds available has also been curtailed so few can be cared for more than a couple weeks before being released. Presumably, this places more of these people in prison instead.

A reference from Doris A. Fuller, formerly chief of research and public affairs for the Treatment Advocacy Centre, is potent: ‘The US mental health system is set up for people who are well enough to walk in and say, “I need help.” If you are not well enough to walk in and say “I need help”, you’re in trouble.’ The ultimate Catch 22.

A common problem is delusional mentally ill people who don’t take illegal drugs aren’t aware they are ill, more so if they hallucinate and aren’t taking illegal drugs. Some of the people noted actually actively even avoid food fearing it contains various things which must cause problems getting them to eat beneficial drugs that would help them. Added into this mix are the problems of civil rights and not being able to keep them without being sectioned or locked up. Even then, said people are often released far too early and without supervision because of cost. I did wonder where medical insurance comes into this, especially for the homeless, but only a little of this is covered.

None of this is helped by so many in the mental health professionals have a low tolerance to helping the mentally ill which must surely be counter-productive and makes me wonder why they chose that direction to find work? Which side is the most mentally ill? Added into this mix are malingerers and those who want to be seen as ill. In fact, many of the mental hospitals prefer malingerers because they cause less problems which sort of defeats the object.

This isn’t a book to advocate locking up mentally ill people forever but certainly long enough to be treated properly than simply let them go after a set time. I find it more remarkable that the number of beds available are cut back than ensuring there is enough. Then again, the American health care economy is based on insurance and who can pay than looking after its citizens. People there would rather think that there aren’t people with mental problems. Something to ponder on with the next mass-shooting as I think the statistic seems to be increasing. Also remember that emergency psychiatric clinician like Nanos aren’t safe neither from attack. Her example of 25 year-old residential counsellor Stephanie Moulton being stabbed to death should make you stop and think although I think didn’t help in recruiting staff.

Although Nanos only covers Massachusetts, this isn’t the only American state with a failing mental health system. If you are interested in American mental issues and their treatment, then you really need to read this and if you live in the USA, harass your senators and politicians not to under-fund their treatment.

I’m still a bit unsure as to SFCrowsnest being the right place for this book but Lynn Nanos pointed out that I reviewed another book on mental issues recently and thinks I have a receptive audience out there willing to listen. After reading this book, I think you’ll find if you live in the USA, you should take this problem seriously. Proper mental health-care might actually reduce the number of mass-killings.

GF Willmetts

June 2019

(pub: Lynn Nanos. 274 page enlarged paperback. Price: $13.50 (US), £10.59 (UK). ISBN: 978-0-692-16842-4)

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Geoff Willmetts has been editor at SFCrowsnest for some 21 plus years now, showing a versatility and knowledge in not only Science Fiction, but also the sciences and arts, all of which has been displayed here through editorials, reviews, articles and stories. With the latter, he has been running a short story series under the title of ‘Psi-Kicks’ If you want to contribute to SFCrowsnest, read the guidelines and show him what you can do. If it isn’t usable, he spends as much time telling you what the problems is as he would with material he accepts. This is largely how he got called an Uncle, as in Dutch Uncle. He’s not actually Dutch but hails from the west country in the UK.

3 thoughts on “Breakdown: A Clinician’s Experience In A Broken System Of Emergency Psychiatry by Lynn Nanos (book review).

  • People in the worst stages are not the mass killers. In fact their psychosis, when the are… is often not a hallucinatory world, not that of Joel Reuter who valiantly fired into the martians , the Swat team. There are those who “merely” believe something no one without psychotic THOUGHT would think. They can easily be shooters, mass of singular. A common form is killing parents after aliens take over their bodies and souls. “Sorry mom, but…” and this happens repeatedly

    “Studies Show” that mass killings are not, in the majority, by the mentally ill. The SMI are no more deadly than the population of which they are a part. Yes, you can find this from the stats. BUT Turn the telescope around and use the microscopic end. Look at the 3% who are SMI. They commit more than their 3%.. If you want a better bet, choose those who drink and drug, select only those who have a history of violence. These, sadly to say, are greatly over represented, even in the same group where the “no more dangerous” Violent history is the best predictor. add anything that messes with self control- speed, alcohol, barbituates etc etc… and you have a very “good bet.” It may not be a mass shooting. When a loved one dies, the total body count does not change the grief. What still hinges is the admission that the SMI are a danger to others AND more, to themselves. Many don’t know they are sick. We allow them this opinion, even against the doctors expert “opionions.” Some call it protecting the liberty. As just shared with me- they loose all othger rights when they “die with their rights (to go free and untreated)on.” Never again will they have a right to choose what to eat, wear, what movie to pay for, or who to fall in love with. These are my thoughts. I share them with many others who are glad this book is getting attention, many of us have stories, many have had their children’s sibling.s, parent’s or mate’s rights erased by this one “right.” Can we call it by its proper name? ABANDONMENT. Mass shooting pale to ALL the slow deaths we watch, helpless to prevent. AOT is not abridgement of rights. it is an attempt to preserve them from deteriorating.

  • As an outsider my views are partisan – but your final sentence rings so true: ‘Proper mental health-care might actually reduce the number of mass-killings’ – though to be frank ‘proper health-care’ might be a better expression.

    • Hello Julian
      The book focuses on mental health-care so stayed within the tone of the material.


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