河邊
相信的就是真實，難以置信的就是虛構。我隨便寫寫，你隨便看看
正文
此NAMI不是彼“納米”，不是那個最近很時髦的納米技術。我說的這個NAMI是National Alliance on Mental Illness，美國的全國精神疾患聯盟。NAMI在1979年成立時叫National Alliance for the Mentally Ill，是一個民間的草根組織，主要由精神疾患的家屬組成，起支持，教育和為精神疾患患者宣傳的作用。
美國有不少類似的民間組織，比如乳腺癌的粉紅絲帶組織（Pink Ribbon），酒精成癮者的AA Meeting等。我知道NAMI組織已經有幾年了，有時候病人問道有什麽民間組織可以加入，得到支持和教育時我也會告訴他們有這麽一個NAMI組織。但是，NAMI組織到底是什麽樣子，我這個星期才第一次接觸到。
我有一個同事告訴我他有時候去當地的NAMI組織參加病人家屬的教育活動，建議我也去，給當地的NAMI組織一些支持，也對當地有精神疾患的病人和他們的家屬有幫助。我就聯係了本市NAMI的組織者，他們讓我有一天晚上去參加一個家屬教育的會議。在會上，這些病人家屬會提出一些問題，主要是關於藥物方麵的問題。
一進屋，看到有近二十位中年人圍坐在那裏，後來知道他們都有有精神疾患的孩子，而且這些孩子大部分都是剛剛成年。他們早已得知有一個精神科醫生要來解答問題，所以都準備好了問題。有人問鋰製劑的副作用以及需要監測什麽指標，有人問抑鬱症的療程，也有人問一些政策相關的問題。
比如，一個家屬提出，她的孩子已經滿十八歲了，有躁鬱症，有時候表現為躁狂症，不願意接受治療。她覺得病人應該住院，但是醫生說病人目前還沒有構成對本人或他人即刻的危險，所以如果病人不願意住院就無法把病人收住院。她覺得這是美國的精神疾患的醫療係統不好，應該改進。
這個確實是目前困擾著很多病人家屬和精神科醫生的一個問題。對比一下，在中國，經常是家屬大包大攬。而在美國，隻要病人是個成年人，而且有自己做決定的能力，病人就自己做決定，這是病人的權利。 比如，被診斷得了癌症，在美國，醫生先跟病人談，然後問病人要不要家屬也參加討論。而在中國，如果有人被診斷得了癌症，醫生一般先瞞著病人跟家屬商量，因為在中國強調的是不能讓病人精神受到刺激，而不是病人的隱私權和自主決定權。
如果在中國有病人有嚴重的精神疾患，一般家屬會把病人送到精神病院，如果醫生覺得病人應該住院，家屬簽字病人就住院了，病人抗議也沒有用。而在美國，對於已經成年的嚴重精神疾患患者，基本沒有家屬太多介入意見的餘地。
在美國，如果病人不構成對本人或他人即刻的危險，而且有自主做決定的能力（有精神疾患不等於一定就失去做決定的能力），則尊重病人的意見。如果病人要自殺或者要殺人，或者比如患有晚期老年癡呆症不能生活自立並且失去自主做決定的能力，則由醫生申請（最終由法官批準），可以違背病人意願將病人收住院。這種情況下，家屬可以提供信息幫助醫生做決定，但是家屬沒有替病人做決定的權力。
下麵我轉帖的一篇英文文字來自NAMI網站，正好講到這種情況。可以看出，美國的精神疾患醫療政策還有不少需要改進的地方。據我所知，中國的精神醫學和相關政策，更不夠完善，人們都精神疾患患者有更多的成見，需要更多的努力去改進。
在NAMI會議上見到的這些病人家屬跟我以前見到的病人家屬比，顯得對精神疾患和藥物的了解比較多，問的問題都比較到位。另外，他們顯然對他們家裏有精神疾患的孩子非常關心。我所知道的那兩個本市NAMI組織的組織者也是精神疾患病人的母親。另外，這些人經常掛在嘴邊的一個詞就是“Advocate”（宣傳），他們希望通過自己的努力，盡量改善精神疾患的相關政策。
NAMI組織的參加者希望能夠改變人們對精神疾患患者的成見，讓這些患者能夠盡量遠離醫院，盡量能過接近正常人的生活，不給自己，家人和其他人帶來不必要的麻煩。即使是一個普通公民，不是我這樣的專業工作者，其實也應該支持NAMI這樣的組織。 這些精神疾患患者急性發病時，住院所花費的費用和資源遠高於門診治療的費用。如果沒有得到及時的治療，他們還可能對自己，家人和社會帶來的巨大損失。如果能改善他們平時能得到的治療，讓他們的症狀得到很好的控製，則可以節省社會的醫療資源，極少精神疾患患者急性發病給社會帶來的損失。
我還沒有聽到中國有類似NAMI的組織存在。中國有不少健康網站，其質量參次不齊，有些網站提供的“健康”知識是不夠準確的，還有不少網站打著健康的旗號大作所謂保健品的廣告。
最後再提一句，NAMI組織在近些年被發現其資金來源有一半以上來自製藥公司，為此，已經有人開始對NAMI組織進行調查，可見這些健康相關的組織在美國會得到公眾的監控，以保證它們正確的方向。在公眾監控這一方麵，中國真的應該很慚愧，連中國紅十字會都爆出那麽多貪汙的醜聞。
www.nami.com
--------------------------------------------------------------------------
We don’t know how to help our son
Our 30 year old son is bipolar. He was diagnosed in May, 2007, when he had his first manic episode. We run a small business in Fort Worth, and have never been able to afford health insurance for our family. The only option we had to get our son to a safe place when he was manic was to go to John Peter Smith Hospital, which is so overwhelmed with patients that they usually do not have a place available for him for longer than 24 hours or so in Psyche ER (unless he is considered ‘a danger to himself or others’) . We finally (after several attempts to get him admitted) had to get a judge to sign a commitment order so the police picked him up and he was eventually committed to the state hospital.
This scenario has cyclically repeated itself over the years. Once, when he was in the state hospital in Wichita Falls, the social worker applied for disability, and he qualified. He has been getting disability for over 3 years now, and that means that last summer he also was able to receive medicare.
Since he had insurance last fall, as soon as he realized a manic episode was coming on, he was able to get admitted to a private facility, and was admitted to Millwood, Sundance and Springwood Hospitals in Texas and several hospitals in other states. (Btw, before last fall, he was attending classes at TCC and making very good grades, but has not recovered enough during this last year to be motivated to go back to school.)
When he was admitted to Millwood and Sundance, they immediately took him off the medications that he had been on (which was basically the same for all the years since first being diagnosed) and put him on a different drug, to which he did not respond. They discharged him anyway, however, after a certain number of days — 10 or 11 — because ‘medicare doesn’t like it for him to be an inpatient longer than that.’
Each time, he got worse after being hospitalized, the mania escalated into psychosis, and it was up to us to figure out what to do, because the hospital would not readmit him, until finally the episode was over, with him back on the same medication that he had been on prior to becoming manic.
During the most recent manic episode this spring, he connected with some ‘friends’ from his past, and got some marijuana (his ‘drug of choice’ when he self-medicated in the past) and another drug from them. When he was walking along the street, with these drugs in his backpack, and saw a police car, he turned himself in to them. He believed this to be the ‘right thing’ to do, and, since I was unable to come pick him up when the policeman called me, he was taken to jail and is now dealing with the consequences of being charged with drug possession. He may not be able to get a job, with this on his record. He was asking for help. He was not in his right mind when this happened, but the help he needed was not available. He was in the middle of a manic episode (he was hospitalized both prior to the incident and for several weeks after). He is being penalized as a result of his illness.
He was an MHMR patient from the time he was first diagnosed and hospitalized until recently. He always takes his medication and does not use any kind of drugs or alcohol between episodes. His doctor at MHMR refused to take ‘walk in’ patients, so if our son felt a manic episode coming on, he was told to go to JPS, which, as I said above, was not able to treat him adequately unless he became ‘a danger to himself or others.’ This aspect of the mental health system did not provide support or planning. This is most probably due to lack of funding and being overwhelmed with patients.
The police at the Arlington City Jail told us that 25% of their inmates would not be there if the mental health care system was adequate. I have seen this same figure in stories about jails across the country.
The private system also does not provide adequate care and support so far, because no one even wants to take his history from us!
We are all in ‘waiting’ mode again now, between episodes, because we do not know where to turn for help. From everything I read, the mental health care system all over the country is the same.
Every time I hear on the news that there has been a tragic shooting and that the shooter is mentally ill, I can’t help but think that this person most likely asked for help, like our son does each time, before it got to the point where they took a gun to other people and then (usually) to themselves. A person in their right mind does not do these things. And, most mentally ill people want help at some point in their illness. If help was readily available to them at that point, our whole society would benefit.e are all in ‘waiting’ mode again now, between episodes, because we do not know where to turn for help. From everything I read, the mental health care system all over the country is the same.
Every time I hear on the news that there has been a tragic shooting and that the shooter is mentally ill, I can’t help but think that this person most likely asked for help, like our son does each time, before it got to the point where they took a gun to other people and then (usually) to themselves. A person in their right mind does not do these things. And, most mentally ill people want help at some point in their illness. If help was readily available to them at that point, our whole society would benefit.
美國有不少類似的民間組織，比如乳腺癌的粉紅絲帶組織（Pink Ribbon），酒精成癮者的AA Meeting等。我知道NAMI組織已經有幾年了，有時候病人問道有什麽民間組織可以加入，得到支持和教育時我也會告訴他們有這麽一個NAMI組織。但是，NAMI組織到底是什麽樣子，我這個星期才第一次接觸到。
我有一個同事告訴我他有時候去當地的NAMI組織參加病人家屬的教育活動，建議我也去，給當地的NAMI組織一些支持，也對當地有精神疾患的病人和他們的家屬有幫助。我就聯係了本市NAMI的組織者，他們讓我有一天晚上去參加一個家屬教育的會議。在會上，這些病人家屬會提出一些問題，主要是關於藥物方麵的問題。
一進屋，看到有近二十位中年人圍坐在那裏，後來知道他們都有有精神疾患的孩子，而且這些孩子大部分都是剛剛成年。他們早已得知有一個精神科醫生要來解答問題，所以都準備好了問題。有人問鋰製劑的副作用以及需要監測什麽指標，有人問抑鬱症的療程，也有人問一些政策相關的問題。
比如，一個家屬提出，她的孩子已經滿十八歲了，有躁鬱症，有時候表現為躁狂症，不願意接受治療。她覺得病人應該住院，但是醫生說病人目前還沒有構成對本人或他人即刻的危險，所以如果病人不願意住院就無法把病人收住院。她覺得這是美國的精神疾患的醫療係統不好，應該改進。
這個確實是目前困擾著很多病人家屬和精神科醫生的一個問題。對比一下，在中國，經常是家屬大包大攬。而在美國，隻要病人是個成年人，而且有自己做決定的能力，病人就自己做決定，這是病人的權利。 比如，被診斷得了癌症，在美國，醫生先跟病人談，然後問病人要不要家屬也參加討論。而在中國，如果有人被診斷得了癌症，醫生一般先瞞著病人跟家屬商量，因為在中國強調的是不能讓病人精神受到刺激，而不是病人的隱私權和自主決定權。
如果在中國有病人有嚴重的精神疾患，一般家屬會把病人送到精神病院，如果醫生覺得病人應該住院，家屬簽字病人就住院了，病人抗議也沒有用。而在美國，對於已經成年的嚴重精神疾患患者，基本沒有家屬太多介入意見的餘地。
在美國，如果病人不構成對本人或他人即刻的危險，而且有自主做決定的能力（有精神疾患不等於一定就失去做決定的能力），則尊重病人的意見。如果病人要自殺或者要殺人，或者比如患有晚期老年癡呆症不能生活自立並且失去自主做決定的能力，則由醫生申請（最終由法官批準），可以違背病人意願將病人收住院。這種情況下，家屬可以提供信息幫助醫生做決定，但是家屬沒有替病人做決定的權力。
下麵我轉帖的一篇英文文字來自NAMI網站，正好講到這種情況。可以看出，美國的精神疾患醫療政策還有不少需要改進的地方。據我所知，中國的精神醫學和相關政策，更不夠完善，人們都精神疾患患者有更多的成見，需要更多的努力去改進。
在NAMI會議上見到的這些病人家屬跟我以前見到的病人家屬比，顯得對精神疾患和藥物的了解比較多，問的問題都比較到位。另外，他們顯然對他們家裏有精神疾患的孩子非常關心。我所知道的那兩個本市NAMI組織的組織者也是精神疾患病人的母親。另外，這些人經常掛在嘴邊的一個詞就是“Advocate”（宣傳），他們希望通過自己的努力，盡量改善精神疾患的相關政策。
NAMI組織的參加者希望能夠改變人們對精神疾患患者的成見，讓這些患者能夠盡量遠離醫院，盡量能過接近正常人的生活，不給自己，家人和其他人帶來不必要的麻煩。即使是一個普通公民，不是我這樣的專業工作者，其實也應該支持NAMI這樣的組織。 這些精神疾患患者急性發病時，住院所花費的費用和資源遠高於門診治療的費用。如果沒有得到及時的治療，他們還可能對自己，家人和社會帶來的巨大損失。如果能改善他們平時能得到的治療，讓他們的症狀得到很好的控製，則可以節省社會的醫療資源，極少精神疾患患者急性發病給社會帶來的損失。
我還沒有聽到中國有類似NAMI的組織存在。中國有不少健康網站，其質量參次不齊，有些網站提供的“健康”知識是不夠準確的，還有不少網站打著健康的旗號大作所謂保健品的廣告。
最後再提一句，NAMI組織在近些年被發現其資金來源有一半以上來自製藥公司，為此，已經有人開始對NAMI組織進行調查，可見這些健康相關的組織在美國會得到公眾的監控，以保證它們正確的方向。在公眾監控這一方麵，中國真的應該很慚愧，連中國紅十字會都爆出那麽多貪汙的醜聞。
www.nami.com
--------------------------------------------------------------------------
We don’t know how to help our son
Our 30 year old son is bipolar. He was diagnosed in May, 2007, when he had his first manic episode. We run a small business in Fort Worth, and have never been able to afford health insurance for our family. The only option we had to get our son to a safe place when he was manic was to go to John Peter Smith Hospital, which is so overwhelmed with patients that they usually do not have a place available for him for longer than 24 hours or so in Psyche ER (unless he is considered ‘a danger to himself or others’) . We finally (after several attempts to get him admitted) had to get a judge to sign a commitment order so the police picked him up and he was eventually committed to the state hospital.
This scenario has cyclically repeated itself over the years. Once, when he was in the state hospital in Wichita Falls, the social worker applied for disability, and he qualified. He has been getting disability for over 3 years now, and that means that last summer he also was able to receive medicare.
Since he had insurance last fall, as soon as he realized a manic episode was coming on, he was able to get admitted to a private facility, and was admitted to Millwood, Sundance and Springwood Hospitals in Texas and several hospitals in other states. (Btw, before last fall, he was attending classes at TCC and making very good grades, but has not recovered enough during this last year to be motivated to go back to school.)
When he was admitted to Millwood and Sundance, they immediately took him off the medications that he had been on (which was basically the same for all the years since first being diagnosed) and put him on a different drug, to which he did not respond. They discharged him anyway, however, after a certain number of days — 10 or 11 — because ‘medicare doesn’t like it for him to be an inpatient longer than that.’
Each time, he got worse after being hospitalized, the mania escalated into psychosis, and it was up to us to figure out what to do, because the hospital would not readmit him, until finally the episode was over, with him back on the same medication that he had been on prior to becoming manic.
During the most recent manic episode this spring, he connected with some ‘friends’ from his past, and got some marijuana (his ‘drug of choice’ when he self-medicated in the past) and another drug from them. When he was walking along the street, with these drugs in his backpack, and saw a police car, he turned himself in to them. He believed this to be the ‘right thing’ to do, and, since I was unable to come pick him up when the policeman called me, he was taken to jail and is now dealing with the consequences of being charged with drug possession. He may not be able to get a job, with this on his record. He was asking for help. He was not in his right mind when this happened, but the help he needed was not available. He was in the middle of a manic episode (he was hospitalized both prior to the incident and for several weeks after). He is being penalized as a result of his illness.
He was an MHMR patient from the time he was first diagnosed and hospitalized until recently. He always takes his medication and does not use any kind of drugs or alcohol between episodes. His doctor at MHMR refused to take ‘walk in’ patients, so if our son felt a manic episode coming on, he was told to go to JPS, which, as I said above, was not able to treat him adequately unless he became ‘a danger to himself or others.’ This aspect of the mental health system did not provide support or planning. This is most probably due to lack of funding and being overwhelmed with patients.
The police at the Arlington City Jail told us that 25% of their inmates would not be there if the mental health care system was adequate. I have seen this same figure in stories about jails across the country.
The private system also does not provide adequate care and support so far, because no one even wants to take his history from us!
We are all in ‘waiting’ mode again now, between episodes, because we do not know where to turn for help. From everything I read, the mental health care system all over the country is the same.
Every time I hear on the news that there has been a tragic shooting and that the shooter is mentally ill, I can’t help but think that this person most likely asked for help, like our son does each time, before it got to the point where they took a gun to other people and then (usually) to themselves. A person in their right mind does not do these things. And, most mentally ill people want help at some point in their illness. If help was readily available to them at that point, our whole society would benefit.e are all in ‘waiting’ mode again now, between episodes, because we do not know where to turn for help. From everything I read, the mental health care system all over the country is the same.
Every time I hear on the news that there has been a tragic shooting and that the shooter is mentally ill, I can’t help but think that this person most likely asked for help, like our son does each time, before it got to the point where they took a gun to other people and then (usually) to themselves. A person in their right mind does not do these things. And, most mentally ill people want help at some point in their illness. If help was readily available to them at that point, our whole society would benefit.
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