Dying in a Mental Health Facility

Mentally or emotionally challenged people are viewed as dangerous and treated as an outcast of society. Some people are afraid of those with mental conditions and do not want these patients living near them. Many emotionally disturbed patients have committed crimes and are serving time for their disruptive behavior. Naturally, most state mental health hospitals are located near a prison and have security guards on duty at all times to keep patients from escaping and harming others. http://www.npr.org/templates/story/story.php?storyId=93581736

Dying an appropriate death means to die in similar fashion to how one has lived—to continue the type of behavior one experienced before he or she entered the dying process. This might be easier to achieve for someone who was killed instantly while doing a daily activity, but it could be more difficult for someone who is bedridden after having lived a very active life. For the patient in a mental facility, death could be appropriate or inappropriate depending upon the circumstances.

Dying with dignity means the patient is allowed to die in a manner that is congruent with his belief system. If a mental patient has a violent and unstable life before entering the dying process, then a mental institution is not going to prevent the patient from dying with dignity—there was little dignity prior. However, the patient may be prevented from harming himself and causing his own death; therefore, a mental health facility definitely limits one’s ability to die if he perceived suicide as a way to die with dignity. According to the American Journal of Psychiatry many patients commit suicide after leaving a mental institution: http://tinyurl.com/AmericanJournalPsychiatry

Many people who have been placed in a mental institution have family members who have given up on them, but this is not always the case. The family may have sent the patient to the facility to help him get medication or medical care to help him stabilize and return to society. That is if he or she survives the stay inside the facility. The staff at many facilities has been accused of either neglecting or torturing patients. It makes me wonder if the real crime was committed before the doors were closed, or afterward.

This is clearly demonstrated in the case of 21-year-old Josh Garcia who entered the Colorado Mental Health Institute at Pueblo. His family sent him there to receive treatment for bipolar disorder. They thought he was in good hands, but when he died in the facility, his family sued for neglect of medical care. Josh was given a number of powerful psychoactive drugs, such as Haldol and Thorazine, which caused severe constipation. Even though he complained to his mom and grandmother for weeks that his stomach hurt, the staff did nothing more than give him Maalox, which can also cause constipation. When he was transferred to St. Mary Corwin Hospital in Pueblo, Josh's bowels were so impacted that they burst during emergency surgery. He suffered a massive infection that raised his temperature to 108 degrees and eventually caused brain death. If a patient is being monitored, these problems don’t occur. http://www.thedenverchannel.com/news/19432754/detail.html.

Josh’s is not an isolated case. Fox news.com ran a story that showed a video of a 49-year-old woman dying in the waiting room of Kings County Hospital http://www.foxnews.com/story/0,2933,374321,00.html while people nearby, including two security guards, did nothing to help. An hour later, a fellow patient finally got the staff to notice the patient lying in the floor.

Nationwide, patients have died while pinned down on the floor by hospital aides until the breath was crushed from their lungs. http://www.toddlertime.com/advocacy/5150/restraint/day-1.htm Some died strapped to beds and chairs with thick leather belts; other was ignored until they strangled or their hearts gave out. http://www.cchr.org/index/5276/6683/6694/10596/

So many patients have died in similar circumstances after being restrained in psychiatric and mental retardation facilities that North Carolina passed a law to require that deaths in state facilities be reported to the medical examiner and be revealed to the public. Department of Health and Human Services officials said autopsies will be conducted at the discretion of the medical examiner (http://www.wral.com/news/local/story/2635294/). State facilities will now be held more accountable to the people in their care. http://tinyurl.com/ylq6vq9.

A good death is free from avoidable suffering for patients, families, and caregivers, and is in general accord with the patients’ and families’ wishes. A good death will include having a sense of control, offering discussion about dying, talking about an afterlife or spiritual issues, reviewing the past, having a sense of humor, being truthful, keeping up personal appearance, having loved ones nearby and participating in loving care. This might be done with medication to alleviate pain, addressing all aspects of dying, using hospice, having a living will. It appears that dying a good death is not a goal of most mental health institutions. Perhaps it is not even possible.

Resources:

Montagne, Renee. “Inside The Nation's Largest Mental Institution.” National Public Radio Accessed 18 October, 2009.
http://www.npr.org/templates/story/story.php?storyId=93581736.

Kane, Arthur and John Ferrugia. “State Mental Hospital Death Not Investigated.” (The story of Josh Garcia). ABCNews.com. Accessed 18 October, 2009. http://www.thedenverchannel.com/news/19432754/detail.html


“Video Shows Woman Ignored While Dying in New York Mental Hospital. ” Associated Press via Fox news.com. Accessed 18 October, 2009. http://www.foxnews.com/story/0,2933,374321,00.html


Weiss, Eric M. with reporting by Dave Altimari, Dwight F. Blint and Kathleen Megan. “A Nationwide Pattern of Death.” Kathy’s Mental Health. Accessed 18 October, 2009.
http://www.toddlertime.com/advocacy/5150/restraint/day-1.htm

“Interim Report on Restraint Deaths in Psychiatric Institutions, A Culture of Violence & Terrorism.” Citizens Commission on Human Rights. Accessed 18 October, 2009. http://www.cchr.org/index/5276/6683/6694/10596/

“State Must Report All Deaths at Mental Health Facilities.” WRAL.com. Accessed 18 October, 2009. http://www.wral.com/news/local/story/2635294/

“Mental Hospital Deaths to Be Disclosed.” NewsObserver.com. Accessed 18 October, 2009. http://tinyurl.com/ylq6vq9

Desai, Rani A. Ph.D. et al. “Mental Health Service Delivery and Suicide Risk: The Role of Individual Patient and Facility Factors.” American Journal of Psychiatry. Accessed 18 October, 2009. http://tinyurl.com/AmericanJournalPsychiatry