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Navigating the Shoals of Mental Illness

Posted - Mar. 28, 2004 at 8:40 a.m.



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In the past two decades, most mental health patients' stays in hospitals have gotten shorter.

However, mental health experts aren't sure that trend has been the best path for the long-term stabilization of patients.

"The decision for a patient's length of stay is better left to the treating physician and the patient, but too often it rests with the insurance company," said Dr. Raymond Crowel, a clinical psychologist and vice president of mental health and substance abuse services at the National Mental Health Association.

And benefits packages continue to offer limited mental health services --- if they offer them at all, he said.

For instance, he said, authorized hospitalizations can be as short as three days. And frequently, even when more time is authorized, it is not adequate to ensure that the patient is stable.

This may result, he said, in a patient being discharged prematurely, setting the stage for a later readmission.

But Bill Custer, a Georgia State University professor who studies health care insurance, said it's difficult for insurers to determine the right lengths of stay for mental health patients because there's still so much debate about how such illnesses should be treated.

Custer said it's only been in the past 20 years that mental health providers have developed methods to more accurately diagnose conditions and treat them.

"The problem for insurance companies is how can we make a policy that pays for appropriate and necessary care and not inappropriate and unnecessary care," he said.

And a quick dismissal doesn't necessarily spell trouble.

While people often assume that psychiatric patients are dangerous, Crowel said, the data don't support that.

People with a history of mental illness are less prone to violence than those without mental illness.

The best predictor of violence is a history of violence, Crowel said. But there are other reliable signs of psychiatric distress: > Changes in sleep or behavior patterns. > Deviation from routine. > Extreme irritation or withdrawal from family and friends.

Copyright 2004 The Atlanta Journal-Constitution

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