While the Alaska legislators spent their time earlier this session on what their new office space will look like, the furniture and the décor, the disabled were mistreated.
In the 1975 movie “One flew over the Cuckoo’s Nest,” actress Louise Fletcher in an Oscar-winning performance convinced the movie-going public that there can be a dark side to locked psychiatric institutions and locked psychiatric units in hospitals.
Forty-one years after the movie’s release, just mentioning the name Nurse Ratched, or examining some of the dark history of locked psychiatric institutions, evokes unpleasant images to most people.
As a person who has spent time in a locked psychiatric institution as a patient, including in Alaska, and volunteering as a patient advocate over the last decade, I can tell the movie-goers and the curious with firsthand knowledge, Nurse Ratched is alive and well. Some employees of psychiatric institutions can be as mean and uncaring as the law and oversight allow them to be.
The road to recovery of a severe mental illness is long and bumpy. For the people traveling on that road there are some things that are not forgotten. I can remember being strapped to a gurney in the hallway of a major hospital, the other patients next to me crying, asking for a drink of water, needing to go to the bathroom. I told the nurse walking by patients needed help. It was the indifference I remember. I remember being handcuffed in the back of a marked police car — the embarrassment. And I remember being placed in a locked psychiatric hospital that treated me more like a prisoner than a patient in need of help.
According to a South Carolina study by Karen J. Cusack, PhD and others, up to 47 percent of the patients in psychiatric hospitals or units or during transportation reported experiencing trauma, trauma as defined by the DSM-IV criteria for Post Traumatic Stress Disorder. Managers of psychiatric hospitals and units have shown a reluctance to recognize and provide treatment for institutional trauma — sanctuary trauma — leaving patients in Alaska without the necessary treatment that could reduce the costly personal and monetary effects of sanctuary trauma.
The third leading cause of patient injury in a hospital is medical errors. In the age of improvements in psychiatric patient rights and quality of care in America, the Department of Health and Social Services have not only not improved rights and quality of care for Alaska’s disabled; since 2011 rights for psychiatric patients have decreased.
Treating a psychiatric patient in an Alaska hospital or unit can cost up to $1,500 a day and will be higher next year. Managers of psychiatric institutions and units in their hospital planning look for more efficient and cost effective ways to process and manage psychiatric patients and that often means removal of psychiatric rights and dignity. There is often a conscious effort by hospital managers to disconnect patient and family — unable to eat meals together, spend time outdoors or in the fenced in courtyard, visit on the unit, etc. Hospital managers in Alaska may be saving money by shortening hospital stays and using assembly line methods of treating patients, but it is at the cost of patient recovery and higher recidivism.
Our message to actress Louise Fletcher and the Alaska Legislature: “One flew over the Cuckoo’s Nest,” a fictional look at an all too real dark side of institutional treatment, actually did a lot to improve psychiatric patient rights and care. But more needs to be done, especially improving the patient grievance procedure law (Alaska Statute 47.30.847). The improvements would give psychiatric patients and guardians the legal right to file an urgent grievance, a shorter time for resolution of grievances and an impartial body to hear grievances.
As with every major issue, including improvements in psychiatric patient rights and quality of care, there are different opinions. Alaska hospitals and clinics providing psychiatric care and even their employee unions have opposed even reasonable improvements in the grievance procedure law for psychiatric patients, improvements widely accepted in the Lower 48.
The mistreatment of the disabled in enshrined in Alaska law. Most of the laws purporting to protect the disabled were in fact written to protect private facilities from lawsuits. All of the rights for the disabled need to be improved, from the state transportation contract to the grievance procedure law for all mental health trust beneficiaries.
• Faith Myers and Dorrance Collins are mental health advocates who reside in Anchorage.
