Getting rid of psychiatry space at Shands is an act of stigma
Published: Sunday, January 1, 2006 at 6:01 a.m.
Last Modified: Sunday, January 1, 2006 at 12:00 a.m.
The recent shots fired by Miami air marshals have struck the tip of an iceberg that is festering right here in Gainesville and throughout Florida.
Although a White House investigation will try to derive airport security lessons from the incident, equally valuable community and medical school priority lessons must also be learned relating to medical events surrounding the incident.
The delusional passenger, Rigoberto Alpizar, displayed erratic behavior which was perceived as an imminent bomb threat. Air marshals decided to rapidly subdue Alpizar in the light of our national vigilance on airport terrorism.
The tragedy of Alpizar's unnecessary death is compounded by the fact that the events were precipitated by a medical condition that can be treatable and manageable. In his case, it was bipolar disorder (manic depression), which is an unavoidable biomedical disease of brain cells affecting mood, thought and behavior.
All medical conditions deserve adequate treatment in 21st century America, but most people avoid or deny effective treatments for mental illnesses because of prevailing 14th century stigma and ignorance. Even when a potentially successful treatment plan is started, the power of our cultural prejudice shames many people with a mental illness into stopping their medications and talk therapy.
As of this writing, investigators believe Alpizar did not take his bipolar medication in a timely manner.
Bipolar disorder is part of a group of medical conditions that collectively comprise the single largest disease category negatively impacting our economy and quality of life. The World Health Organization, the World Bank and Harvard University studies reveal that mental illnesses are more disabling in economic markets than all cancers, AIDS and cardiovascular diseases.
By U.S. Surgeon General statistics, over 3 million Floridians have a diagnosable mental illness whose disability impacts the lives of millions more citizens, family members and co-workers.
Stigma within the medical care community itself marginalizes mental illnesses, pushing such diseases into the shadows behind name-brand body illnesses. The magnitude of mental illness disability and its economic impact on society is openly ignored by senior administrators at the University of Florida College of Medicine.
The entire inpatient psychiatric facility in Shands Hospital is currently proposed to be evicted soon in favor of space allocated to somatic (body) medical conditions. Shands revenue would increase under this plan, with one reason being that most insurance policies pay only limited coverage for medical disorders of the brain associated with the mind, compared to somatic (bodily) disorders. Ironically, these are the very insurance policies offered - uncontested - to College of Medicine faculty.
The overall community impact of evicting psychiatry from Shands Hospital would mean that Florida citizens would bear much greater costs in terms of economic burden to businesses, negative impact on quality of life for families and co-workers, impeded advancements in psychiatric clinical research and curtailed training of new doctors needed to treat mental illnesses in Florida.
A greater, even more destructive message of this eviction is to further propagate the stigma of mental illnesses, in defiance of the U.S. Surgeon General's edict that mental illnesses must be treated with the same urgency as body illnesses and injuries.
National studies show that stigma is the single greatest reason why people with a mental illness do not seek out or receive the effective treatment they deserve.
This propagates the vicious cycle of sustaining lower revenue for psychiatry space within the hospital. A similar vicious cycle occurs for funding biomedical and clinical research of mental diseases.
Although mental illnesses represent the single largest disabling disease category in our state, even prominent elected officials routinely propagate its underclass status. For example, Florida Sen. Durell "Doc" Peaden, chair of Committee on Health Care, has encouraged Florida's Legislature to restrict Medicaid payouts for medications used to treat mental illnesses, with his calloused justification that "Nobody's died that I know of (from a mental illness)."
The Miami airport killing of a man with bipolar disorder was a terrible tragedy that provides many lessons. It can open our eyes to our community's priority of addressing mental illnesses as true medical conditions that should be front and center priorities in the UF College of Medicine, and as common household words.
To learn more about bipolar disorder or any mental illness or brain biomedical condition, visit the Web site of the local affiliate of the National Alliance on Mental Illnesses (NAMI): www.NamiNorthCentralFlorida.org.
Bruce R. Stevens is co-president of the National Alliance on Mental Illnesses (NAMI) North Central Florida Affiliate.
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