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.
Thirty-eight years after the release of "One flew over the Cuckoo's Nest," just mentioning the name "Nurse Ratched," or examining some of the dark history of psychiatric institutions, evokes unpleasant images to most people.
Having spent over six months in locked psychiatric institutions, including in Alaska, and volunteering as a patient advocate over the last decade, I can tell the movie-goers and the curious with first-hand 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.
According to a South Carolina study by Karen J. Cusack 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 (PTSD). (One of the most costly illnesses in America). Managers of psychiatric hospitals and units have a reluctance to recognize and provide treatment for institutional trauma (sanctuary trauma) because admitting the hospital has caused trauma to a patient may leave the hospital open to some future lawsuit. Of course, that leaves patients without the necessary treatment that could reduce the costly effects of sanctuary trauma.
In 2013, treating a patient in a psychiatric hospital in Alaska costs up to $1200 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.
In 1975, Alaskan psychiatric patients in a psychiatric institution did not have a legal right to call an attorney -- that right was given to Alaskan patients in a 1984 law. Patients did not have a right to have visitors or use the telephone until 1981. Patients did not have a legal right to file a grievance until 1992.
In 1984, Alaska psychiatric patients were given the legal right to be free from corporal punishment. Giving patients that legal right is implying that employees in psychiatric institutions in Alaska were inflicting corporal punishment on patients prior to 1984.
We are highlighting some of the advancements in patient rights in Alaska, not to show how far we have come as a state, but to show how far we have to go, both as human beings and as a state.
The wide-ranging inability for psychiatric patients and guardians to file an urgent grievance and to have their grievance or appeals heard in front of an impartial body is very damaging. It removes the dignity of the patient, hinders recovery and puts patients in danger.
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 (AS 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, 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.
From our point of view, as patient advocates, Alaska must improve the grievance procedure law and oversight for psychiatric patients. At this point it is up to the legislature to sponsor a bill from the several work drafts available.
Faith Myers and Dorrance Collins are mental health advocates who live in Anchorage.
The views expressed here are the writer's own and are not necessarily endorsed by Alaska Dispatch, which welcomes a broad range of viewpoints. To submit a piece for consideration, email commentary(at)alaskadispatch.com.