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Wed Apr 18 06:11:06 BST 2007

Ken

While I hear your frustration and share it - the same thing (psych bed reduction) has occured here in South Africa, I need to maybe explain some of the rationale behind the approach changes (not that I totally agree with them)in mental health management:

Most mental health disorders do not require more than initial diagnostic/therapy initiation in-patient care; the therapy is easily monitored in the community (one therefore needs good liaison psychiatry services). The small number of chronically mentally ill patients (burned out schizophrenics, mentaly disabled patients etc) are small enough to be managed in "secure community" environments rather than traditional psychiatric hospitals. Most of the acute psychiatric emergencies have to some extent a biological basis and thus are often best worked up by medicine rather than psych; psych can best manage the long-term (outpatient) follow-up.

Regarding the mental health of "mass-murderers", most will be undiagnosed or those with personality disorders, which are either untreated or not usually managed with medication, so improved mental health may not solve this problem.

Both our countries suffer from the scourge of guns and knives; our experience here over the past three years with stricter gun control is that it does not decrease violent crime, rather it leaves the victims (who may previously have had legal weapons) defenceless against the proliferation of illegal weapons used by gangsters and other criminals. Our murder rates and innocent victim shootings in my unit have actually increased!

Regards
Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
ATLS  instructor and DSTC Cape Town Course Director
Intern program Coordinator: Surgery
M.Med (Emergency Medicine) Executive Committee member
Clinical Head (Director): Diana Princess of Wales Trauma Unit
Division of Surgery (General) Room 4064
Department of Surgical Sciences
Tygerberg Hospital / University of Stellenbosch
PO Box 19063
Tygerberg 7505
Western Cape
South Africa
e-mail: tch at sun.ac.za
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302

-----Original Message-----
Finally:

IF THE MENTAL HEALTH CRISIS IN HOUSTON, IN TEXAS, IN THE UNITED STATES IS  
NOT ADDRESSED SYSTEMATICALLY, MORE HUMAN OUTBURSTS ARE GOING TO  HAPPEN.   IN MY 
VIEW WHAT WE ARE SEEING IN VIOLENCE IN OUR SOCIETY HAS  AS ONE ROOT CAUSE, 
OUR BROKEN MENTAL HEALTH INFRASTRUCTURE.  

Kenneth L. Mattox, MD
Houston

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