Psychology Today

"Nanos makes the case that the commonly-heard idea that chronic psychiatric patients are less likely to commit violence than others is highly misleading. While true, it ignores the significant minority of mentally ill folks who do have violent propensities – and who are often more dangerous than others – when their violent episodes could have been stopped if they had received proper medication. Not to mention that the violence-prone mentally ill are highly unlikely to participate in the epidemiological studies that are the basis of the misleading argument." 

"With the increase in concern for the rights of people with mental illness and the passing of the Lanterman-Petris-Short Act in 1967, which severely restricted the criteria for which people could be involuntarily admitted to inpatient units, many mentally ill people were simply released onto the street...' Those patients who suffer the most are those who are most impaired and who are unaware that they are ill and need treatment,' writes Nanos. To that end, Nanos suggests that the autonomy of patients should not always be the guiding feature of a clinician’s treatment plan. One example is in the case of patients with psychosis. Not only is a patient less likely to understand the ramifications of his diagnosis, but he may also lack the ability to navigate the treatment system. 'There is a link between violence, untreated serious mental illness, and a lack of awareness of one’s own illness,' writes Nanos."

"Her honesty about what she sees in a 'broken system' is admirable. She analyzes research from both her own state and throughout the United States...The book is well-documented and the author discusses many topics that seriously mentally ill patients face...Though scientific, full of research studies, and anecdotal stories, I found the book easy to read. I recommend this book to all people involved in receiving a diagnosis and achieving and maintaining recovery." 

"This isn’t a book to advocate locking up mentally ill people forever but certainly long enough to be treated properly than simply let them go after a set time. I find it more remarkable that the number of beds available are cut back than ensuring there is enough. Then again, the American health care economy is based on insurance and who can pay than looking after its citizens. People there would rather think that there aren’t people with mental problems. Something to ponder on with the next mass-shooting as I think the statistic seems to be increasing." 

"This is an excellent read for all community leaders and family/caregivers advocating to improve emergency psychiatric services/supports. The author is very experienced and articulate in describing opportunities and solutions.  

She describes heart-wrenching stories of real cases but also suggests what could make a difference.  If you have a friend/family-member experiencing psychiatric emergency - this book may help you understand..."

"Nanos describes the daily struggles of an emergency clinician seeking to balance care and public safety with civil liberties. She writes with a provider’s insight about bed shortages and the revolving door of inpatient admissions as hospital stays get shorter. She’s honest about inherent and structural obstacles to good care and builds a strong argument for increasing access to assisted outpatient treatment."    

"She points out that mental health services have cycled back to the 19th Century when the reformer, Dorothy Dix, was appalled at what she witnessed in Massachusetts. 'She would be shocked, bewildered, terrified, and unimpressed with both the Massachusetts and United States systems if she were alive today.' And I might add that other industrialized nations are no better in dealing with mental illness than the United States." 

"Breakdown  uses objective and dramatic accounts from the psychiatric trenches to appeal for simple and common-sense solutions to reform our dysfunctional system. This book will benefit anyone interested in seeing a glimpse of the broken mental health system way beyond the classroom. It can guide legislative officials, family members, mental health professionals, and law enforcement officers toward a better understanding of the system."

"There are many types of mental illness but this book focuses mostly on those with psychosis, especially those who don’t know they are psychotic. This includes Schizophrenia and some Bipolar with psychotic episodes. Borderline Personality Disorder is also talked about in one chapter, even though they aren’t psychotic. The point being made is that BPD is more severe than other personality disorders and perhaps shouldn’t be considered JUST a personality disorder."

"Overly restrictive, involuntary hold criteria often result in only the most ill getting admitted to inpatient units. When they are deemed appropriate for inpatient care, they can languish in hospital emergency departments for weeks, or even months due to the severe shortage of inpatient beds. Or, they excessively wait because inpatient admission units refuse to accept some of the most challenging cases." 

Feature of Breakdown in electronic newsletter to members - March, 2019 

"One of our goals is to persuade the federal government to abolish the Social Security Administration’s Medicaid Institutions for Mental Diseases (IMD) Exclusion law. The IMD Exclusion prohibits the federal government from financially reimbursing Medicaid for inpatient psychiatric facilities with more than sixteen beds for patients aged twenty-one (and in certain circumstances twenty-two) to sixty-four years old." 

"Ruth: And even when you do authorize a hold, they’re admitted to the hospital but you might find out a few hours later that they’re back on the street. Breakdown has lots of stories like that. You wrote one thing about hospital funding that shocked me. Can you explain here why hospitals are motivated to admit a patient but not to keep him or her?

Lynn: Breakdown uses a restaurant analogy to describe why hospitals often prematurely discharge patients."

"Recently, a social worker and friend who works on inpatient psychiatry expressed her belief that DMH should be doing a lot more to resolve homelessness. I agree with her. Her patients tell her that their DMH case managers tell them, 'We don’t help with housing.' Really? Disillusionment sets in again. If they don’t help with housing, then what does DMH help with? Without supportive and supervised housing, seriously mentally ill people will inevitably have difficulty taking care of themselves..." 

"It sounds like there are so many moving parts with the way people are admitted. There has to be enough beds, private pay insurance, Medicaid or state insurance that will pay. I’ve heard where it’s described like the hospital gets paid based on quantity of people they can admit over a number of days, like a revolving door." 

"As someone who has advocated for mental health awareness and seeks to improve and see the mental health education and rehabilitation of this world improve, this was a book that spoke volumes to me.  The author does a spectacular job of presenting the struggles and heartbreak of the profession."  

"According to the author, private hospitals often tend to favor hospitalizing malingerers who fake mental illness in order to have a place to stay and receive food, over the more highly disturbed and potentially violent SPMI’s who really need the beds. This, along with drastic decreases in the number of available beds, has led to a situation in which patients are stuck in hospital emergency rooms..." 

"...your book should be read by state Senators and Representatives to pass bills to be mandated in all states, including the criteria for meeting the legal definition of insanity.  Your book should also be read by laypersons in order to understand their responsibility in speaking out to prevent violence and killings."  

Feature of Breakdown in Sheriff & Deputy magazine - May/June, 2020 - "If the officer had known that delusional patients often lack insight, perhaps he wouldn't have chosen such a brutally honest approach. He might not have disputed her belief that the food was contaminated. Jessica's lack of insight was impenetrable, and the officer was not part of a specialized Crisis Intervention Team (CIT)...All officers are required to have a basic knowledge of mental illness, but most are not part of CIT units. They are not sufficiently trained in managing the breadth of mental illness that exists outside of secure settings."

Book by Kartar Diamond includes a paragraph praising Breakdown

"It is antiquated to apply shame to mental illness…It is now uniformly understood in all scientific areas that serious mental illness originates in the brain. The brain is just as much a physical and tangible organ as the liver, heart, and stomach. Leading research demonstrates that the greatest risk factor for bipolar disorder and schizophrenia lies in genetics, which confirms that serious mental illness is biological in origin…The belief that mental illness doesn’t exist and that medication is largely unhelpful runs amok throughout government-funded programs."

"There is no such thing as a perfect system and in the case of the mentally ill, nothing could be truer. The mentally ill face an uphill battle to secure appropriate services, avoid being caught up in the criminal justice system, and most of all, steer clear of the revolving door that has become our mental health system." 

(Psych Central deleted hundreds of book reviews after its ownership changed. The full review is missing.) 

"...author Lynn Nanos, L.I.C.S.W., shows such concern, knowledge, and caring for people like my son Ben (who is diagnosed with paranoid schizophrenia), that I kept wishing she were on the team treating and caring for Ben right now. I had to sharpen my pencil several times, I underlined so many facts and observations...Why do psychotic people not engage in treatment? Nanos lists 17 reasons, and “stigma” was not among them. She argues (backed up by research) that stigma is overrated as a reason to not seek treatment for the seriously mentally ill. She says not one patient has ever mentioned that as a barrier to seeking help. Lynn Nanos knows her stuff, truly cares about her cases, and fights for what’s right – while fearless in exposing the cracks in the system. Highly recommended reading."

"He glared at me, 'I knew you were part of the plot!' 

The officers and I spent five minutes trying to persuade Tom to get onto the stretcher, but he refused.  

Finally, the CIT officer said, 'I don’t want to restrain you.' 

All eight of them manually restrained him on the stretcher as he yelled to 'get off of me!' 

He thrashed restlessly, trying to break free from the restraints to no avail. 

When I got back to office to start typing up my report and contact insurance to request inpatient authorization, I noticed contact information for Tom’s brother in a recent mobile crisis record. I reached out to the brother, James, and updated him. James was relieved to hear that Tom was safe and on his way to inpatient because he hadn’t known where he was for about two months since he was previously hospitalized. James expressed concern that 'they’re just going to release him to the streets without help again. That’s what they always do. Sometimes they never even contact me.'"