"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."
"While in Massachusetts, health insurance companies are expected to assist emergency services programs in the search for inpatient beds, admission can be refused for a variety of reasons, everything from the expected stay extending beyond one week to arguments over the clinical necessity of admission...
Nanos’ book is a treatise on the current mental health crisis. It offers a rich and often appalling view from the inside, exposing a failing mental health system that is at best overwhelmed and at worst, deeply misguided."
"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..."
"Predictably, those patients end up homeless, jailed, harming others, or even dead. Using vignettes based on real interactions with patients, their families, police officers, and other mental health providers, Breakdown shares Nanos' passion for helping people, many of whom are unable to request help themselves. She also helps open an important dialogue about our mental health treatment system – one that we hope will spur interest in improving care for individuals with severe mental illnesses, in Massachussets and across the country."
"Breakdown opens a dialogue with anyone interested in improving the system of care for the seriously mentally ill population. Using vignettes based on real interactions with patients, their families, police officers, and other mental health providers, Lynn Nanos shares her passion for helping this population. With more than twenty years of professional experience in the mental health field..."
"As a parent of a thirty-year participant in the mental health system, I found Breakdown informative, comprehensive, well-researched, and thoroughly-referenced. Practical advice and familiar vignettes weave through the narrative as only someone who has been on the front lines of psychiatric emergencies can document."
"The revolving door that Owen and too many patients enter exists due to several combined factors. The nationwide shortage of inpatient beds creates a backlog of patients waiting excessively in emergency departments for placement. The involuntary hold criteria in most states are so restrictive that it is often difficult for patients to get the help they really need. Oftentimes, such laws don’t prevent danger."
Feature of Breakdown in electronic newsletter to members - February, 2019
"Solutions can be implemented to slow the revolving door. More inpatient beds are needed. Inpatient units that discriminate against the most challenging cases should be held legally accountable. Legislative changes are needed to enable professionals to invoke involuntary emergency and inpatient care with less difficulty. Treatment options for patients who are not finding basic outpatient treatment enough, but who don’t qualify for inpatient care have to be easily accessible."
"The book is well written, heart-wrenching in many of the real patient stories. I could well imagine the author going home each night, still worrying about the safety and continuum of care (or lack of it) for those she evaluated each day. And in the current times we live in, with such a severe shortage of hospital beds in psychiatric wings, I was shocked to learn from her research that about 12% of those admitted for emergency psychiatric care are what the mental health care industry calls 'malingerers.'"
"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."
"I hear the stories from the providers and in the voices of the families who do not know where to turn when their loved ones turn violent and end up in the vicious cycle of homelessness, incarceration, to short term or no placement in poorly funded psychiatric facilities and then cycle back and forth due to for lack of long term facilities. Then there is the stark absence of short-term halfway houses such as board and care facilities for just such cases."
"Her book uses her personal experiences to tell a much broader story – how our underfunded and broken system is failing those with serious mental illness. Here’s how she explained why she feels so passionately about helping those too often forgotten. I know there are success stories out there. But as an inpatient social worker, I was alarmed at the extremely high rate of readmission to our units."
"Four police officers arrive to assist. I tell them why Jessica needs to go to the hospital. Two of them approach Jessica and introduce themselves, expressing an interest to help. Their attempts to persuade her to go to the hospital don’t work. As the officer glances and points at me, he highlights, 'They said you’re delusional. There’s no feces in your food. You have to go to the hospital.' Jessica suddenly picks up a nearby ceramic vase and attempts to throw it at me."
"Q: In the preface to your book, you write about a tragedy that was part of the inspiration for you to write Breakdown. In what ways do you hope the book helps to change the system of emergency psychiatry in this country?
A: As an inpatient psychiatric social worker, I tried to help a patient with psychosis who refused to accept treatment because he didn't believe he was ill..."
"According to Nanos, there are three core problems in the broken psychiatric system: a lack of inpatient beds due to deinstitutionalization; malingerers, who falsify claims of mental illness to request inpatient treatment; and that patients are 'dying with their rights on.'"
Review of Breakdown in electronic newsletter related to his son with schizophrenia - July, 2019
"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."
"Lynn Nanos clearly has expert knowledge and experience in this field, and carefully constructs her arguments citing studies, academic papers and personal anecdotes to support her points. Where her own cases are used as supporting evidence, they are anonymised factual accounts, with no attempt to sensationalise these serious conditions for entertainment purposes."
Breakdown is listed in "Recommended Reading - Books"
Feature of Breakdown in electronic newsletter to members - March, 2020
"I’m a great believer in civil rights and believe that patients should have the right to refuse treatment. Nanos is changing my mind, at least in the case of psychiatric disorders which prevent victims from knowing their own needs and taking care of themselves. She makes an excellent case that schizophrenic and psychotic patients, especially those with anosognosia, are the most likely of all psychiatric patients to commit violence and be victims of violence. This she refers to as 'dying with their rights on,' a powerful phrase."
Book by Pat Morgan includes a paragraph praising Breakdown
"I was hooked on this book starting at the 'Dedication: For seriously mentally ill people who need help but lack the capacity to request it.' This is not just well-researched, in this book Lynn shares her experience, and gives us a look at the many problems that have affected our 'broken' mental health system for years. Lynn accurately describes in detail the devastating consequences of untreated serious mental illness. Many people stop at discussing and identifying the problem, or as she refers to it our 'broken system', but Lynn goes in depth to outline the reasons, and then she offers evidence-based, practical solutions."
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."
"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."
"...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."