A few days ago, a 3-year-old boy was playing with a broom in the center of Luochuan County, Yan’an City, a man in black suddenly rushed out, the child is a kick, knocked down and hit the child with a broom, and repeatedly stomped on the child’s head and body, cruel behavior lasted about half a minute. It was later confirmed that the injured man was a patient suffering from schizophrenia. He is currently in criminal detention and is facing a psychiatric forensic evaluation.
It is reported that the wounded man’s speech was more confused during his arraignment. Therefore, it is likely that the man is currently in an episode of the disease. The man suffers from schizophrenia, which is a severe mental illness.
Types of Psychiatric Patients “Civil, Martial, Flower, and Political”
Some severe patients are affected by hallucinations, delusions, and other psychotic symptoms during the illness period, and may exhibit impulsive aggression, injury, and destruction of property. For example, the patient’s symptoms are hallucinations, hearing voices out of thin air, “This person is a bad person, you should go kill him!” Then the patient may actually be driven by the symptoms to kill.
If the patient’s symptom is delusion, the morbid thought is “This person is going to hurt me!” then the patient, in revenge or self-defense, will attack his delusional enemy. In addition, other psychiatric symptoms may prompt aggressive behavior, such as emotional irritability. Of course, not all severe psychiatric patients exhibit aggressive behavior, and in the field of psychiatric forensics, there is a simple and practical classification of abnormal behavioral manifestations of patients: civil, martial, floral, and political.
”Wen” refers to the patient only abnormal mental symptoms, but no obvious impulsive bizarre behavior, that is, many symptoms are not outwardly, the performance is more quiet; “Wu” refers to the patient has a pathological performance of beating and cursing, impulsive aggressive behavior; “Flower” refers to the patient chasing the opposite sex, frivolous behavior, instinctive activity hyperactive; “political” refers to the patient on the basis of the reality of some paranoid ideas, repeated petitions, complaints, difficult to dissuade. Usually, patients who are the most dangerous to others and to public safety are the ones who are “martial”. Among patients with schizophrenia, a large percentage of patients are “martial” and have become a top priority for treatment, prevention and management.
Current Situation Insufficient psychiatric hospitals and lack of psychiatrists
Currently in Beijing, inpatients and outpatients with severe mental illness are reported as “severe mental illness” once they are diagnosed. Of course, other mental illnesses such as depression and neurasthenia are not reported. Once a serious mental illness is reported, it is passed on to the community or village council for monitoring by the local administration. Some communities or health departments also provide free medication for serious mental illnesses.
However, a more serious fact exists that there is a serious shortage of psychiatric hospitals and a shortage of psychiatrists nationwide. A significant number of county-level cities do not have specialized mental health hospitals. As a result, many psychiatric patients face many practical difficulties in diagnosis, treatment and review. Serious patients like schizophrenics require long-term or even lifelong treatment, so this huge gap between supply and demand has set the stage for many tragedies. Many patients have relapsed just because they stopped taking their medication, and if families then take a chance, wait and see attitude, and drag their feet to see a doctor, the end of the disease relapse is likely to become unmanageable.
In 2014, a male schizophrenic patient in Shanxi was discharged from the hospital and once performed more normally, and also went out to work for a period of time. He later relapsed, refused to take his medication, and bought a sharp knife, threatening to kill his father. The patient’s father did not take it seriously, for one thing, because the father was tall and strong and did not fear the child’s attack; on the other hand, deep down, the father did not believe that his son would really kill himself. But on a summer morning, this son really stabbed his father with a knife, leaving the deceased dead.
After the incident of the injured child in Luochuan, Yan’an, the family of the injured man was also distressed, and the patient’s second brother said that after watching the video of his brother brutally beating the child, “I hate to kill him.” His family also said that having this one person sick in the family has almost changed the fate of their family. They try to do their best in their guardianship duties, but also think: “Who can guarantee that there are no mistakes for almost 10 years?”
It is true that a mentally ill person, even if hospitalized, is not the same as being in a safe, and symptoms can still recur. It can be very difficult to monitor a mentally ill person, especially one who is prone to “violence”. Many helpless families end up locking the patient up or keeping him or her in a closed room.
Some people have questioned the patient’s family: Why is a mentally ill person, who is often violent, not locked up at home? The patient’s brother claimed that he did not lock him up because he saw that he was sometimes not violent and just giggled at people. The patient’s father was even more distraught: “We’ve seen people chained up patients on TV, but that’s my son, and our family can’t do this kind of thing.”
Regrettably, antipsychotic drugs have long been misunderstood, and the side effects are actually not that great
The patient’s father is right, a son is his own child, no matter how ridiculously sick he is. It is important to hold such an accepting and tolerant attitude toward patients, but only if you try not to endanger others or even public safety. And to do this, medication is the first priority. The patient’s family said the hospitalization cost of several thousand dollars was an overwhelming expense for their family. But unfortunately, there is another method that is overlooked, and that is long-acting injections.
For patients with schizophrenia, a long-acting drug was developed a long time ago, with an injection given intramuscularly for as short as two weeks or as long as about four weeks. Between injections, it is almost unnecessary to take other antipsychotic medications. Families who can find a way to get the patient’s long-acting injection on time and in the right amount nearby, such as in a health office, can eliminate day-to-day aspects such as supervised dosing and mandatory dosing.
Most of all, this injection is very cheap, only about a few dozen dollars a shot. This method can be a relative relief for patients and their families who are located in remote areas. Even though the injection cannot completely control the symptoms, it can roughly control the patient’s tendency to get excited and impulsive. Compared to mechanical restraint methods such as tying with ropes or chaining, drugs can be considered a chemical restraint. Although long-acting injections also have their imperfections, such as the beginning of the drug, side effects will be on the high side, etc., but it is not lost a simple and feasible approach.
But this long-acting injection has been introduced for many years, why is not widely recognized by patients’ families? In fact, not only the injection, even the tablets of the drug, many family members also feel that the side effects are large, or worry about eating stupid or like chemotherapy drugs to harm the body. This is a deep-rooted misconception. It is true that some traditional antipsychotics do make patients look dull-eyed and stiff after taking them.
But these side effects can really be ignored compared to the improvement in symptoms obtained. There are also other medications that can be taken to deal with these side effects. The bottom line is that many of the newer antipsychotics now have very mild side effects compared to the older drugs. It’s just that relatively, the price can be higher.
There is also a temporal background to the incident of the Luochuan man who injured the child, which occurred in the spring. The patient’s family also said that he was prone to attack in spring and autumn. There is a popular saying among the people: cauliflower yellow, demented son crazy. It is said that psychiatric patients are more likely to relapse or worsen their illness in spring. It is also true that many incidents of psychiatric patients injuring others occur in the spring.
Therefore, for family members with guardianship responsibilities, they should be moderately more vigilant and supervise more during these relatively special seasons of spring and fall. Of course, some patients will have special periods when they tend to fluctuate, such as the season when the initial onset of illness occurs, etc., and families need to pay special attention to them.
Serious psychiatric patients who commit crimes and accidents have received the attention of many national health, civil affairs, public security, social security and other departments. As the state invests more in the construction of psychiatric hospitals, the training of mental health personnel, and the establishment of a sound mental health prevention and treatment network, the danger of mental patients to others and public safety will be better and better controlled. At that time, patients’ symptoms will be completely locked up in a cage of “comprehensive treatment” instead of just relying on drugs.