Breakdown: A Clinician's Experience in a Broken System of Emergency Psychiatry (Serious Mental Illness, Psychosis, Reform)

“Breakdown by Lynn Nanos offers a very engaging view into the kinds of troubling conflicts that illuminate why AOT is often necessary. Lack of insight for people with serious mental illness Is a problem that Carries through at levels of the individual, family, and society. Well informed doctors and social workers can make all the difference to people at the end of their rope feeling there is no option but to act out. A good AOT team allows for progress to be made for those experiencing serious trouble due to their brain disorders. Helping someone understand it is a disorder at work can be challenging, but over time persistently working with those affected pays off. Though in this field answers are not black and white, with structures like AOT in place, less people fall through the cracks. It is painstaking to Ensure people get engaged to the level of understanding when their illness versus a different matter altogether is causing problems, but Breakdown illustrates that AOT can make all the difference.

I had a very personal interest in reading Breakdown, by Lynn Nanos, because I have a family member with schizophrenia. Along with many others, I have felt intensely frustrated with every aspect of the mental health care system, including hospitals and their staff. I needed to find out what she had to report from her own professional experiences as a mobile emergency psychiatric clinician, with the special skills and ability to orchestrate involuntary hospital admissions. 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 up to 12% of those admitted for emergency psychiatric care are what the mental health care industry calls “malingerers.” These are folks who don’t fit the criteria for gravely ill when they are evaluated, but they work the system so they can gain admission and have a nice all-expenses paid mini-vacation in a hospital. This is also at the expense of so many desperate people who really do need the care, but there are no beds available for them. My own family member once spent five days in the E.R. at USC Medical Center, waiting for placement and continuing to deteriorate each passing day. Even more frustrating was the author’s confirmation from her own documentation, the frequency with which the hospitals discharge psychiatric patients before they are stable. This is just one of many ways in which the broken mental health care system actually encourages relapse and sabotages recovery for the most seriously mentally ill. On the up side, it was very comforting to know that there are such dedicated professionals like Ms. Nanos, working on behalf of those with little-to-no capacity to help themselves. An underlying theme in Breakdown also addresses the touchy issue of involuntary treatment. We live in a nation where many people maintain the myopic view point that a person has the right to be as psychotic as they want to be (until they harm someone.) Both inside and outside the mental health care industry, there are very powerful and vocal opponents of involuntary treatment because they claim that a person’s rights would be violated. The case studies and research done for Breakdown make it very clear that we need to intervene for those who don’t have the capacity to make rational, safe choices for themselves. A temporary suspension of personal “freedoms” may just save a life, or many lives, and actually provide enough treatment for a person to gain some insight and eventually experience a higher quality of life. A copy of Nanos’ book should be read by every mental health policy maker in the country. I recommend Breakdown to anyone who wants to understand more of the process and circumstances under which a seriously mentally ill person gets hospitalized, including those who are homeless or without family members to help them.

Lynn Nanos, LICSW, chronicles her years of in-depth experience as an emergency psychiatry clinician. In Breakdown, she shares from numerous compelling personal accounts of the interactions she has with those who have SMI (Severe Mental Illness) and symptoms of psychosis and anosognosia. For someone like myself, who has had episodes of psychosis and anosognosia in the past, I am fascinated by how the patients appear through Lynn's eyes. When we (persons with psychosis) are not aware of why we are acting so strangely, and cannot control the abnormal impulses due to our broken minds, it poses numerous challenges to those serving us in the mental healthcare field. Ultimately, the way things work currently, it disserves us when we are sick and cannot tell what is real from delusion. A person who lacks insight into her mental illness is usually paranoid, thinking the social worker and doctors are working against them, when they may actually be working against them, just not intentionally. Lynn uncovers these unintentional but lacking ways the mental health care system fails those whom it tries to serve. Lynn documents in great detail and straightforward storytelling, her unbelievable realities of the holes in our nation's mental healthcare system. Breakdown gives plenty of evidence for the need for a reform in our nation's system for an underserved SMI population and unequipped treatment system. Her profession is perhaps one of the riskiest and challenging environments due to the population she serves, and yet undeterred, she strives to do what is best through the help she offers. Ironically, and unfortunately, many most in need of the care she can help provide are the least likely to take it. Her book shows and gives a compelling argument for how vital it is for a more competent system for the wellbeing of individuals who may not realize it but need it the most. I highly recommend Breakdown to anyone who has a loved one with SMI, serves the SMI population, or holds any influence within and around the mental healthcare system. Breakdown paints a large, detailed picture of the variety of colorful people who have SMI, who are most in need of help, who need better ways to reach that place of recovery. They cannot reach it on their own. This book is a guide and an answer to why they cannot, and points the way to how they could. -Katie R. Dale former bipolar disorder type I inpatient Creator of BipolarBrave.com

My father and brother are schizophrenic, and this book covers much of what my family has experienced from the medical world, but not understood. Lynn's perspective was a missing link for me to see why families like mine fall through the cracks. It’s very validating to have an experienced professional acknowledge the perspective of the family and caregivers of the Seriously Mentally Ill because otherwise we don't have a voice (their "right" to remain in untreated psychosis overrides everyone else's rights for safety and order). I wish the true cost of this negligence was realized.

As a crisis clinician, Lynn Nanos is familiar with the consequences of the destruction of our mental health system. She introduces the uninitiated reader to the nightmare of untreated psychosis, by sharing anonymous cases she has encountered as well as scientific research results. She notes that patients with untreated psychosis are very apt to have no understanding that they are ill - literally, their brains are not working correctly - and since they don't believe they are sick they also don't believe they need treatment. By not embracing the help they need, these people often have dire consequences such as homelessness, incarceration, violence and suicide. She argues that a patient's right to refuse treatment should be negated when the psychosis is in effect making that decision. I agree. A patient who is unable to make decisions in his or own interests - a patient not in their right mind - needs society to make those decisions for them. The use of Assisted Outpatient Therapy (AOT) must be expanded, the IMD exception must be ended, long-term inpatient care must be more available, and supportive housing must be better funded. However, in using case study after case study - sometimes dozens in a single chapter - Nanos managed to burn me out rather than strengthen her argument. Each chapter seemed to fit in one of three boxes - naming the problem or offering theories to solve the problem; citing research studies about the issue; or demonstrating the problem with dozens of case studies. The book would have been more powerful had the three been more integrated throughout. While I agree with Nanos on almost all points, there were parts that as a person with mental illness I took offense. These were relatively minor, however. For example, she disparages the Hearing Voices Network, because their position is that the experience of hearing voices or having other hallucinations is not necessarily a medical problem, but rather is a personally real and perhaps meaningful occurrence. As a participant in a voice hearer's group, I can say that the opportunity to speak openly about my experiences in a non-judgmental environment has increased my acceptance of my illnesses and helped me be more honest with my treatment team. There was also one thing I wished Nanos addressed to a better degree - while she spoke of a mental illness spectrum, she only addressed the two ends of the spectrum - untreated psychosis and malingering or the worried well - as well as somewhat clumsily mentioning borderline personality disorder. There lives a wide variety of people in the middle. I do not have schizophrenia but do have other illnesses. Sometimes I have required unwanted intervention to get appropriate care, even when I have been fully participating in outpatient treatment. I am grateful today for those interventions from clinicians much like Nanos. I wish the book offered a nod to those of us that struggle in the middle of the spectrum. All in all, a good book with lots of evidence supporting expanding efforts to humanely serve the most seriously mentally ill patients.

With anecdotal examples and substantively researched documentation, Lynn Nanos, a clinical social worker, invites us to walk with her through the nighttime hours of her profession, maneuvering a broken treatment system where professionals like her struggle daily to find and secure placement for those most in need, the seriously mentally ill. Lynn is tasked with making the difficult decisions of whether to seek admittance for persons needing treatment, then to find placement for them in a system that has limited resources, maneuvering that system that allows far too many to fall through the cracks. Those who know how difficult it is to get their loved ones into treatment when they are too ill to recognize the need will find Lynn's stories all too familiar. With compassion and obvious concern, Lynn somehow manages to maintain an objectivity in her writing that is akin to the old detective novels which narrate first-person stories of crime and punishment, except in this case, the biggest crime story is that of a systemic failure throughout our nation to recognize the need for treatment for those most seriously in need and to provide adequate resources to meet those needs. While daunting and frustrating, there is hope. Lynn offers insight into solutions for this system to effectively serve those who for far too long it has neglected. For those who are unacquainted with the pitfalls of the broken mental health system, this book is a much needed eye-opener into the very real world of mental health professionals and the clients they desperately seek to help. It's not an easy read, but a necessary one, if we are to understand and contribute to the movement for change.

Get this book! Send it as a gift to anyone you know with a loved one struggling with any kind of brain disease or mental illness. I love Lynn Nanos’ writing style .. it’s like reading an intriguing, intense moment to moment story as she takes us through processes and experiences in her career as a mental health clinician. “Breakdown” should be required reading by everyone who has struggled with mental health care or who can make changes for the better in the system. Our systems are broken. A transition HAS TO BE MADE to get to the real needs of those with a brain disease and Lynn lays out the pathway to boost that journey. It’s time - and this sensitive, honest and helpful book can save lives. She GETS our people whose brains work differently and I’ve not seen a book quite like this one that lays out the emotions, confusion and love that gets tangled up with a brain disease. So glad I got my copy. I am now retired from working at my local county mental health department so I have seen the results of misunderstood illness, desperation and helplessness - and watched families break down under the stress of trying to keep a loved one alive. Please give this book a read - as legislation for change falls on ALL of us to understand what this is all about. Plus, it’s a fascinating read. Kudos to you, Lynn!!! You’ve written a gem 💜

I bought this book mainly for the chapter regarding malingering. I was not disappointed. The chapter is, "Three Hots and a Cot." The author candidly states that malingering will never go away yet also offers solutions for mitigating the problem. Malingering is problematic because in such cases, inpatient psychiatric beds are inappropriately used/filled to the detriment of those who are in true psychological crisis. Consequently, the “mentally” (ie, neurologically) ill are often denied proper access to care because of it. As a former psychiatric crisis clinician myself, I have always wished someone would speak out the prevalence of malingering in the emergency setting and its consequences. I have seen it mostly in major cities but smaller towns/hospitals are in no way immune. I have witnessed ERs discharge suicidal patients from their hospitals because the hospitals needed the room in their ERs and there were “no psych beds available” for days at a time. I was not at all surprised to learn that I have been faced with many of the exact same frustrations/roadblocks as the author, and not only regarding malingering. The author takes direct aim at mental health administrators and legislators in their enabling of this problem. I applaud the candidness and courage it took to speak out about this taboo and ignored subject in “the system.”

This is an amazing book. I have been a psychiatric nurse/nurse practitioner for 47 years, most of those in emergency psych, crisis intervention, and consultation/liaison in large university affiliated hospitals in Detroit. When I began practicing in 1972, things were pretty good in psychiatry. The treatment teams decided when patients were ready to leave, not the insurance companies. For people who were too ill to live in the community, or needed more time and treatment in order to be able to do that, there were long term state hospitals. Yes, some of those facilities had problems, but they were better than sleeping over a steam vent in the streets of Detroit, getting frostbite, gangrene, and having your legs chopped off. When they closed, thousands of human beings with serious mental illnesses were literally dumped into the streets and the prison system. We are now of third world quality. When I picked up this book, I felt a sense of relief that someone else understood and had written about it. I wish that every American and every politician could read this book. Everything the author says is 100% accurate. Every medical and nursing student needs to read this book. So does every malpractice attorney. So does every politician, not that they’d care. Thank you for this gift of a book. I hope it starts a revolution.

Absolutely, positively one of the best books I’ve ever read about the mental health system and the people it affects so deeply, including the book’s author, a licensed, independent mobile emergency psychiatric clinician on the front lines where her decisions can literally mean life or death. Meticulously researched and strongly endorsed by some of the nation’s leading voices for the right to treatment, the writer’s compassion, courage and clear-eyed description of the people who desperately needed inpatient treatment, and the difficulty (or impossibility) of securing that treatment for some of the sickest, had me up all night. On the other hand, she also writes about some of the people (most often homeless and desperate for a warm bed) who try, and sometimes succeed, in getting admitted to inpatient treatment that they don’t need. But this author doesn’t stop with describing the problem. She’s also more than done her homework, citing well-researched and effective programs that, if expanded, could make a huge difference in the lives of people with severe and persistent mental illness, and in the lives of those who love, and/or care about them. If you wonder why, after half a century of deinstitutionalization, we have so many homeless, mentally ill people on the streets and in the jails of America, or if you already know, and want to know more about what needs to be done to reverse the tide, read this book.

“Breakdown by Lynn Nanos offers a very engaging view into the kinds of troubling conflicts that illuminate why AOT is often necessary. Lack of insight for people with serious mental illness Is a problem that Carries through at levels of the individual, family, and society. Well informed doctors and social workers can make all the difference to people at the end of their rope feeling there is no option but to act out. A good AOT team allows for progress to be made for those experiencing serious trouble due to their brain disorders. Helping someone understand it is a disorder at work can be challenging, but over time persistently working with those affected pays off. Though in this field answers are not black and white, with structures like AOT in place, less people fall through the cracks. It is painstaking to Ensure people get engaged to the level of understanding when their illness versus a different matter altogether is causing problems, but Breakdown illustrates that AOT can make all the difference.

I had a very personal interest in reading Breakdown, by Lynn Nanos, because I have a family member with schizophrenia. Along with many others, I have felt intensely frustrated with every aspect of the mental health care system, including hospitals and their staff. I needed to find out what she had to report from her own professional experiences as a mobile emergency psychiatric clinician, with the special skills and ability to orchestrate involuntary hospital admissions. 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 up to 12% of those admitted for emergency psychiatric care are what the mental health care industry calls “malingerers.” These are folks who don’t fit the criteria for gravely ill when they are evaluated, but they work the system so they can gain admission and have a nice all-expenses paid mini-vacation in a hospital. This is also at the expense of so many desperate people who really do need the care, but there are no beds available for them. My own family member once spent five days in the E.R. at USC Medical Center, waiting for placement and continuing to deteriorate each passing day. Even more frustrating was the author’s confirmation from her own documentation, the frequency with which the hospitals discharge psychiatric patients before they are stable. This is just one of many ways in which the broken mental health care system actually encourages relapse and sabotages recovery for the most seriously mentally ill. On the up side, it was very comforting to know that there are such dedicated professionals like Ms. Nanos, working on behalf of those with little-to-no capacity to help themselves. An underlying theme in Breakdown also addresses the touchy issue of involuntary treatment. We live in a nation where many people maintain the myopic view point that a person has the right to be as psychotic as they want to be (until they harm someone.) Both inside and outside the mental health care industry, there are very powerful and vocal opponents of involuntary treatment because they claim that a person’s rights would be violated. The case studies and research done for Breakdown make it very clear that we need to intervene for those who don’t have the capacity to make rational, safe choices for themselves. A temporary suspension of personal “freedoms” may just save a life, or many lives, and actually provide enough treatment for a person to gain some insight and eventually experience a higher quality of life. A copy of Nanos’ book should be read by every mental health policy maker in the country. I recommend Breakdown to anyone who wants to understand more of the process and circumstances under which a seriously mentally ill person gets hospitalized, including those who are homeless or without family members to help them.

Lynn Nanos, LICSW, chronicles her years of in-depth experience as an emergency psychiatry clinician. In Breakdown, she shares from numerous compelling personal accounts of the interactions she has with those who have SMI (Severe Mental Illness) and symptoms of psychosis and anosognosia. For someone like myself, who has had episodes of psychosis and anosognosia in the past, I am fascinated by how the patients appear through Lynn's eyes. When we (persons with psychosis) are not aware of why we are acting so strangely, and cannot control the abnormal impulses due to our broken minds, it poses numerous challenges to those serving us in the mental healthcare field. Ultimately, the way things work currently, it disserves us when we are sick and cannot tell what is real from delusion. A person who lacks insight into her mental illness is usually paranoid, thinking the social worker and doctors are working against them, when they may actually be working against them, just not intentionally. Lynn uncovers these unintentional but lacking ways the mental health care system fails those whom it tries to serve. Lynn documents in great detail and straightforward storytelling, her unbelievable realities of the holes in our nation's mental healthcare system. Breakdown gives plenty of evidence for the need for a reform in our nation's system for an underserved SMI population and unequipped treatment system. Her profession is perhaps one of the riskiest and challenging environments due to the population she serves, and yet undeterred, she strives to do what is best through the help she offers. Ironically, and unfortunately, many most in need of the care she can help provide are the least likely to take it. Her book shows and gives a compelling argument for how vital it is for a more competent system for the wellbeing of individuals who may not realize it but need it the most. I highly recommend Breakdown to anyone who has a loved one with SMI, serves the SMI population, or holds any influence within and around the mental healthcare system. Breakdown paints a large, detailed picture of the variety of colorful people who have SMI, who are most in need of help, who need better ways to reach that place of recovery. They cannot reach it on their own. This book is a guide and an answer to why they cannot, and points the way to how they could. -Katie R. Dale former bipolar disorder type I inpatient Creator of BipolarBrave.com

My father and brother are schizophrenic, and this book covers much of what my family has experienced from the medical world, but not understood. Lynn's perspective was a missing link for me to see why families like mine fall through the cracks. It’s very validating to have an experienced professional acknowledge the perspective of the family and caregivers of the Seriously Mentally Ill because otherwise we don't have a voice (their "right" to remain in untreated psychosis overrides everyone else's rights for safety and order). I wish the true cost of this negligence was realized.

As a crisis clinician, Lynn Nanos is familiar with the consequences of the destruction of our mental health system. She introduces the uninitiated reader to the nightmare of untreated psychosis, by sharing anonymous cases she has encountered as well as scientific research results. She notes that patients with untreated psychosis are very apt to have no understanding that they are ill - literally, their brains are not working correctly - and since they don't believe they are sick they also don't believe they need treatment. By not embracing the help they need, these people often have dire consequences such as homelessness, incarceration, violence and suicide. She argues that a patient's right to refuse treatment should be negated when the psychosis is in effect making that decision. I agree. A patient who is unable to make decisions in his or own interests - a patient not in their right mind - needs society to make those decisions for them. The use of Assisted Outpatient Therapy (AOT) must be expanded, the IMD exception must be ended, long-term inpatient care must be more available, and supportive housing must be better funded. However, in using case study after case study - sometimes dozens in a single chapter - Nanos managed to burn me out rather than strengthen her argument. Each chapter seemed to fit in one of three boxes - naming the problem or offering theories to solve the problem; citing research studies about the issue; or demonstrating the problem with dozens of case studies. The book would have been more powerful had the three been more integrated throughout. While I agree with Nanos on almost all points, there were parts that as a person with mental illness I took offense. These were relatively minor, however. For example, she disparages the Hearing Voices Network, because their position is that the experience of hearing voices or having other hallucinations is not necessarily a medical problem, but rather is a personally real and perhaps meaningful occurrence. As a participant in a voice hearer's group, I can say that the opportunity to speak openly about my experiences in a non-judgmental environment has increased my acceptance of my illnesses and helped me be more honest with my treatment team. There was also one thing I wished Nanos addressed to a better degree - while she spoke of a mental illness spectrum, she only addressed the two ends of the spectrum - untreated psychosis and malingering or the worried well - as well as somewhat clumsily mentioning borderline personality disorder. There lives a wide variety of people in the middle. I do not have schizophrenia but do have other illnesses. Sometimes I have required unwanted intervention to get appropriate care, even when I have been fully participating in outpatient treatment. I am grateful today for those interventions from clinicians much like Nanos. I wish the book offered a nod to those of us that struggle in the middle of the spectrum. All in all, a good book with lots of evidence supporting expanding efforts to humanely serve the most seriously mentally ill patients.

With anecdotal examples and substantively researched documentation, Lynn Nanos, a clinical social worker, invites us to walk with her through the nighttime hours of her profession, maneuvering a broken treatment system where professionals like her struggle daily to find and secure placement for those most in need, the seriously mentally ill. Lynn is tasked with making the difficult decisions of whether to seek admittance for persons needing treatment, then to find placement for them in a system that has limited resources, maneuvering that system that allows far too many to fall through the cracks. Those who know how difficult it is to get their loved ones into treatment when they are too ill to recognize the need will find Lynn's stories all too familiar. With compassion and obvious concern, Lynn somehow manages to maintain an objectivity in her writing that is akin to the old detective novels which narrate first-person stories of crime and punishment, except in this case, the biggest crime story is that of a systemic failure throughout our nation to recognize the need for treatment for those most seriously in need and to provide adequate resources to meet those needs. While daunting and frustrating, there is hope. Lynn offers insight into solutions for this system to effectively serve those who for far too long it has neglected. For those who are unacquainted with the pitfalls of the broken mental health system, this book is a much needed eye-opener into the very real world of mental health professionals and the clients they desperately seek to help. It's not an easy read, but a necessary one, if we are to understand and contribute to the movement for change.

Get this book! Send it as a gift to anyone you know with a loved one struggling with any kind of brain disease or mental illness. I love Lynn Nanos’ writing style .. it’s like reading an intriguing, intense moment to moment story as she takes us through processes and experiences in her career as a mental health clinician. “Breakdown” should be required reading by everyone who has struggled with mental health care or who can make changes for the better in the system. Our systems are broken. A transition HAS TO BE MADE to get to the real needs of those with a brain disease and Lynn lays out the pathway to boost that journey. It’s time - and this sensitive, honest and helpful book can save lives. She GETS our people whose brains work differently and I’ve not seen a book quite like this one that lays out the emotions, confusion and love that gets tangled up with a brain disease. So glad I got my copy. I am now retired from working at my local county mental health department so I have seen the results of misunderstood illness, desperation and helplessness - and watched families break down under the stress of trying to keep a loved one alive. Please give this book a read - as legislation for change falls on ALL of us to understand what this is all about. Plus, it’s a fascinating read. Kudos to you, Lynn!!! You’ve written a gem 💜

I bought this book mainly for the chapter regarding malingering. I was not disappointed. The chapter is, "Three Hots and a Cot." The author candidly states that malingering will never go away yet also offers solutions for mitigating the problem. Malingering is problematic because in such cases, inpatient psychiatric beds are inappropriately used/filled to the detriment of those who are in true psychological crisis. Consequently, the “mentally” (ie, neurologically) ill are often denied proper access to care because of it. As a former psychiatric crisis clinician myself, I have always wished someone would speak out the prevalence of malingering in the emergency setting and its consequences. I have seen it mostly in major cities but smaller towns/hospitals are in no way immune. I have witnessed ERs discharge suicidal patients from their hospitals because the hospitals needed the room in their ERs and there were “no psych beds available” for days at a time. I was not at all surprised to learn that I have been faced with many of the exact same frustrations/roadblocks as the author, and not only regarding malingering. The author takes direct aim at mental health administrators and legislators in their enabling of this problem. I applaud the candidness and courage it took to speak out about this taboo and ignored subject in “the system.”

This is an amazing book. I have been a psychiatric nurse/nurse practitioner for 47 years, most of those in emergency psych, crisis intervention, and consultation/liaison in large university affiliated hospitals in Detroit. When I began practicing in 1972, things were pretty good in psychiatry. The treatment teams decided when patients were ready to leave, not the insurance companies. For people who were too ill to live in the community, or needed more time and treatment in order to be able to do that, there were long term state hospitals. Yes, some of those facilities had problems, but they were better than sleeping over a steam vent in the streets of Detroit, getting frostbite, gangrene, and having your legs chopped off. When they closed, thousands of human beings with serious mental illnesses were literally dumped into the streets and the prison system. We are now of third world quality. When I picked up this book, I felt a sense of relief that someone else understood and had written about it. I wish that every American and every politician could read this book. Everything the author says is 100% accurate. Every medical and nursing student needs to read this book. So does every malpractice attorney. So does every politician, not that they’d care. Thank you for this gift of a book. I hope it starts a revolution.

Absolutely, positively one of the best books I’ve ever read about the mental health system and the people it affects so deeply, including the book’s author, a licensed, independent mobile emergency psychiatric clinician on the front lines where her decisions can literally mean life or death. Meticulously researched and strongly endorsed by some of the nation’s leading voices for the right to treatment, the writer’s compassion, courage and clear-eyed description of the people who desperately needed inpatient treatment, and the difficulty (or impossibility) of securing that treatment for some of the sickest, had me up all night. On the other hand, she also writes about some of the people (most often homeless and desperate for a warm bed) who try, and sometimes succeed, in getting admitted to inpatient treatment that they don’t need. But this author doesn’t stop with describing the problem. She’s also more than done her homework, citing well-researched and effective programs that, if expanded, could make a huge difference in the lives of people with severe and persistent mental illness, and in the lives of those who love, and/or care about them. If you wonder why, after half a century of deinstitutionalization, we have so many homeless, mentally ill people on the streets and in the jails of America, or if you already know, and want to know more about what needs to be done to reverse the tide, read this book.

Are you tired of stepping over homeless street people on your way to work? This impressive book goes into detail concerning the horrifying deterioration in the psychiatric care of the Severely and Persistently Mentally Ill (SPMI’s - primarily people with schizophrenia) in the United States that I have personally witnessed since I was a resident in psychiatry in the late 1970’s in California. The author provides sad, disturbing, and hair-raising case studies of suicides and murders of both family members and strangers due to the premature discharge of dangerous, delusional patients who did not think they were ill and refused treatment. Due to the mutual biases of the so-called patients’ rights social warriors on the left of the political spectrum, and tax-phobic, private prison subsidizing politicians and government agencies on the right of the political spectrum, hospital stays have been whittled down to just a few days, so that patients are either not referred for psychiatric follow-up at all, or do not show up even if they had been. Many are discharged with no prescription medication to take after they leave. Often they end up in jail due to committing minor nuisance crimes, and sometimes much worse, when that could have been prevented. Highly recommended.

I've often wondered what treating patients with SMI (Serious Mental Illness) is like for medical professionals. I want to know, too, what the intake process is like for clinicians, and whether they feel as frustrated with the system as we family members do. This book answers these questions, and more. Through it all, 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. She knows her stuff, she fights for what's right - and is fearless in exposing the cracks in the system. Nanos supports her opinions with lots of research, and with stories about patients she has worked with. Highly recommended reading.

Excellent Read for all who want to know the truth about mental illness in America today. The author takes actual cases she has worked changing the names to give real insight into the reality of having a serious and persistent mental illness. Lynn is a good and we need more like her who really honestly cares about those she is trying to help to the best quality of life possible. You will come to understand how difficut it is for the person who does not have insight into their illness - does not understand they are sick and getting wrong information from their own brain. The true sad reality of having a serious mental illness. Mental illness attacks the brain leaving person helpless to help themselves. This is a excellent read for all going into to the field and anyone having a love diagnosis with a mental illness. It would also be excellent for Federal /State Legislators, Lt. Governors and Governors and those running for high office.

I read Breakdown because a friend told me about it. She did not know that I had a long time awareness/concern over what has been happening to this most vulnerable population. I saw the legal system’s “hands off” approach when my aging stepfather was in need of protection and have been witnessing a cousin’s heartache as her bi-polar son went from top of his class at one of our service academies and Ivy League law school grad to barefoot and homeless in NYC. In both cases there have been caring family members and top notch legal help. I kept wondering how we went from a system which had its share of abuses and was desperately in need of reform to individuals “dying with their rights on”. Lynn Nanos explains why, even with family support, these most vulnerable individuals often don’t get the care/protection they need and worse, end up in prisons and/or are victims of violence and other crimes. Nanos gives clear examples of how our current system is failing them and the rest of us as well. However, she doesn’t stop there, she also recommends specific reforms.

Although I am only half way through "Breakdown" by Lynn Nanos at this writing, I am sharing my impressions. Rarely have I been so engaged with a book on the broken system of emergency psychiatry by an experienced clinician that I find myself marking pages with a highlighter and sticky notes and using notecards for future references as bookmarks. Practical advice and familiar vignettes weave through the narrative as only someone who has been on the frontlines can document. But who am I to make such bold statements? I hold no professional credentials, nor have I ever been employed in the psychiatric or social worker industry. The only letters after my name are m.o.s.b.p.s. (mother of a survivor of the broken psychiatric system), earned by 30 years of love and advocacy for my daughter labeled with a diagnosis of schizophrenia, under continuous care and treatment in the State of Idaho. If you are a provider, emergency room, housing provider, law enforcement, judicial, legislator, advocate, family member, or a survivor in recovery, and care about making a better life for an underserved population, I recommend reading Breakdown by Lynn Nanos. Be prepared with a highlighter, sticky notes, notecards and tissue for tears.

Anyone interested in understanding the failures of America’s approaches to helping people with schizophrenia and other psychotic disorders should read Lynn Nanos’ superb book. Nanos’ years as a psychiatric social worker in Massachusetts give the reader an up close look at the lives impacted by misguided policies; her composite presentations of individuals struggling with untreated psychosis show us what horrors ‘human rights’ activists create when their ill-informed beliefs leave profoundly ill people ‘free’ to choose if they want treatment. Nanos’ book is also a carefully researched account of the impact of the psychiatric survivor movement and the overly empowered peer movement in blocking access to necessary services for people with psychotic disorders. I’ve been worried about trends in the education of social workers that seem to lead too many to undermine medically necessary treatments. Nanos’ solid knowledge about mental illnesses and wise use of her experiences helps us know that there are social workers doing the right things. This is an extremely valuable resource for anyone wanting to fix the US mental health system.

This book should be required reading for those entering the mental health profession. Lynn does a great job of educating others about how the system works, particularly in relation to those suffering with chronic mental illness. Difficulties, obstacles and frustrations for clients and families seeking help are detailed through the use of case studies, providing powerful narratives for those who often have no voice. Lynn masterfully connects these stories to well researched background information regarding the system and shares useful and practical suggestions which could help many who are suffering. As a social worker with experience in emergency services I learned things I did not know and found her observations and insights spot on. Her positions are thoughtful and well reasoned and it is clear she is dedicated to her work and serves as a passionate advocate for this population.

I was interested in reading this book because I have two adult sons with schizoaffective disorder. One son recently took his own life and the other son is inpatient in a psychiatric hospital as I write. The author's use of case studies helped drive her points and helped me understand better what obstacles and barriers there are to treatment. I was particularly interested in her description and use of case studies to illuminate the very difficult problem of anosognosia from which both my sons suffer to some degree. Like the author, I am in favor of AOT being used more extensively.

I enjoyed reading this book for many reasons. I have schizo-affective disorder. I hate the idea of being told to do something against my will because I have a mental illness, but while experiencing psychosis and anosognosia I had no free will. Dr's have the most power in the hospital, but social workers spend the most time with the patients. This book gives a detailed first person account of what it is like to be on the front lines in a broken system. I recommend this book to anyone who is an advocate for people with mental illness.

Read it and you will to learn from someone in the field how broken the mental health care system is in every community in America. Every road block, frustration and unfathomable experience that I have experienced in the system is covered in this book. I have tried to help my son navigate and get care through a completely broken system for three years. It has not gone well! Anyone who wants to help is met with so many road blocks that most give up eventually. All of the books examples show exactly the same issues that I have experienced. The book is well written and a an interesting read too.

Thank you, Lynn Nanos, LICSW, for writing Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry. Her book highlights how our mental health system fails those most in need of help. Our system must change. ASAP. We must improve our health care and mental health care systems to care for our most vulnerable citizens who live with serious mental illnesses. As someone with insight and resources, I’m able to obtain care for my own mental health. But life is not fair. Not everyone has the resources or symptoms (insight vs. lack of insight) that I do.

The author did a great job putting in simple understanding terms what a professional is up against trying to help or do her job to help the severely mentally ill in the USA. Lynn Nano using case examples painted a very informative picture of what is actually happening. I would recommend this book to be read by our representatives in government who make the laws to educate them on what is wrong in our health care system and what can be done to correct it.

This book should be required reading for anyone involved in the mental health system. I am a “customer” of the system and it needs a total overhaul. The book is well written with examples of experiences the author, a clinical social worker specialist in emergency psychiatric care, was involved in. If you or a loved one have issues with mental illness please read this book

I have a family member who suffered jails, prisons, homelessness instead of continuous treatment for his mental illness. He died behind a dumpster, alone. He is why I became an advocate decades ago. Unfortunately, I know the tragic, unjust realities span our nation. THANK YOU LYNN NANOS!!! She bravely shares the realities our loved ones with serious mental illness suffer. They have been ignored and allowed to languish in their illnesses for decades. Major changes need to happen NOW! It is a great idea to share Breakdown with all your law and policy makers, law enforcement and advocates working to assist the seriously mentally ill.

Breakdown is a measured, well-researched and carefully documented portrayal of the disaster that is our nation’s current mental healthcare “system.” The combination of first-hand experience and careful research give this book immense credibility, and Lynn Nanos clearly does not exaggerate or sensationalize her personal experiences working as a crisis manager in the field of mental healthcare. As director of Mothers of the Mentally Ill, fighting for mental healthcare reform in Washington State, I recommend anyone who is passionate about helping to invoke change to read this book and then use this knowledge in advocacy.

I have not seen a book about the seriously mentally ill (SM)I from the perspective of a licensed clinical (psychiatric) social worker. Ms. Nanos writes about the broken system that provides no way out for those with SMI. She provides touching and gritty vignettes in each chapter that may seem isolated cases but the problem is epidemic in our society. Her stories about cases as a first responder show the frustration of all of us who are advocates. It is a great read for laymen and health care professional. By Paul Golden, MD

A heartbreaking, maddening look at why those who most need help are turned away. Lynn Nanos is to be commended for telling the real reasons those with severe mental illness are turned out to the streets, the jails and prisons, and the morgue. As the mother of a son with a severe mental illness, I highly recommend this book for those who cannot fathom why our loved ones don't get the treatment they need and deserve. Why day after day the news has stories of tragedy before treatment. Follow the money, eye opening. Thank you Lynn Nanos.

Very informative and very useful! 👍🏻👌🏻

I really liked this book because I am also an LCSW like author Lynn Nanos. Her experience is quite typical, in this country, of what it's truly like to navigate a mental health system fraught with challenges. Our mental health treatment systems are often uncoordinated, siloed, unresponsive, and generally dysfunctional. It is a sad state of affairs indeed. Kudos to Lynn Nanos for shining a light on a this important issue.

This book is excellent. She explains how our current Mental Health System excludes the most seriously mentally ill from much needed psychiatric medical treatment and why. I cannot put this excellent book down. I recommend this book for anyone who is interested in advocacy for the most seriously mentally ill and their families. Plus for the General Public also.

If you have a loved one with serious mental illness then you already understand what an absolute nightmare this country's mental health system is. The author gives you an insiders look at how brutally cold, cruel and unfair this system really is. She is in the trenches, she knows. I love it. I recommend it to everyone too!

As someone without much prior experience in mental health, I was totally riveted on every page. The examples of how and why the system is broken, beautifully detailed, are astonishing. Every authority in state governments and at Capitol Hill should read Breakdown.

If you want a street level view of the fragmented mental healthcare system, with real concrete examples, read Breakdown. No esoteric, ivory tower, theoretizing here. Lynn Nanos doesn’t hold back her punches in describing the pass/fail mental healthcare system, with vivid details how disastrous politics, bureaucracy, legislation and even some ignorant, misplaced good intentions have allowed mental healthcare administrators to abdicate responsibility for the most difficult patients suffering from serious mental illness.

Lynn's book "Breakdown" was very informative written with such honesty and compassion. A must read for anyone working with the mentally ill or to those of us who have a loved one with mental illness.

Psychiatric social worker, Lynn Nanos, describes the barriers put up by our legal and health care systems that ignore and hurt instead of helping those with serious mental illnesses. Her thorough research shows how the nation has come to this shameful circumstance as well as offering critically needed solutions. Read and share this book!

Excellent book, written from a clinician’s viewpoint. Nanos uses real life vignettes to illustrate the failures of the system of mental healthcare. It’s apparent that the author is dedicated to this hard to reach population. Through her book, hopefully other clinicians will learn to have a passion for the most seriously ill.

Lynn Nanos provides a thoughtful and well written commentary on the tragic state of our deeply flawed mental health care system. This book is an important work that should be required reading for anyone seeking a better understanding of how we have failed the mentally ill in this country and what we can do to reverse course.

Lynn Nanos hopes her book will motivate people to advocate for changes in our mental health system. I've read Breakdown and I believe this book has the potential Lynn hopes for.

Amazing read! Definitely recommended to anyone in the mental health field.

You can tell it's self published. Overly academic and a slightly boring read. Factual. Some good examples. But I didn't get the vibe that Nanos really spends time in the field with people in active crisis. Too confined to an office setting.

A fascinating account of the daily struggles of an emergency clinician and recommendations for how to make the system better for everyone.

Well written and true to form of the broken mental health system

Very informative and accurate

Nanos understands the big picture. As a pschizoaffective with seriously mentally ill (SMI) relatives, I've seen the fallout from handing over psychiatric care to hospitals and clinics that have a lot of other priorities.

Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry by Lynn Nanos is a heart wrenching read for those who yearn for a humane society in America. Everyone with a caring heart needs to read this book to see why an immediate improvement in public policies, hospital policies, and public education must happen so humane treatment is available to anyone who may fall ill to a physical mental health ailment. The masses need to rise up and take a stand for humanity; and, Breakdown demonstrates why! The reader gets the inside story of how hospitals, law enforcement and others are treating human beings with physical mental health conditions in the 21st century. And, it’s unconscionable, as the care of our country’s seriously mentally ill by hospitals, other providers, and insurers has improved little, if any, in over 50 years. Nanos is a licensed clinical social worker with clinical experience working in the emergency psychiatric admissions space. Her book gives real life examples of the poor care and nonchalant concern for improvements of administering medical care, especially hospitalization, which can infuriate a reader compassionate about humanity. Some of the ED psychiatric patients who present with severe symptoms of a physical mental health condition, have a symptom called anosognosia, which means they are unaware they have a medical condition that needs prompt appropriate medical care which includes, but is not limited to, proper diagnosis and medications. Nanos shows the immediate need for a better way to help these people. When reading the book, one realizes if a person was wrestling with psychosis from a problem with unregulated insulin or because of a stroke medical care would be the best America can offer. But, having psychosis from a mental illness, which can include substance misuse the person only receives medical care rated at 19th to 20th century stagnant services. Several times the patient leaves the hospital without receiving proper care because of “rights” they have been accorded under State laws to refuse care. Often these sick individuals, many homeless, living with a physical medical condition that has cognitive and emotional symptoms, not much different from someone with a brain tumor, untreated or improperly treated diabetes, or stroke damage, are left to die or cause significant harm to themselves or others with their “rights on!” Nanos makes several recommendations in her analysis of the inhumane treatment; and, she documents well her extensive research. This book puts everyone on notice! America needs to make significant exponential improvements to the health and wellbeing of individuals struggling with a severe physical mental health condition. Because these physical medical conditions impact virtually all areas of our society – public safety, education, commerce, communities, families, taxpayers, health care institutions, health providers, our judicial systems, etc. etc. etc. -- it is imperative improvements in the administration of care and treatment for the humanity of all occur NOW! Sharon Engdahl, Executive Director, American Mental Wellness Association

*I received a free copy of this book, with thanks to the author. The decision to review and my opinions are my own.* Breakdown is a thoroughly researched and well-argued treatise on the failures of mental health care provision for severely delusional and/or schizophrenic individuals in the US. 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. Similarly, the tone is professional, businesslike and detached, despite the author’s obvious passion for her subject matter. The main focus of the book is Nanos’ observations about the inefficacy of the current system for involuntary transfer to hospital and also the lack of resources and ability to hold the patient in hospital once the transfer has been achieved. The author clearly defines the problem and causes, then offers her solutions, which are based on her years of experience within the current system. If you are looking for cheery anecdotes about mental health and illness, to entertain and titillate, then this is definitely not the book for you. However, if you have an interest (vested or casual) in the subject, then this book is an excellent scholarly resource on the current issues faced by practitioners and patients. Those who bravely choose the path of advocacy are heroes. Their tragic stories inspire me to join their fight. They remind me to be courageous when I authorise involuntary transfers to hospital for patients who, I expect, will be discharged too soon. I am taking my outrage about the injustices I’ve seen as a clinician and turning it into positive energy through this book. It’s not only a book that I want to share with as many people as possible; it’s a book that I need to share. – Lynn Nanos, Breakdown Review by Steph Warren of Bookshine and Readbows blog

America’s mental health system is broken. It has failed millions of people suffering from mental illness and will continue to do so unless sweeping changes are made. That’s the premise of Lynn Nanos’ Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry. I was offered a copy by the author in exchange for an honest review, which after reading the book, I am thrilled to provide. Nanos is a clinician in the field of emergency psychiatry in Massachusetts with over twenty years of experience in the field. She is uniquely qualified to write this book, having spent much of her life caring for the sickest of the sick. 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.” The latter means that a prioritization of patients’ rights causes people suffering from psychosis who refuse treatment due to a lack of insight into their mental illness to be discharged from hospitals too early. These patients are often homeless and vulnerable to being attacked on the streets. Nanos’ solution to these problems is to promote a program called Assisted Outpatient Treatment (AOT), a court-ordered program which forces patients suffering from psychosis to comply with treatment when living in the community. Nanos describes a condition called ansognosia, where patients have a lack of insight into their mental illness. This book has special significance for me because I have bipolar and have endured psychosis, like the patients in the many case studies Nanos covers in Breakdown. When I suffered a psychotic break, I had no insight into my mental illness, like many of the patients suffering psychosis that Nanos describes. I was fortunate in that, as I complied with treatment, I gained such insight and was able to take steps towards recovery before I left the hospital. Like Nanos points out, this is not the case with the majority of others. What Doesn’t Work Well in Breakdown Because I don’t want to end on a negative note, I’ll start with one item that didn’t work well for me in Breakdown. Disclaimers: The opening chapter is full of disclaimers about what the book does and does not cover. These disclaimers are vital to understanding how the rest of the book works, but they make for dry reading, especially for a first chapter. However, I don’t know how else Nanos would have structured this. These disclaimers are necessary, and they need to be placed upfront. That’s it. That’s all I didn’t like. If a reader can get past the tedious first chapter, the meat of Breakdown is brilliant. What Does Work Well in Breakdown As promised, here’s what does work well in Breakdown: +Fulfilled Promise: In the opening chapter, Nanos promises a solution to the issues she raises later on, and she delivers on this promise. The writing is accurate and engaging, with case studies of patients offering an emotional look into people who suffer psychosis and their mental illnesses. The book is a blend of clinical information and painfully personal writing, which is another part of what Nanos promises and delivers. Research-Backed Opinions: Nanos’ commitment to scientific research is admirable. She cites approximately 300 studies, and the last chapters of Breakdown are especially filled with mental health statistics, which back up her claims. +Professional Formatting: Despite being self-published, Breakdown is professionally formatted. The cover, featuring a presumably homeless man being confronted by police while lying on a sidewalk, is well-drawn and fabulous. Not that I’m saying to judge a book by its cover, but Breakdown is visually pleasing inside and out. +Case Studies: The most arresting parts of Breakdown are the case studies. Nanos demonstrates why psychotic patients need treatment through the examination of her encounters with them in a clinical setting. Some examples are: a woman who traveled from Maine to Massachusetts because a spirit called “Crystal” ordered her to, a man who smeared dead insects on his neighbors’ doors to help purify toxins in their apartments, and Lily, a woman who delivered dead dogs to strangers, among other stories. Most of these people refused adequate treatment due to ansognosia. A great number of them bolted before Nanos was able to arrange for transportation to hospitals. Some of them were violent, and a few went on to assault their loved ones, with two specific cases ending in death. The case studies are the most effective parts of Breakdown, and demonstrate why the AOT program is so important. Final Thoughts Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry (affiliate link*) is a fascinating book. It’s professionally written and formatted, research based, and effectively delivers its message. The case studies were especially enlightening, and are the heart of Breakdown. Mental health issues affect all of us, whether we suffer from mental illness, have loved ones who do, or are impacted by the mentally ill people all around us. Read this book and see how you, too, can join the mental health discussion.

Years ago back in the late 70's and early 80's, I worked as a mental health worker at a psychiatric hospital in Belmont MA. I originally worked on the Intensive Care Unit. We had the most homicidal and suicidal patients on that unit. Everyone was on five minute checks. The average hospital stay was 60-90 days. I have worked in Law Enforcement for over 32 years, and our officers handle calls daily involving people with untreated mental illness. Emergency rooms are nothing but revolving doors. It was really upsetting to find out from the research in this book, that input from family members of mentally ill patients was turned away by some of the larger mental health reform organizations. The family members are also the forgotten ones. I love that this book offers very viable solutions to a real crisis. It breaks my heart because the reality is, the tearing down of hospitals with locked units has displaced these poor people to the streets and too often prison. Often for crimes they would have not committed had they been on the proper medication. (I try not to use the word Institutions because it feeds a false perception of places where we throw people away) This book was clearly written with great passion and knowledge. It is a must read for our legislators who are working hard to solve issues such as lowering crime, homelessness, and mass shootings. In the late seventies and early eighties, when we had longer hospital stays covered by insurance, we were not experiencing the Mass Shootings that are occurring today. It's clear from reading this book, the author Lynn Nanos is not going to stop until she has made a difference for this very vulnerable and neglected group and their families. We all know these poor people could be anyone's family member. This review is my own personal opinion based on my own experiences.

"Having spent the majority of my career working as an Attending Psychiatrist in state hospitals in Texas and Wisconsin, I have witnessed many injustices in the delivery of psychiatric care to severely ill patients within the public sector. I’ve also worked every day with social workers on our hospital treatment teams, who are most directly responsible for navigating bureaucratic systems in order to secure appropriate aftercare for our patients. No one better understands the obstacles to treatment and negative consequences of insufficient aftercare better than a social worker. Unfortunately, systemic sclerosis and monolithic political opposition can be demoralizing, even when clearly identified solutions are identified. In Breakdown, Lynn Nanos demonstrates an impressive understanding of the indisputably flawed system of modern public sector psychiatry, and then logically and energetically provides suggestions to improve the system. In multiple clinical vignettes, she illustrates the human toll of the “broken system.” She clearly understands that the greatest obstacles to improvement are legal and economic, and she provides ideas which deserve further exploration within our courts and systems of reimbursement. I heartily recommend Breakdown to any mental health professional, psychiatric patient and/or family member, and to anyone who wishes to be better informed regarding current challenges in the mental health arena, and who strives to be more effective as an advocate for these unfortunate souls who need our help now, more than ever…"

The Review 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. From the book’s opening pages readers are shown the levels of illness and sad state of affairs for both the patients and the doctors attempting to treat them. What really stuck out to me reading this novel was how the author wrote it all out in a methodical and precise tone of voice, and yet was still written in a way that the average reader, someone who isn’t an expert in the field of mental health, will be able to understand and empathize with. Each chapter elevates the struggle by showing not only individual cases the author worked, but the journey to fight for the rights for all mentally ill patients to seek help or get help they need. The details given by the author and the statistics laid out for the mandates for mental health by state showcase a lack of cohesive treatment plans and emphasizes the need to expand and grow the mental health profession in this nation and the world at large. The Verdict A well written, powerful and heartbreaking non-fiction read that everyone should try for themselves. Breakdown by Lynn Nanos is a detailed and meticulous book that gives readers the inside look into a very under appreciated field, and novels like this are the steps needed to take the United States and the world forward into the mental health profession for both patients and care providers alike. Be sure to grab your copy today!

This is a very honest and unflinching look, by a person who works "in the trenches" so to speak, of mental health crisis work. Well written, excellent vignettes. This should be required reading for anyone thinking of entering the field, or even someone like me, who has been in the field for a quarter century. Some parts will make you feel so frustrated, as the barriers (dealing with patients' anosgnosia, is the big one) in trying to render help and treatment. The author also dares to go where few have gone before in asserting that Borderline PD is a serious mental illness, not only as experienced by the patient, but their loved ones. The phrase "dying with their rights on" is introduced as a quote, and used frequently throughout the book, and I cannot think of a more appropriate way to describe what it feels like to watch someone refuse care for a serious illness, and to then suffer terrible consequences (including death, homelessness, forensic involvement). Please, do yourself a favor, and read this book.

The work that author Lynn Nanos does here is without a doubt an important contribution to the current word of the mentally ill in our country. Her heart shines through as she takes us through the heartbreak of how the system has failed this population. Any other illness is met with proper care all through the diagnosis, the medical care and the recovery process. When brain illnesses are looked upon as other illnesses, we will finally have the parity on a complete medical level. Until that time books like this put a glaring light on the shortfalls, the true stories and the eventual discovery that the money spent on mental illness needs to be better spent in order to have proper treatment initially and throughout the process. Breakdown: A Clinician's Experience in a Broken System of Emergency Psychiatry is written for all of us who have SMI, MI, and all those professionals involved in the system. I recommend this book for anyone in the field and anyone who has ever suffered as patient, family member, friend or clinician. Readable and fundamentally another important resource.

As a psychiatrist, I found this book fascinating and informative. Nanos describes patients she has met and treated who are severely mentally ill, and over and over again I found myself reflecting on my own patients, particularly those on the inpatient units where I have worked. She is a very accurate observer and reports details of conversations that ring true. Overall I very much agree with her premise that our mental health system overemphasizes patient autonomy and liberty at the expense of adequate treatment. “Protecting civil liberties” is a nice talking point for misguided lawmakers who aren’t on the frontlines of treatment, where discharged patients are symptomatic and often victimized due to untreated mental illness. This book is a great read for professionals and laypeople alike.

In this book has provided great insight into the problems that persons and their loved ones with severe mental illness encounter. She has described incidents in these patient's lives that really illustrate the obstacles they face in obtaining the care they need . Her premise is that some patients have conditions that cloud their judgement to the point that they do not seek or grant permission for treatment, and this can cause harm and danger to the patient and those around him . Lynn strongly believes this mental health issue should be addressed , for the patients's sake , thier families sake and for the safety of society in general .