Breakdown: A Clinician's Experience in a Broken System of Emergency Psychiatry

by Lynn Nanos

When hospitals release seriously mentally ill patients too soon without outpatient follow-up, the patients can end up homeless, jailed, harming others, or even dead. When patients are deemed suitable for inpatient care, they can languish for weeks in hospital emergency departments before placements become available. Meanwhile, patients who fake the need for care are smoothly and swiftly moved to inpatient settings. Breakdown opens a dialogue with anyone interested in improving the system of care for the seriously mentally ill population. This book helps to answer questions such as:

Is inpatient care too inaccessible to those who need it most?
Do mental health professionals discriminate against mentally ill patients?
Are more stringent measures needed to ensure that patients take their medication?
Is borderline personality disorder too serious to be classified as just a personality disorder?

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, her deep interest in helping people who don't know how to request help is evident to readers.

A woman travels from Maine to Massachusetts because she was ordered by her voice, a spirit called "Crystal," to make the trip.
A foul-smelling and oddly dressed man strolls barefooted into the office, unable to stop talking.
A man delivers insects to his neighbors' homes to minimize the effects of poisonous toxins that he says exist in their homes.

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.

Genres: Psychiatry, Mental Health

296 pages, Paperback

First published October 6, 2018

About the author

Breakdown includes fifteen testimonials from well-known professionals, including attorneys, psychiatrists, authors, and professors!

Lynn Nanos is a Licensed Independent Clinical Social Worker who has a lot of experience as a full-time mobile emergency psychiatric clinician in Massachusetts. After graduating from Columbia University with a Master of Science in Social Work, she worked as an inpatient psychiatric social worker for approximately seven years. Nanos is an active member of the National Shattering Silence Coalition that advocates for the seriously mentally ill population.

Book Launch Party - Dialogue on Breakdown with Guests
October 21, 2018 - Norwalk Inn & Conference Center, Norwalk, CT:

GUEST: What inspired you to write the book?
LYNN: I had done mental health advocacy work on a national scale for years and was very inspired by their stories. Their stories motivated me to try harder at what I do, and I didn’t feel that my employment was enough of a difference in the world, and had come across so many dramatic shocking stories that all of a sudden it dawned on me that the world has to know these stories. They’re so shocking that very few people are aware of the population and what they struggle with.

GUEST: How long did you work on your book every day?
LYNN: Well most of the work was done on the weekends because my employment is Monday to Friday. I decided to write the book in December of 2016. I gave up most of my hobbies. I found it a love of labor. It might sound odd to some people, who, as my brother said, you know most people - they want to forget about work when they go home - they don’t want to do work, but I have felt so passionate about caring for the sickest of the sick, that it was something that I truly loved doing.

GUEST: Does your boss know about your book and how will it impact your career?
LYNN: The bosses are aware of the book. They are aware that it’s controversial. It’s controversial because it requests a revision of the current commitment laws. It also gets into detail about the rights of patients and whether patients have the right to be psychotic. A lot of administrative staff, and even clinicians, often say that they cannot help this population because they have the right to be psychotic and do bizarre things, and that the civil commitment law should only be enforced if someone is about to imminently die. But the problem with that is it’s not a preventative approach and there have been many instances, including two that I detail in this book, in which people have been killed because of the poor laws..the lack of laws that exist. How will it impact my career? I still have a job. Let’s put it that way.

GUEST: What was your favorite part of the process, and least favorite part?
LYNN: My favorite part was running into technological difficulties (everyone laughs). My favorite part was writing the case vignettes and doing the research. My least favorite part was making sure that all the citations - all the references at the back of the book - there are approximately 350 of them, were good - that was very painful to do. I also found waiting for other people - for example waiting for the formatting professionals to come through, waiting for the illustrator to finish, prompting him to ensure that the illustration is perfect. So depending on other people was the hardest.

GUEST: What advice would you have to anyone who is interested in publishing a book, given now that you’ve gone through it?
LYNN: Being organized is critical. I don’t believe that anyone who’s disorganized, unless they have billions of dollars and can hire someone to do it for them - I don’t believe it’s possible to do it without being very organized and disciplined, and truly wanting to do it is a key factor.

Lynn can be contacted through www.LynnNanos.com or by emailing her at breakdown@lynnnanos.com.

Reviews

[Steph Warren · Rating 4 out of 5]

*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
https://bookshineandreadbows.wordpres...

[Rose Joyce · Rating 5 out of 5]

This was a very interesting , well written book . The author , who has been a social worker for many years has very definite ideas on how to fix a broken system . Her vignettes about her troubled patients and their families were written with great sensitivity.

[D.B. Moone · Rating 5 out of 5]

My Review of BREAKDOWN: A CLINICIAN’S EXPERIENCE IN A BROKEN SYSTEM OF EMERGENCY PSYCHIATRY by Licensed Independent Clinical Social Worker Lynn Nanos is going to be presented outside of my typical review style. To begin, I am going to write a personal note of accolades to the author:

Lynn, There is no one that can read your book BREAKDOWN and not give this book a 5 Star Review, as well as applaud your knowledge and efforts from your experience, and the factual statistics and vignettes you provide throughout your book unless the reader is in denial. You expertly present your findings in a precise, chronological and methodical style. Your book is written on a level that the average layperson, without a background in psychiatry, psychology, social work, et cetera can comprehend. I commend you for your insight, concern, compassion, care, and empathy, through writing this book to bring into the open that which has been covered-up and overlooked for far too long; when deinstitutionalization began, it led to severely mentally ill patients being released into mainstream society, thus resulting in a significant increase in homelessness, criminalization, and violence of today.

I have immense respect for you for testifying at the Boston State House in favor of a bill to implement Assisted Living Outpatient Treatment (AOT). I am appalled after reading your book and digesting the information regarding the number of seriously mentally ill persons that remain untreated living in the United States; this is not only disgraceful to the U.S., but it is also frightening. I would love to see you take your book and your research to the Senate and testify on behalf of all the mentally ill in our country. An expense I know, but if you could find the means to provide all state Senators with a copy of BREAKDOWN, and pummel them with the data from your extensive research, I believe you could break through deaf ears. I understand you are fighting for Massachusetts, but when I read, “The criteria for meeting the legal definition of insanity vary from state to state,” I was aghast. The criteria, the treatment, the programs should be consistent throughout the United States, no exception. I was not shocked however, to read the commonality of a mentally ill patient being diagnosed by multiple psychiatrists with one mental illness and another psychiatrist changing the diagnosis.

There have been many mental health professionals recommending that all of those involved in the mental health field read BREAKDOWN. However, I believe we have an epidemic and 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. Things will not change until professionals such as yourself, and communities as a whole work to stop the epidemic. Of course, you will have to finesse the backing of The Department of Mental Health (DMH) and the National Alliance on Mental Illness (NAMI), And I find it disturbing that these two organizations do not support adherence to psychiatric treatment. It has to feel as if you are fighting a fight that cannot be won; however, after reading your book, I believe in your ability to push the critical information and data out to the masses.

As a prior Anti-terrorism/Force Protection Officer, I have to speak on behalf of the police officers that were charged at by the schizophrenic wielding a knife. Deadly Force is not taken lightly, and when you cannot verbally stop someone coming at you with a knife or any other weapon with the intent of inflicting death or bodily harm to you or others, you, as the police officer, are authorized to use deadly force. I do not believe these police officers had any other choice. However, having shared my opinion on this matter, I do believe that we need to do a better job of training our law enforcement personnel in exercising more empathy. Helen Riess, MD wrote a book titled The Empathy Effect: 7 Neuroscience-Based Keys for Transforming the Way We Live, Love, Work, and Connect Across Differences and in my review I recommend this book from the White House down to the family home. If you are interested you can read my review of The Empathy Effect on my blog (https://dbmoone.com/2018/08/31/book-r...)

Thank you, again, Lynn for writing a book filled with crucial information and data. It is my hope that those who read BREAKDOWN will be affected by the degree of demanding change and inciting a movement for those who have a severe mental illness. I am going to share some excerpts from your book in hopes of inspiring more people to read BREAKDOWN. You are doing amazing work, and I appreciate all that you have done and continue to do.

Excerpts from BREAKDOWN by Lynn Nanos, L.I.C.S.W.

“We memorialize Sandy Hook Elementary School every year.” – D.B. Moone

“Adam Lanza had killed his mother and then killed twenty children and six adults before killing himself.” “In September 2005, Adam had an emergency psychiatric evaluation at a hospital, but his mother refused to cooperate with the recommendation that he remain there for an additional evaluation by a hospital psychiatrist. He went home instead.” – Lynn Nanos

“Perhaps if his mother would have cooperated, she and twenty-six others would still be alive today.” – D.B. Moone

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“She knew he was on the unit, so I just supportively listened to her concerns. She told me that he had been increasingly distant from her over the past several months, despite her attempts to converse with him, When he did talk to her, she had difficulty understanding what he meant because he was so vague and refused to elaborate. He spent most of his days locked in his bedroom without any structure, occupational productivity, or social ties. Once in the past year, he had slapped her across the face, an action that seemed to her to be unprovoked…Shortly after this patient’s discharge, he used a knife to stab his mother to death.” - Lynn Nanos

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“On July 20, 2012, James E. Holton killed twelve people and injured seventy others at a movie theatre in Auro, Colorado, while untreated for his mental illness.” – Lynn Nanos

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“On April 16, 2007, twenty-three-year-old Seung-Hui Cho, who was untreated for what probably was schizophrenia, killed thirty-two people and injured seventeen others at Virginia Polytechnic Institute and State University in Blacksburg, Virginia.” – Lynn Nanos

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“Andrew Goldstein, who had unmedicated schizophrenia, pushed Kendra Webdale in front of a subway train, killing her on January 3, 1999.” – Lynn Nanos

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“Research shows that 59 percent of one hundred eighty-five mass shootings in the United States from the years 1900 to 2017 were committed by either mentally ill people or those who showed signs of serious mental illness.” – Lynn Nanos

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“The National Institue of Mental Health estimates that in any one-year period, 40 percent of schizophrenic adults have not undergone treatment.” – Lynn Nanos

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“As of September 2016, researchers estimated that ten times more seriously mentally ill people were in jails and state prisons than in state psychiatric hospitals in the United States. When needed mental health treatment is insufficient or missing, a patient’s judgment declines. When judgment declines, the patient is more likely to commit a crime, intentionally or unintentionally, that leads to an arrest.” – Lynn Nanos

These excerpts do not begin to cover the extensive information and data that Lynn Nanos provides in her book BREAKDOWN, but my intent with what I’ve shared is to wake up the general populace to why innocent children and adults continue to be slaughtered by those who are seriously mentally ill, unmedicated, and we lack the legislative laws to untie the professionals hands to do anything about the loss of life at the hands of the mentally ill.

I implore those who read this review to share it, whether you reblog this post, tweet it, or share to Facebook. But what I would ask more is for you to purchase and read BREAKDOWN by Lynn Nanos, L.I.C.S.W., and then share her book with others. Advocate for mental health reform to tackle this epidemic. As a last note, Nanos speaks to so much more in her book than the few excerpts I shared to get your attention. You will be shocked at the numbers, the obstacles and the non-existent laws to keep the public and the mentally ill safe. I have never given a book my STRONGEST recommendation until now.

I went on the Treatment Advocacy Center’s website last night and was shocked by what I read there, along with the numbers provided regarding those with mental illness and the consequences of non-treatment. You read about some of the consequences in the excerpts from BREAKDOWN by Lynn Nanos, L.I.C.S.W. Read the book and then visit the Treatment Advocacy Center’s website. And then do something to help allay this epidemic.

Thank you, Lynn, for being persistent with me to read and review this long overdue and valuable book. My hope is between your book, your research, people affected by mental illness, whether parents, siblings, friends, those who read your book and get involved, et cetera., is that this will become the beginning to an ending.

To read my complete review ofBREAKDOWN, visit my blog https://dbmoone.com/2019/02/25/book-r...

[Karen Prive · Rating 3 out of 5]

Strong argument for improving care for serious mental illness

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.

[Sharon Engdahl · Rating 5 out of 5]

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

[Kathleen Garber · Rating 4 out of 5]

This book is about the breakdown of the mental health system, specifically in the United States and even more specifically in Massachusetts. Even though I’m in Canada and our health system is quite different, I was curious to see what Lynn had to say.

She explains how the treatment of the mentally ill has changed from the 1800s through to now, specifically about the deinstitutionalization era which was meant to not have so many people fully institutionalized (a good idea) but ended up kicking out many seriously ill people who might need inpatient treatment. (bad outcome.)

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.
A statement from page 129 shocked me at first but then when the author goes on to explain and give examples, I realized it was true:

“Mental Health Professionals discriminate against mentally ill people.”

It’s hard to accept that this might be the case. But I’m sure that the US isn’t the only place where this happens. Basically inpatient hospitals are saying they are full when really they don’t want the violent or difficult patients or ones who might need to stay long because a high turnover gives them more money. They also don’t want to take the patients who don’t realize their ill because they are difficult to convince to take treatment. The book explains this better.

I would really like a Canadian author to write a book on similar issues in Canada. I’m curious how much of it is the same. I know the insurance issues aren’t the same because of our universal health care but I know for a fact it’s still very hard to find an inpatient bed here and the system needs work. I know from personal experience and CMHA agrees with me.

Definitely worth a read if you are interested in how the mental health system in the US is failing, you are mentally ill in Massachusetts, your loved one suffers from psychosis or you work in the mental health profession.

I received a copy of this book in exchange for a review.

[Anthony · Rating 5 out of 5]

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!

[J. Peters · Rating 4 out of 5]

Lynn Nanos’s book Breakdown paints a bleak picture of the mental health system. Specifically, the book is based on her work in the state of Massachusetts as an emergency psychiatric social worker or clinician working with ‘patients’ (Nanos, Breakdown) with extreme psychiatric diagnoses i.e. psychosis or schizophrenia.

In the book’s introduction, Lynn states as clear as day, the population she has worked with the most during her tenure as an emergency clinician are also, in fact, the most problematic. Lynn makes an argument for changing the mental health system in her state. In doing so, Lynn identities long standing issues of access to treatment and the lack of parity between medical and psychiatric care.

The book makes these flawed aspects of the system visible to the reader when it comes to how insurance companies operate in the US, along with other issues of hierarchy within the medical profession and its impact on patient care and the shortage of psychiatrists in the country.

This book is dedicated to patients who have lost capacity. Lynn does not conceal her interest in working with the most impaired patients. The book features cases with patients experiencing severe psychosis, complex fixed delusional systems, aggressive behaviours, and other complex symptoms impacting her patients lives necessitating their need for inpatient care because they have lost capacity and are at risk of serious imminent harm to themselves or others. While Nanos has no one speciality or specialisation as an emergency clinician, as her training and job responsibilities require her to have a broad skill set and compels her to work with diagnoses across the spectrum.

However, disorders like anxiety, depression, and other diagnoses with less complex symptoms are left absent from this book. Nanos indicates many people, in her experience, with these diagnoses are ‘higher functioning’ or at least, have a greater potential to be better advocates for themselves and be more adherent to their treatment.

Research on the correlation between diagnosis and adherence continues to be limited and making such a claim may be problematic, as many patients whom retain full capacity may also be poor advocates.

Nanos suggests her view of the system is narrow given her experiences as an emergency clinician working with the most extreme and troublesome cases across multiple systems intersecting the provision of mental health treatment. The book purpose and intent is to raise awareness to the defects inhibiting patients receiving adequate care, specifically in-patient treatment through conversion of their rights to involuntary status.

Lynn makes it quite clear, these are the patients that have lost all capacity and require involuntary in-patient treatment. The goal, Nanos states, is to empower legislature to make the necessary changes across systems, and to provide ‘comfort and validation’ to family and friends of severally mentally ill patients.

Mental health treatment, social work, psychology and the allied fields are rich with acronyms. This book references many of them, several specific to the state of Massachusetts. However, any clinician will be able to decipher the more specific references to programs and liken them to larger levels of care. In this sense, the case vignettes are accessible, well written, dramatic, vivid, and at times, extremely disturbing for those who do not work with complex traumas and forensic cases.

Each vignette raises profound realities of the limits of the system in Massachusetts and states with similar laws surrounding mental health treatment, and the conversion of the rights of patients from voluntary to involuntary status to ensure their safety, and the welfare of others in the community.

In no uncertain terms, the book takes a hard line stance on the need for what so many refer to as forced treatment. Lynn does not negotiate a few complexities which are left conspicuously absent from the the text. Nanos indicates such cases – substance abuse or illicit drug use as well as the children’s mental health system are not included in the case examples. Given the diagnostic problems generally associated with working with drug abusers, concurring disorders, and working with children, vignettes including these cases are not included in the book.

Given the high number of dual diagnoses, MICA (Mentally Ill and Chemically Addicted) or co-occurring disorders among patients suffering from severe psychosis, this book offers little diagnostic advice and direction to clinicians seeking information on how to treat or even manage these disorders on a systems or clinical level. The book also doesn’t evaluate the etiology of her patients disorders, which is less problematic, given this isn’t a clinical priority in the provision of care and/or treatment of people with severe psychosis with an emergent need for clinical intervention.

Ultimately, Breakdown achieves what it sets out to accomplish in the book. Lynn Nanos cites case examples of systematic failures in which patients were clearly a danger to themselves or others and their safety was in jeopardy if they were not provided emergency in-patient treatment, albeit involuntary.

At the root of it, these case examples, while vivid, and telling of the extreme dysfunction in the system, are extremely black and white, with little grey area for clinical interpretation in terms of direction in the provision of patient care and treatment. When it comes to the superabundance of liminal psychosocial contexts related with this population, these cases offer little insight into their treatment or new avenues in how to proceed with negotiating the system for their rights and care.

[Kitt O'Malley · Rating 5 out of 5]

Lynn Nanos used her experiences working as a clinical social worker in the emergency mental health care system to write this much-needed wake up call. After dumping our most vulnerable seriously mentally ill patients out of state hospitals and onto the streets, we failed to treat them adequately in the community. Instead, we have a revolving emergency crisis-oriented system that does not provide stability or continuity of care. We must change our mental health care and health care systems NOW. I live with a serious mental illness, but have the insight and resources needed to obtain and maintain treatment. Not everyone like me does.

[Janet · Rating 5 out of 5]

Breakdown is an important book on a serious topic – the treatment of the seriously mentally ill and involuntary commitment. Nanos writes from the perspective of someone who has been involved in using "Section 12" with schizophrenic and psychotic patients. Her work is both personal and thoroughly researched and provides a thoughtful approach to a difficult and controversial topic.

[Susan · Rating 5 out of 5]

Lynn's professional insight to the revolving door of hospitals, jail, homelessness, and mental illness is spot on. Well researched and with the perspective of an insider, this book discusses the broken system and offers a solution. Read this book and advocate for AOTs (Assisted Outpatient Treatment) in your state.

[Cindy · Rating 5 out of 5]

The truth about our broken mental health system in our country. The author’s experience is so similar to the experiences that I hear about over and over when communicating with loved ones of a mentally ill person. The book is well written and her examples are great.

[Fred Fanning · Rating 5 out of 5]

I really enjoyed this book. The writer really shows how the system of Emergency Psychiatry is really broken. The book is well-written and full of evidence of how the system is broken. Anyone with an interest in Emergency Psychiatry really must read this book.

[gj indieBRAG · Rating 5 out of 5]

We are proud to announce that BREAKDOWN: A clinician's Experience in a Broken System of Emergency Psychiatry by Lynn Nanos is a B.R.A.G.Medallion Honoree. This tells readers that this book is well worth their time and money!

[David Geiger · Rating 5 out of 5]

I have experience in the field of mental illness, having it myself, and I find Ms. Nanos' book spot on. I find her book complementary to my own In the Matter of Edwin Potter: Mental Illness and Criminal Justice Reform. Presently she and I have a running conversation on email.

[Dovilė Dirsaitė · Rating 4 out of 5]

Great educating book if you ever wonder why mentally ill people remain untreated and eventually end up on the streets or prisoned. Can they even access proper treatment nowadays? This book reveals flaws of the broken system and encourages to start thinking about solutions.

[David Allen · Rating 5 out of 5]

see my review at: http://davidmallenmd.blogspot.com/201...