For one thing, I think the patients need to be empowered.  The truth is that no one except the sufferer can really tell how the condition and the medications for it, make them FEEL.  There are no diagnostic tests for that.  So the doctor really has to rely on communication skills to determine how to best find out what is working or not.  And our modern mds have given up the timehonored practices of diagnosis through interpersonal communication for machines - so most of them are at a loss as to how to really treat.  So they fall back on dispensing literature, and so on, and often have a one-size-fits-all method.  This is obviously wrong. 

In a brief stay in a mental facility, I saw more than one patient who seemed overmedicated to me - but the patient didn't know what the drugs were supposed to be doing, and just accepted the probably wrong dosage.  When I complained about the effects of my meds (I am bp2 and was being overtreated for mania which is non-existant!) I was considered to be an "uncooperative patient"!

The other aspect frequently neglected, is the wholistic approach to the disorder - how diet and other aspects of a healthy lifestyle can affect mood swing - how some supplements help.  This is left to the patient for DYI treatment! Luckily the internet is full of helpful information, but how many patients are really in the position to treat themselves in this respect?  I have often felt that I was doing dyi medicine, for want of other professional input.

I also see doctors neglecting basic parts of the diagnostic process - like taking thorough family histories to determine as best as possible, the genetic component of the disorder - and explaining what symptoms equate with what diagnoses.  I rejected being bipolar,  because I was never manic enuf to buy S. America - but later discovered that my racing thoughts and irritability was another sign of my form of disorder!

My doctor now is excellent - but even there, ideally it would take much more input from him to provide care as is described by the book.  I supplement with therapy, my own research, and some homeopathy, vitamins and so on.  As for my stay in the mental health facility?  I describe it as a rest cure with lots of drugs.  I don't think I will do that again soon.

Mental health care is in a woeful state in the U.S. - either sloppy or often non-existent.  The ones who most need treatment and medications are often the ones who are left homeless, muttering to themselves on a street corner.  This is scandalous! In California, a large mental health facility was turned into a college, and all the patients shuttled off to a dismal facility in industrial L.A. - It really is a hideous Social Darwinism that is being practiced, just as at the same time, the elite of the profession is making such strides!  On one level, never has there been so much hope for those with mental (now really neurological) disorders!  And yet, the state of general mental health and facilities is abysmal! 

We now know that that brain is malleable and not a static thing.  It can be affected for good or ill over time.  We also know that our prisons are really defacto mental hospitals - and that any monies spent on the youth would more than be worth it in the savings of future prison construction!  So why are we so loath to put our shoulders to the wheel and really DO something about these pressing problems?  I am the lay person and patient and am asking you.