It is so demoralizing to read how bad it really is. This is inhumane and itself conducive to ill mental and somatic health--it couldn't be more obvious.
Perhaps we should remember what the best sanitariums were or tried to be. Grand architecture (and the architecture matters, not just the art inside. The brutalist style of these facilities is bad for the mind and soul.), lush grounds, gardens, including those patients could work a small allotment on, libraries, etc.
I, too, have worked in some pretty run down psychiatric units. None of this will change unless incentive structures change. That won’t change unless we reframe (or at least augment) our biologically reductionistic model of psychiatric care. Hospital admin, psych leadership, and payors need an understanding of the human that needs fresh air, art, and good food. It’s not such an easy technical fix without that understanding.
Arguing with insurance companies about whether a patient needed to be admitted to the hospital was one of the worst parts of my job as an inpatient psychiatrist. Insofar as the insurance company acted in good faith at all (which I suspect they often didn’t), it was predicated on the belief that we could somehow rapidly modify neurobiology with medication. Even for psychotic or manic patients, though, the milieu, in the ways you describe, mattered as much or more, particularly for those who were recurrently admitted.
This goes to show what good intentions can lead to. Both closing psychiatric units as well as HIPPA started with good intentions. I don't think most of the public understands why there are so many homeless folks living on the streets (because they need psychiatric care!) When I worked in schools as a psychologist and did frequent suicide assessments, I would refer kids at high risk with trepidation, knowing they'd be out within a few days or less, and not get the help they needed unless parent(s) had really good insurance. A couple thoughts on improving the environment, for what they're worth if doable, would be adding plants, mini-waterfalls (like what you find on Amazon) because the sound is so soothing, and if possible, having a Therapy Dog there (link #1 below). Caring for other living things such as plants and animals seems therapeutic for lots of folks. Visiting the children's ward for those who can? As for exercise equipment, maybe seeing if a gym is willing to donate their old stuff when they buy new stuff, and/or forming partnerships with pro sports teams to get their old equipment. For example, the NFL is very involved in helping out in their communities. (link #2). I hope you can find others you work with willing to get creative with you to at least implement a few of your great suggestions, and thanks for all you do!
I worked in one unit that had a wonderful therapy dog, everyone loved her of course. And I agree about the importance of caring for others. One of the best things people can do when feeling down is caring for someone or something else.
My son, who had not been able to manage in a traditional university, went to work at a special needs school where many of the students were extremely challenging. He found the work difficult but very fulfilling, and I think it improved both his overall mental health and his commitment to furthering his own education (he wants to become a psychologist).
Such a great read. Makes me glad I’m retired but there are times I miss when I felt like my work made a difference in a large hospital setting. Like you, I have always felt that HIPAA was a horrible idea - one that has enables “frequent flyer” addicts quite terribly. I was never one to mince my opinions and words and we had a pretty fly program before treating addiction - especially opiate addiction - became profitable. Now it’s pill mill treatment not unlike pain treatment back in the 90’s with ORT and virtually no therapeutic help for people. Can’t change if one doesn’t change. Regardless, your job is exhausting and almost thankless at times; I applaud you for your work and appreciate your wish list - it a good and important one.
Thank you so much for this important article. I hope we can get these thoughts in front of the people who can make change for all of the reasons that you've expressed so well.
If one looks at the work that Van Gogh created while in the asylum, comparing his depictions of what he saw inside the walls to what he saw when he went out into the garden, that should be enough to support your thoughts on allowing for more outside time!!! A Corridor in the Asylum compared to Starry Night for example.
I obviously have an interest in the arts as they relate to mental health so the design part also very much interests me. There's a project called Hospital Rooms that brings art into inpatient care. From their "about us" ... "Artist Tim A Shaw and curator Niamh White founded Hospital Rooms after a close friend was sectioned and admitted to a mental health hospital. On visiting her, they were shocked to find that the hospital environment was cold and clinical at a time when she was so vulnerable. Having worked in the arts for 10 years each, they felt they had the skills and community to be able to transform these spaces with high quality artworks." https://hospital-rooms.com/about-us
Horrifying to read. My sister is in the field of special needs children, and she once commented to me that the loss of long term care facilities for children with moderate levels of issues has only made things worse, for similar reasons
I'm a parent of a young adult with bipolar disorder and learning issues. He has never been admitted but has had a couple of close calls. In both cases, I asked him whether he wanted to go to the hospital and he said yes. The first time he stayed overnight in the pediatric ER but was referred to IOP and the other time he calmed himself down enough that we felt OK bringing him home. We live in an affluent suburb with a superb regional medical center. It does not, however, have a psych unit, and patients who are admitted are referred or transferred to a satellite hospital that does have an acute psych unit. Both his doc and his therapist had counseled us to take him to the ER in a crisis but try to avoid having him admitted. Why? Apparently, the psych unit affiliated with our hospital has pretty much every deficiency you write about. Interestingly, during his more recent crisis, when I was pleading for them to take him on the peds side again (he really had aged out) they told me - in almost a whisper - that they had this new 4-bed short-term unit in the ER where they could observe him for a day or so, so we didn't have to worry about sending him to the adult psych unit at the other hospital. He didn't wind up staying there, but you can't imagine how reassuring it was to hear that such a unit was available.
Anecdote from my college days. As a psych major I volunteered at the state psychiatric hospital that was near my campus. I was on a long term ward with about 8 patients. There was both a standard day room (brightly lit, with TV, board games, patient expression encouraged) and a quiet room (much less stimulation). Part of my job was simply to interact with patients in the main day room, and help patients to the quiet room if they asked for it. But another part of my job was to take higher functioning patients for walks on the hospital grounds. This was a fairly large and highly secure facility, and we students were told not to worry about escape attempts, because that would cause the patient to lose outdoor privileges. In fact, the patients were grateful for every outdoor opportunity, even in the worst weather, and usually seemed more engaged and cooperative right before and after every time we took them out. One of the first times I had a patient out there was a nasty storm but the look of delight on the patient's face was priceless.
Thank you so much for this thoughtful essay. Having been in a few hospitals myself, I agree with most of this. Especially easier communication and shared medical records. This is critical. If they had had these in place in a hospital I was in during my worst crisis, I would have been out in a week, reasonably sane on the right med. Instead, I became homeless and divorced and had several years of misery.
I would add that, while I realize that this is difficult to implement, doctors should not dismiss so much of what the patient says--even someone who is psychotic. Some of it would actually be helpful to consider and may make the difference between saving someone's life and having a disastrous and ineffective outcome. I know you mentioned that mistakes happen, and I know that being overworked and stressed out has much to do with it, but it is so crucial. While in that hospital, I told the doctor which medication had worked for me in the past, but he wasn't really listening and just increased the dosage of the medication I was on when I came in. It didn't work. The second time I found myself in that hospital they didn't even give me any medication. I was discharged with no care in place or medications to take. They did give me change for the bus.
We desperately need help solving these kinds of problems. Thanks for your efforts.
Excellent article with good suggestions. Thank you for writing it. Psychiatry is a poorly understood discipline. I didn’t fully grasp it until I cared for patients with medical and psychiatric conditions.
It is very hard for me to read what you've written, though I appreciate your insider perspective, and I think I will go back and read it again, because of the reaction I had to it..... some of these places are like living nightmares.
I got to see the inside of one of these units (inside of a large hospital) several years ago when someone dear to me (an older man) was put there with the wrong diagnosis. He had had a stroke, you see, and that was not diagnosed. Instead, his resulting difficulty in speaking and some of his other issues went entirely untreated and he was put in the psych ward and given very high doses of psychiatric medicines which made him worse, while not treating the real and underlying problem. So tragic.
The psychiatrists in the ward even said that they had never seen a senior citizen patient present with a sudden-onset psychosis like that, with no prior psychiatric history. (maybe because it was something more like a hospital-induced psychosis?). So they just cranked up his dosage and added even more meds. It felt to me like they really didn't know what they were doing to try to help him, and just making shit up.
He was frightened to death to be in there. He told me about the terrifying experience of the naked, body-cavity search he had to undergo on his first entrance to the unit, and how violated he felt. (he should have been a stroke patient receiving rehab therapy -- not an inmate of a psych ward).
He was released after 3 weeks as an inpatient and slowly recovered from the effects of the high doses of meds once he was weaned off, which took awhile.
To this day, I am traumatized by what happened to him, and I still have no idea how he could have been misdiagnosed like that. It wasn't until a year later that he had another stroke and this time, in a different hospital with different ER doctors -- they properly diagnosed him and said "this is not his first stroke, obviously." This time he was sent to stroke rehab where he got the help he needed.
So when I visited him on the psych ward, I saw what you mean. Rooms with no windows. Food was worse than you could ever describe -- I took a bite that he offered to share, and I was afraid to swallow, quite honestly. The common area had nothing pleasant about it, with worn-out furniture and a few, dog-eared decorating magazines and a TV, and that was about it.
This was the stuff of nightmares, and I can't fathom how anyone could possibly get better if they were there as an inpatient.
Misdiagnoses like that are terrible. One benefit of the redundancy that I often complain about is that it can sometimes catch things we miss the first time.
by then, the harm is done though... you lost your rights, dignity, job maybe, pets, housing, etc... plus you get billed thousands of dollars. There is a lot of iatrogenic harm to forced hospitalization.
Are you familiar with a for-profit company called UHS( United hospital systems) . A national company that has more than 100 stand small alone psychiatric hospitals throughout the country? Each facility is given a unique and unrelated name so it takes a bit of research to discover that there is one parent company. Most are ECT mills offering lucrative ect for both inpatient and outpatient referrals.Ect is performed in “ academic teaching hospitals as well. There is no reporting about ect procedures, no standards of lead placement or strength of the current applied to the delicate human brain repeatedly to induce grand mal seizures. Neurologists aggressively treat such seizures to prevent the brain damage that repeated seizures cause. The Board of Neurology and Psychiatry can’t have it both ways... safe and dangerous. When are you seemingly concerned psychiatrist going to ban ECT until or unless well designed RCTs are done with follow up well beyond 6 months, which is the maximum follow up time in the few poorly designed RCTs from the 1970s that are the only ones out there.ECT needs to go the way of the lobotomy as it’s equally unscientifically based. It has never been shown to be safe or effective It’s never been through FDA approval but was grandfathered it many decades ago. It is however a profit maker for psychiatrists, anesthesiologists and facilities that offer it . Psychiatric patients are uniformly told “ ect doesn’t do that it’s your underlying diagnosis” when they try to report severe permanent retrograde amnesia , loss of the ability to experience human emotions ( except for a dull anger) . ECT is being used on younger and younger teens for a growing list of “ diagnoses”. This is a national disgrace .The inpatient psychiatrists have no further follow up once the ectd patient is discharged. If there is no follow up what right does the psych community have to say there are no long term sequelae ? There are many parallels to the corruption and lies we have seen in the covid debacle.
The country is in a mental health crisis , it’s all over the news and yet there really is no care available for the vast majority of people. What is available is often ugly, barbaric , and unproven. Big corporate interests rule and their only care is bigger and bigger profits. ( not decorating units for psychiatric patients on locked units)
I have seen depressive and bipolar people state that, although they were initially frightened of ECT, it probably saved their lives. (Andrew Solomon, author of "The Noonday Demon", for one).
you know, we could push associate-physicians/nurse-physicians to be best known in psychiatry first: especially if re-training from somewhere like ClinPsych or social work.
yes, this does eat more of the overall physician specialist coin, overall, & does risk psychiatrists being hired more as managers & removing them from pts a little bit: but when thr are staffing shortages and you can hire 5 associates for teh cost of every psychiatrist (& not have to always be waiting on someone, or finding someone to write a script, or d/c): this seems the actual answer to a lot of medical problems on the staffing front.
the entry to these grad programs is having already worked 7yrs in a clinical assisting capacity of some variety, plus an undergraduate in a medical/science discipline, THEN you do a practice masters in prescribing w a focus on a specialty (usually whr the candidate already works.) plus the hundreds of hrs of MoC (tho no1 needs that. but still: thr it is. actually, maybe for PAs MoC actually makes more sense than usual, given the qualia of the role change? anyway. ) & re-certification exams every 10yrs.
People seem to not know, & vastly underestimate, the level of both experience and formal training required for associates. & if these are the conditions: perhaps certain roles currently in charge are being over paid. again, gr8 piece. _JC
It is so demoralizing to read how bad it really is. This is inhumane and itself conducive to ill mental and somatic health--it couldn't be more obvious.
Perhaps we should remember what the best sanitariums were or tried to be. Grand architecture (and the architecture matters, not just the art inside. The brutalist style of these facilities is bad for the mind and soul.), lush grounds, gardens, including those patients could work a small allotment on, libraries, etc.
I, too, have worked in some pretty run down psychiatric units. None of this will change unless incentive structures change. That won’t change unless we reframe (or at least augment) our biologically reductionistic model of psychiatric care. Hospital admin, psych leadership, and payors need an understanding of the human that needs fresh air, art, and good food. It’s not such an easy technical fix without that understanding.
Arguing with insurance companies about whether a patient needed to be admitted to the hospital was one of the worst parts of my job as an inpatient psychiatrist. Insofar as the insurance company acted in good faith at all (which I suspect they often didn’t), it was predicated on the belief that we could somehow rapidly modify neurobiology with medication. Even for psychotic or manic patients, though, the milieu, in the ways you describe, mattered as much or more, particularly for those who were recurrently admitted.
This goes to show what good intentions can lead to. Both closing psychiatric units as well as HIPPA started with good intentions. I don't think most of the public understands why there are so many homeless folks living on the streets (because they need psychiatric care!) When I worked in schools as a psychologist and did frequent suicide assessments, I would refer kids at high risk with trepidation, knowing they'd be out within a few days or less, and not get the help they needed unless parent(s) had really good insurance. A couple thoughts on improving the environment, for what they're worth if doable, would be adding plants, mini-waterfalls (like what you find on Amazon) because the sound is so soothing, and if possible, having a Therapy Dog there (link #1 below). Caring for other living things such as plants and animals seems therapeutic for lots of folks. Visiting the children's ward for those who can? As for exercise equipment, maybe seeing if a gym is willing to donate their old stuff when they buy new stuff, and/or forming partnerships with pro sports teams to get their old equipment. For example, the NFL is very involved in helping out in their communities. (link #2). I hope you can find others you work with willing to get creative with you to at least implement a few of your great suggestions, and thanks for all you do!
https://www.therapydogs.com/therapy-dogs-at-hospitals/#:~:text=How Therapy Dogs Are Used,their handlers at the hospital.
https://www.nfl.com/community/
I worked in one unit that had a wonderful therapy dog, everyone loved her of course. And I agree about the importance of caring for others. One of the best things people can do when feeling down is caring for someone or something else.
My son, who had not been able to manage in a traditional university, went to work at a special needs school where many of the students were extremely challenging. He found the work difficult but very fulfilling, and I think it improved both his overall mental health and his commitment to furthering his own education (he wants to become a psychologist).
Such a great read. Makes me glad I’m retired but there are times I miss when I felt like my work made a difference in a large hospital setting. Like you, I have always felt that HIPAA was a horrible idea - one that has enables “frequent flyer” addicts quite terribly. I was never one to mince my opinions and words and we had a pretty fly program before treating addiction - especially opiate addiction - became profitable. Now it’s pill mill treatment not unlike pain treatment back in the 90’s with ORT and virtually no therapeutic help for people. Can’t change if one doesn’t change. Regardless, your job is exhausting and almost thankless at times; I applaud you for your work and appreciate your wish list - it a good and important one.
Thank you so much for this important article. I hope we can get these thoughts in front of the people who can make change for all of the reasons that you've expressed so well.
If one looks at the work that Van Gogh created while in the asylum, comparing his depictions of what he saw inside the walls to what he saw when he went out into the garden, that should be enough to support your thoughts on allowing for more outside time!!! A Corridor in the Asylum compared to Starry Night for example.
I obviously have an interest in the arts as they relate to mental health so the design part also very much interests me. There's a project called Hospital Rooms that brings art into inpatient care. From their "about us" ... "Artist Tim A Shaw and curator Niamh White founded Hospital Rooms after a close friend was sectioned and admitted to a mental health hospital. On visiting her, they were shocked to find that the hospital environment was cold and clinical at a time when she was so vulnerable. Having worked in the arts for 10 years each, they felt they had the skills and community to be able to transform these spaces with high quality artworks." https://hospital-rooms.com/about-us
Horrifying to read. My sister is in the field of special needs children, and she once commented to me that the loss of long term care facilities for children with moderate levels of issues has only made things worse, for similar reasons
I'm a parent of a young adult with bipolar disorder and learning issues. He has never been admitted but has had a couple of close calls. In both cases, I asked him whether he wanted to go to the hospital and he said yes. The first time he stayed overnight in the pediatric ER but was referred to IOP and the other time he calmed himself down enough that we felt OK bringing him home. We live in an affluent suburb with a superb regional medical center. It does not, however, have a psych unit, and patients who are admitted are referred or transferred to a satellite hospital that does have an acute psych unit. Both his doc and his therapist had counseled us to take him to the ER in a crisis but try to avoid having him admitted. Why? Apparently, the psych unit affiliated with our hospital has pretty much every deficiency you write about. Interestingly, during his more recent crisis, when I was pleading for them to take him on the peds side again (he really had aged out) they told me - in almost a whisper - that they had this new 4-bed short-term unit in the ER where they could observe him for a day or so, so we didn't have to worry about sending him to the adult psych unit at the other hospital. He didn't wind up staying there, but you can't imagine how reassuring it was to hear that such a unit was available.
Anecdote from my college days. As a psych major I volunteered at the state psychiatric hospital that was near my campus. I was on a long term ward with about 8 patients. There was both a standard day room (brightly lit, with TV, board games, patient expression encouraged) and a quiet room (much less stimulation). Part of my job was simply to interact with patients in the main day room, and help patients to the quiet room if they asked for it. But another part of my job was to take higher functioning patients for walks on the hospital grounds. This was a fairly large and highly secure facility, and we students were told not to worry about escape attempts, because that would cause the patient to lose outdoor privileges. In fact, the patients were grateful for every outdoor opportunity, even in the worst weather, and usually seemed more engaged and cooperative right before and after every time we took them out. One of the first times I had a patient out there was a nasty storm but the look of delight on the patient's face was priceless.
Good list for looking at residency programs, sadly even brand new 20 mil + facilities ive seen don't have many of these
I enjoyed reading this with my wife during some down time on our honeymoon. Entertaining and informative as always. Thanks!
100%!!!
SAINT...
Thank you so much for this thoughtful essay. Having been in a few hospitals myself, I agree with most of this. Especially easier communication and shared medical records. This is critical. If they had had these in place in a hospital I was in during my worst crisis, I would have been out in a week, reasonably sane on the right med. Instead, I became homeless and divorced and had several years of misery.
I would add that, while I realize that this is difficult to implement, doctors should not dismiss so much of what the patient says--even someone who is psychotic. Some of it would actually be helpful to consider and may make the difference between saving someone's life and having a disastrous and ineffective outcome. I know you mentioned that mistakes happen, and I know that being overworked and stressed out has much to do with it, but it is so crucial. While in that hospital, I told the doctor which medication had worked for me in the past, but he wasn't really listening and just increased the dosage of the medication I was on when I came in. It didn't work. The second time I found myself in that hospital they didn't even give me any medication. I was discharged with no care in place or medications to take. They did give me change for the bus.
We desperately need help solving these kinds of problems. Thanks for your efforts.
Excellent article with good suggestions. Thank you for writing it. Psychiatry is a poorly understood discipline. I didn’t fully grasp it until I cared for patients with medical and psychiatric conditions.
It is very hard for me to read what you've written, though I appreciate your insider perspective, and I think I will go back and read it again, because of the reaction I had to it..... some of these places are like living nightmares.
I got to see the inside of one of these units (inside of a large hospital) several years ago when someone dear to me (an older man) was put there with the wrong diagnosis. He had had a stroke, you see, and that was not diagnosed. Instead, his resulting difficulty in speaking and some of his other issues went entirely untreated and he was put in the psych ward and given very high doses of psychiatric medicines which made him worse, while not treating the real and underlying problem. So tragic.
The psychiatrists in the ward even said that they had never seen a senior citizen patient present with a sudden-onset psychosis like that, with no prior psychiatric history. (maybe because it was something more like a hospital-induced psychosis?). So they just cranked up his dosage and added even more meds. It felt to me like they really didn't know what they were doing to try to help him, and just making shit up.
He was frightened to death to be in there. He told me about the terrifying experience of the naked, body-cavity search he had to undergo on his first entrance to the unit, and how violated he felt. (he should have been a stroke patient receiving rehab therapy -- not an inmate of a psych ward).
He was released after 3 weeks as an inpatient and slowly recovered from the effects of the high doses of meds once he was weaned off, which took awhile.
To this day, I am traumatized by what happened to him, and I still have no idea how he could have been misdiagnosed like that. It wasn't until a year later that he had another stroke and this time, in a different hospital with different ER doctors -- they properly diagnosed him and said "this is not his first stroke, obviously." This time he was sent to stroke rehab where he got the help he needed.
So when I visited him on the psych ward, I saw what you mean. Rooms with no windows. Food was worse than you could ever describe -- I took a bite that he offered to share, and I was afraid to swallow, quite honestly. The common area had nothing pleasant about it, with worn-out furniture and a few, dog-eared decorating magazines and a TV, and that was about it.
This was the stuff of nightmares, and I can't fathom how anyone could possibly get better if they were there as an inpatient.
Misdiagnoses like that are terrible. One benefit of the redundancy that I often complain about is that it can sometimes catch things we miss the first time.
by then, the harm is done though... you lost your rights, dignity, job maybe, pets, housing, etc... plus you get billed thousands of dollars. There is a lot of iatrogenic harm to forced hospitalization.
The strip search happened to me to. If you try to refuse they will rip your clothes off and drug you
In this case, thank goodness for short stays!
Are you familiar with a for-profit company called UHS( United hospital systems) . A national company that has more than 100 stand small alone psychiatric hospitals throughout the country? Each facility is given a unique and unrelated name so it takes a bit of research to discover that there is one parent company. Most are ECT mills offering lucrative ect for both inpatient and outpatient referrals.Ect is performed in “ academic teaching hospitals as well. There is no reporting about ect procedures, no standards of lead placement or strength of the current applied to the delicate human brain repeatedly to induce grand mal seizures. Neurologists aggressively treat such seizures to prevent the brain damage that repeated seizures cause. The Board of Neurology and Psychiatry can’t have it both ways... safe and dangerous. When are you seemingly concerned psychiatrist going to ban ECT until or unless well designed RCTs are done with follow up well beyond 6 months, which is the maximum follow up time in the few poorly designed RCTs from the 1970s that are the only ones out there.ECT needs to go the way of the lobotomy as it’s equally unscientifically based. It has never been shown to be safe or effective It’s never been through FDA approval but was grandfathered it many decades ago. It is however a profit maker for psychiatrists, anesthesiologists and facilities that offer it . Psychiatric patients are uniformly told “ ect doesn’t do that it’s your underlying diagnosis” when they try to report severe permanent retrograde amnesia , loss of the ability to experience human emotions ( except for a dull anger) . ECT is being used on younger and younger teens for a growing list of “ diagnoses”. This is a national disgrace .The inpatient psychiatrists have no further follow up once the ectd patient is discharged. If there is no follow up what right does the psych community have to say there are no long term sequelae ? There are many parallels to the corruption and lies we have seen in the covid debacle.
The country is in a mental health crisis , it’s all over the news and yet there really is no care available for the vast majority of people. What is available is often ugly, barbaric , and unproven. Big corporate interests rule and their only care is bigger and bigger profits. ( not decorating units for psychiatric patients on locked units)
I have seen depressive and bipolar people state that, although they were initially frightened of ECT, it probably saved their lives. (Andrew Solomon, author of "The Noonday Demon", for one).
I’ve lost count of how many patients have told me ECT saved their lives.
you know, we could push associate-physicians/nurse-physicians to be best known in psychiatry first: especially if re-training from somewhere like ClinPsych or social work.
yes, this does eat more of the overall physician specialist coin, overall, & does risk psychiatrists being hired more as managers & removing them from pts a little bit: but when thr are staffing shortages and you can hire 5 associates for teh cost of every psychiatrist (& not have to always be waiting on someone, or finding someone to write a script, or d/c): this seems the actual answer to a lot of medical problems on the staffing front.
the entry to these grad programs is having already worked 7yrs in a clinical assisting capacity of some variety, plus an undergraduate in a medical/science discipline, THEN you do a practice masters in prescribing w a focus on a specialty (usually whr the candidate already works.) plus the hundreds of hrs of MoC (tho no1 needs that. but still: thr it is. actually, maybe for PAs MoC actually makes more sense than usual, given the qualia of the role change? anyway. ) & re-certification exams every 10yrs.
People seem to not know, & vastly underestimate, the level of both experience and formal training required for associates. & if these are the conditions: perhaps certain roles currently in charge are being over paid. again, gr8 piece. _JC