What happens when someone in the grip of a psychotic break commits a crime? In this episode of DoctoRx Unscripted, host Dr. Tania Small sits down with renowned forensic psychiatrist Dr. Ilan Melnick to confront that dilemma head-on.
What happens when someone in the grip of a psychotic break commits a crime?
Do we brand them a criminal forever—or recognize a human being still worthy of evidence-based care, rehabilitation, and a true second chance?
In this episode of DoctoRx Unscripted, host Dr. Tania Small sits down with renowned forensic psychiatrist Dr. Ilan Melnick to confront that dilemma head-on.
Dr. Melnick directs a dignity-first program that blends comprehensive psychiatric treatment, cognitive-restoration therapy, trauma-informed support, and structured community re-entry. The outcomes are extraordinary: 0 percent recidivism and 90 percent sustained reintegration—results that upend long-held assumptions about severe mental illness, justice, and what true healing can look like.
Together, Drs. Small and Melnick unpack how this model works, why it succeeds, and how clinicians can begin adapting its principles today. This conversation reveals what becomes possible when we treat the person behind the psychosis—with dignity, rigorous care, and a roadmap for real-world impact.
00:00:01:13 - 00:00:28:07
Tania
Welcome to Doctors Unscripted. I'm Dr. Tania Small, and I'm here to bring you into a different kind of conversation with some of the brightest minds in medicine and research.
How do we respond when a person diagnosed with schizophrenia commits a crime during a psychotic break? Do we see a criminal or a human being worthy of treatment, dignity, and a second chance at life?
00:00:28:09 - 00:01:06:02
Tania
Our guest today, Dr. Ilan Melnick, is challenging every assumption we’ve held about severe mental illness, justice, and rehabilitation, with a 90% reintegration success rate and 0% recidivism. Today, we'll explore psychosis on trial, rehabilitation and evidence-based care, rights reclaimed, and compassion on locks. We'll step inside Passageways, the largest forensic reintegration facility in the US, a pioneering model built not on confinement but on trust, empathy, and comprehensive care.
00:01:06:04 - 00:01:29:09
Tania
And here's the remarkable part. There are no locks on the doors. That's right. No locks. Dr. Melnick will show us why these individuals don't just need care; they deserve to be seen, treated, and unlocked. Now let's get started.
00:01:29:11 - 00:01:32:14
Tania
Thank you so much for joining us here at Doctors Unscripted.
00:01:32:14 - 00:01:35:12
Dr. Melnick
Thank you so much for inviting me. I really appreciate it.
00:01:35:14 - 00:01:51:07
Tania
So I have a lot that I want to get from you.
Dr. Melnick
Talk to me.
Tania
The first question is when you were in med school…actually, let me take a step back. When did you know you wanted to be a psychiatrist?
00:01:51:09 - 00:02:17:11
Dr. Melnick
Great question. So, my path really didn't start with psychiatry. When I was in medical school, I loved working with my hands, I thought it was just really cool to be in a controlled environment, and really thought surgery. Actually went and started a residency in surgery and ophthalmology at Harvard, at Mass Eye & Ear.
00:02:17:13 - 00:02:43:22
Dr. Melnick
And, after about 2 months, realized that it was something I really hated doing. At the end, I was stuck doing refraction a lot and not something I really enjoyed. One of my mom's friends was head of Jackson Memorial Hospital Crisis, and he invited me to come and see what he did. And day one, I walk in and we’re, like, tackling people to give Haldol and Ativan to people.
00:02:43:22 - 00:03:00:18
Dr. Melnick
And I thought this was so much cooler. Really loved it. Loved every moment of it. And realized quickly that this is - this was a better fit. Quit my residency in surgery and ended up starting at the University of Miami.
00:03:00:20 - 00:03:04:19
Tania
Usually in med school, we can typically predict what people are going to be.
00:03:04:19 - 00:03:05:21
Dr. Melnick
Yes.
00:03:05:23 - 00:03:08:11
Tania
What did people assume you are going to be?
00:03:08:13 - 00:03:32:23
Dr. Melnick
Gosh. A dropout, I think, was what they were…No, in med school, I was, you know, growing up with dyslexia was always very difficult for me to kind of imagine myself doing anything that had to do with reading a lot and managing those kind of patients. So I think surgery was where people really thought I was going to do well.
00:03:32:23 - 00:04:00:00
Dr. Melnick
It is something that really that I learned early on when doing psychiatry that my ability to recognize patterns really was helpful in being able to become a better psychiatrist. Being able to recognize how people think and realizing that neurotransmitters do play a role in that, and being able to figure out what neurotransmitters were either too high or too low, and being able to manage it was something I thought was so cool.
00:04:00:02 - 00:04:14:08
Dr. Melnick
And so, although, yes, surgery was something that I really thought I loved a lot, I realized that this is really my true calling.
00:04:14:10 - 00:04:21:14
Tania
So talk about a little bit what kind of psychiatrist are you. I know you — I learned a little bit about forensic psychiatry. Can you tell us a little bit about that?
00:04:21:14 - 00:04:46:22
Dr. Melnick
Yeah, sure. So, I'm one of these — I have a lot of different types of practices. So although I do work in forensics, and forensic psychiatry is not what you see on TV. A lot of it has to do with testifying. A lot of it has to do with recognition of patients that maybe are found either incompetent to proceed or are not guilty by reason of insanity.
00:04:47:00 - 00:05:04:04
Dr. Melnick
But the other half of my practice is working with celebrities, models, and athletes in a concierge psychiatric practice. So I get the balance of working with the, you know, the very sick who don't think they're sick and the not so sick who think they're desperately ill and pretty much everywhere in between.
00:05:04:06 - 00:05:11:16
Tania
What led you there in terms of forensic psychiatry? And then, what exactly does that mean, and how does that translate to the patients that you see?
00:05:11:16 - 00:05:53:19
Dr. Melnick
So I came into forensic psychiatry kind of by accident. I was doing a lot of, a lot of testifying in court. I was, talking to different types of patients. And I realized that this was a very difficult-to-treat population, but gave me a lot of challenge. And I was asked to cover for a forensic psychiatrist at a program and I thought that was kind of cool. And, when I had the opportunity, they asked me if I would join in, and, as the chief medical officer. And at the time we only had, like, 25 patients. And then we managed to escalate it now. I've been there since 2008, and now we have about 130 patients there.
00:05:53:19 - 00:05:59:16
Tania
So take me through the process. You're in court, so a patient is found.
00:05:59:18 - 00:06:03:02
Dr. Melnick
Well, let's put it this way: A patient goes and they commit a crime.
00:06:03:06 - 00:06:04:12
Tania
Okay. Start there.
00:06:04:14 - 00:06:11:14
Dr. Melnick
So they commit a crime. At that point, either they're competent to proceed to trial or incompetent to proceed to trial.
00:06:11:20 - 00:06:12:02
Tania
Okay.
00:06:12:06 - 00:06:36:20
Dr. Melnick
If they're competent, then they go through the normal court system. If they're incompetent, they have to restore competency within a forensic psychiatric facility, where they give them classes to understand the criminal justice system. And some of those patients are restorable and where they're able to become competent, and some are considered nonrestorable, where they're not able to regain competency.
00:06:36:20 - 00:06:39:21
Tania
And how do you determine if a patient is nonrestorable?
00:06:39:22 - 00:06:49:11
Dr. Melnick
So it's usually about 5 years. So if a patient after 5 years is not able to become restorable, they kind of drop all their charges.
00:06:49:12 - 00:06:50:03
Tania
Interesting.
00:06:50:04 - 00:06:51:01
Dr. Melnick
Yeah.
00:06:51:03 - 00:07:04:02
Tania
And you said at one point, which I found fascinating, you can tell whether someone is, I guess, faking versus truly, truly not guilty due to reasons of insanity. How can you tell?
00:07:04:04 - 00:07:48:08
Dr. Melnick
Yeah, it all has to do with the patterns. Patients who are illogical are consistently illogical. So, usually when patients start changing from becoming illogical to logical within conversations, we normally think very linearly, where we think in a straight line. And what happens is that, as, you know, patients who have psychosis and they're having delusional thoughts, they may become circumstantial and sometimes even tangential. With a, you know, when you're dealing with patients and, and asking them questions, I usually will start asking things very quickly to try to get them off beat, to see whether or not the illogical becomes logical within their, their thought process.
00:07:48:09 - 00:07:49:20
Tania
Give me an example.
00:07:49:22 - 00:08:13:21
Dr. Melnick
I will say things like, you know, ask questions in rapid successions. You know, what's your name? Where are you from? You know, where did you go to high school? And then start going into more theoretical questions and start changing topics. And people who are illogical will continue in the illogical thought. People who are logical will start thinking, why is he asking me all these questions in different orders?
00:08:13:21 - 00:08:47:11
Dr. Melnick
And, and oftentimes that shows me that the patient is, you know, not able, it is not really telling the full truth of things. We also look at body reactions, body tone. If they are very comfortable in the way that they're talking, even though they're talking about some illogical things, compared to people that, let's say, are trying to come up with ideas, what you'll see is that they'll start stuttering things won't make sense. You know, things they say at the beginning differ from things that they say at the end. The story isn't fully developed.
00:08:47:12 - 00:08:56:04
Tania
Let's talk about the illogical. First, it starts illogical or not straight. And then what is your end game, is it to get them to…
00:08:56:05 - 00:09:16:22
Dr. Melnick
Basically the, the laws in the United States say that you cannot try somebody or someone who doesn't understand what they're being tried for, or whether the court system, that they understand the court system at all. Reasons why we can't, you know, people with severe mental retardation, you can't bring them to court for certain, you know, crimes that they commit.
00:09:16:23 - 00:09:37:07
Dr. Melnick
Once they were able regain competency, then all of that changes; they are able to come out with, they're able to then understand what the court system is all about, you know, why they're there, what the seriousness of their charges are, what are the consequences of the, of the charges that they had. In that way, we’re able to restore competency.
00:09:37:08 - 00:10:40:19
Dr. Melnick
So once you restore competency, then they go to trial. And either they're found guilty or they're found not guilty. Now, if they're guilty, then they go to jail, whatever it might be for whatever crime they committed. If they're considered not guilty, then you have either they're not guilty because they get let go or they're not guilty because at the time of their crime, they didn't understand what was right and wrong, they didn't understand what was happening within that, that moment because of their mental illness. So patients with schizophrenia who hear voices that say, the people on the bus are, you know, aliens, and it's my job as a citizen to kill all the aliens on the bus, and so that may happen. It didn't mean that they were killing them with the idea of, of just killing people for, you know, fun;it was really because of the delusional thought process that they were having. Once they get better in their delusional thought process, these people would probably not have killed those people on the bus.
00:10:40:21 - 00:11:07:01
Tania
So then let me ask you this question because, how do you reconcile, I guess, the ethical dilemma between knowing that this patient did not know what they were doing and really couldn't control their actions, versus to the actual crime being committed? Like, like, do you ever walk into this ethical dilemma when it comes to that? Because you're seeing families who may have lost a loved one versus a patient?
00:11:07:03 - 00:11:33:06
Dr. Melnick
So oftentimes in our forensic facility, it's usually directed at family members themselves. So it's, usually it's their parents, it could be their children, it could be, you know, spouses. The idea is, is that usually the ones that do it because of insanity, do it because not, there's no secondary gain or any, any secondary gain to, to do the crime.
00:11:33:09 - 00:11:56:18
Dr. Melnick
I'll give you an example of an arson. We have a patient that was cold one winter, and he lit a, a little can on fire, just to kind of heat himself up. And it caught a dumpster on fire, which then caught a building on fire. And it wasn't, you know, he was a person with chronic paranoid schizophrenia, and he ended up having to go to prison because of that.
00:11:56:20 - 00:12:13:06
Dr. Melnick
But, you know, when he was then found, you know, when he went out and was found not guilty by reason of insanity, he became a part of our program. And we've now been able to rehabilitate him to the point where, it's not like he was trying to hurt somebody, it was just accidental that this happened.
00:12:13:08 - 00:12:17:16
Tania
And did he understand what he had done over time?
00:12:17:17 - 00:12:35:05
Dr. Melnick
Yeah. So at the moment, he was just trying to get warm. It had no bearing on, you know, what was going on. And if it wasn't for his mental illness, not being able to cognitively come up with good ideas or, or really rationalize the consequences of what was going on, then he probably would have never done, lit the original can on fire.
00:12:37:11 - 00:12:57:10
Tania
So these patients that you, I guess, come across, is it, do you come across them once they get into the court system, or do you have patients that haven't been to court and yet they're still part of your facility?
00:12:57:12 - 00:13:16:03
Dr. Melnick
Yeah, so, to come to our facility, these people are usually found not guilty by reason of insanity. And they are then committed to a forensic psychiatric facility, usually about 3 to 4 years, while they stabilize. And after they stabilize them, then at that point they can apply to come into our program.
00:13:16:03 - 00:13:34:17
Tania
At your facility, I saw those paintings, and again, just fascinating taking us through, I guess, the process of this patient's mind, you know, that you were able to see visually. Can you just tell us a little bit about the step process that it took to get her there?
00:13:34:23 - 00:14:10:01
Dr. Melnick
Yeah. When she first came to us, she was very psychotic. And you start seeing the disorganization of thought. And she heard voices at the time. And then, you start seeing that when she's finally comes into our facility, she starts learning coping skills, life skills, she's able to kind of manage herself a little better. And once her brain starts getting more organized and the paranoia starts going away, the focus of the art changes to something much more organized, about people, about caring, versus the disorganization and the paranoia that you saw in the previous paintings.
00:14:10:03 - 00:14:24:17
Tania
Now, how frequently can you get a patient going from that level of, of disorganization to, to actually have an empathy, to have an insight? Because from what I understood, that is the hardest piece to get to.
00:14:24:18 - 00:15:12:13
Dr. Melnick
Yeah. So in our facility we're, we're close to 90%. I mean, part of what we do in our psychoeducational groups is to understand the seriousness of the crimes and how their actions impacted others and why, maybe they aren't, you know, they, they don't call every week to see how they're doing. Despite the fact that, in their minds, a lot of them didn't know that what they did was wrong. So what we're seeing here is we're seeing that change, and we're starting to incorporate empathy, and how they respond to others is a big component of their wellness. So as they move through the levels, that's one of the things that we look into is how they're able to, how they're able to empathize with the seriousness of the crime, despite the fact that they were considered not guilty due to it.
00:15:12:14 - 00:15:27:14
Tania
You said a lot of the way this works was based on trust. You say, sometimes they, they leave your facility and become outpatients. How do they continue on their medication? How do they continue on the regimen when they're now outpatient, not being watched?
00:15:27:18 - 00:15:33:19
Dr. Melnick
So the first level, when they're in the outreach, in their second phase of our program, they actually come in to take their medicines every day.
00:15:33:19 - 00:15:35:00
Tania
Okay, okay.
00:15:35:00 - 00:16:01:03
Dr. Melnick
And then as they kind of go and show that they're able to do things, we take away their morning, they can take their night doses at home, but they have to call in every single day to tell the staff that they took their medicines. And usually those patients are in there with somebody who's much more seasoned. And that person also monitors their pills. So there's a 360-degree view of what happens with the individual patients.
00:16:01:05 - 00:16:25:10
Tania
So when, you know, again, maybe you can educate me and whoever's listening, from what I understood, a lot of the medications that are out there do not, do not really treat cognition; they treat, to your point earlier, they treat mostly positive symptoms. But yet, what you're telling me, these patients are becoming, the cognition starts to improve, insight starts to improve. Is that the medication? Is that the, the, like, what, like, like what do you think is allowing that to happen?
00:16:33:23 - 00:17:20:11
Dr. Melnick
There's a certain part, you know, when the psychosis is gone, patients are able to think a lot clearer. But also the psychoeducational groups that we go through actually help improve cognition. Everything we do has a purpose. And so they'll, they'll do puzzles and they will do, as part of their psychoeducation they'll do word finding, they’ll, you know, and, depending on what level they're at, in terms of their functioning, we're able to kind of go and find ways to challenge them mentally. So we have them come up with ideas, we have them work in groups, we have them, you know, do things together to try to find if, you know, ways that they can think in a group. And that way we’re able to kind of get them a little bit more of a cognitive recharge.
00:17:20:14 - 00:17:21:06
Tania
Yes.
00:17:21:08 - 00:17:24:03
Dr. Melnick
More than it is just the medicine itself.
00:17:24:05 - 00:17:29:10
Tania
You know, what I hear is also group thinking is also, it’s very interesting. So they do it in a group, not just individually.
00:17:29:10 - 00:17:33:05
Dr. Melnick
Correct. Yeah. They do projects together.
00:17:33:07 - 00:17:42:05
Tania
Now I'm very curious about a prison system. And how many patients do you believe are actually misdiagnosed that are in the prison system?
00:17:42:05 - 00:18:17:05
Dr. Melnick
Vast majority. You know, it's, the Twin Towers in Los Angeles is the largest psychiatric facility in the United States. Here in Miami Dade County, same thing; it's one of the largest psychiatric facilities in the United States. The prisons have become the new forensic psychiatric facilities. And it's really sad because these patients, when they're in the prison system, don't get the services that they really need or the help that they need, as the money is usually funneled into taking care of the guards and the people that are staffing the prison versus the patients that really need the help.
00:18:17:07 - 00:18:22:14
Tania
How do we get into the system and get these patients better diagnosed?
00:18:22:16 - 00:18:46:20
Dr. Melnick
Yeah, it's unfortunate, but that happens quite a bit. I wish, better training, I guess would be the first. You know, the, the reality is, is there's not enough space. Psychiatric facilities have been closing down, not opening up. When they open up new ones, they're fractionally the size of what they were, the hospitals that they replaced. And unfortunately, the money just isn't coming in to the people who need it.
00:18:46:22 - 00:18:53:09
Tania
What you do needs to be replicated, and we need to figure out how to support such type of program to really expand it.
00:18:53:15 - 00:18:54:14
Dr. Melnick
Yeah.
00:18:54:15 - 00:19:08:23
Tania
We talk about rehabilitation and that's exactly what you have done. So again, going back to the question asked about the end goal, what does success look like for you? And then I will have to then talk about how do, how do you get there.
00:19:09:03 - 00:19:47:08
Dr. Melnick
Yeah. So success for me is really trying to do what I can to help as many patients as possible. You know, I've always, you know, I went into medicine to really be a patient advocate. Not only finding the right medicine for the patient and doing it in a successful way, but the other piece here is keeping them out of hospitals, keeping their brains healthy, keeping their physical, you know, well-being intact, and being able to teach them those life skills and coping skills so that they can go out in the community to be members of society rather than just the outcast that we've all trained them to be.
00:19:47:10 - 00:20:04:22
Tania
You and I spoke about clinical trials, and a lot of it being done in academia. But then you have the hands-on experience, and each patient, I think, as we spoke about before, gets more of a personalized approach. How do you do that? Like how do you know what's the optimal treatment for each patient?
00:20:05:00 - 00:20:31:10
Dr. Melnick
Yeah, I mean, I got to tell you, it's, it has a lot to do with understanding the pattern of behavior and what they're doing and how they think and how early they are into the disease state. The earlier into the disease state, the better outcomes we're going to look at, right? So when you're looking at medicines, and you're trying to get a patient stable, you know, we're trained to use some of the older medicines which tend to hit a lot of off-target receptors.
00:20:31:12 - 00:20:56:02
Dr. Melnick
And what we see now with some of the newer medicines is that they're very guided, very, you know, they're, they're, they're very much targeted, exactly, to this, to these receptors. And by doing so, doesn't hit the off-target receptors, which can give us some effects that maybe we weren't counting on. And so hopefully that way we're able to not only get them better, but keep them well on the medicine for a longer period of time.
00:20:56:03 - 00:21:19:09
Dr. Melnick
And we've been able to successfully manage our patients in a way that's not only good for their mental health, but by keeping them out of the hospital, preventing relapses, our patients actually do better in a healthier way long-term. Medicines that have less side effects, in that are newer; the way I describe it is a laser beam versus a shotgun approach to medicines.
00:21:19:11 - 00:21:35:18
Tania
You know, it’s funny, I think about it as I think through chemotherapy versus targeted therapy, same thing in oncology where I usually tell people chemo is like putting a blindfold on and just shooting, right. You're just knocking down everything versus getting very specific to get on-target effect and less get off target.
00:21:35:18 - 00:21:36:12
Dr. Melnick
Exactly.
00:21:36:18 - 00:22:00:02
Tania
So let's talk about relapses. I watched a program that you spoke on, and you explained that every time a patient relapse, you know, it gets worse and worse and worse. So my assumption is to go then to, I guess to your point, get the ideal treatment early, prevent the relapse, and therefore you can actually keep their brain as healthy as possible. Like what is, what is the, I guess, the method to this.
00:22:00:04 - 00:22:48:22
Dr. Melnick
Yeah, it's exactly what you said. I mean, the earlier the intervention, the longer that they've been on medicines that help them stay stable and out of the hospital and prevent relapses, the more intact they are not just cognitively but functionally. And there are multiple studies that have shown how we're able to kind of manage those patients successfully and keep them out of the hospital, but also give them the cognitive reserve that they deserve as time goes on. We know that patients that have early psychotic symptoms have worse prognosis. We know that people that break later on have, have better prognosis. But what if we were able to get those patients stable and not have any more episodes? Well, then at that point, we're able to keep their cognitive reserve intact and be able to get them to become more functional members of society.
00:22:49:00 - 00:23:01:12
Tania
You took us through the patients that you treat, which were really, I guess I'm, I guess we assume are pretty severe to get to that point. How do we get ahead of it? How do we get, how do we prevent that from happening?
00:23:01:14 - 00:23:29:14
Dr. Melnick
Great question. Early recognition is vital. You know, we tend to, we tend to use medicines that are, that, that really don't allow our patients to really show their wellness over time. We know that some of the typical antipsychotics, which are still being used quite a bit, especially in psychiatric facilities, are neurotoxic, as per Dr. Henry Nasrallah.
00:23:29:16 - 00:23:53:19
Dr. Melnick
And, you know, we're seeing how the newer generation of medicines are not only able to get our patients stable today and to treating their positive symptoms, but also, long-term, minimize the chances of having some of the movement disorders, cardiovascular issues, diabetes, and waking. And as we're able to get these patients better, we're able to keep them better for long-term.
00:23:53:21 - 00:24:04:15
Tania
You've seen the change in medicine over the last 10 years. Where do you see it going over the next 10 years when it comes to treating patients with severe mental illness?
00:24:04:16 - 00:24:28:20
Dr. Melnick
Yeah, I mean, there needs to be an approach that's done beyond just giving somebody medicine and sending them home. There needs to be a, you know, biopsychosocial formulation to every patient that walks through your door. This is not a cookie-cutter disease, unfortunately.
00:24:28:22 - 00:24:53:06
Tania
In terms of stigma, even when people have family members diagnosed with this, people get afraid, and they’re embarrassed and they're ashamed. How do we unwind that and, and get people to understand that this is a disease that, that deserves a chance, it deserves people, it deserves empathy, deserves care. How do we, how do we, change that around?
00:24:53:06 - 00:25:17:18
Dr. Melnick
For many years, people with schizophrenia were just thrown into hospitals. You know, they were mistreated, they were locked in dungeons, they were put on insulin. They were, you know, frozen, given seizures. I mean, so many different ways that they were mistreated. We finally have resources, and we need to start changing our way of thinking. The stigma is our creation, not theirs.
00:25:17:19 - 00:25:58:20
Dr. Melnick
And we need to start doing what we can to bring these patients out into the community, which is what we've done at Passageways: being able to give patients their lives back even though they've had mental illness, even though they've committed serious crimes. The fact that we're able to get them into community and be able to become functional members of society is something that needs to be taught and educated about. That these people are not people we just throw away into a hospital or into a hole like we used to do, but actually are able to be rehabilitated. Maybe not all, but the ones that can and the ones that want to, we got to give them that opportunity.
00:25:58:22 - 00:26:47:00
Tania
So I'm going to switch gears a bit because, you know, most of our listeners will be practitioners. And as we spoke about before, what you have done, to me, is remarkable. And, I mean, for those who don't know, when I first heard you speak, I had a whole list of questions I wanted to ask, which got thrown away because I was so fascinated by what you did. I mean, coming into medicine, you're, our, our goal is to make a difference in patients’ lives. Our goal is, is, is to turn things around. And, and when you hear about patients who have committed such crimes being rehabilitated in a way that most people think is impossible, I mean, it was, I'm fascinated, I'm touched. It is the way, to me, medicine should be practiced.
00:26:47:01 - 00:26:57:13
Tania
What advice, what knowledge can you impart on people seeing patients that want to rehabilitate, that want to get them better and just don't know how to do it.
00:26:57:15 - 00:27:19:05
Dr. Melnick
I mean, first is, I tell my residents, don't ever follow the same rut that everybody has laid down. You know, everybody tries to follow the same path. And what we need to start doing is creating new paths. You know, and when you come up against a wall, don't just stand there and expect the wall to move down. Go around the wall; figure out new ways.
00:27:19:05 - 00:27:29:18
Dr. Melnick
We need to start thinking outside the box, and we need to start changing our mindset and putting our patients first, which we really haven't been doing for many years.
00:27:29:20 - 00:27:35:21
Tania
So then, with that, what is your proudest moment?
00:27:35:23 - 00:28:02:00
Dr. Melnick
My proudest moment professionally is, is really seeing patients get out of from underneath a hole, underneath a rock, be able to kind of come out and be able to see the light at the end of that tunnel by rejoining society, being able to move into their own apartment, being able to keep it clean, being able to, you know, start dating.
00:28:02:00 - 00:28:21:22
Dr. Melnick
We have patients that have started to date, we've had 2 that have gotten married. The idea is, is that where before our limits were just the fact that, well, they have schizophrenia, we're going to have to take care of them. But we've been able to show that that's not the way this works. We're able to get some of those patients back into society and be able to become functional.
00:28:21:23 - 00:28:38:13
Dr. Melnick
And my proudest moment are the days that these patients graduate high school, they learn how to read and write, which before they were not able to do so, are able to get jobs, are able to go out and really start making something more than just a patient with schizophrenia.
00:28:38:15 - 00:28:51:02
Tania
Yeah. And last question. What advice do you have to give to all of us, whether we're in pharma or treating practitioners? Any advice?
00:28:51:04 - 00:29:21:06
Dr. Melnick
Yeah. Again, follow your own drum. You know, don't allow others to tell you what has to happen. If you feel a medicine is the one that's right for your patient, fight for them. Be a patient advocate. We all went into psychiatry to be patient advocates. We didn't do it for the money. So it's important for us to find ways to be able to go out and be able to manage those patients appropriately so that they can be successful patients in society.
00:29:21:08 - 00:29:37:09
Dr. Melnick
And my advice is don't allow people to tell you no, don't allow people to say you have to do this, this, and this. Follow your heart, follow your brain, follow your own path to be able to get to what you feel is important for your patients.
00:29:37:11 - 00:29:44:01
Tania
I've learned a lot from you. You've given me optimism on what we can do, what you've done. Imagine if this can be replicated.
00:29:44:03 - 00:29:45:01
Dr. Melnick
I hope it will be.
00:29:45:04 - 00:29:59:01
Tania
And thank you now for taking the time to go through this experience with us. Thank you for taking us through your center. Thank you for sitting with us. This has been quite, I would say, an inspiring discussion.
00:29:59:01 - 00:30:04:20
Dr. Melnick
Thank you.
00:30:04:22 - 00:30:43:00
Dr. Melnick
Some of our patients really respond to art pretty well. What we start learning from them is that when they're more psychotic that they are, you start seeing some of those things come through the art. This is one of our patients. This is a woman who ended up killing her husband. And while killing her husband, you see in the top, you see a machete going through a heart. You see the x’s through the heart, and you see her underneath it, holding the heart up. But what you also see within the heart are the different faces that she was. You see the white face at the bottom of the heart. But you also see at the upper right hand side a teal face as well. This was in ‘89, right after she committed her crime.
00:30:43:03 - 00:31:06:21
Dr. Melnick
You see here in 2008, 2009, much more organized in her thought process. You start seeing that there's organization within the paintings and much less of the paranoia that comes out, less psychosis. So same person painting in different ways. Showing the wellness of her after we ended up treating her in 2009. Part of what our program does is teaching empathy, teaching the remorse.