LET'S SPREAD THE WORD

You hear “just ask for help” if you’re depressed, having panic attacks, or otherwise having a mental health issue.

Only the help has to be there when you ask for it. And it’s not. Three common things happen in the mental health world. I’ll describe them. 

First, when you or a loved one has a physical illness, everyone comes to your aid. When it’s mental, they don’t. They might offer brief moral support, but they don’t really offer help. They don’t know what to do.  They don’t want to upset you by bringing it up. They assume it’s resolved if you don’t say more. You’re alone. 

Second, there is no urgency to stop the suffering, as there is when someone is in physical pain. You have to wait for help. Hunt for it. Call and call and call. Are you taking new patients? Who is? Is this program full? Where else can I go? You wait and wait, becoming more desperate with time.

Think about the worst emotional pain you’ve ever felt, like a death in the family, a breakup, or a loss that caused you intense emotional pain, where you were clutching your chest and crying in the shower. Now picture yourself or one of your friends or relatives in this state. 

Third, you can’t necessarily access help even if you want it. A common refrain when looking at programs is, “It depends on what your insurance will cover,” or “I’m sorry, we don’t accept that insurance," or, in the case of some providers, “I’m sorry, but we don’t accept any insurance.” Imagine a doctor for physical ailments saying this. Even if you have insurance, they won’t take it.

This isn’t unique to Connecticut. Psychiatrists all over the country do this. So do other licensed mental health providers. 

So there’s the illness which creates one hell, then add isolation, no urgency to stop the pain, and programs and providers that won’t take insurance so you can’t even help yourself. 

Don’t believe it? Check or call around and see how many psychiatrists in Connecticut are taking new patients and will see someone with Husky insurance. See how many choices you’d have for your parent, your child, your friend. Now imagine you couldn’t pay out of pocket. What would you do?

I’ll tell you what you’d do. You’d hear people say, "I wish there was something I could do," if you had that much support, and you’d wait and wait and wait. While you or your loved one suffered. Unless you had money and could pay out of pocket or borrow from every living relative.

That’s wrong, it’s 2023, and we’re better than that.

Imagine going to the emergency room and saying you’re so depressed you wish you would die.

And being sent home.

Don’t believe it happens? It does.

The emergency room is the place you go when you’re the most desperate; when you don’t even know what to do anymore.

Here’s the problem: It’s not equipped to help you. When you’re having a mental health crisis, you need someone with expertise and time. An emergency room may or may not have the first, and it definitely doesn’t have the second. It has to refer you somewhere else.

Only thing is, there’s no place to refer you to. The treatment programs you need are either full, inadequate, or they don’t exist. There is no long-term inpatient program you’re going to find even if you need one. Unless you can travel and have $50K. Minimum.

Hospitals won’t keep you unless they deem you an immediate danger to yourself or someone else, and I mean an immediate danger. If they think you are one, they’ll hold you in a hallway or a bed within eyesight of the staff or in a locked unit while they look. You won’t get treatment while they’re searching.

If you need inpatient care and they find it, you won’t stay long.

Try 5-10 days. Think about that. Can you actually solve anything in 5 days? Most antidepressants don’t begin to work for two weeks. But the minute you say you’re feeling a bit better, you’ll be discharged.

Now let’s consider another scenario. You tell the doctor you’re so depressed you wish you were dead. You don’t want to die; not really. You just feel so horrible you wish life would do it for you.

You’re not necessarily badly off enough to be deemed an immediate danger. Depending on the doctor who sees you, you could be sent directly home.

Is there an outpatient program that you are set up with immediately? The next day? Or week?

No. They’re full. You have to wait.

Is there a follow up appointment set up for you, with a counselor or psychiatrist who can see you the next day? Or week?

No. You’re expected to find that person yourself. Perhaps you’re given a list of providers to call.

Notice, we’re not talking about the quality of these inpatient or outpatient treatment programs. We’re not even there yet. We’re talking about anything at all.

Do we send someone home with chest pain, give them a list of cardiologists to call even though they’re booked, and tell them to call 911 or come back after they’ve had a heart attack?

We do not.

We wouldn’t think of doing it, and it wouldn’t matter if they couldn’t pay.

When we fail as a state to provide sufficient mental health care for people at their most desperate, we undermine their faith in the very system they thought would help.

Let’s talk about what it’s like to be hospitalized in a mental health unit.

First, to even be referred, you must be having serious difficulty. Perhaps you plan to take your own life. Or you’ve already tried.

What happens when you enter inpatient treatment? Below is one scenario. It is not meant to be representative. Nor is it rare.

You wait for a bed. Perhaps you’re in the emergency room or in a psychiatric holding area. It could be hours, even days. Rarely does someone have time to sit with you while you wait. These are holding areas with limited staff.

You typically do not have family with you. Remember during COVID, how badly we felt for people in an emergency room or in a hospital without their families? That’s how it is for people with mental health issues much of the time. 

Once you’re admitted, you are unlikely to receive intensive one-on-one therapy. The chances of you getting this are, in fact, slim, unless you are placed in a psychiatric hospital set up for it. That takes additional staff and is typically not available. You don’t get to choose where you go.

Most of the time, you receive group therapy. You may be in a room with people who have problems that look nothing like yours. It may be exceedingly difficult to deliver effectively, depending on who is delivering it.

You are not separated by diagnosis. The facilities aren’t available. You may be in a unit because you are depressed and sharing a room or a hall with someone who has a psychotic episode.

You are also locked in. This is stressful, and for some, it is terrifying.

You are receiving medication, which may or may not be immediately effective. There is no opportunity, if you are already taking medication and it’s not working, to take you off what you are on, let it leave your system, and start over.

That takes time and it’s unavailable. Your doctor is fighting with your insurance company which would like to discharge you as soon as possible.

If you want to decline the medication recommended, you may be afraid to. You may fear being deemed “non-compliant” and decide to be obedient.

I want you to imagine you are there: You waited and waited for treatment, possibly on the verge of suicide.  You don’t have your family. You are not receiving regular individual therapy. Your roommate is combative. You are waiting for medicine to work. You are locked in. You feel powerless.

What would you do?

I’ll tell you what some people do.

They lie. They lie to get out. Or to not go in to begin with.

I want to return to who is in these units. Think for a moment about who is referred there.

Inpatient mental health units should provide effective treatment. At the very least, they should not create such psychological stress that someone would rather lie than be hospitalized.