Emergency Room’s Deadly Cracks for Mental Health

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Author: Bayley Levy
As a suicidal 23-year-old woman searching for psychiatric treatment options throughout the pandemic, my findings were disappointing; there was next to nothing.
In January 2022, I began struggling with the worst depressive episode I had ever experienced and became very suicidal. During a crisis feeling the urge to act on my suicide plan, I turned to the place that is supposed to provide support only to be turned away and told, “I am not sure what else there is to do for you”.
After trying to investigate my remaining options after learning the psychiatric wards at other hospitals were full, the only other option appeared to be a stay at a private facility that would cost over $20000, which was not financially possible. Three weeks later I ended up back in a different emergency room after trying to find enough pills in my room to overdose and asking my parents to take me to the hospital, but once again I was told that unless I absolutely could not keep myself safe at home, I should return home and wait to speak with my physician.
I was told I was one of the lucky ones as I had a psychiatrist in a city with looming waitlists. I did not feel lucky at all as I felt my pain had surpassed suffering, but it also made my heartbreak for those in similar situations without any supports at all. If I feel that I am hanging on by a thread, what is keeping those alone in their struggles from taking their lives? This was the point at which I was able to identify the deadly and devastating cracks in the mental health care system.

While struggling with any illness or medical struggle it is reassuring to feel that there is a place to go for help if things deteriorate beyond your ability to *handle it. This is a sense of comfort I have lost for my mental health. Over the past 3 months, I have been forced to face the reality of what the emergency room can provide for mental health crises – not a lot. Mental health crises fall on a spectrum and the level of distress will differ from person to person. However, it is important to acknowledge that one does not need to be acting on their plan to take their life to need immediate intervention.

Nonetheless, this is the hospital’s approach for determining which patients to admit or send home. Every time I have been sent home from the emergency room without any help; I feel like I have been branded with “not sick enough.” As I sat in the consultation room with the psychiatry resident crying, I tried to advocate for myself and explain that because I did not attempt to take my life and never have does not make me “less sick”. It seemed that my words did not impact the resident as he continued to give me the impression that since I didn’t attempt, I was okay to go home – ignoring everything else I had said until this point.

I felt penalized for asking for help and made me think that I had to actually attempt suicide before anyone would take me seriously. The whole experience left me feeling like a lost cause and I wanted to take my life more walking out through the hospital doors.

The emergency room and admission to the psychiatric ward in the hospital are not designed to provide well-rounded care to promote recovery. It is a place solely designed to keep patients safe by creating a “no harm” environment and stabilizing using medication. Once a patient is safe to return to the community, they are discharged for outpatient care. The problem I have found with the current system is that treatment is one of two extremes: remain home and speaking with healthcare professionals every so often or getting to the point where one is so unsafe, they must be hospitalized.

We need to have more levels of care in between because so many people are falling through the cracks and not receiving the help they deserve and need. There have been so many nights where my suicidal ideation is so strong that it causes such distress, but I know that since I am not acting on it the hospital will just turn me away.

I want inpatient care that can provide the intensive treatment I need – the conjunction of medications and the hard work of therapy. Unfortunately, it does not appear that this exists or there is very low access to these types of treatment. The result is that I feel stuck in my options and so hopeless. A quote that perfectly describes how I feel is, “the only thing that scares me more than this killing me is living the rest of my life like this.”

I feel I have fallen through the cracks of the system as I am not “bad enough” to be admitted to the hospital ward but need more support than outpatient can provide. At a speaking event an audience member asked me, “where do you hope to see mental health treatment in 5 years?”

My answer is simple: more levels of care.

Mental health struggles are not all or nothing, so treatment options should not treat it that way. There are so many different avenues that can be discovered with mental health treatment, such as inpatient intensive therapy, outpatient day program intensive therapy, inpatient safety measures at all intensities, and so much more.

A person dies by suicide every 11 minutes, and about every 30 seconds a person attempts suicide.

While reading this article, 4 people have attempted to take their own life. It is time to change the treatment of mental health care to save the hundreds of thousands who die each year.

What are we going to do before it takes more lives?

 

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