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Musings for Friday - Mental Health in America. A Personal Anecdote [1]

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Date: 2023-03-17

Fight for your friends and loved ones. And then fight for a better system.

Clarification; This story isn’t about me, but it is a story I experienced with someone very close and important to me. I won’t reveal some details and definitely no names. Also depending on where you live, your experience may be entirely different

This week I experienced the state of the mental health system in America up close. Someone very close to me had a mental health crisis. Getting the system involved begins with dialing 911. The response you get is quite different than when you dial 911 for a regular medical emergency. And then you get to the ED (Emergency Department formally known as the Emergency Room.)

The staffing availability may vary depending on where you live, but this facility is a Level One Trauma Center at a teaching hospital and medical school. The staffing is entirely inadequate. No Psychiatrist(read MD) immediately available. Hours after arrival a psychiatric NP shows up and does a quick assessment while the patient is not in a condition to give adequate responses. There was no later follow-up to reassess or as a lay person observing, better assess.

After medical release psychiatry took over and things start looking grim. It’s a one size fits all. This Level One Trauma Center (which just completed a $257M, seven story, 357,000 square foot Surgical Tower) doesn’t have state of the art facilities for mental health pages. What it does have is something more akin to the middle ages. Staffing is inadequate and the nurses will admit as much when you have discrete conversations with them. Transfer out of this unit to a room in the main hospital’s psychiatric beds are limited is practically impossible (IMHO it’s because the majority of incoming patients don’t have insurance.) The more likely occurrence is transfer to a private (read for profit but not exclusive) facility.

At this facility one becomes acutely aware that incoming patients are more likely to come from the local jails than a hospital. Meaning the majority of patients are there on the State’s dime. Intake room holds 20 -30 incoming patients all together no matter what their level of needs may be. Incoming process took more than 6 hours. Btw, while these 20 incoming patients are processing in, the beds they are going to occupy are still occupied by outgoing patients. (I should point out here that this facility claimed the incoming patient up to two days before their arrival. So it’s not like they didn’t know who or how many were coming.)

The other reason it takes six hours is staffing. It takes several interviews before room assignments. There is one staffer assigned for each level of the interviews. More staff would equal less time for patients possible exposure to another volatile patient..

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