Cory grew up in a violent home. He turned to alcohol at an early age. He also suffers from schizophrenia. When he drinks, he sees the world as a threat and responds in kind. He was released from prison a few months ago after a decade for making a threat he did not have the ability to carry out.
Cory needs psychiatric help. He’s been on a waiting list for months. Now he’s back in jail, awaiting trial for getting drunk and making a threat he had neither the means nor the knowledge to act on.
Jack, too, grew up in a violent household. He turned to drugs at age 12 and lived on the streets for a time. He recently graduated from a recovery house and is trying to live clean and sober. But Jack suffers from bipolar disorder. When he gets manic, which is about every other week, he gets paranoid and believes the world is out to get him. The only way he knows how to manage this is through self-medication. Needless to say, he hasn’t stayed clean for more than a few days at a time.
Jack, too, has been on the waiting list to see a psychiatrist. In his desire for help, he went to the emergency room and was hospitalized, but the medications they put him on didn’t help. He wound up back there again last week, in a suicidal depression after a week of manic behavior and drug use. The doctors changed his medications and sent him home.
These two men, both of whom want to change their lives, may be just statistics for most people, sad stories that we want to believe are the exception rather than the rule.
I don’t have that luxury. Like them, I have struggled with addiction. Like them, I suffer from mental illness– in my case, PTSD (Post-Traumatic Stress Disorder). And like them, I struggle to get help in a broken mental health system.
When Trauma Comes Home
My recent troubles began, like so many things, with Covid. The isolation caused by the pandemic not only led to depression, but eliminated a lot of my regular coping mechanisms. Visiting friends and working at the library became impractical if not not impossible. My world shrank to our home, and my family became my social circle. Between Covid and the weather, my 6-year-old, special-needs son has only been to school about one day a week this year, causing his problem behaviors to multiply and adding to my emotional challenges.
Meanwhile, our political situation deteriorated, frighteningly resembling a traumatic situation I experienced almost 30 years ago. I’ve done a lot of work on my trauma over the past two decades, but now the nightmares returned. So did the irritability, depression, and sensitivity– all classic symptoms of PTSD.
I’d been seeking help. It took over two years to find a practitioner who dealt with trauma (and accepted my insurance), and I’ve only been working with her for a couple of months.
About two weeks ago, unbeknownst to me, my 16-year-old intentionally startled my wife. She let out a blood-curdling scream. And something inside me snapped. I left the house and drove around for two hours, unable to deal with my feelings and the world around me. I scratched myself because the pain felt good.
After much internal consideration of less desirable alternatives, I went to the hospital. They shipped me to a facility two hours away, where I received medication and watched TV for a week. (I hate TV, so this was not a relaxing vacation.) Then they released me, advising that it would take weeks to know if the medication was really helping. The side effects are arguably worse than the PTSD symptoms they are intended to treat, and the psychiatrist I saw after leaving the hospital immediately discontinued the medication.
Our Broken System
Our mental health system is broken. It doesn’t do prevention or healing, it manages crises. Getting an appointment if you’re not in crisis can be difficult or impossible, even with health insurance. Waiting lists are long for those who are not bad enough to be hospitalized.
For those requiring hospitalization, our system uses a “catch and release” approach, diagnosing and medicating patients, then sending them home before the effects of the medication on that specific person become evident. How often have we heard a psychiatrist, following up on a hospital visit, say, “I don’t know why they selected that medication!” When side effects crop up, refer to the previous paragraph. Your options are to suffer, or go back into crisis management. Six years ago, I was hospitalized three times– once for the condition, and twice to deal with the life-threatening side effects of the supposed treatment of the condition.
And our system doesn’t do healing. Instead, it manages crises of symptoms with medication. It works for some, but many do not find relief. This approach pays little attention to addressing the underlying condition– much like using pain pills without treating the broken bone.
There are exceptions. Dialectical Behavioral Therapy, for example, has been shown to reduce both the frequency of crises and, for some conditions, the need for medication. Eye Movement Desensitization and Reprocessing (EMDR) is incredibly effective in treating trauma. Long term inpatient substance abuse treatment, when paired with mental health care for underlying conditions, can be very effective not only in treating addiction, but in preventing future mental health crises. But there isn’t enough of it. In fact, in many communities, there isn’t enough mental health care available, period.
A system is defined as “a set of things working together as parts of a mechanism or an interconnecting network.” By that standard, our mental health “system” isn’t a system at all. The parts don’t work together. Some parts are missing.
Does ignoring our mental health make the problem go away? Hardly.
An estimated 56 percent of state prisoners, 45 percent of federal prisoners, and 64 percent of jail inmates have a mental health problem. –“The Processing and Treatment of Mentally Ill Persons in the Criminal Justice System“