-Published by a guest writer-
Between 2000 and 2016 death by suicide in the United States increased a whopping 30%. The rate increased by about 1 percent per year from 2000 through 2006 and by about 2 percent per year from 2006 through 2016. In fact, suicide was the 10th-leading cause of death in the United States in 2016. It was the second-leading cause of death among people ages 10 to 34 and the fourth-leading cause among people ages 35 to 54.
The reasons for such increases are not completely clear. Experts have pointed to an increased sense of isolation among Americans, as well economic factors and a rise in mental illness. Others pointed to the rise of technology, which has replaced important face-to-face interactions, though some also argue technology actually decreases loneliness. Either way, stopping individual suicides is possible. For instance, in a 10-year study at the Henry Ford Hospital in Detroit, doctors and therapists deployed several interventions that led to an 80-percent drop in suicide rates.
However, knowing what causes individuals to take their own lives and having improved treatment options won't help if people don't reach out when they are feeling hopeless. After having an accidental encounter with the United States' suicide prevention infrastructure myself, I can imagine why people might hesitate to ask for help.
Several years ago I was on vacation when, to my surprise, an officer arrived and told me there was a concern I was intending to hurt myself, and was provided with two options: either go to the hospital voluntarily or involuntarily. I chose to go voluntarily so as not to cause any problems and get in and out as quickly as possible once the hospital staff recognized I was fine. To my dismay, I was placed in handcuffs and put in the back of the squad car, a terrifying ordeal for someone who has never been in either situation.
Upon arriving at the hospital I was checked in and given a hospital gown, and was forced to change my clothes. My request to keep my socks instead of the horrible rubber ones they provided was met with a stern "No". My belongings were locked away and I had to request access to them each time I wanted something of mine. Afterwards, they demanded my insurance information and informed me I needed to pay the $95 co-pay. Yup, you read that right: I had to pay for this forced visit even though I did not want nor need it.
I was shown to my room, which was a very cold and small box with no windows and bright fluorescent lights. After my vitals were taken a psychiatrist walked in, and while introducing herself she pointed out she worked for an organization that contracted with the hospital, and thus was not an employee of the hospital. Her questioning began with general inquiries, which I had no problem with answering, but her questions got more and more personal and so I became very uncomfortable and began refusing to tell this stranger the personal details of my life. She told me if I continued to refuse to cooperate I would "be here longer than you'd like". Panicked and wondering if I had just been blackmailed by someone who is supposed to help those in my position, I began to disclose what she wanted to know.
She left the room after about an hour of questions and returned shortly thereafter. It was then that I discovered my friend was in the waiting room and the psychiatrist was going back and forth between us. She would not let me see him. Classic prisoner's dilemma. It was then that she informed me I was staying the night. Why? I've been lying to her, she accuses. I was furious. I demanded my cell phone so that I could call my lawyer, to which they said no. I felt like a prisoner. Nay, I was a prisoner.
The psychiatric ward wasn't busy that day except for a few other patients so I received my lunch of choice relatively quickly: a chicken Caesar salad, applesauce, and a fruit bowl. The nurse who delivered it stuck around and we started talking. I explained to her that I didn't belong, that this was a mistake, and to my surprise, she agreed. The nurse explained to me that because of the rising suicide rates the hospital needed to meet quotas in order to maintain its current funding levels for the psychiatric ward, which, in turn, provided the psychologist contracting firm with their paychecks, though the latter half was my conclusion. While the nurse informed me there was nothing she could do since only the psychiatrist could release me, she was kind enough to bring me my cellphone. My first call was to my attorney, who coordinated with a firm located in the state I was currently in. Unfortunately, though, the psychiatrist was out for the rest of the day, and I was stuck there for the night.
After the nurse left a fellow patient asked if he could have my banana that was left over from lunch, to which I obliged. He lingered in my room as he was eating the banana in an awkward silence, before asking what my story was. In other words, he wanted to know why I was in there. I told him the truth: I don't belong. He seemingly ignored my answer and we started talking about what we do for work, what we want from life, et cetera. Before walking out back to his own room he told me, "You shouldn't be here". I was immediately reminded of a research experiment I read about where several sane laymen with no history of mental illness claimed to hear voices and were admitted to psychiatric units. Nearly every person in the experiment was diagnosed with schizophrenia, and although none of the pseudopatients were unmasked by hospital staff, other patients on the psychiatric units became suspicious of them. Across several of these hospitalizations, 35 patients expressed doubts that the pseudopatients were actually mentally ill, according to the study.
Upon bedtime I shut my door because it was loud in the lobby between blaring TVs and noisy conversations. Within ten seconds a team of hospital staffers came rushing through the door, undoubtedly presuming I was intending to harm myself. They told me I had to leave the door open and then confiscated my phone (again). I couldn't sleep. I felt lonely and afraid, terrified I was going to be there for several days or even weeks. I swallowed my pride and begged the nurses for my phone back so that I could FaceTime a friend who might be able to cheer me up a little. They agreed, albeit reluctantly, though I felt powerless, as if I was in pre-school.
When the morning finally came I was greeted with a different psychiatrist, and she was much nicer and more understanding than the last. She asked me the same general questions as the first psychiatrist before telling me she was releasing me, pending some paperwork, of course. About an hour later I was out.
When I got home I logged into the hospital's patient portal so that I could view the reports. Here's a quick summary:
- My refusal to answer personal questions was described as "combative and cynical behavior".
- My original demand for my cellphone to call my attorney was described as "aggressive, threatening and violent".
- My third request for my cellphone so that I could FaceTime a friend was deemed "attention-seeking behavior".
- Oh, and despite being an adult they called my parents using the emergency contact information I provided on the hospital form without my permission.
In the weeks after I suffered from symptoms of PTSD. I could barely sleep, and when I did I had nightmares that I was trapped in that room again. I had trust issues and became extremely anxious and agitated whenever I heard a police siren. The hospital smell produced by disinfectants used by medical facilities makes me sick. In essence, I was perfectly sane and healthy upon being admitted to the hospital, and left in a far worse condition than I arrived in. Throughout my life I've been blessed with a healthy mind, but should that ever change I don't believe I would consider reaching out for help for fear of being subjected to the same treatment I've described above. How does that help anyone?
Prison is now among the largest settings for mental health services, a final destination for individuals failed by the medical system. Yet neither correctional facilities nor emergency departments constitute the best therapeutic environment for people in the midst of mental health crises, and the care (or lack thereof) they get there often leads to poor outcomes.
It doesn’t have to be like this. Health care providers can help improve things by treating mental health conditions like any other disease process, instead of treating them like burdensome acute flare-ups that can be squashed and forgotten. System-wide, when patients with psychiatric issues arrive at the hospital, we need an easier way to transfer them to a higher level of care for psychiatric issues. Better coordination with mental health providers, even bringing such providers into the initial decision-making process, would speed treatment and free up hospital resources.
The goal of medicine is to help people become happier, healthier, and more functional members of their communities. Having people with mental health issues cycle through the high-intensity, anxiety-inducing emergency room environment is not the way to do this.
A successful 30-day study suggests the following:
...investigating the establishment of a national billing code for Crisis Stabilization may be a worthy goal. Such a code, available across the U.S. for both Medicare and Medicaid, might encourage the free market to create self-sustaining programs, without the need for new government projects or separate funding. Essentially, adding the code would promote the formation of the services without any new targeted monies—while the overall system would actually save dollars, from less utilization of psychiatric inpatient beds and reduction of expensive boarding in medical EDs.
Our country's treatment plan for mental health is broken. Patients are treated as subjects instead of human beings. Profits rank in priority over treatment quality. Expensive and addictive pills are pushed when what many need is compassion. We need a systemic and cultural overhaul to change how our society treats and considers mental illness, a change that favors the interests of everyday people. After all, it could really happen to any of us.