Opinion

Deadly cracks in a broken mental-health system

As a suicidal 23-year-old woman searching for psychiatric treatment options throughout the pandemic, my findings were devastating; there was next to nothing.

In January 2022, I began struggling with the worst depressive episode I had ever experienced and became suicidal. During a crisis and feeling the urge to act on my suicide plan, I turned to the place that is supposed to provide support only to be told, “I am not sure what else there is to do for you.”

After investigating my remaining options and learning that other hospital psychiatric wards were full, the only other avenue appeared to be a stay at a private facility that would cost more than $20,000, which was not financially possible.

Three weeks later, I ended up in a different emergency room after trying to find enough pills in my room to overdose. My parents took me to the hospital, but once again I was told that unless I 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 that has long waitlists.

I did not feel lucky at all.

And if I was hanging on by a thread despite the support I had, what was keeping those alone in their struggles from taking their lives?

While struggling with any illness, 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.

Over the past four months, I have been forced to face the reality of what the emergency department 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. But despite the fact that one does not need to be acting on a plan to take his or her life to need immediate intervention, in my experience the hospital approach seems to be to determine which patients to admit or send home.

I felt penalized for asking for help; it made me think that I had to attempt suicide before anyone would take me seriously.

Every time I have been sent home from the emergency department without any help, I have been branded as “not sick enough.” As I sat crying in the consultation room with the psychiatry resident, I tried to advocate for myself and explain that by asking for help and coming to the emergency room voluntarily does not make me “less sick”. It seemed that my words did not impact the resident – I was OK to go home, ignoring everything else I had said to this point. I felt penalized for asking for help; it made me think that I had to attempt suicide before anyone would take me seriously.

The emergency department and admission to the psychiatric ward in the hospital are not designed to provide well-rounded care to promote recovery. They are places to keep patients safe by creating a “no harm” environment and stabilizing them using medication. Once patients are deemed safe to return to the community, they are discharged for outpatient care.

The problem I have found is that treatment is one of two extremes: remain home and speak with health-care professionals every so often or get to the point where you are so unsafe that you must be hospitalized. There have been many nights where my suicidal ideation is so strong that it causes such distress, but 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 for me. The result is that I feel stuck in my options and hopeless. I have fallen through the cracks of the system since I am not “bad enough” to be admitted 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 five 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 many different avenues for mental health treatment, such as inpatient intensive therapy, outpatient day program intensive therapy, inpatient safety measures at all intensities, and much more.

A person dies by suicide every 11 minutes, and about every 30 seconds a person attempts suicide. While reading this article, four people have attempted to take their own life. It is time to change the treatment of mental health care to save the thousands who die each year. What are we going to do before it takes more lives?

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3 Comments
  • Marina T. says:

    You are absolutely right that there are a lot of people who commit suicide every day and it is truly awful that the emergency department can’t provide patients with the neccesery help because it is only the way to aggravates their mental contrition. I think that it is really important not to ignore this problem and not to turn a blind eye to this because it is a road to nowhere which will only contribute to increasing the suicide rates around the world. Unfortunately, not so many people raise this issue and talk about it, but you are so brave that you found the strength to be frank because it is the only way to break the deadlock, laying the foundation of new reality. I think that if more people delve into this problem and if we are more partial, there will be more opportunities to achieve progress. People with mental disorders need to feel hope and be sure that they will not leave without assistance. I really hope that the emergency department will achieve a new level and this problem will be eradicated.
    // Marina Teramond

  • Margaret says:

    I agree with you whole heartedly. Although I am at the other end of the life-scale,78, the reaction at ER is the same.
    Getting to see a psychiatrist to evaluate depression, provide medications, and continue to see the patient as necessary is impossible. Private psychotherapy, is the only substitute and not available to huge numbers of those needing help. Mental health care in ON is cruel joke.

  • Ethan Lidsky says:

    This took a lot of courage to share and your message is sincere and goal-oriented. This was a great perspective piece. I hope we can implement some of the changes you’re suggesting soon. Nice article

Authors

Bayley Levy

Contributor

Bailey Levy is a Master of Science in Community Health student at the University of Toronto specializing in Addictions and Mental Health. She is  passionate about advocating and educating others on the depths of mental illness and the gaps in the health-care system.

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