Like many helping professionals, I started out in a master’s program with the goal of helping other people. I dreamed about holistically changing lives. I thought with the right training, I could truly help others. I thought it was my purpose in life.
Now I am a young therapist, two years in if you count my internships. I don’t even have a state license yet. I work in an emergency room, assessing patients with psychiatric needs. I help them get the treatment they need, provide resources, refer to outpatient providers. Sounds like a helpful thing, right? It is, some days. Until I feel like I have miserably failed my patients.
If I’ve learned anything in these two years, it’s that America’s mental health system is broken. When it comes to a disposition, i.e. where the patient is going to go next, we have few options in the ER. If a patient is cooperative and wants treatment and fits in these little boxes, everything works out. Except I work with people, and very few fit into a little box that a government agency or a CEO of a for-profit hospital system came up with. A lot more people fall through the cracks.
I have urged families to call the police on their own children because there’s no other way to get them to treatment. I have witnessed mentally ill patients be taken to jail, and there was nothing I could do. I have cared for patients who have been in the ER for days at a time, with minimal medical care, because they cannot function outside a facility. But no facility we try to get them to wants to care for them, so they just lie there until we can figure out some sort of plan or we can no longer legally hold them.
I have admitted people to a psychiatric facility knowing it probably wouldn’t help them but having to prioritize my hospital’s liability. I have hospitalized patients who truly needed it but who may lose their job due to “unexcused” absences. And they do lose their jobs every day, whether that’s “legal” or not. I have encouraged people that they will get better, when really I have no idea.
I have admitted transgender and gender nonconforming patients to facilities, unsure if their hormone regimen or even gender identity will be honored once they’re in the hospital. I’ve had to explain to them and their partners that their identity likely won’t be honored, in fact. I’ve attempted to give them autonomy in the decision but worry they’ll be traumatized no matter what.
I have advocated for patients, only to be shut down. I’ve watched as patients I knew went to the ICU after suicide attempts. I admit the same patients over and over again because nothing the system has to offer is really helping.
I’ve had good days too.
I have advocated for patients and actually succeeded. I let a patient smoke after I had to tell him he’d be admitted involuntarily. I volunteered to watch him myself. It significantly helped his anxiety in that really scary moment.
I made a patient smile after my usual joke of “hope I don’t see you again… in a good way” as he left the ER. I’ve had parents hug me, patients too. I’ve been told I’m the first person to actually help them. A patient I know really well told me how much her outpatient group was truly helping her gain insight. Some patients recover and live their lives and never see me again. That’s a good thing.
I know I help some days. But I can’t help but wonder what happens to my patients after they leave my ER. I worry for my patient when I send her to a hospital I know has a bad reputation. I do it anyway because I have to. My job is to get her out of the ER and get her to whatever facility accepts her first. Choice isn’t really part of the deal. I’ve called CPS on parents who simply didn’t want to pick up their child from the ER. I don’t know what happens to them.
I see a lot of people who shouldn’t have any diagnoses but do because we have to label them to bill their insurance and get them help. And that label could stick for decades until someone is brave enough to challenge it. I see others who have never been diagnosed, and just giving them an idea of what could be going on is life-changing because now they have a direction in which to go. They needed answers more than anything else.
I hear about horrific trauma and abuse. And I assess entitled people who want a magic pill to fix all their problems. I wish I could offer that. People ask me for more pain pills, even though I know they’ve gotten early refills for months. When I say no, they scream at me.
Sometimes, my best efforts fail. The reason I say this is because there are a lot of people out there who need to know that a bad experience with the mental health system doesn’t mean they’re all bad. Many of us really do care about each and every patient we see. We know what we’re up against with the resources we have, and we wish it were different. But right now, all we can do is fight for the best care we can give in the moment.
Working in mental health has taught me how little control I have. I only have control over what I say and how I treat people. So I hope to use that to empower people to take back their mental health and their lives, and to stand as their ally.
If you or someone you know needs help, visit our suicide prevention resources page.
If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255, the Trevor Project at 1-866-488-7386 or text “START” to 741-741.
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