I'm lying in an emergency room bed, wires and sticky pads clinging to my chest. My pulse zigs and zags across a screen. Fluorescent lighting illuminates my blue-and-white-striped hospital gown; my hands are folded neatly across my belly. My husband Dan is sitting with our sweet four-month-old baby girl in his lap. Claire is still wearing the white fleece pajamas with pink roses that I zipped her up in last night. They’re my favorites.
It was around four a.m. when I rubbed her back to wake her. I had woken up panicked by a tightening in my chest and shook Dan by the shoulder. I knew that the answer to his question — Do we need to go to the hospital? — was “probably not.” But what came out was, “Yes.”
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I have dealt with depression and anxiety for most of my adult life, learning to recognize some of the symptoms. But this morning, my irrational mind had me convinced that a pain in my chest was a heart attack and that the numerous waves of dizziness were due to a brain tumor.
The doctor walks in and does a couple of quick checks, pressing on my abdomen and listening to my heartbeat. He makes jokes like pediatricians do to distract a child from a needle aimed at their arm.
I start going through my list of symptoms: the feeling of a weight on top of my chest, heart palpitations, numbness in my arms and dizziness. I tell him I’m not sure if it’s just the after-effects of having a baby. The doctor, a large man with wild, curly gray hair, looks at me above his glasses and says, “Well, you know they are aliens right?” A grin spreads across his face and he tells me about how the fetus, with distinct genes than the mom, is not unlike a foreign invasion.
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I feign interest, but all I can think about is that I have felt like there has been a intruder in my body ever since my daughter’s birth, something clawing at my throat to make its way out.
The doctor says he can’t find anything outstanding about my physical evaluation, and that my blood work and chest X-ray came back normal. A nurse comes in to discharge me and hands me papers about non-specific chest pain. I want to hand them back and tell her I already have the information from the last time I was here, just a month ago.
We leave and I think: Why is no one stopping me? Why can’t anyone see that I need help?
* * *
“Unless you are lucky enough to be in an emergency room at a hospital with a reputable psychiatric unit, you are not likely to encounter care providers that have sufficient training in mental health,” says Sepideh Saremi, a Los Angeles-based psychotherapist. “That, coupled with stigma, means that you probably won’t get good referrals or resources if you are having something like a panic attack.” Saremi says that in traditional medical settings, mental health care tends to be separated from other services.
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According to a poll conducted late last year by the American College of Emergency Physicians, 52 percent of ER physicians surveyed said the mental health systems in their communities have “gotten worse.” Additionally, the emergency department has become “the dumping ground for these vulnerable patients who have been abandoned by every other part of the health care system,” Dr. Rebecca Parker, president of the American College of Emergency Physicians, asserted in a press release. Only 16.9 percent reported having a psychiatrist on call in the emergency department.
“It isn’t an illness or injury that you can physically see,” says Dawn Daum, who has worked as an ER mental health evaluator and is the co-editor of the website Parenting with PTSD. “For some reason, there is an unspoken attitude that it is acceptable and encouraged to seek help with a physical ailment, such as a broken bone; however, if the complaint is in regards to mental or emotional pain, it is unacceptable for a person to seek help.”
She says that, because of a constant cultural reinforcement to “get over it” or to adopt an “other people have it worse” attitude, this stigma and lack of empathy continues to “create barriers in seeking emergency mental health attention.”
This was painfully apparent when Jacqueline Ledoux-O’Donnell, a 23-year-old Boston resident, attempted suicide five years ago by swallowing an entire bottle of prescription Prozac. One of the first questions an ER staff member asked her was, “Well, why would you want to do that anyway?”
Ledoux-O’Donnell had been on the phone with her friend when she took the pills and told her she “just wanted to go to sleep.” The friend rushed to Ledoux-O’Donnell’s house and took her to the ER. When her parents arrived at the hospital, Ledoux-O’Donnell felt patronized by the staff, who kept discussing her situation with her parents “like I was a kid.”
“They made me feel like they were disregarding my experience,” she says.
After an evaluation by a psychiatrist, a nurse was tasked with suicide watch until Ledoux-O’Donnell was moved to the psychiatric ward. She was deemed stable after five days and provided with no further instructions for care.
* * *
When I left the ER that day after my apparent panic attack, I felt calmer, but only as a result of spending hours with my anxiety tucked underneath a scratchy, sterile hospital blanket. Every monitor and test indicated my health was O.K., giving me a temporary point of view that the facts would be enough proof to send my anxiety packing. As my daughter Claire and I sat in a Whole Foods parking lot while Dan ran in to grab a few things, I called my mom to tell her what had happened.
“Oh, honey, when is enough going to be enough?” she said. “It’s O.K. to get help.”
A week later, I was rocking Claire to sleep when the dimmed lights in her room seemed to grow increasingly darker. My palms started to sweat and my vision tunneled until I felt encased in blackness. I kept yawning, desperately trying to catch my breath. Swaying back and forth, I clung to Claire as if she was the only thing keeping me anchored. I didn’t move for at least an hour.
It was another panic attack.
* * *
One in five adults — more than forty million Americans — have a mental health condition, according to Mental Health America. Under the Affordable Care Act, hospital, maternity and mental health care are considered essential benefits. But the American Health Care Act that passed the House of Representatives earlier this month categorizes each as pre-existing conditions, allowing states to obtain waivers and dictate what type of benefits insurers have to cover.
Should this bill pass the Senate and become law, the results, Daum says, will be disastrous for Americans, leading to recurring mental health crises being presented in emergency care settings “with no direction to go in except the same damaging ‘not my problem’ cycle.”
It took five months before Ledoux-O’Donnell sought help. At the time, she was living with her grandparents because her parents could no longer handle her condition. She was bedridden, refused to shower, change her clothes, work or eat. “I knew that if I didn’t make a change, I would likely attempt suicide again and be successful,” she says.
She searched the internet for answers and found information about electroconvulsive therapy (ECT). With a referral from a psychiatrist, Ledoux-O’Donnell tried ECT and found that it “got me to a place where I could function like a normal person again.” She still struggles with several mental health conditions, including depression, anxiety and obsessive-compulsive disorder, but she graduated from college last year and is now working full-time.
“I wish the ER staff understood that each and every person is different,” Ledoux-O’Donnell said. “We’re not all textbook cases of depression and anxiety and there are different reasons we all ended up where we did. A one-size-fits-all style of treatment is not helpful to someone who’s currently operating in crisis mode.”
* * *
According to a September 2016 study, psychiatric visits to the ER increased by 55 percent – from 4.4 million to 6.8 million – between 2002 and 2011. Many of those patients were met with longer wait times than non-psychiatric patients. The solution is dedicated beds and care for mental health treatment within the emergency department, says Lee Tomatsu, a physician assistant in the ER at Sharp Grossmont Hospital in La Mesa, California. Tomatsu says that because of “a dire shortage of psychiatric inpatient beds” patients can spend “up to several days” in the ER at Sharp Grossmont.
“Psychiatric patients generally have different needs than medical patients,” she continues. “When in acute crisis, the patients can be agitated, requiring efforts at verbal de-escalation and sometimes chemical or even physical restraint, if the patient is felt to be a danger to themselves or others.”
Psychiatric patients at Sharp Grossmont are taken to the “E station,” a section of the ER that opened in January 2017 with thirteen beds dedicated to psychiatric patients. Patients receive a medical evaluation to be cleared for underlying medical conditions, and then meet with a psychiatric specialist who can assess if there is a need for inpatient psychiatric admission.
If a patient is discharged, he or she receives information about outpatient therapy and community resources, as well as follow-up with the hospital’s social workers.
“This is a tremendously helpful service we have recently been able to provide our psychiatric patients, many of whom have not had consistent access to outpatient psychiatric care,” Tomatsu says.
* * *
It took me almost a year after that early morning trip to the ER to find the help I needed. Like Ledoux-O’Donnell, I had to eventually establish my own course of action, one that included regular acupuncture and therapy. A prescription for Lexapro followed, but when I think about the time I spent looking for solutions and the people I had to lean on, I can’t help but worry for those who leave the ER and don’t have the same support on their side.
When I got in the car on that early October morning, my need for help felt no less urgent than when I was twelve years old and my mother took me to the ER after I fell from a tire swing and shattered my ankle. But whereas my broken bones were met with immediate care and follow-up appointments with an orthopedic doctor and physical therapist, my mental state was completely overlooked. As I signed my discharge papers and walked through the hospital’s sliding glass doors, I left feeling like a trespasser in a place where there were no answers for people like me.
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