Why Mental Health is Bad for My…Mental Health

12 04 2012

When ACS refers a case to us, there are certain things they want done. (Most often, these are things we don’t do. But that’s for another blog…) A lot of times, it’s counseling for domestic violence, sexual abuse, or substance use. These don’t apply to everyone. But one thing is constant. Everyone in the family–parents, kids, household pets–should have a psychiatric evaluation.

I’m rarely against an evaluation. It can’t hurt, right? Well, I guess anything can hurt, but the professional would have to be a real idiot. Surely there aren’t any of those. I think our kids are overdiagnosed and too often prescribed serious psychiatric meds but evaluations…why not?

There are a few problems, of course. Some parents don’t agree with them, some kids think it means I think they’re crazy. The number one obstacle, though?

Where the fuck are they supposed to get this done?

With the health care debate raging in this backwards ass country, I keep hearing about these “free clinics” that one supposedly trips over on any stroll through the ghetto low-income side of town. They’re doing free well-child visits and tossing out birth control like Gobstoppers at Willy Wonka’s factory.

Unfortunately, they don’t exist. Most of those “free clinics” actually charge Medicaid. You can get urgent care, not ongoing treatment.

This is also true for mental health clinics. In my first months on this job, I thought they were a myth, like Sasquatch, or the G train. But they’re out there. They’re just hard to find. It’s especially hard to find one that takes your insurance. Sure, everyone has Medicaid, but most people also have supplemental insurance. This place takes straight Medicaid, not Health First. This place only takes blah blahdiddy blah…

Most unfortunately, we don’t have mental health staff here at anonymous agency. We’re social workers and case workers, but no doctors. I can do family counseling, play therapy, which is all good stuff, but I can’t prescribe Ritalin. No matter how much I may try. This means that we have to refer out.

Until recently, we had a connection with a nearby mental health clinic. They came by when they felt like it to collect our referrals, and our clients were able to get appointments within a couple of months. To be honest, I thought they did supbpar work. But we had to take what we could get.

That relationship was terminated for some reason that hasn’t been explained to any of us because we’re not important. Now, we’re back to the old referral process.

Agency names have been changed for my amusement.

I call Shining Time Mental Health Station to refer a nine year old girl and a thirteen year old boy. Their mother is also to be evaluated, but I don’t mention that at first, as I don’t want to seem greedy. No one answers, so I leave a message. I do this fourteen days in a row, while also leaving messages at Miss Kitty Fantastico Memorial Mental Health Center and St. Mungo’s Center for Nonmagical Mental Maladies. No one will answer me, and I start to take it personally. I leave decoy messages, telling the intake worker that she’s won a sweepstakes and needs to call me immediately, or saying that I’m holding her puppy hostage. Nothing. That woman does not care about her imaginary millions, or her puppy.

At some point, I give up on St. Mungo’s, because they don’t take this family’s supplemental insurance. Miss Kitty Fantastico is no longer seeing children. That leaves me with one in their area. Oh god.

Finally a coworker sees me sobbing into the phone, and mentions that she has a contact at Shining Time, who might help. I get my hopes up (always a mistake) and call. Of course, this person is a domestic violence specialist only. Could you encourage their dad to stop by and rough up the mom? OK, in that case I can’t help you. Let me transfer you to our intake worker.


Next, I try the child study center at St. Anastasia Beaverhausen Hospital. I call their general intake number, and am given the option to press one for the diabetes program, two for women’s health, three for dental, all the way to nine for foot problems, but no child study center.I start cursing into the phone, hoping that this will cause them to connect me with a real person (it works with FedEx) but all this gets me is some looks from my coworkers.  I hit zero for all other calls, and am told that my call is very important to them, but there are six other callers ahead of me. After an hour, I begin to doubt the importance of my call. Someone answers. I ask for the child study center. She transfers me to the foot center. I ask for the child study center. Foot lady transfers me back to the lady who transferred me to her. I finally get the child study center after three more rounds, only to be told that they aren’t accepting new clients for five months. Can’t I put my kids’ names down now, that way in five months they can have an appointment? No, it doesn’t work that way, because we say so. Oh.

While I’m chasing my tail, there are children who need help and aren’t getting it. Counseling, play and art therapy, are crucially important to their well being, and I do that. But when there are things like PTSD, ADHD, bipolar disorder, or a family history of schizophrenia going on, they need to see a doctor.

People in need can always walk into the ER. We always hear this from people who don’t want to pay for our frivolous health care, and it’s true. They can walk in, sit down, and wait for hours. Wait, and wait, and wait. Often they choose to leave. Generally, if they aren’t actively suicidal, they don’t get to stay. I once got frustrated enough that I asked a mobile crisis worker if I should wait to call back when my (pregnant, schizophrenic, drug abusing, cutting, but not presently suicidal) client was setting herself on fire.

In retrospect, that was too far. This is not how we get what we want.

If a client is admitted, they’re often transferred to a different hospital, particularly if they’re a child. Depending on insurance, this can take forever. Not literally, but just about. There’s a sort of time suspending limbo you enter when you walk into an ER.

One of my teen girls who had attempted suicide more than once wound up being sent to a notoriously unpleasant (to say the least ) psych hospital in Brooklyn. They had an available bed and would accept her despite not having insurance. Her mother was afraid to send her there, and didn’t want her to be two and a half hours away, but she did it because she had no other choice.

I don’t think I need to point out the irony that the mental health system in the Bronx has driven me a bit insane. I’m glad I get to absorb this frustration for the parents I work with, honestly, because I can’t imagine that they could do this on their own while also worrying about everything else going on in their lives. But it’s infuriating to see how difficult it is to get someone help. Are they a danger to themselves or others? Yes, but not enough of a danger. Come back when something tragic happens, so we can all blame the parents for not having done enough.

We are tragically failing our people in need when the only way to get (temporary, kinda-ok) treatment is to be brought in slitting your wrists.

I wish I could end this by offering a solution. All I can say is that we need more, and we need better. Prevention is almost always the answer, says the preventive worker. Maybe if some of those earlier evaluations and mental health treatment could happen, we’d be taking fewer trips to the ER.

But what do I know.

Don’t read this, it’s just a cry for help!

6 10 2011

Recently, at a family party, I was talking with someone whose friend was training to work at a suicide hotline. (This is the normal turn for family parties. Right?) Another guest didn’t care too much for the idea.

“That’s for people who don’t really mean it. I know people who wanted to kill themselves, and they’re dead. If you’re calling the hotline, it’s just a cry for help.”

It’s one of those clichés we’ve all heard. “It’s a cry for help” or “He’s only doing it for attention.” Somehow, these two concepts have been conflated in a dangerous fashion. We all know that if someone, say a two year old, is doing something for attention, say, throwing a tantrum, we should ignore it and go get a margarita.

A “cry for help” is not the same thing wanting attention. It’s a recognition that there is something very wrong going on with someone, something that they can’t handle on their own. It’s a way of reaching out for support and intervention. Some people are able to do this in a constructive way, by calling a hotline or going into the hospital. Plenty of people aren’t able to do this, due to their mental health, cognitive abilities, or other reasons.

So they “act out.” We see it with kids all the time. They’re angry about their parents divorce, so they start skipping school. They’re traumatized from being abused, so they start using drugs. Some people are depressed, and untreated, so they start hurting themselves.

Cutting seems to be the fashionable “cry for help” these days. I’m never one to buy into that hysteria that you see featured on the Today show or Dr. Phil about the latest teen trends–you know, they’re all blowing each other in the school cafeteria and having “pill parties.” I don’t know how they even have time for their pregnancy pacts and school shootings!

But self-mutilation does seem to have caught on. My younger cousins keep my finger on the pulse of all things emo, and it has become something of a rite of passage. Not something that people do all the time. But lots of them seem to have tried it. Everyone has moments of feeling depressed, misunderstood, or crazy in high school. Emo kids strive to have as many of those moments as possible, so it kind of makes sense.

I remember first hearing about “cutting” when I was about 13. It was on an episode of 7th Heaven. (I admit to that, because I feel that I’m in a safe space here.) It was one of those “special episodes,” where one of the eighteen kids brings home a new best friend, who serves only to teach a lesson, and is then never heard from again. They discover that she’s cutting herself, talk about the warning signs (“I should’ve known! She was wearing long sleeves out of season, keeping to herself more, and seemed moody!” Who talks like that?) and send her on her way. I thought it was weird, until I read an article in 17 magazine. (Again, we’re not judging.)

Like all kids at that age, I had my times of feeling down and like things would never get better. An idea that otherwise would never have crossed my mind did, and I cut my finger. I found that it hurt, I still felt down, and I didn’t care for the sight of blood. So that was that.

This has now become a concern due to all the media attention given to teen suicides. Obviously the attention is not to blame for making kids feel bullied or depressed. But is it possible that it’s planting an idea, a more effective cry for help?

Honestly, I don’t know. But I am pretty confident that the answer isn’t going after the media for paying attention to these deaths, or their friends for memorializing them. We should probably be playing closer attention to those early warning signs, so that when the kids finally get that attention they’re looking for, it isn’t too late.

A girl I’ve written about in the past, Angelica, was a cutter. Her mother and I twice brought her to the emergency room, for this and other troubling behaviors. Both times, the doctors told us that this was “attention-seeking behavior” and generally wasn’t serious. I explained, as not hysterically as I could, that I understood this, but did that matter when she was slashing up her arms for some unknown reason?

Apparently it didn’t. Until things escalated and she was hospitalized, where the truth about her rape and abuse came out.

Just because it’s a cliché doesn’t mean it’s entirely wrong. It would seem that a lot of people who attempt suicide don’t really want to die. (A rather popular first thought, upon jumping off the Golden Gate Bridge seems to be, “I wish I hadn’t jumped off this bridge.”) They want help. Obviously this doesn’t mean we should let them jump. “But SJ, it’s just a cry for help! Responding to it will only feed their desire for attention!”

Maybe. Maybe not. But if in their quest for attention they’re going to be crushed and swept away in the waves, or accidentally hit an artery and bleed to death as Bullet for my Valentine (thanks emo cousins!) plays in the background, does it really matter? Where does this idea that we should wait for a genuine desire to die come from? We accept the need to early intervention in seemingly everything else (I mean, not in the sense that we should insure for it, but as a concept) but not for depression.

Wanting help, and even wanting attention, are not bad things. We need to stop acting as though they are.