Filling in the Cracks: The Fight for Mental Health

Jun 11, 2014, 3:11 PM, Posted by Beth Toner

In December 2009, I found myself in a narrow, cramped waiting room that looked, via one small window, into the locked psychiatric unit of a suburban Pennsylvania community hospital. On the other side was my oldest son, just a week shy of his 17th birthday. He was clad only in a thin hospital gown, perched in a wheelchair that was outfitted for restraints—although he wasn’t restrained. He looked tired, frightened, and overwhelmed. My husband, his stepfather, sat next to me as we waited for answers. Tears sprang to my eyes. Could my son—and our family—find our way back?

That moment was the culmination of six months of escalating anxiety and mood swings in my son’s life. He had always been, from a very young age, an intense child: bright, intensely focused, and articulate—which occasionally manifested itself in stubbornness and a reluctance to back down from an argument. But the fall of his junior year of high school had proved to be something very different. Suddenly, his occasional anxiety multiplied exponentially, completely out of proportion to the stressors in his life. Ten-point assignments in an advanced placement bio class turned into all-night crying and screaming sessions that ended with him sitting in a corner sobbing—and us all exhausted and at wit’s end. We tried therapy, with minimal effect. His school guidance counselor, not really understanding the depth of Wesley’s despair, encouraged him to “tough it out.”

Which finally led us, one bleak December day, to a community hospital emergency room to ask for a psychiatric evaluation. I wasn’t uninformed; I was, at the time, a second-year nursing student who had just come off a psych rotation. But I was ill-equipped to deal with our system’s mental health shortcomings when it came to my own child. The emergency room attending physician was dismissive: “Sounds to me like you just have trouble prioritizing, son,” he told Wesley—and then signed an order to transfer him to the inpatient unit “for evaluation.” I was furious, sad, panicked, worried, and uncertain.

Our story has a happy ending. Despite fragmented and inconsistent partial inpatient psychiatric treatment from aforementioned hospital—including care provided by a therapist and a psychiatrist who never once consulted with each other about Wesley’s case—my son is thriving. We found a psychiatrist who understood the unique challenges adolescents face when it comes to mental health—and found a combination of the right medication and talk therapy to help him cope. While he will always be conscious of his mental health challenges—and there will certainly be ups and downs along the way—my son is making his way in the world. When I asked him if I could share his story publicly, he said “Of course. I hope what I went through can help others.”

We are among the lucky ones.

On May 29, I attended the 2014 Health Summit—presented by the Lancaster County (PA) Business Group on Health and the Lancaster Health Improvement Partnership. At the summit—which was supported, in part, by an RWJF community health implementation grant (part of the County Health Rankings and Roadmaps collaboration with the National Business Coalition on Health)—a wide range of community stakeholders discussed the many challenges they face in integrating mental and physical health in Lancaster County.

Keynote speaker Paul Keckley, a health industry analyst and policy expert, talked about his own son’s struggle with mental illness. “We need to develop the mindset that mental health is a medical problem that can be treated,” he said—and pointed out that primary care providers often don’t know where to start when it comes to treating mental illness. His argument? Mental illness—and the fight for mental health—must be addressed first within the community.

A panel of community stakeholders—including representatives from schools, psychiatry, business and law enforcement—agreed. They highlighted the struggles they face in helping their communities connect mental health to physical health: fragmented care and lack of understanding about the prevalence of mental illness, as well as its treatments.

And, in an unusual take on a SWOT (Strengths/Weaknesses/Opportunities/Threats) analysis of mental health in Lancaster County, attendees texted words for each category to a predetermined number. From those words, conference organizers displayed word clouds—updated regularly—that showed the frequency of words that were mentioned in each category. The one word that figured prominently in all four categories? “Provider.” When it came to weaknesses and threats, “stigma” was a key concern.

The summit in Lancaster County was a first step of many toward improving mental health in this Pennsylvania county; there will be many more discussions. As I walked away from this event, I reflected on the lessons that had been reinforced for me:

  • When it comes to measures and metrics around health, we need better indicators for mental health. (This year, for the first time, the County Health Rankings included a measure that included mental health providers.)
  • We need to increase primary provider awareness of—and capacity for managing—mental illness.
  • Despite many good-faith efforts to reduce it, the stigma surrounding mental illness remains a key obstacle to early and effective treatment. Yet, the more we talk about mental illness openly, the faster this stigma will disappear.
  • We cannot separate mental health from physical health—or the health of our families and communities. Mental health is an integral part of healthy communities.

I am grateful my son has the tools he needs to manage his mental health and live a life that now successfully balances moments of great struggle with moments of great joy. My hope is that our work in this area will advance in a way that creates more stories like my son’s.

While we have indeed come a long way in the way we think about mental health, we have a long way to go.