Last week provided two grim case studies in how fans, friends and family react to the suicides of beloved celebrities. It also provided a view into something far more obscure: the insights of mental health workers who are on the front line of America’s suicide crisis.
As news of Kate Spade and Anthony Bourdain’s suicides emerged last week, mental health workers took to The New York Times’s comment section to describe what the crisis looks like to them.
Some talked about how they have reacted to the depression and suicide of their own friends or patients. Others explained the obstacles mental health workers face in trying to do their jobs.
Here is a selection of the comments condensed and lightly edited.
‘A patient of mine took her life’
TheraP, the Midwest
A patient of mine took her life two weeks to the day before 9/11. I felt “destroyed” for a very long time — even though I debriefed with many colleagues and had literally consulted with a few of them a week or so before her death.
People feel they should have done something. Or known. There’s either a sense of collective guilt or an effort to deny any guilt and place blame instead.
If anyone reaches out to you who is suicidal, don’t be afraid to call the police if you’re feeling helpless to get them to get help. Or if they’re depressed, don’t be afraid to ask if they’ve considered harming themselves.
But in the end, people have even committed suicide on psychiatric units. In the end it’s a tragic and lonely choice. In end they’re gone and you’re left with all the emotions.
‘Only the absolute sickest patients were prioritized’
Carolyn, Los Angeles
I’m a licensed therapist who worked for a major health insurance company for nine months in 2007, on their crisis hotline. I will never forget the way members with H.M.O.s were treated vs. members with P.P.O.s.
In the case of a P.P.O., where the insurance company was not going to make any money off the crisis, authorizations for psychiatric hospitalization were granted liberally, a week at a time, with no reviews necessary.
However, if a member had an H.M.O., the insurance company had to pay directly for all the services and for every night spent at the hospital. So the sooner the member got out of the hospital, the more money the insurance company retained/earned.
Therefore, severely ill patients were given stingy authorizations, 24 hours at a time, with an extensive, 30- to 60-minute review required every single day in order to extend the authorization another 24 hours.
These reviews were time consuming and inevitably humiliating to the hospital doctors and staff, who had to account for every tiny aspect of their treatment, and be told by insurance company bureaucrats what treatment approaches they could and could not take.
The hospital staff could not devote their entire day to reviews, therefore only the absolute sickest patients were prioritized.
I only lasted in this dressed-up, immoral environment for nine months, but I appreciate the education and will never get an H.M.O. if I can help it.
‘Physicians and ‘prescribers’ do not know
the correct dosing regimens’
Greeley Miklashek, M.D., Spring Green, Wis.
As a retired psychiatrist, I spent 41 years attempting to redirect my patients (25,000) away from self-destruction and toward meaningful lives.
In that process, I wrote 1,000,000 prescriptions and found the correct psychopharmacological combinations to restore normal mood without side effects.
The vast majority of physicians and “prescribers” do not know the correct dosing regimens, and the drugs they prescribe according to the Big Pharma guidelines actually make patients feel worse, sometimes resulting in utter despair and suicide.
To my knowledge, I never lost a patient to suicide. I thank God for that!
‘The very worst of it is watching my clients suffer without mercy’
As a mental health worker, the conditions under which people have to suffer prolonged difficulty accessing and affording services is enough to make me suicidal.
I’ve suffered several burnouts over the years, working many pro bono hours, years with no raises, no retirement or benefits as a contract worker after 22 years in a field that gave me one raise, which was taken back a few years later due to our state’s perennial budget crisis.
Teachers have a union. There are no options for master’s level licensed clinicians, who continue to be paid far less than chronically underpaid teachers.
But the very worst of it is watching my clients suffer without mercy, the foot of the state on their collective neck as they wait for the next whack job on their ability to care for themselves and their hopes dim for recovery and for a life worth living.
‘Perhaps we need a national program called
‘Lean on Me’’
This country is in a crisis. As a physician, I find myself talking to countless young adults about suicide. I call it the ‘new autism’ because of the sheer increase in the numbers of teenagers expressing suicidal thoughts, sadness and depression.
Perhaps we need a national program called “Lean on Me” that is available in schools, emergency rooms and places of employment. Trained individuals with a “Door Always Open” policy can be available via phone or in person.
To honor Mr. Bourdain, a voluntary donation at restaurants around the country can be attached to the bill to pay for the program.
‘Stop referring to the ‘mental health system’ in this country’
Patricia Veech, Santa Fe, N.M.
As a mental health therapist who has been practicing for 26 years, I appreciate the attention that the recent celebrity suicides have been given by journalists. I believe it is important to shed a light on this issue and that talking about difficult subjects is crucial.
What I sincerely wish, however, is that journalists would stop referring to the “mental health system” in this country. This is the United States, not Canada or the U.K. There is no “system.”
There are only providers: some individual and some groups. But the idea that there is an established, organized “system” of care is simply incorrect.
Is help available? Yes. If you have health insurance and can locate a provider who will see you, then help is available. But please stop alluding to a “system” of mental health care in this country. It simply does not exist.
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