Military veteran Jason Ramirez has called Ventura’s Cemetery Park home for several nights following his release from Ventura County Medical Center’s Hillmont Psychiatric Hospital. Since discharge from the Marine Corps five years ago, Ramirez has had a difficult time adjusting to civilian life or finding successful employment, which affects his ability to maintain stable housing. Despite his former service, Ramirez does not qualify for veterans medical benefits.
Being overwhelmed by his struggles and feeling abandoned by the government he served, Ramirez began experiencing a depression that he did not feel he could safely pull himself out of, requiring checking himself into the county’s emergency room.
“After hours of sitting in a cold backroom, I was walked across the street to a different building that was just another cold waiting place.” He then explained that his three-day stay primarily consisted of occasional check-ins with staff and watching television.
Ramirez represents one in five adults in the U.S. struggling with a behavioral health illness. In the wake of the loss of several prominent public figures to suicide and others speaking candidly about their own behavioral health struggles, dialogue has been significantly on the rise.
Conversation, however, is not changing the resources, cost or preventative measures.
Since the 1960s, the dwindling number of psychiatric accommodations in the U.S. has given rise to a large increase in mental health-related emergency department visits. Places such as Hillmont Psychiatric Hospital are more of a prevention holding space than an actual care center.
Nearing the end of October, Nicole V. found herself battling self-harming thoughts.
“I walked into the ER because if I didn’t, I was going to kill myself.”
The care provided was not what she expected for someone experiencing a dangerous mental health emergency.
“I saw an MD once and had once-daily sessions with a psychiatrist,” Nicole said. “Those sessions consisted of rating my depression on a scale of 1-10 and asking if I want to hurt myself or anyone else.”
Her stay occurred over a weekend, when therapy is often scaled back in terms of number and quality of sessions.
Calling around to find potential options for someone in need of immediate care, most centers I spoke with primarily support eating disorders or substance-related addictive disorders. Behavioral health services were provided to patients with a dual diagnosis, the condition of suffering from both a mental illness and a substance abuse problem. For many, this leaves ill-equipped emergency rooms as the only option.
For Nicole, whose employer-sponsored insurance does not cover inpatient mental healthcare in any capacity, the financial burden she now faces is overwhelming, making her feel even more hopeless than before seeking help.
The most crucial key in behavioral health care is crisis prevention. Aside from suicide prevention hotlines, Ventura County Behavioral Health provides outpatient services to registered adults at clinics located throughout Ventura County, but it can take months for individuals on non-emergency wait lists to access these services. Once in the program a patient can receive monthly or bimonthly visits with a psychiatrist for prescription medication, and the option to sit with a therapist as needed. The primary encouraged treatment is group meetings or group recreational activities.
Ventura resident and successful small business owner Robin F. inquired about an appointment with local services after a death in her family became emotionally too difficult to manage.
“I wasn’t a harm to myself or anyone else. But my depression was really low and I didn’t want to get to that place,” she said. Yet, making such a call or visiting a clinic can lead to the possibility of a 72-hour involuntary detention (5150) in a psychiatric hospital, which is exactly what happened to Robin F. “That was the last time I will ever ask for help. It’s not fair I got held because I was being responsible in my care and asking for information.”
Robin experienced similar inpatient care to the others who I spoke to with.
“There is a big room in the back of the ER at VCMC with chairs and a desk across the way with police. I was the only woman in the room with three men. Two were from the local jail with sheriff escorts. The other man was filthy and in a gown that was not covering everything.”
After three hours of sitting in the ER, she was placed in a wheelchair and transported to Hillmont. “It was me with a couple guys. There was no structure, people just wandering around the single short hall. Staff stayed in the nurse’s station and talked to one another.”
While lying scared in her chilled dark room on a crude resemblance of a hospital cot, Robin said all she could do was think. “I don’t know what they expect. If I didn’t want to die before, I did in that horrible room.” Not all persons who admit to depression are suicidal, and treating them as a suicide risk can be more harmful than helpful.
Of those I spoke with, all felt regret in seeking help.
“I left feeling worse than when I went in and had no real follow-up plan. I was given some suicide phone numbers and told to follow up with county,” said Jason R., who also told me that he currently does not have a working cellphone, making hotlines useless.
There seems to be a severe lack of preventative services and the care feels like punishment once a crisis occurs. If those seeking help run risks of being placed on an involuntary hold in a center that cannot provide care and will result in a substantial medical bill that they can’t afford, are we offering actual help or are we giving good cause for those in need to avoid seeking treatment and assistance?
Reality Check is a new column that will run periodically to shine a light on systemic failures in a variety of arenas that were created and designed to help, but often do not. If you would like your story to be considered for a future column, email firstname.lastname@example.org.