By Crystal Defatte
I went to my psychiatrist today, just a normal check in to let her know my meds are working fine. I was waiting in the lobby, minding my own business, when two women frantically came in. One of the women explained to the receptionist that her daughter was in the middle of a nervous breakdown and needed to be seen. I couldn’t help but to listen in; I knew where this was going but I hoped that I was wrong.
The receptionist asked if her daughter had an appointment. The woman replied that she did not. The receptionist asked if she’d ever been seen there before and my heart sank as I heard the woman say no. The receptionist then told her what I knew she’d tell her, that she could set up an appointment but in the meantime she’d have to go to the emergency room. The first available appointment was in April. Five months away. April.
But hey, she can go to the emergency room and get help there, right? Wrong. An emergency room physician won’t prescribe psychiatric medications because a patient has to be regularly seen in order to monitor for side effects and medicinal efficacy. I know this because I was this woman, less than a year ago.
I moved to Iowa the weekend after Thanksgiving. I had just seen my psychiatrist and had enough of my medication to last me through December. When we moved my partner was a full time student at Palmer Chiropractic School and wasn’t working and I had no job set up yet so we had to get on Medicaid, at least until I could find work. It took until the middle of December to get on Medicaid. At the beginning of January I called my psychiatrist in Wisconsin so she could send in a refill for my medication, but I quickly learned that Iowa Medicaid wouldn’t pay for my meds because the prescription was written by an out of state doctor. I started to panic, but I figured now that I was insured I’d be able to get a doctor here and have my meds within a couple of weeks. Surely I could survive that long without them.
Then I learned that Iowa was going through Medicaid privatization, and it was going to mess with everyone’s billing. They wouldn’t even look at scheduling anyone new who was on Medicaid until after the switch over in March. The first available appointment after that was in June.
Within a couple of weeks I felt myself begin to crack. The feelings of despair and isolation that come with the territory of being bipolar came creeping in like a dark fog slowly engulfing me. The panic that comes with my anxiety disorder made me feel like I wanted to jump out of my skin. My personality disorder made me feel like the only way to deal was to harm myself. I was losing myself to diseases I came by honestly; that perfect storm of screwed up genetics and the kinds of childhood trauma they make tragic Lifetime movies about.
After dozens of calls I was able to find a counselor who would take me on February first. She couldn’t prescribe meds though and without them talk therapy wasn’t enough. She suggested I go to the emergency room, the very same advice the woman today was given, and I did. That’s when I learned they wouldn’t prescribe my meds either.
Dealing with mental illness while in crisis mode is like hanging off a cliff. You want to hold on. You know you’re minutes away from dying as you feel the mental equivalent of your arms starting to shake from fatigue. You’d do anything to pull yourself up but it feels impossible. Eventually you feel like the best idea is to just let go.
That’s when I started researching the most painless way to die. I don’t want to give anyone ideas, but it turns out the best option was helium toxicity, and I started to research the right grade of helium and where I could order a tank from. Before ordering I frantically called the psychiatrist’s office and tried to get an earlier appointment. I was crying hysterically while begging to be seen. Unfortunately with the shortage of psychiatrists in Iowa, there was nothing that could be done.
In a perfect world I could have gotten a bed at a mental health institution, prescribed meds there, and be held until I could be stabilized. Except in the world of Governor Branstad’s war on the mentally ill, beds at institutions were already scarce (for example, out of the 78 beds in the facility in Mt Pleasant only nine were allocated for acute psychiatric patients) and are even scarcer now due to Branstad closing two of the four mental health facilities in Iowa just this month. To justify the closures, Branstad noted that a consultant hired by the state in 2009 recommended closing the institutes at Clarinda and Mount Pleasant. A separate state task force disagreed, however, saying that none of the institutions should be closed until suitable alternatives in the community were set up and running. But Branstad said that there are alternatives at the University of Iowa and within community mental health programs. He also noted that state prisons and other facilities at the Mount Pleasant and Clarinda state campuses would remain in operation. (Petrowski) Even before the closures occurred there was obviously a lack of suitable alternatives, and now this woman I heard of today would be even more hard pressed to find the help she needs. Then again, she can always get herself sent to prison if she really needs help.
According to the National Alliance on Mental Illness, 4.1 percent of Iowans — or about 123,000 people — have a serious mental illness. A 2015 report indicated that Iowa ranked 47th nationally for its general fund spending on mental health services. (Boshart) Branstad has said in the past that he’s even open to closing the remaining two mental health facilities, yet the governor claims to care about reforming the mental health system here. If we can’t be treated in a doctor’s office, an emergency room, or a mental health institution, what are we supposed to do besides fall off that proverbial cliff?
Obviously my story has a happy ending. My counselor was able to label me a critical patient and fight for me to get into the psychiatrist’s office sooner. The same provider that told me (while I cried and begged) that I couldn’t be seen until June suddenly could see me by the middle of February. This gave me renewed strength to hold on long enough to get my medications and wait for them to kick in again, and I am once more a relatively functional human being.
I hope the woman I heard of today finds someone to advocate for her the way my counselor advocated for me, because if her mental breakdown is anything like mine, she won’t make it until April. Her blood and the blood of others like her who won’t be able to find help in time in a mental health system devoid of funding and providers will be on the hands of Governor Branstad. I hope it keeps him up at night.
Boshart, Rod. Globe Gazette. 30 July 2015. 17 November 2016 <http://globegazette.com/news/iowa/branstad-urged-to-keep-iowa-mental-health-institutes-open/article_63ff0c72-17c5-59b1-ac1a-e6aa0222c548.html>.
Petrowski, William. The Des Moines Register. 26 January 2015. 17 November 2016 <http://www.desmoinesregister.com/story/news/2015/01/26/branstad-mental-health-iowa/22352287/>.