I have no doubt that many other states have the same or similar issues when it comes to navigating the mental health system, but I have to say Arizona is pretty bad! While I am certainly grateful for the treatment and care I have received it certainly has not been an easy journey. There are definitely good points and things that are done very well, but it seems that it doesn't take much of the crappy stuff to outweigh the positives. Things go pretty smoothly, I'd say, when you are in crisis and need immediate help. There are resources available that I don't thing most people are even aware of. I've been blessed in that one of my best friends just happens to be a psychiatric social worker and, at my darkest hour, knew just what to do and who to call. If it weren't for her I'm not sure I would have had any idea who to reach out to or where to turn. Now that I'm no longer in crisis mode, however, things just keep getting harder and harder. I'm being tenacious and forging ahead, don't get me wrong, but it's unbelievable how many road blocks keep popping up here and there. It's maddening to the point that if you didn't have a serious mental health issue when you began, you definitely might by the time you're half way through!
The first major negative involves the intake process for inpatient care. The process is set up in such a way that prior to admission you must go through an observation period. Having been at two separate facilities as I began my journey, and getting feedback from other patients, it's pretty much the same at all locations with some being better than others of course. This observation stay includes being in a holding area that feels much like what general population appears to be in prison, much like you see on that MSNBC program Lockup. There is a central section with about fifty hospital furniture style recliners that aren't comfortable even on the best day. Each patient is required to wear matching paper scrubs and given a blanket and pillow. Staff observes from a glassed in room and there are only one or two "techs" with less than a warm and fuzzy demeanor kind of barking orders at patients. There is very little, if any, interaction with a doctor or counselor at all during this time. I was in this environment for fourteen hours, but many fellow patients reported being there for up to five days. I just couldn't imagine that! In my humble opinion this is not the best environment for someone who is experiencing some form or mental health crisis. It is frankly a very frightening experience, especially not knowing what would be next. This is one of the reasons I lovingly referred to this period as being in the snake pit. Once you get fully admitted it's a completely different world and, at least for me, the care and treatment was excellent for the duration of my stay.
The inpatient staff, including the doctors and case managers, do an incredible job of preparing a patient for discharge and hopefully a smooth transition to outpatient follow up. Appointments were scheduled for me with various providers and I was enrolled in the intensive outpatient program prior to setting one foot outside of the hospital. Needless to say I was expecting things from there to go smoothly. Well, not so fast there buckaroo, the road blocks are just beginning. Getting set up for the outpatient group did turn out to be very easy and straightforward, but not so when it came to finding an outpatient psychiatrist and individual counselor. Two full weeks out and I still haven't gotten established with either one. I've been through three unsuccessful scheduled appointments that never actually took place for one reason or another. Since I am not an evil or vindictive person, though some may disagree with that, I am not going to bash any particular provider here, although I certainly could! I haven't even been able to get a return phone call from any of the individual therapists I've left messages with so that remains to be completed as well. Providers that are listed with my insurance either no longer participate, are not accepting new patients, or in at least one case they don't even exist. I've had to lean on my primary care doctor for an additional month's worth of medication to allow me extra time to get established with someone ... anyone!
Now I feel like I'm one of the lucky few that does have excellent insurance benefits, and you'd think that providers would be fighting over me since their reimbursement would be not only better than medicaid, but also pretty much guaranteed. I guess that's just not the case though. If I didn't have the strong support system established with friends and family, I think I would have ended up right back where I started and would have given up completely. I know it will all work out somehow, but I cannot help but conclude that the mental health system in general is woefully inadequate, horrifically underfunded, and desperately limited in both providers and inpatient beds available to meet the overwhelming and genuine needs that exist. I guess that is an obvious and rhetorical statement and I don't think the general population gives it much thought either, until of course some crazed gunman goes on a rampage or they are in need of services and find out first hand what it's truly like. At best it has been a truly challenging test of patience for me and I can see that it is going to require tenacity on my part to assure I get the care and treatment I need. God help those who don't have an adequate support system, if they have one at all. And for those without any benefits or economic means, well they are just pretty much fucked. I can only hope and pray that more emphasis and increased resources are eventually applied to the issue. There just has to be a better way!
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