“Hello darkness, my old friend. I’ve come to talk to you again. . .” The Sound of Silence by Simon and Garfunkel
On August 20, 2016, I posted the following comment on Facebook:
“I need to confess a recurring thought that has troubled me all day and into the night. It is stopping me from sleeping. Confession holds me accountable for taking care of myself. My confession will terrify and worry several of you. But I need you to trust me enough not to freak out. Please don't tell me that my life is worth everything. I know that. Don't call the police, or my parents, or the Netcare Access Van. Please don't show up on my doorstep. I just need to confess because stuffing my secret thoughts deep inside only feeds the insanity of wanting to harm myself. So here it goes. I am overwhelmed with depression. Though it does not happen everyday anymore right now I just want to lay down and die.”
In 2013, when I finally emerged from a seven year slog out of my last depression pit, I vowed to never allow dark thoughts of suicide to hold my mind hostage again. So, last August while immersed in a full-blown depression crisis I decided to write my suicidal thoughts out loud on Facebook. I did not want these thoughts to become imbedded in my mind. I do not want death to begin stalking me daily as she did for many, many years. Writing my depression out loud holds me accountable for zealously guarding my mental health. It also freed up the space I needed to identify the source of my seemingly sudden depression crisis.
My depression crisis was a red flag signaling that I was out of balance. The question was how and where? Was I overly tired or more stressed than usual? Had I overindulged in too many sweets or processed foods? Did I need a respite from the nonstop merry-go-round that is my life as a solo mom? Had my biochemistry changed making my current antidepressant regimen ineffective? My antidepressant medications had not been evaluated since my now former psychiatrist retired four years ago. Four years is an eternity in the world of antidepressants. Eventually, I identified my antidepressant regimen as the probable source of my crisis.
Over the last four years, I have searched in vain for another psychiatrist or advanced nurse practitioner to manage and evaluate my medications. Every clinic and practice that I called told me that they were not accepting new patients. Why? Because there is a chronic shortage of psychiatrists across the United States that continues to worsen as the need for mental health services increases.
The United States Department of Health and Human Services, Health Resources and Services Administration has identified 4,000 communities across the country with a ratio of one psychiatrist for every 30,000 people. These 4,000 communities need roughly 2,800 psychiatrists to eliminate the shortage of mental health professionals. The factors contributing to this shortage include an aging profession where 59% of psychiatrists are 55 or older. Statistics also reveal that between 1995 and 2013 the number of psychiatrists only rose 12 percent while the U.S. population increased by 37 percent. Additionally, because of the Affordable Care Act, commonly known as Obamacare, more Americans are now eligible for mental health coverage. Inadequate pay, cumbersome insurance plans, and psychiatrists who only accept cash are all contributing factors. Finally, the fear, stigma and shame surrounding mental illness causes some medical students to view the field of psychiatry unfavorably.
In my own case, the sudden onset of my depression crisis shook me to the core. I could no longer allow the dearth of mental health professionals to impede my search for a new psychiatrist. So once again I returned to and started working through my list of clinics and mental health practices only to be turned away because there was still no room at the proverbial inn. One clinic reported receiving between 35 and 45 calls daily from those seeking medication management. The intake professional at that clinic was horrified when I told her that my antidepressants had not been evaluated for four years. I then called two psychiatrists one of whom is a childhood friend for recommendations. She told me about one psychiatry practice with a waiting list of 600 people. A waiting list of 600 people is not a waiting list.
I knew that a psychiatrist would evaluate me if I went to the emergency room. However, the question was at what cost. The price of seeing a psychiatrist in an emergency room raises the specter of a 72 hour hold. In short, I could be placed on an emergency 72 hour hold, meaning involuntarily committed to a psychiatric facility, if hospital officials determine that I am a danger to myself or others. For a solo mom parenting alone with no one to care for my children, an involuntary 72 hour hold is simply not a viable option. Most importantly, an involuntary commitment of any length is overkill for someone in need of medication management. Though not the focus of this post, suggestions for resolving the nationwide shortage of psychiatrists include intensive outpatient treatment, tele-psychiatry to evaluate patients via video across wider regions of the country and allowing mental health practitioners to work collaboratively with traditional healthcare providers.
After two weeks spent culling through the list of mental health providers, I was able to schedule an appointment with an advanced nurse practitioner in a practice located two hours south of where I live. Seeing her would involve driving two hours each way after a full day of work. Such an arrangement is just not sustainable. Eventually, my insurer found a psychiatrist in my community who is accepting new patients. That said finding a new psychiatrist is only the beginning. Now my new psychiatrist and I must find a medication regimen that effectively treats my depression.
Finding a psychiatrist in the midst of my depression crisis has been extremely overwhelming. But, protecting my mental health requires that I soldier on. Living in the darkness and silence that is the hallmark of my depression is no longer an option.
My mantra for living with depression is #noapology #noretreat #nosurrender