What mental health care is like, or, one was ignored by the cuckoo's nest

A friend of mine was experiencing a relatively severe crisis involving self harm and thoughts of suicide that had progressed to an actual plan a couple nights ago. This person lives with Borderline Personality Disorder and was recently greatly helped by Dialectical Behavioral Therapy, but was unable to continue this therapeutic process after returning to work. Unable to continue because the DBT sessions that are available and covered by insurance are from 10 am to 1 pm, weekdays, guaranteeing that people who are in desperate need of DBT but also in desperate need of income are fucked. There isn't much DBT in the Valley, although there's more now than there used to be. 

Fancy facilities at Banner Behavioral Health, Scottsdale, including, for some reason, squadrons of landscaping plants

Anyway, the crisis was serious enough that I should have called 911, but I didn't. The person going through this was up pretty much all night long, then went into work. At work, people became aware of the crisis and the corporate liability crisis response process started. 

The crisis team that was called in was totally incompetent. Basically. After a lot of nonsense and after this person in distress, whose life was at risk, was escorted through the work place by security and the crisis team and her supervisor in front of many coworkers, the decision was to transport to Community Bridges for an inpatient intake assessment. 

Problem: Community Bridges doesn't do inpatient mental health. Only outpatient. They do inpatient medical detox for junkies and drunks, but not inpatient behavioral health services. So the supposedly trained crisis team sent a person in crisis to a locale where the services needed are not even provided. 

At this point, exhausted and without support, the person decided to get an Uber home. I met up with them and we relaxed for a little while and considered several options. The person indicated not feeling safe being alone, so we either were going to get some people who could be there 24/7 until DBT classes started up again or we were going to go to Banner Behavioral for an inpatient intake. 

I felt the crisis was serious enough that medical attention was warranted and the person agreed, so we went to Banner. 

The daily bed rate at this facility is $2500. There are no typos in that sentence. 

One of the first things a staff member did, before any trained psychiatric personnel interacted with a person having a life threatening crisis, was go over how much being admitted would cost. I understand that it's good to let people know what their financial responsibility will be, but it also seemed callous and not conducive to creating a calming or reassuring context for a person in crisis. Fortunately, my friend has a dark sense of humor and joked that the deductible ($2500) from insurance that would have to be paid made suicide seem like a good idea. The staff member didn't laugh at this, but I did. 

We waited for nearly 4 hours for the assessment process to be completed. The lobby was a dreary place and there were a couple of very seriously disturbed, unsupervised people there, as is fitting for the lobby of a behavioral health hospital, but one of them in particular was acting out in an aggressive way and generally creating an atmosphere of some tension, with hardly any response from staff. The television featured UFC boxing matches, which I thought was strange for the lobby of a behavioral health place. The original intake interviewer rapid fired boilerplate questions aggressively and obviously in a hurry-- the person having the crisis was able to be an advocate and say "You are making me feel uncomfortable and attacked." The response of the staff member was "Sorry! It's a shift change!" 

Anyway, after almost 4 hours, the determination was that the crisis had moderated and the person could either choose to be admitted for observation or go home. It turned out that admission involved a 24 hour observation period in a big open room where several patients were placed on recliners, wearing paper gowns, with a television going 24/7. ($2500 to spend 24 hours in a big room on a recliner and not get any sleep). The person having the crisis was exhausted, hungry and just completely worn out. The wisdom seemed to be to go to the dark quiet privacy of home, after getting some food. 

So we did that. 

So if you trace this sequence of events, you get an idea of how America and a lot of our current culture worldwide deals with (or doesn't deal with) mental health emergencies. This was a person who had engaged in self harm and who had strong suicidal impulses connected with a plan, who did not feel safe alone, who has taken steps to get help for a serious illness. And throughout an entire day, *none* of the people who supposedly function entirely to support people in a crisis were able to come through in any supportive, consistent, effective or helpful way. None. 

Keep in mind also that the behavioral health hospital is located in Scottsdale. Imagine the scene in South Phoenix, or any other already medically under-served area. And when you are out and about, and see the abandoned, lost, forgotten, raging and disoriented people who are everywhere, who do not have friends or family anymore, who are really just treated like human garbage in a society with no compassion and only a profit motive, have a heart. If you are able, get into advocacy for the mentally and emotionally ill. If we consistently ignored and discarded people with physical illnesses, as we do in so many cases with mental illness, we would have had a fundamental health care rebellion long ago.