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Desert Companion

"I swear I will!"

mental_health_final.jpg

Mental Health
Illustration by Michael Waraksa

When my son threatened suicide, I thought help would be a phone call away. Instead, I entered a maze of false hopes and shockingly scant resources

Editor’s note: Because of the sensitivity of this issue, and to protect the identity of the author’s son, we have agreed to her request to remain anonymous.

It was last August when my 16-year-old told me, over the phone, that he was going to kill himself.

“I know exactly how I’ll do it, too,” he said. “I’ll do it at the school, just like—” and he said the name of a friend who’d committed suicide, the previous year.

Although I could plainly hear that he was in the midst of some sort of panic attack, it was the benign circumstances precipitating his threat — he hadn’t received the course schedule he’d wanted for his junior year — that led me to treat it not very seriously.

The overly dramatic reaction of a teenager, I thought, and I told him that his threat was in poor taste and disrespectful to the tragic circumstances of his belated friend. 

His assignment to a general chemistry class, based on his previous year’s math grade, was what had set him off. The tipping point was the school’s refusal to consider that he had repeated his math course in summer school to improve his grade, in order to qualify for chemistry honors. 

“Relax, Bud,” I said, mostly concerned with calming him down — his voice was shaking and his breathing was quick. “I’ll talk to your counselor. You’ll get into chemistry honors.” And I did. And he did.

It was about a month later when he threatened again to kill himself.

I can’t remember what had unraveled him that time, but I do remember that he was promising to hurt himself then and there; and that his father was out of town; and that his younger sister was frightened; and that I, in turn, threatened to call the police.

I explained to my boy, who’d grown both bigger and stronger than I, and who was in a highly erratic state, that once the authorities were involved, it would be out of my hands — the hands that had always protected him.

I watched him process this. And I watched him calm down.

And, still, I didn’t take his threat very seriously. Mostly, because he was so angry. More angry than sad. And as I understood it, depression — not fury — preceded suicide.

He was, I knew, somewhat sad — he called it depression — since his older sister had left for college and his girlfriend’s family had moved out of state. Considering these losses, it was natural that he’d be suffering during the adjustment phase, I thought.

He wanted antidepressants: “Please, Mom,” he said.

Time, I told him, would heal his heart. I wanted him to try exercising first. I wanted him to get off the video games, to get outdoors, to socialize more.         

When he grew even more angry, and defiant, and willful — instead of sad — I thought that I’d encountered the dreaded teenage years parents are forever being warned about. I thought the hormones of a boy developing into a man were to blame. 

“We have to get him under control,” I told my husband. 

Also, I suspected the positive results of his first threat were prompting the others. l thought that in gaining him access to his chemistry honors class, I’d set a precedent — in the way a parent can train a toddler to misbehave in the checkout line by first denying his request for candy, then surrendering to the screams of his tantrum.

So, I responded by laying down the hammer. By demanding more chores. Better grades. I sought politeness and gratitude from this new angsty character in our home. I responded by refusing to be manipulated by hostile threats.

And I was wrong. So utterly wrong. 

Support comes from

 

* * * * *

I didn’t know, then, that depression in teenagers often manifests as anger — knowledge I came upon while consulting experts online to back me up. (“See, video games are bad and exercise can help,” was the ammunition I’d been seeking.)

I also didn’t know that 14 percent of teens suffer at least one major depression, annually, or that 16 percent of high school students have reported to have seriously contemplated suicide.

I didn’t know that, every day, nearly 5,400 American teenagers try to kill themselves. Every day!

I didn’t know that four out of five of these kids attempting suicide first sent out very clear warning signs.

And I certainly didn’t know that suicide is the third leading cause of death among American adolescents between the ages of 12 and 18.  (And in Nevada, the second leading cause of death for 15-19 year-olds.)      

And because I was ignorant of all of this — so much critical information I would learn during the course of his struggle, our struggle — my son’s future threats, his calls for help, escalated into grand and violent conflicts of will. Each more explosive than the last, because we both were so intensely terrified.

He, terrified of being so alone in such a dark place; and of what he might do to himself there.

And me — stupid, stupid me: “You’re not going to kill yourself,” I said back at him, flexing my parental authority (so effective in the past) in the face of his rage, in the face of my fear.

“I will, Mom! I swear I will!”

Later — after doors had been slammed, after the shouting had subsided, once the hot energy had tempered to a lukewarm — I said to my husband, “I swear he’s going to kill himself just to prove to us that he’ll kill himself.”

My voice shook. My hands quivered with my maternal heart. 

It’s unfortunate, I think now, but not surprising, that his depression arrived to coincide with his 16th year, so that I could confuse the two. While wasting so much precious time.

 

* * * * *

By mid-October, not 45 days from his original threat, my son’s grades had plummeted. His weight had plummeted. His confidence had plummeted. So that even a mother in denial could see he truly needed help.

When he said, “I need antidepressants,” I told him, “I know you do.”

I began researching teen psychologists and therapists online. I made calls to those whose therapeutic philosophies matched my own, whose profile photos made them seem both professional and personable, and whose offices were relatively near to our home.

None were returned.

So, I broadened my parameters: I called a woman who specialized with LDS families, although we are not Mormon. I called another who claimed expertise with teens. I called another who hadn’t claimed this specialty, but whose picture seemed to indicate kindness. I called another whose headshot — long blonde hair, made-up eyes, cleavage — screamed Vegas bimbo, but whose bio wasn’t half bad.    

Nothing.  

For three weeks, I left voicemail after voicemail for local therapists, explaining that I was afraid for my teenager who was struggling with depression, but nobody seemed to care.

Then, finally, a voicemail back! However, this highly-qualified psychologist only held office hours on Fridays, and I would retrieve his message on a Saturday morning — which meant another seven days before I could even set up an appointment.

“Mom, help,” my son began texting from school, where his anxieties had spiraled so far out of control that he was hiding out in the boys’ bathroom instead of attending his more nerve-wracking classes. 

I left more messages — tearful and panicked, now. 

“Why is nobody calling me back?” I cried into the voicemail box of my preferred choice from my original list, a woman whose office was close, whose credentials were impressive, and whose maternal face suggested strength and sensitivity. It was my third message to her. “Please, please call me back. Please.”  

The following day, she did. But only to apologize: First, for not returning my previous calls — she was just so busy. Then, for our situation. And, finally, because she wasn’t taking on new patients. She did, however, give me the numbers of two of her colleagues who also had expertise with teenagers.

Neither of them returned my calls.

It was early in November, prior to the Friday when I might reach the one psychologist interested in helping us, that our situation turned dire. I was making plans for our Christmas holidays and I’d texted my son about his vacation preferences. His response set off sirens.

Free of rage or bitterness, now, with only weary resignation, he texted back, “Mom, really? I’m not likely to be here at Christmas.” 

I knew already that he’d researched ways to kill himself. And I knew, from his shouts during our ugliest incidents — that wild chase to the laundry room, the frenzied battle for the bleach he meant to drink — that he’d chosen his preferred method. 

And now, here, a timeline.

“December,” he told me, when I asked, and it suddenly occurred to me that he hadn’t begun his annual lobbying for game systems and the other usual Christmas-list items.

I remember, in that moment, thinking to call a suicide hotline — but it was still November, and so there was no imminent threat. He would come home from school, do or not do his homework, play video games, eat dinner, harass his little sister: This was not a scene of emergency demanding immediate response. He only wanted — needed — not to feel so sad. He only wanted — needed — an appointment with a mental healthcare professional, a prescription, some counseling.

Instead of a suicide hotline, I called one of the mental healthcare hospitals I’d researched, in previous weeks, during my search for help.

After a brief conversation, I was advised to bring him in. 

But … well … there was something lacking in the woman’s voice. Sensitivity? That and the canned marketing of the website: words like beautiful environment and serene surroundings (I’d driven by it — it did not appear serene) juxtaposed with other words, like 58-bed facility, made it all feel fraudulent. Also, substance abuse was the foremost topic of the site, so who would he (who hadn’t yet had his first alcoholic drink, who was by all accounts a really good kid) be rooming with in his dual occupancy room? Undoubtedly, too, I’d seen too many movies, read enough books not to be concerned. And there were those news articles, from not so long ago, about one-way bus tickets and the mentally ill, to further fuel my distrust.

Plus, for God’s sake, he was still holding on. He was still asking for help, for therapy and antidepressants. He wasn’t, I was certain, in requirement of institutionalization.

I got back on the phone. I dialed number after number after number until, at last, a real live voice picked up. This therapist — whose credentials and philosophy didn’t particularly impress me, and whose almost immediate availability raised a red flag — could see us that afternoon.

Of course, we went.

 

* * * * *

By the end of an hour — during which she spoke to my son, my husband and me, simultaneously; then my son, alone; during which she inspected his arms for recent signs of cutting (there were none) — this, the only therapist with time for us, recommended that my son be institutionalized. Immediately.

Not because he actually required institutionalization, she explained, but because he needed meds (her word) and because the only way for him to get him these in any timely fashion — here in Southern Nevada — was to be hospitalized. As an emergency patient in a mental healthcare facility, he would, in accordance with federal law, be evaluated by a psychiatrist within 48 hours and be prescribed the medication that she’d determined he needed and which only a qualified psychiatric professional could prescribe for him.

This, she explained, was the only way to successfully navigate Nevada’s lacking mental healthcare system and save my son’s life.

Failing institutionalization, the state’s severe shortage of child psychiatrists — 45 in total, or 6.79 per 100,000 children, according to a 2016 report published by the American Academy of Child & Adolescent Psychology — meant that he wouldn’t likely secure an appointment (or meds) for another three months.

“Your son doesn’t have three months,” she said.

 Meaning, we were, in fact, already in a deep state of emergency.

Indeed, with the clock ticking at the erratic speed of teen despair, up against the long waiting lists of children seeking psychiatric treatment, our situation had grown instantly critical months earlier, upon the onset of his first suicidal thoughts.

In fact, any Nevada teenager experiencing depression verging on suicidal thinking (16 percent, assuming the national average) who isn’t already in consultation with a psychiatrist, is indeed already at fatal risk.  

“I could call Metro, right now,” said the therapist, apparently feeling the need to drive the point home for my husband and me, who stared dumbly at her, processing the implausibility of what she was saying, the lengths our son would need to go to — institutionalization! — to get a scrip for antidepressants.

This, in 2015? When, according to a 2005-2008 Center for Disease Control and Prevention national health survey, one in 10 Americans older than 12 is using antidepressants, and likely more, these seven years since, considering the drug’s increasing usage rate: It’s up 400 percent since 1988, according to the same survey.

Could a prescription really be so difficult to get?

It turns out: Yes. 

Postponing her next appointment (“An emergency,” she told her waiting patient) the therapist ran down a list of mental hospitals available to us. There were some she didn’t recommend, including the one I’d called that afternoon; she didn’t agree with their treatment methods, she said (making my imagination run wild). Others, which commonly treated juvenile delinquents, wouldn’t be suitable for an upper-middle class boy from Henderson.

“You don’t want to do more harm than good,” she said.

My husband and I nodded in stunned agreement.

Finally, she recommended a newer behavioral healthcare hospital in central Las Vegas.

We could call from her office, she said.

I watched my son’s eyes grow wide with terror while my husband dialed the phone.

Then all three of us breathed a sigh of relief to learn that there were, in fact, no beds currently available.   

In that case, the therapist continued, we should take him immediately to the ER, where he could be held until a bed opened up.

“But, he’s not going to kill himself today,” I said, incredulously. “Are you?” I asked him.

“No.” He shook his head in anxious certainty. His eyes still so big. 

Missing not a beat, she continued in her campaign: As an ER patient, he would earn a priority position in Nevada’s long line of children awaiting beds, psychiatric services, and meds.

This was the way it had to be done, she said.

Instead — seeming confident that she had impressed upon us the severity of our situation — she agreed to release us under the condition that we call again, a few hours later, to learn if a bed had become available, as per the behavioral hospital’s directive, and with the promise that, failing that, we would consider the ER.   

Home again, we all sat down to catch our breath and recover from the assault of the day’s rapid escalation: Five hours earlier, I’d been planning our Christmas holiday and now I was committing my son to a mental institution. On the advice of the only therapist who had time for us? What the hell?!

 

* * * * *

Several hours later, when we called, a bed still had not become available. Nor had one opened, 12 hours after that. Or the day after that. Still, the behavioral hospital’s instructions remained the same: “Try again, later.”

When I asked that my son’s name be put on a waiting list, I was discouraged: “It’s pretty long.” 

“Still,” I said.  

Then — although the therapist had advised against it: “Family doctors just aren’t helpful in these situations” — we turned to my son’s pediatrician. We hoped that she might be able to expedite an appointment with a child psychiatrist, or offer us an alternative solution, or, at the very least, confirm that what the therapist had told us was, in fact, fact. 

It was.

Having heard the details of my son’s condition, his pediatrician was visibly unnerved. “There’s just no help for kids, here,” she said. “They’ve only recently implemented help for adults.” She made a reference to squeaky wheels. She said, “Kids don’t pay taxes. They have no voice in Vegas. You might try California.” 

She suggested a written contract between my son and me, by which he promised not to hurt himself without first reaching out, and to which he agreed while we were in her office — but scoffed at, once we’d returned home. 

Later, having made some calls, she offered us the name of a good Henderson therapist and the phone number of a local child psychiatrist, but she couldn’t make any promises. She told us, again, to consider California.

According to my online research, this psychiatrist was one of the best in Vegas; others had disturbing reviews. I called, immediately and — undeterred by the outgoing message that warned  if the doctor hadn’t returned my call in a timely manner, she wasn’t likely accepting new patients — left yet another pleading voicemail. Then I crossed my fingers. No luck.

I called again.  

Nothing.

 

* * * * *

California’s mental healthcare services for youth is decades in advance of Nevada’s. Where our 58-bed facilities with their private children’s wings recall scenes from disturbing movies set half a century ago, California has a multitude of programs offering care specific to teens and to their individual disorders. The programs take place in comfortable residential settings and cater to small groups of carefully screened admissions, to ensure safety and compatibility. California’s programs are everything I had assumed modern psychiatric therapy would be: In these homelike settings, unlike our Vegas institutions, patients are allowed to keep their shoelaces — to me, a disparity indicative of the vastly different therapy environments and treatment philosophies.

So — in between the calls I continued to make diligently to the local mental health hospital, seeking a bed — I narrowed in on a program I liked for my son, in Malibu.

Reputed to be one of the best in the nation, accredited by The Joint Commission and highly rated by Psychology Today, it would cost us $49,000. (Another we had considered, a provider with our health insurance company, would leave us only $5,000 out-of-pocket: the two ends of the price spectrum, according to my findings.)

“We’ll finance,” my husband said of the Malibu option, and we began the registration process.   

But, because it was a 30-day residency stay (the industry norm) and so far from home, my son was hesitant. He wanted to wait for a bed here; he wanted to try his local options, first.

“Can you call again?” he asked, with increasing frequency.

During this excruciating waiting stage — when we were afraid to leave him home alone, afraid if he shut his bedroom door for too long — I’d determined that, if nothing else, I would love him. As much as I possibly could. While he was still here to love.

It seemed, for a time, the only course of action available to me. And I counseled his father and his sisters, all whom were suffering, too, to do the same. Fear, guilt, anger, frustration: Suicide is, certainly, a lonely, lonely business — but, too, all-inclusive.

“Just love him,” I said, petting his youngest sister’s head.

 

* * * * *

Meanwhile, his condition grew worse.

Weeks later — well past rage and weary desperation — he’d finally grown jaded in his hopelessness. So that, as Thanksgiving approached, when he began to self-mutilate — a steak knife to the delicate white skin of his forearm — he actually found it comical.

“It’s like a trailer to a movie. The teaser for the feature show.” He laughed out loud.

This authentic amusement, his warping perspective, tinged with madness, made our decision to finally take him to the ER. It had grown glaringly evident that we had, at last, run out of time.

But, just as my husband and I were readying for the struggle we knew it would be to get him into the car, I made one last ditch call to the behavioral healthcare hospital.

“Bring him in,” they said, to my incredible surprise. It was because of Thanksgiving that so many beds had been vacated.

“We got lucky,” I said, although lucky was not what I felt.

The admission process amounted to the most wrenching four hours of my entire experience of motherhood, abandoning — it felt like abandonment! — my son in this place. Against my every screaming maternal instinct! But, too, what choice did I have?

After they’d taken his shoes and his clothes (no laces, no hoodies) and lent him a set of nurse’s scrubs, oversized and hanging from his thin frame.

After we’d hugged each other so desperately.

And he, returned now to his compliant self, walked willingly away with a large orderly in matching scrubs, down a hall where a pair of thick industrial doors would open for him, to a world I could only imagine.

Before pulling shut to lock between us.

Four hours later, it was past midnight and I was in his bedroom, touching the items on his dresser, his desk: his comic books; his Rubik’s cube collection (his record is 45 seconds); a newspaper clipping of his fourth-grade self, smiling proudly for the borax crystals he’d made for the school science fair; soccer medallions from before he quit sports; a plastic egg of silly putty; a photo booth strip of him and his girlfriend, being goofy, being serious, kissing; the trophy he’d recently earned for his success with the Speech and Debate team.

I was trying to understand how we’d come to this place; and I was beating myself up for failing him.

Then, “F---ing Vegas,” I said, refusing to bear the responsibility alone.  

Early the next morning — having packed the bag I hadn’t thought to pack the previous evening: a pair of flip-flops (his only shoes without laces), clothes (drawstrings snipped from his pajama bottoms), comic books, his toothbrush — I rose from my restless sleep in order to deliver it to him in advance of 7 a.m., when, according to the daily schedule, he would rise for grooming, showers and morning hygiene.

It was 3 p.m. (before his bag was yet to see its way from the reception desk to the adolescent floor where he awaited it, still wearing the oversized scrubs he’d slept in) when the hospital’s accounting department called seeking payment arrangements, a $1,500 deductible: If I were to compile a list of complaints, I would start here. But, since rare is the patient who stays in such a place and doesn’t have grievances — “It’s worse than prison, Mom. There are kids here who’ve been to juvie (a new word for him) and they say it’s way worse” — I won’t bother.

Suffice it to say that the experience was no better or worse than I imagined: In pajamas and flip-flops, my son spent long hours playing cards — war, mostly — with the other kids, all of whom (except him) had drug addictions or at least drug experience. They lined up daily for medication — antidepressants for my son. They moved to and from the cafeteria in this same single file line, where they ate with plastic utensils; spoons and forks, only. They had escorts to the toilet.    

Some of the staff seemed genuine, like the night nurse with the soothing voice who assured me, when I called that first time, that despite refusing sleeping pills, my son appeared to be resting just fine and to call back, anytime; and the head social worker who led the patients in group therapy sessions, where my son would learn coping skills he still uses today.

Others were as terrible as the movies would have you believe, like a nurse who, when I called one too many times, laughed at my son in front of the other kids, nicknamed him Mama’s Boy. And another who would so roughly manhandle a young autistic child that my son, when he was returned, wanted us to call the authorities. And a therapy leader who began his group session by asking, “Who wants to be here? Well, me neither, so let’s get this over with,” before he embarked on a tirade about taxes and gun control laws, omitting to address therapy whatsoever during the entire hour.

It was Monday when we admitted him. On Thanksgiving Thursday, my son — having grown visibly thinner, still — assured my husband and me, when we asked during a special holiday visiting hour, that he wanted to see his stay through. He felt certain, according to a conversation he’d had with the attending psychiatrist, that he would be discharged the following day.

In order for him to secure an aftercare appointment with an outpatient psychiatrist within 30 days of his hospitalization (an industry ideal, we’ve come to learn, not a regulation or even a norm), we were under the assumption that he needed to see the process through, that he needed to remain hospitalized until such time as his attending physician assessed him fit for discharge. That was the route to a psychiatrist appointment, as we understood it. So, my son meant to do just that — otherwise, what was the point of it all?

He’d come this far, he told us. He could handle another day. (Plus, he wanted to avoid the trip to Malibu that my husband and I were still considering.)

 

* * * * *

Friday evening, he changed his mind: “Mom,” he said, during the phone call he was permitted between 7 and 8 p.m., “can you get me out of here?”

Although he’d been deemed healthy enough for discharge, according to the attending psychiatrist, there was paperwork to be done. And since the office staff wouldn’t return until Monday, he was advised that he would need to hang around for another three days — at a cost of $715 per day (the rate contracted with our insurance provider).

Fortunately, I managed to get the doctor on the phone, nearly immediately, since he was only then making his rounds on the adolescent floor — which, as my son explained, consisted of daily visits, five to 15 minutes in length, pertaining primarily to medication: “Any issues with the drugs?” 

“I don’t know what you’re accusing me of,” the doctor said, when I asked why, if my son was fit to leave, he would need to stay until Monday.

His defensive stance surprised me because I hadn’t accused him of anything. Rather, I was advocating for my son, trying to ascertain if I could have him immediately discharged while still securing an aftercare appointment with a psychiatrist, the appointment that he’d jumped through all the hoops required of Nevada’s mental healthcare system to secure. 

It turns out yes. Or maybe the doctor bent the rules. I can’t be certain.

But an hour later, he was released. Yes, he was still depressed, still suicidal, but, in his hand, a prescription for anti-depressants that would last him 30 days. And, the following week, the hospital called to report that two aftercare appointments had been scheduled: the first with a local therapist, the second with one of Nevada’s high-in-demand child psychiatrists — one with frightful online reviews, but nevertheless. 

If Nevada’s mental healthcare system for youths was only lacking — and not actually fractured — our story would end here. But it doesn’t.

On December 18, the day he was scheduled to finally see the outpatient psychiatrist as part of his discharge plan, the psychiatrist had already left for the Christmas holidays. He was not seeing patients that day, according to his receptionist.

Yes, she confirmed, my son’s name was in the system but, “There must have been a miscommunication. I have no record of an appointment,” she said. And, “There isn’t room in the doctor’s books for several months,” she added.

Meaning that my son would run out of the meds he needed, the meds he suffered institutionalization to earn, two to four weeks short of the time they would normally take to achieve full effect.

Furthermore, the receptionist explained, if we did choose to reschedule, we should not expect couch time (her words). “It’s only med management. Not therapy. People are always surprised.”

 

* * * * *

According to the National Alliance of Mental Illness, 8 percent of youth have anxiety disorders; 10 percent have behavior or conduct disorders; 11 percent have mood disorders; and 20 percent, between the ages of 13 and 18, live with mental health conditions. Despite these numbers and despite the 16 percent of high school students contemplating suicide, the child psychiatrists to whom Nevada’s behavioral healthcare facilities are referring patients seem to only offer medication management.

No couch time with the psychiatrists whom teens are being institutionalized to get to. Only meds. And these, only if one’s appointment wasn’t inevitably lost in the system.

Despite all the odds against us, our story has a happy ending. While the therapist to whom the hospital referred us was not especially compatible with my son, she was able to refer us to a physician’s assistant, in Henderson, who also happens to have psychiatric qualifications which allow her to prescribe antidepressants to patients. (I understand there’s a PA in Summerlin doing the same — prescriptions, without the long wait for a psychiatric appointment or the requirement of institutionalization.)  While this PA wrote my son’s scrips, he sought weekly counseling with the therapist his pediatrician had originally recommended. This therapist, in turn, secured him an appointment with the psychiatrist we weren’t able to access, earlier.   

Having secured dedicated assistance via a series of lucky connections and despite a broken system, he was, for a while, much improved. On his best days, he smiled and laughed in ways I hadn’t seen him do in a long time. I did, too. 

Then spring arrived, bringing with it the painful anniversary of his friend’s suicide to coincide with final exams, and he plummeted again into an anxious and dangerous depression.

It was early on a Sunday in May when we packed his bags for Malibu, where he would stay in a home with six similarly troubled teens, working intensely under a whole team of therapists and psychiatrists specialized in healing adolescents by focusing on the emotional underpinnings of their behavior. A place where, having toured it, I felt confident leaving him — relieved, even: He would not only be safe, I knew, he would be healed.  

When he returned to us a month later, he was stronger, happier, more willing to talk, motivated and empowered — and with an entire toolbox of coping strategies and a new network of understanding friends. He’d learned to be more responsible for himself and his problems. And my husband and I, during the program’s regular family therapy sessions, learned to let him be.

It was a positive, life-changing experience — a life-saving experience! — entirely counter to and decades ahead of the stay he suffered (I’ve considered it, carefully; that’s the right word) in Nevada.

“Why don’t they have anything like that here?” he’s asked me, since.

“Well,” I told him, “we could share your story. See if it makes a difference.”

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