I shifted my gaze from the Zoom screen on my phone to the timestamp in the corner of my desktop screen, which my phone was propped against.
9:16 am.
Sixteen minutes.
“Is that your final decision?”
“It is.”
And with that, I tap “Leave”, hanging up on my psychiatric practitioner. Moving to my desktop, I punch in the web address for the popular online psychiatry website that I had signed up for. First, I found the messaging portal. “I need treatment. Let me know if you decide to be a treatment provider and listen to who I am as a person, and not a pill mill.” I hit send, navigate to billing, and cancel my plan.
I know I was rude, but I don’t care. The amount of God-like power the nurse practitioner wielded over me in just sixteen minutes was disturbing. My almost-ended life was balanced in her hands, and the entire sum of our conversation was a standardized questionnaire. No dialogue about what I was experiencing or what I had done, no communication about which medications have worked for this type or that type, no conversation about life circumstances and their impact. Just pills.
About six months before that unhelpful call, I started to notice the sinking feeling of dread I am all too familiar with. Major Depressive Disorder first disrupted my life in 2014, staying well past its welcome into 2017. In the six years between episodes, I had shorter bouts of depression, but spent the in-between battling an onset of anxiety and panic attacks. It was still Hell, but with better graphics.
This time, I noticed the feeling this time the way someone picks up on an unpleasant but familiar smell. “What is that?” you’d ask, sniffing around with your nose scrunched up against the offending odor. The depression slowly seeped in, at first mildly unpleasant yet very faint, getting stronger until the stench was overpowering. By the time I realized where the smell was coming from, the problem had polluted almost every corner of my life.
(Almost, because I’d still end up losing so much more as the sadness eroded parts of my life that felt indestructible. Spoiler alert; they weren’t.)
Despite their accessibility, signing up with a virtual psychiatric provider wasn’t my first choice. My past is more complicated than most, a statement of fact, not pride. The idea of ending up with medication-induced diabetes and a low sex drive all on the hope that the shot-in-the-dark medication would make me less suicidal wasn’t any more appealing than what I was dealing with. I wanted, and needed, someone I could cultivate a relationship with that would take the time to stand at all corners of the problem with me and help me make sense of it. And, that’s exactly what I would have done, had I been able to find a reputable provider that treated adults, was accepting new patients, and had an opening less than three months out.
It wasn’t until after the second plan I made to end my life five months after the onset of the depression that I caved and signed up for the web-based psychiatry service. Like Mario hopping up over and over again to pelt the pixelated dragon with fireballs, I finally figured out that the only way to defeat the beast was to come at it with everything I had, from every angle. By then, I was already enrolled in a psychedelic therapy program (more on that in another post) and while it was having a significant impact, I was having an even more significant crisis. Backed into a corner, I did the only thing I knew how to do in that situation; come out swinging with everything I’ve got.
Up to and including psychiatric medications.
Conventional antidepressants have saved millions of lives since the first plastic bottle was passed over a pharmacy counter and into the desperate hand of a suffering person. These medications have done wonders to improve the quality of life for those of us who struggle with mental health issues, and the world is better for having them exist.
But, to ignore the consequences of using them as a panacea for everyone's woes is reckless, if not wilfully harmful. Most medications take weeks to kick in and are often the start of a duck-duck-goose game of different prescriptions until one finally works. After the “just right” pill is found, the side effects begin; weight gain, stomach issues, and low libidos being just the most popular of the complaints. All this is rounded off with the very real possibility of not being able to come off the medications easily, without risk of seizure or a psychotic break.
As if those considerations weren’t discouraging enough, the entire experience of receiving mental health care became comedic when I learned that the person diagnosing me and the person treating me were not the same: A psychologist is a person who figures out what’s wrong with you, and a psychiatrist decides how to treat it. Except in rare and sophisticated settings, it’s unlikely that a patient could reasonably receive both services by communicating with colleagues in the same practice.
The insanity is staggering. (Pun not intended.)
By the time I had wrapped my mind around my care options, I had a carefully designed end-of-life plan and relentless desperation north of several days. The only benefit of brushing up that close to my own mortality was that I had relinquished all hold on any ideas I had about what my life would be like after, and that if I truly was going to follow through with my plan, there was no harm in a last-ditch effort. I signed up.
(To be fair, it did save my life. The one-more-try approach, by itself, stalled me long enough to continue my other treatments, which began to take effect and give me slivers of hope. For those who have or will ever come that close, just give it one more try. Maybe it will work, or maybe it will buy you time for something else to work. You’ve got nothing to lose - give it one more try.)
On the morning of my appointment, I sat at my desk five minutes early, turned on my good webcam with the built-in ring light, and logged into Zoom. Almost twenty minutes later, I closed out the meeting window while hot, salty tears splashed down furiously onto my shirt. My provider no-called, no-showed.
Although I had reached out to the Customer Service center immediately, it wasn’t until four days later that someone returned my messages. By then, my furious anger had bloomed into rage. It was, and remains, unfathomable to me that a service built on the needs of emotionally compromised people would not only have a provider who failed to turn up for an appointment but then take in excess of 72 hours to acknowledge it.
When my messages were finally returned, I was assigned another provider and sent a link to schedule another visit.
My second provider was an improvement in that she did show up for our appointment, thankfully. I felt the flutter of optimism play against my ribcage at the start of our appointment. Just knowing I was about to meet with a psychiatric practitioner did wonders for my mood in that moment. My heart quickly sank right back down as she began asking me questions I had taken the time to answer, in detail during my intake.
These questions would be the same preformatted questions I’d have to answer both in writing and verbally at the start of every appointment. As a small business owner, I fully appreciate the systematic performative tasks associated with positive outcomes. However, within those performative tasks is a vast amount of personal interpretation and autonomy. To hold the container itself with no regard to its contents is a disservice.
(Note: Wanting to stop feeling a certain way and wanting to die are not the same thing. I wanted help to stop the feelings that were making me want to die. The difference is very important.)
My third and final conversation with that provider came a little after 4:00 AM on a Monday morning. I had taken the assessment prompted by the app, and in my honesty landed on suicide watch for a third time. That it triggered a response from my provider wasn’t a problem - the fact that the response came more than twelve hours after I submitted my assessment was. My provider called me the next morning, at 4:00 AM, to follow up.
“You know it’s barely four in the morning, right? What were you going to do if I didn’t answer?”
“Yes, Amelia, I know. I still have to call.” We had a brief conversation in which we talked about the results from the assessment as well as what I was doing right at that moment - which, given the hour, happened to be journaling and meditating. A few minutes later, we hung up, I finished journaling and pressed play on a guided meditation.
The quiet settling was just starting to slow my breath when the sound of my guide’s voice cut off. That only happens when someone is calling, so I picked up the anonymous number knowing full well it must be related given the hour.
LVMPD was on the other line, having received a call from my provider. I was safe, sane, sober, and not armed. I explained all of this to the dispatcher, including how the form I completed that triggered the suicide watch was done hours ago and that in the moment, I really was just meditating. Despite not needing immediate intervention, I did understand the liability and reasons for calling the local police. Having that taken care of, I resumed my meditation, got up, and started dressing for the gym.
I was halfway into wiggling into my skin-tight leggings when a BOOM BOOM BOOM rang through the house, terrifying me. I ripped the leggings the rest of the way on and bolted downstairs to find two cops and two cruisers outside my door.
The entire experience was terrifying, poorly timed, and automatic.
Instead of feeling protected and safe, I was left with a choice; either I start lying on my assessments and don’t get the help I need, or I tell the truth and get intimidated and afraid.
Once the police left, I hopped into the app and requested to switch providers. Everything about the experience was so mishandled, from the delay in response to the intensity of the response when it finally came. I sent in a request to switch providers, hoping that the third one would use a modicum of autonomy to assess the situation, instead of just following a procedure after clocking in.
Sixteen minutes.
In sixteen minutes, the nurse practitioner in front of me was fully prepared to dose me down with medications that may or may not work, may or may not have debilitating side effects, may or may not be able to be stopped without risk of seizure, and may or may not make me worse than before. So, I left the appointment wordlessly.
Because I am who I am, I can’t help but look at this from a solution-oriented entrepreneurial perspective:
Why did she only spend 16 minutes with me? Bc she only had half an hour per appt.
Why did she only have half an hour per appt? I suspect a combination of demand, price, and staffing.
What is wrong with the demand, price, and staffing? Demand is too great, and to meet it the price has to be accessible, which means staff have to take on more patients, which means there needs to be more providers.
Why aren’t there more providers? Barriers to entry include education accessibility and stigma.
As angry as I was clicking “Cancel” on my billing plan, these problems cannot be laid squarely at the feet of an absent provider, a delayed provider, or an aloof provider. Although I would argue that each of them could have made a better effort, they are, as I am, a product of circumstance. Withholding their ability to provide treatment, as clumsy as it is, would still be a greater disservice than letting them tinker with people’s brains a quarter of an hour at a time. But, we have a very, very long way to go.
This is a call to arms. Entrepreneurs, venture capitalists, philanthropists, and healers: this is where you are needed the most. The time has come to leave your silos and link arm in arm to move the needle on the mental health crisis. We need yogi’s collaborating with doctors, we need therapists chatting with psychiatric nurse practitioners. We need venture capitalists talking to psychedelic guides and entrepreneurs having coffee with spiritual healers.
This is where we begin. Not at the top of a bottle, but at the start of a conversation. Not twelve weeks into a worsening state, but at the beginning of treatment.
And we need people rallying on the inside, too. We need employees advocating for collaboration across psychiatric treatment and talk therapy. We need medical staff demanding supportive behavioral experts to work with. We need visionaries to go on a quest and find a person, a team, or an organization to stand with and say “We will solve this.”
I am lucky. My ketamine clinician, who I’ve grown very fond of (and tease that I’m her favorite) changed my protocol and it’s finally starting to work. I’m still in the same body of water I was drowning in, but this time, the waters have stilled. I can catch my breath. I can look around for the shore. I can start to think calmly about which direction I need to swim. She saved my life. Psychedelic therapy saved my life.
As I’m starting to wake up again, I’ve come to realize one thing with absolute certainty:
There is work to do.
