Psychiatry in Crisis: Are Patient Advocates Responding?

Written and submitted by GNA member, Avrom Fox 

It was a Thursday afternoon in late June. My phone rang, I picked up the call and listened to a woman telling me about a pressing need: A friend of hers from facebook was posting very alarming comments about her illness. The friend came across as desperate, very troubled and confused.

Thinking this was the end of the interaction, I went on with my day. Not even 15 minutes later, I got a call from another woman in another State. I answered and quickly pieced together that I was hearing the same story. A woman from the same facebook group told me the same story: Her friend was posting frightening comments which suggested she was in a crises and needed help urgently.

Why are they contacting me if there is already so much support for the patient in question? 

At this point, I was perplexed. How did both of these women find my number? Why are they contacting me if there is already so much support for the patient in question? While these questions swarmed my mind, the phone rang a third time. A different state and number, but the same story about the same patient. At this point it was unclear if this was a real case or some kind of scam. I did a bit of foundational research on google, as all advocates should, and I found that these women were all from the same industry and were all involved in activism for the African American community. This added context was vital to my understanding of the situation. 

The phone rang again. Same thing: same story, same background, same facebook group. This call was different from the others. This individual called on behalf of the others and explained the situation to me in great detail. Their friend, a high profile female personality in the African American community in Chicago, has a facebook following of over 10,000. She has influenced and inspired thousands of people who have grown to love and support her. When the posts continued to appear, her friends grew anxious and alarmed. Many tried reaching out with limited success. 

She asked to speak to a private health care patient advocate. She had gone earlier in the day to the ER but decided to walk out, as they talked about sedation, and possible inpatient psychiatric care. 

One of the posts from the celebrity stated that she was manic and bipolar, and that she was in crisis. She asked to speak to a private health care patient advocate. She had gone earlier in the day to the ER but decided to walk out, as they talked about sedation, and possible inpatient psychiatric care. Her followers did some googling and found me as a patient advocate who specializes in cases dealing with psychiatric and behavioral health.

I was asked by the spokesperson if I would be willing to go to her apartment and speak to the client. I agreed to become involved and visit the client. It was clear that this client was indeed in a serious crisis. I felt challenged after I was formally engaged. The client did not have a competent and accessible psychiatrist and her medication was not being properly managed. The scope of her illness was complicated and she needed a great deal of help.

 The waiting period in the ER exacerbates the patient’s issues. Nurses often resort to sedation. Patients are frequently abused in the er while waiting days for in patient treatment. 

My first goal was to find a psychiatrist. The facts are simple: There are almost no psychiatrists who are accepting new patients. Call any major medical center and their department of psychiatry will state that “we are not accepting new patients.” If you are in crisis, go to the local ER. This is a national problem. Most psychiatrists do not accept medicare, and few accept medicaid. Many do not even accept private insurance. There is a major shortage of in patient psych beds. Many patients can spend days in the ER waiting for an inpatient bed. The waiting period in the ER exacerbates the patient’s issues. Nurses often resort to sedation. Patients are frequently abused in the er while waiting days for in patient treatment. 

Upon discharge from in patient units, there are limited options for step down inpatient treatment, or even outpatient care. The system is in a state of total disarray. Having worked as a patient advocate for many clients in this area, it is a disgrace that our great country can allow this to occur. 

Much of this devastating crisis in psychiatry had already been prevalent before COVID. However, COVID exacerbated the situation, with a skyrocketing number of individuals who became clinically depressed. With millions losing jobs and businesses and kids confined to their homes, the need for psychiatric treatment increased dramatically. 

In summary, young medical students seem to veer away from psychiatry, and opt for other areas of practice. Perhaps internal medicine residents should be required to spend more time learning the basics of diagnosing mental illness and prescribing psychotropic medication. There are nurse practitioners who specialize in psychiatry and prescribe and manage medications. This is laudable but not a solution. 

We as patient advocates must take an extra step, or even a giant leap to respond to the needs of patients who are suffering from mental and behavioral health issues. These are difficult cases, but we can gain great satisfaction by helping and supporting people and their families who are suffering.