Between 1993 and 2008, emergency psych visits throughout Missouri rose from 26,028 to 67,256, and now, they’re shooting even higher.
Which sounds like terrible news.
Experts toss out various reasons: economic stress and unemployment; diversion from rural hospitals; people unable to access treatment, whether because the illness muddles their mind and they can’t finish the paperwork or track their appointments, or because there are no appointments to go to. The state’s new directive is that those without Medicaid cannot receive state-funded services, so agencies like Places for People are forced to turn people away.
Other reasons for the rise in psych emergencies are actually signs of progress. Specially trained police officers are more likely to take psychotic individuals to a hospital than a jail. Jails are sending inmates to hospitals for care. People with mental illness are living more independently and seeking help more willingly.
And the greatest progress of all has led to the biggest reason for emergencies: people stop taking the medication that’s let them live independently in the first place.
Sometimes they stop for a simple reason: the cost or logistics of refilling the prescription, or the shame of needing it. Sometimes the medicine has stabilized them so remarkably, they think they can manage without it. Or the side effects become intolerable. Sometimes the prescription needs adjusting, or they’ve added a little booze or pot for self-medication. And sometimes the illness itself pushes them to stop: Paranoid schizophrenia can make you think the meds are part of a plot to kill you, and if you’re manic, you’ll resist anything that will dampen that wild energy.
So time and time again, patients shove aside that carefully labeled little amber bottle, and their brain veers into psychosis. It’s the supreme irony of modern psychiatry: Until the middle of the last century, there was nothing to do about mental illness except confine and restrain its sufferers. Then we started inventing the right drugs, and they worked so miraculously, we emptied out the asylums. And now people wind up homeless because they can’t or won’t take the drugs.
