The Crisis Stabilization Television Unit
I spent a week detoxing in a state funded psych ward
Drunkenness is temporary suicide. -Bertrand Russel
As part of a gonzo investigative journalism story I checked myself into a state funded psychiatric ward. Not really. I’m an irresponsible alcoholic who didn’t pay his health insurance. But I did end up in a state funded psych ward.
Backing up for a bit, I’m prone to bouts of severe depression, soemtimes even paranoid psychosis. Shortly after my most recent one I decided to pour alcohol on it and go out Leaving Las Vegas style. I figured if I didn’t die they couldn’t stick me in the hospital for a suicide attempt. After all, drinking is legal. There’s a medical protocol in my state that a physician can invoke if a patient is suicidal, homicidal or otherwise a threat to them self or others. I’ve had that pulled on me three times with varying degrees of accuracy. I thought I found a loophole.
First, I drank for about a week, morning to night. I knew it probably wouldn’t kill me since I’m poor and not a Nicolas Cage character so somewhere in there I took two partially full bottles of a beta blocker called propranolol after drinking all day, then drank some more. Turns out it was more than a lethal dose, maybe not for someone my weight but the beer should have made up for that. I woke up flopped around like I my limbs were made of string cheese, fell out of bed, fell trying to stand up, probably fell again then managed to fall into bed. When I woke up again I was still uncoordinated but standing.
After another week of marathon drinking and rarely eating, I came to the groggy conclusion that this wouldn’t work. When my mom came over to check on me I let her take me to her house, about 45 minutes away. Shortly after arriving, I tried to collapse into sleep in one of her spare bedrooms. I didn’t sleep. I wandered around in the dark, going outside to smoke, drinking water, peeing, and half-heartedly looking for booze, which would have been pretty good for me in a manner at this point. Alcohol withdrawal can kill you. But my mom and step dad cleared the house out before I got there so I lay in bed, shivering, watching YouTube on my phone, sweating and not sleeping.
I couldn’t tell if I was having the DTs or was actually cold but I thought I had made it through without violently shaking . When morning came and I had to face other people in the house who were awake it became clear that I hadn’t made it through anything but the night. I was shaking and twitching and could only walk with uncoordinated difficulty. Not having talked to anyone more than a bit in two weeks, my step dad tried to glean some insight into what he could do and what I was thinking. I also couldn’t talk very well so there wasn’t a lot of voluntary muscle control available to detail what caused my depression, even if I didn’t exactly know, but at a point he asked what he could do. I told him, “You can get me some booze before I die.” He said ‘no’ so I told him to look up alcohol withdrawal. Which he did, starting a manic search for a blood pressure monitor and a trip to the ER that I figured would end with a saline drip and some benzodiazepan. I really just wanted a bit to drink and a ride back to my apartment for some trazodone to help me sleep but he mentioned the word ‘stroke’ and it scared me. We drove to the ER where I was certain I would be out in the afternoon, withdrawal over. That didn’t happen because my state also has a medical directive that will put drug users and alcoholics involuntarily into the hospital following overdose or seizure (I still don’t think that fits what I was going through but what do I know).
In the emergency room I was given a saline drip, a vitamin drip and an IV line of anti convulsants. A counselor came in, asked me how much I’d been drinking and asked me where I wanted to go to detox. I didn’t want to go anywhere else but that wasn’t an option. Being that having an extra $200 a month was more important to me than adequate health coverage, I was being sent to detox at a community mental health crisis center.
A hospital van took me from a room at the hospital to the crisis center. I was looking out the back window which was disorienting itself even though were driving roads I knew. When we arrived I saw a sparse concrete building that had a loading dock. The EMTs took me up the back stairs and buzzed me in through a magnetically locked door that was keyed to an RFid card. Every door that didn’t lead to an office in the building was locked by RF card.
During intake I was angry and belligerent but I’ll dispense with the wit of an upset drunk. The first thing, besides the security, that caught me off guard was that the intake nurse seemed to reach into her pocket and take my patient picture with her cell phone camera. Not grasping that I was committed for observation I tried to lie as much as possible thinking that it would shorten my stay, get me out the next day after the drugs they gave me at the hospital ran through me.
They gave me a towel, some new hospital socks, toiletries and showed me to my room which I would share with two other patients. Three low, pine beds and a night stand next to each. It wasn’t cramped but it wasn’t big. I slept behind a curtain at one hospital so this wasn’t really too surprising. I tried to sleep on the cardboard matress with the plastic pillow, refused food again and listened to what sounded like YouTube clips from the main room on the unit. I took my detox med, ativan, when prompted thinking it would help me sleep. It didn’t work very well. I also took a nicotine patch. I kinda thought a facility with less money would have smoke breaks but that didn’t pan out.
Meds were given out from behind a small overhead door. The pharmacy was kept in a small room connected to the nurses’ station. The nurses’ station was behind glass separating it from the common area of the unit while also letting the staff monitor the patients. It immediately reminded me of One Flew Over the Cuckoo’s Nest but smaller. The common area consisted of a large television, a table and about 15 large black armchairs, with the padded isolation room in a corner alcove near the nurses’ station. One corridor extended off of the common area where the patients rooms and bathrooms were located. There were no windows to the outside in the entire crisis unit. A white cave with linoleum floors and an LCD TV was where I would spend my time until the doctor determined he’d absolved himself from legal responsibility in the event of my death following release.
A nation’s greatness is measured by how it treats its weakest members. -Ghandi
At around 6 o’clock everyone was woken up for vital signs and meds. Vitals were blood pressure and temperature. Seven o’clock was breakfast. Meals lasted about twenty minutes. Seven thirty until 10 o’clock was free time to mill around and watch whatever the dominant personality on the unit wanted to watch on the TV, shower, sleep more. The doctor had his sessions in there somewhere which individually lasted about 5–10 minutes. At 10 o’clock was the first group therapy session.
In a privately funded hospital group therapy is the predominant activity with a bit of free time in between sessions and one or two extended periods of free time to do as you please. It’s tedious but not in the mind numbing way that watching 12 hours of television is. Private hospitals also restrict the available channels on their TVs. I watched someone spray blood out of a Vietnam War helicopter during a movie one night in this place. I suppose the destitute and uninsured aren’t a sensitive lot. I attended two or three professionally conducted group therapy sessions during my stay. One devolved into a very loud patient leading the group. She was coherent, I’m not sure why she was there really, but it was not what anyone would call therapy.
Lunch was at noon. The food was awful but was probably better than food in the county jail, worse than prison food or school lunch. The latter two have kitchens. This place had the food delivered from buffet leftovers or God knows where. Cold meals were set out at the table when we entered, hot meals were served into styrofoam trays from steel buffet containers. Breakfast was a bagel and cereal or a biscuit and a little chicken patty, decaf coffee in styrofoam cups. Lunch was a sandwich, tuna or chicken salad, or an iceberg lettuce salad. Dinner was sloppy joes or salsbury steak and once something almost no one ate or could identify. I think it was cornbread stuffing with turkey mixed into it. There were sides of vegetables like mashed potatoes, corn or beans with hot meals. Cold meals had Jello and a cookie or a muffin. I drank lots of milk and grape juice from tiny cartons. I ate an apple every time we went into the cafeteria which doubled as a group therapy room because I was hungry every two hours. There weren’t always apples. There were always jars of peanut butter and jelly, sometimes there was bread. During group therapy we were given milk and granola bars or caffeine and sugar free soda with Cheez Its. Writing it all down it seems petty and whiny to complain about the food in such a place but there were homeless people in there who pecked at it like fat pigeons.
The next group session was at 3 o’clock which lasted an hour on a good day. Dinner was at 5:30 and from six to eight was more television before an 8 o’clock session that was never really therapy but an excuse to give us a snack and maybe some loosely constructive banter. I tried to go to bed as soon after I got my new evening medication as I could. I got my last meds around 10:30. Lights out at a private hospital is around 10 o’clock. And it exists. I think many of the other patients went to bed when they felt like it which is nice if you want to stay up and watch Once Upon a Time in Mexico on TNT, not so much if you haven’t had quality sleep in 3–4 days (two weeks if you want to argue about the quality of sleep you get from drinking yourself there).
There’s still work to be done in a psych ward at night. Room checks to make sure everyone is still breathing and hasn’t tried to off them self. Not at this one but at most. I had my blood pressure taken and was given more ativan at 2AM on the first night. Detox patients got this special treatment so they didn’t seize up in the night and swallow their tongue or wake up in opiate agony.
I don’t want to unfairly put upon the staff here or seem like I’m championing the private healthcare and employer sponsored insurance system, I’m not. Letting these patients have some kind of free reign probably keeps them happy enough that they don’t organize a coup against the limited staff. And the staff was limited. Filling more than one role seemed common. I thought one social worker was a well dressed maintenance worker because he was carrying a screwdriver and seemed to be changing a fluorescent light bulb in the ceiling. I know one guy worked a sixteen hour shift once. He also fell asleep a lot in one of those big chairs while he was supposed to be monitoring the unit from the floor of it.
Not to say that the staff were terribly good at their jobs or took them seriously. Many seemed to be young nursing students just out of the local college. There was the floor attendant who routinely slept while he was supposed to be monitoring the unit for people hanging them selves with sheets. One of the two social workers I met shook like a leaf during the group therapy sessions he held which were not terribly productive as he seemed to cobble them together from whatever superficial lessons in college had prepared him for this job. One of his sessions involved playing the “Hokey Pokey” and “Electric Slide”. I don’t know what he was getting at but I wasn’t paying attention. The other social worker and the charge nurse were the two best employees there but I only saw them a handful of times. The nursing staff and even the program director used cell phones frequently, and an iPad on one occasion, to amuse each other. One night at evening meds, I asked one of them how they could take pictures in there when I saw them laughing at a video of someone behind the nursing station. “Oh, we’re not taking pictures,” I was told. I guess a video isn’t technically a picture. Privacy was given lip service there on paper but the staff could use recording equipment. The staff wouldn’t confirm your presence there to anyone on the phone without a patient identification number that was provided in a packet during intake. Indirect confirmation in an iPad video was acceptable.
The patients ranged from the poor with no insurance to a woman living in her car and the outright homeless. One guy who was my roommate towards the end shot up with a mixture of meth and opiates so large that he was placed there as a suicide threat instead of a detox case like I was because the medical professionals were convinced no one would try that unless they wanted to die. The problems were drugs, depression, both and even outright violent paranoid psychosis. All peppered together in a little mixture of the unfortunate, those who society would rather not deal with and those who were forgotten except for the state compulsion not to let them die. Set in front of the Crisis Intervention Television to wile away the days until the doctor felt safe releasing them and the staff found them a place to stay. No one was released onto the streets.
Men and women mixed together, which seems like an invitation for a rape investigation. There was a seemingly platonic heterosexual couple who cuddled on the couch during movies. I heard it had been worse in the past (lots of repeat tenants at this place). Not the set of Caligula or anything but I guess that goes back the staff giving some freedom in exchange for a side table not being thrown at them. Strictness varied among the staff. One of them said lascivious incursions into bedrooms were not tolerated, although I don’t know what the punishment would be seeing as how being thrown out was more or less what everyone wanted.
I met with the doctor for the first time on the morning of my first full day. Still thinking this was just a chance to sober up, I let him know how upset I was.
“I want you to lift the order and transfer me to the care of my psychiatrist. I can’t afford to stay here for ten days while you adjust my medication.”
“I wouldn’t want to adjust an alcoholic’s medication.” He pulled a sheet out of my patient binder and spun it ninety degrees. “All right. Sign this and you’ll no longer be under the ER doctor’s order, you’ll be a voluntary admission. You’ll need to meet with a counselor to create a safety plan before you’re discharged”
He was unflappable facing a red eyed idiot in blue scrubs. I’m sure he’s dealt with worse. He effortlessly coerced my past history with mental health problems out of me which calmed me down somehow. He prescribed some new meds for me to replace the ones I’d stopped taking a month or more ago. I was pretty sure I’d be signing myself out within the next 24 hours. And I had a new goal to push me through the hours: meet with a counselor.
* * *
If you sit in your room and sleep, ignoring everyone else on the unit, it’s going to prolong your stay. I knew that from other hospitals and knew that would be true here. I didn’t really want to talk to anyone there, I didn’t want to talk to anyone, I wanted to leave, eat and smoke a cigarette, that’s about the extent of my desire at the time.
On the second day I spent all morning in a chair where I could watch the clock, who was coming and going in the nurses’ station, watch for the doctor, the social worker and trying to see if the were any noticeable changes to my patient binder. I’d noticed patients getting discharged had their discharge papers sticking out of the binders to flag them for the nurses doing paperwork.
After lunch I saw a counselor in the small hall between the unit and the group meeting room. Even though the phrase ‘voluntary admission’ and some other, smaller words evaded me, I managed to convey that I wanted to meet with him so I could create a discharge plan and sign myself out. “Well, uh, you just got here. The average stay is 5–7 days. You should be out Saturday or Monday. Maybe Friday.” This isn’t what I wanted to hear and it was a blow to an already fragile engine of hope but I felt better in a few hours when he saw me in his office.
He was a milquetoast middle aged man, thin and nerdy in a way people on Twitter don’t feel proud of. He asked me what brought me there.
“I haven’t been in a relationship in eight years, I’ve been on two second dates in three years, I’m unhappy with my job, I don’t make enough money, I’m facing bankruptcy or garnishment and the work I do that usually gives me some fulfillment isn’t fulfilling anymore. And if you keep me here I might lose my car and apratment. You want me to keep going?” I’d been having trouble concentrating but could be direct when I was explaining myself or not speaking off the cuff.
“I’ll just put depression.”
We hashed out some horseshit I knew he’d like to hear about coping strategies, goals and triggers, whatever I thought would look good to someone assessing my state of mind in relation to my release. I didn’t mention light dreams of falling asleep with a beer in my hand or that this place was making me more depressed than when I arrived. It was late afternoon so I knew I had another night there but I was still hopeful I’d be out the next day now that I was voluntary and had spoken to the social worker.
* * *
One of my roommates was discharged and a bedraggled replacement was brought in wrapped in a blanket a few hours later. When it was time for bed, my other roommate had the door propped open, sitting in bed and reading a two day old newspaper. “Gotta air it out, man. Cause of him,” he pointed to the third bed. A horizontal heap of limbs was snoring away, wrapped in the blanket they brought him in with. Andre was doing good work. The room smelled but not as bad as it would have if the door was shut. It was an early night for the three of us.
The third day started with cries from a patient’s room. Loud, agonized noises that repeated with the rhythm of language. After hearing it a handful of times I realized it was Spanish.
“Mi amor! Mi amor!” You’d’ve thought he was dying. After a while he came out of his room, a young latino man with slumped shoulder wearing blue scrubs like the ones I was brought in with. He used the phone on the wall near the nurses’ station. I’ve forgotten most of my spanish from high school so I don’t know what he was saying. Maybe someone died, maybe his girlfriend broke up with him. After ten minutes on the phone he went back to his room and resumed his chant. For the rest of the time I was there he slept in the main room in two chairs pushed together for hours. He was there for depression or addiction or both as near as I could tell, and though there were other people on the unit worse off than he was, I felt the worst for him. He could only talk to one other patient, there was no one on staff who spoke Spanish. I can only imagine what it’s like to be in a place like that with only a fleeting grasp of what anyone is saying at all times. He might as well have been in the isolation room.
The next morning, I planted myself back in a chair where I could see the nurses’ clock and also aim my head in the direction of the TV making it look like I was watching it but also watching the clock and who was coming and going from the nurses’ station. I was still hoping to get discharged that day. I learned I couldn’t sign myself out without the doctor’s approval and I had a job starting that day that I needed desperately after shirking responsibility in favor of malt liquor for two weeks.
When I met with the doctor I told him that I’d met with the social worker and was ready to sign myself out.
“I’d still like to observe you for a few days with my colleagues. And after I sign off on discharge it takes another day for the staff to get your meds together, make sure you have a place to stay and a way to get there.”
I sighed out all the delusive fight I had in me, “OK.”
“You haven’t been taking your detox medicine?”
“No, I don’t think I need them.”
“No symptoms? Shaking, headache, hallucinations?”
“No.” I sat slumped a bit before I thanked him and shuffled back to the unit to hypnotize myself with the wall above Maury Povich.
The pharmacy techs still casually asked about me taking my ativan but didn’t offer it after I took two doses in 24 hours and started refusing it which was part of my plan to get early discharge when I proved how I didn’t need it by not got into some alcoholic epilepsy. That didn’t work and I was as firmly under medical observation as I would have been if I’d cut my wrists and almost bled out in the bathtub. They had stopped waking me up at 2AM after the first day so that was nice.
“This place is worse than jail,” I heard another patient say, “at least if I was in jail I could bond out.” Smiling occasionally was also part of my plan to wait and stare at the ceiling.
* * *
“Franklin, it’s time for vitals.” My name isn’t Franklin but I still held out my arm for the blood pressure cuff. I was getting a couple hours of something like sleep and I wanted to try to get back to that. “Now stand up for your ativan.” I stood up and swallowed some pills, they turned off the lights and I lay back down.
In the morning I woke up closer to 7 o’clock than I had since I got there and I was groggy. “Oh, yeah, I they gave me the heroin addict’s ativan last night.” After breakfast I went back to bed.
The most miserable outcast hugs some memory or some illusion. -Joseph Conrad
I’m not terribly social under the best condition but by sitting on the unit and passively listening to the other patients I got to know them or at least how they got there.
Mary was a pretty lady in her early forties who arrived earlier in the same day that I did. She had major depression and claimed to be an alcoholic as well. I was on my way out by the time I saw her smile and heard her speak. She had a beautiful smile that I saw once or twice. It reminded me of a girl I dated in high school even though they had no other common physical characteristics.
Kim was a heroin addict who was living in her car after leaving her husband who still using. She had three kids 12–19 and had been married for 17 years. Her skin was an uneven color that displayed to the world how ill she was. She was the one who had us watching Maury and Jerry Springer in the afternoon. She was also depressed and hopeless, silent when she arrived. During one of the weak group sessions we attended to get some cheese crackers she said she didn’t believe in God due to the unfairness of the world which sent scorn and disbelief through the unit.She perked up and the scorn seemed temporary. The day I was discharged I woke up early and she was watching the 700 Club. She wanted hope but couldn’t find it anymore.
Franklin was my roommate, the heroin addict whose meds I was given in the middle of the night. His arms were covered in tattoos and he had track marks. He wore a tanktop that revealed the needle mark over his heart where the paramedics shot him with naloxone. They also poured ice over him to jolt him awake and he said that he would’ve died if they came 20 minutes later. He ate everything they served and asked for seconds (except the turkey stuffing). He was waiting to be discharged so he could be transferred to jail for possession of drugs that almost killed him.
Barbara was a tall blonde in her forties with a severe psychotic condition. There were three single rooms on the unit, I assume for people like her who are divorced from reality, and she spent her time in one of those rooms with the lights out. When she came out she went to the nurses’ station to ask for phone numbers to her job and the police and a phone book to call her family. She wanted to tell work where she was and file a police report for her missing wallet. No one has a phone book anymore so she wasn’t very happy to learn there wasn’t one in the building. After she got a few of the numbers she wanted she came out to accuse people on the unit of coming in her room and stealing them after she misplaced them. She wasn’t well tolerated by the other patients who complained about her behavior every time she left.
Ashlee was a young latina who checked herself in and couldn’t get out much like I couldn’t even after I’d been transferred to voluntary admission. Ashlee was loud, her personality and voice dominated the common area. She bragged about how often she’d been there and the ability it gave her to gain favor with the staff. On my second day there she spent close to an hour on the unit’s phone crying and forcefully hanging up the handset because her girlfriend had been beaten up, which I took to mean in as a platonic friend but she was a lesbian. She was melancholy the next morning but bounced back soon and explained the story to everyone including how well she can physically handle herself in a confrontation against a man. In a couple days she found out her new roommate was also gay and they filled the air with the kind of unsubtle flirting I hadn’t seen since high school.
Alberto and Manuel were the translator and his client. Alberto was some kind of godsend with dual fluency. By luck or a friendship that brought them in together, Manuel had one person to talk to and to express himself secondhand after he overcame whatever kept him screaming for his love in his bedroom. They played a lot of Uno together on a side table when Manuel wasn’t sleeping.
Will was a large black orderly who, through some quirk of scheduling, was on duty for nearly the entire time I was there. In his teens and twenties he was a drug dealer and addict in Washington DC. In his new life twenty years later it was his responsibility to monitor the day to day activities of a bunch of junkies and crazy people in part to ensure their safety. He did this by taking naps and filling out his observation chart in his free time with blocks that said everything was fine. I didn’t appreciate his lax attitude towards his job but he was a funny and amiable man who had actual real world experience with recovery and addiction. He had great stories like the time he sat in a tree all night smoking crack with a pair of binoculars, making sure his girlfriend wasn’t cheating on him and his admission that even so far removed from that life he wished every day he could get high. I found that personally affecting, moreso given his vernacular delivery of most things.
Jon was a patient who arrived late afternoon on my third day. His knuckles were scabbed over from fighting or punching something inanimate. He was twenty three and bipolar. Jon made sure to tell everyone shortly after he sat down. His immaturity struck me immediately. Soon he had us watching the Super Mario Bros. movie from the nineties which is a wretched film I don’t remember enjoying when I was ten. He went to bed after a half an hour before more patients could start emulating my ‘watch the wall above the TV’ move. At dinner he refused to eat after seeing the sloppy joes we were eating, which were relatively good, and went back to bad. In the morning he complained to the pharmacy nurse about needing his Lexapro and when she told him he’d have to see the doctor first he went to bed. At lunch he refused to eat the meal, made a PB&J and went to bed. I never saw him eat anything but those sandwiches.
Jon said that he was there after violating a restraining order placed on him by his eighteen year old ex girlfriend who was crazy. He was a good guy and, yeah, he got on Skype one night and said things he shouldn’t have, especially given the legal troubles, but he was a good guy and his ex was psycho. He didn’t want to hurt anyone. Jon couldn’t understand why girls didn’t want a nice guy like him but Jon also didn’t understand that he was dating a girl barely out of high school and he was the one in the psych ward. Nor did he understand that he was not in the kind of psychiatric facility he was accustomed to as a child of affluence and no one could or would be bringing him something else to eat no matter how much he turned up his nose and pouted. He said he was diagnosed bipolar in his teens. Some people let their illness become a defining trait, even an identity, and I believe he was one of those people who let two words on a doctor’s steno pad define and cripple their life, guiding behavior by the symptoms outlined in the DSM.
On my fourth day I was still coddling a hope that the doctor would discharge me but I was also ready to spend another four days there. Maybe not ready, I was ready to get the hell out and never look back, but the possibility that I’d be there through the weekend was a creeping it’s way through my mind. The doctor was running late that morning and it cancelled the group session. Because of the patient priority that relegated the longer term patients to the end of the line, I saw the doctor at 10:45. The first thing he said to me was, “I have good news for you. We’ve decided to discharge you.” I cried and as I pouted in the chair across from him I worried that it would make him change his mind.
I would rather have anything wrong with my body than something wrong with my head -Sylvia Plath
This was my fourth hospitalization and since my first I’ve thought that the treatment of the mentally ill in this country is abhorrent. I’m pretty good at worming myself out since I’ve never gone to one of these places voluntarily and it’s not hard to predict what a doctor wants to hear. There’s a loss of privacy, loss of freedom and a strict regimen of medical care in the better hospitals that I always found stifling as an independent person who doesn’t like to sit still or be restricted in all but the most necessary ways, but on the crisis unit I was wishing for the things that I hated about every other hospital I’d been to. I wanted bed checks at night, I wanted a group therapy session every forty five minutes if for no other reason than to alleviate boredom and I wanted to be told when to go to bed so there would be a period of relaxation at the end of the day.
I’m not even that bad off at my worst and neither were the vast majority of other patients in the crisis unit. In well funded private facilities these places can turn into prisons for those imprisoned in their minds, hidden by their families in a hospital instead of an attic or a Bedlam grounds for the affluent to gawk at. They’re expensive for families causing further problems or they get their money from Medicare and/or Medicaid not even leaving a financial reason for families to visit just to look at someone with a superficial resemblance to their son or sister or mother but with a heartbreakingly altered personality.
I know that there is always a worse place than the worst place I’ve ever been. I’m not sure I conveyed effectively how shitty I thought this crisis unit was. It wasn’t the Anne Frank House in 1944, it wasn’t a Gettysburg surgical tent, it wasn’t a juvenile cancer ward for kids with terminal brain tumors, it was the Abu Gharib prison ten years ago. There are worse places I could have been and there are worse places I could have been given my situation. Convulsing and shivering under a bridge for example.
I don’t know if I’m lucky there was a place for me to go, if that place was an artifact of an overreaching state government approach to people with predilection to self injury, I don’t know if there’s a better solution to the needs of the poor and homeless who disproportionately display mental illness and substance abuse compared to the population at large. The company that runs the crisis unit also does counseling and psychiatric care for low income individuals at little to no cost and my fabulous stay was free. I know there are many places in the country outside of large metropolitan areas where there is no such option. I don’t know and I don’t know of anyone who has anything approaching a solution to the problem of mental illness other than the status quo of cocktails of medication, a lonely bed to sleep in for a while and an assisted living approach for the worst victims.