Mondays with Jane
Today is that day. The day that comes once a year that I dread for the weeks leading up to it, and for which I will suffer in the weeks that follow. Today marks 9 years since the loss of my client to suicide (let’s call her Jane). On this day, I was forced to join a club whose membership I never wanted, joining many other therapists who are members for reasons they’ll probably never understand.
Sometimes I envision this massive club of burnt out providers who’ve had to endure a patient slipping through their hands into a place where night falls fast. Other times I’m alone wearing a ‘members only jacket’, where I’m literally the only member. It’s an isolating place, but one that I return to year after year. Maybe it’s because I want to beat myself up a little or maybe it’s to honor her memory. Either way I always feel a renewed sense of purpose to fix something that feels so broken … our mental health system.
My client Jane was a bright, funny, and industrious thirty-something. Despite a number of set-backs from childhood, Jane had built a pretty good life. She was actualized and insightful in sessions despite the severe depths of her depression. Faithfully, every week on Monday, Jane would join me for a swim in the deep end of existence. Together we would try to untie the Gordian knots of her life, both of us not understanding that Jane’s biggest problem was one big paradox. Jane lived in the richest country in the world, but couldn’t afford the insurance needed to treat her very treatable illness.
Like many other Americans, Jane couldn’t make the high deductible insurance plan work. So, Jane turned to her employee assistance program hoping to get a few free counseling sessions. Instead she got referred to a smoking cessation and weight loss program. This is actually a common practice in a commoditized industry that often deters people from getting help in order to turn a meager profit. A terrible EAP, the lack of reasonably priced coverage, and unaffordable providers were the converging forces that would lead Jane down a dark path.
Quick flashback to industrious Jane. Somehow, she had managed to track down an obscure community grant that would allow her free therapy sessions in a community clinic. I was able to see Jane right away, but she was placed on a 6 month wait list to see our clinic psychiatrist. This was problematic because I suspected that some of what we were dealing with was likely organic, and would require appropriate medication management. Based on this fact alone, Jane and I were entering therapy with a huge handicap.
Over time when things got really rough I would send Jane to a local crisis clinic. It was complete hell, wrapped up in a 6-hour wait, tied neatly with a bow of patients in severe psychosis. Jane and I liked to joke that the crisis clinic was like Hotel California where you could check in, but never leave. Each time she made the journey to the clinic there would be an incremental change to her meds, and always a nasty gram sent my way stating that she wasn’t acute enough to be there, despite the fact that she was having continual passive suicidal ideations.
So, I did what a lot of therapists do, I held on for dear life staring down the calendar willing January 29th to happen sooner. Jane was a true soldier though, because even on the most defeating of days, she’d promise a return and say with a slight smile, “So Doc, my same shit, same time, same place. Monday?”
Imagine the irony of saying, “See you on Monday Jane,” not knowing that those would be our last words. In the months that followed her death I went over and over our last session trying to understand what happened. We were making plans, talking about major breakthroughs in her relationships, getting promoted! Things looked good, really good, I don’t know … maybe too good? You know as I write this, it just hit me that sometimes hindsight isn’t 20/20, sometimes it’s just a bitch.
Jane left me on that Monday and went home to swallow 11 bottles of pills. She was found slumped against her apartment door two days later by her brother. One of the most painful facts I’ve had to face in Jane’s story was that I was very likely the last person to see her. After Jane’s death, I was forced to trudge through the stages of grief, but no matter how hard I tried I couldn’t move past the anger. I was angry at Jane, angry at my inability to save her, but mostly angry that what killed Jane wasn’t depression, it was our broken mental health system.
Cold Truth
With only 1 psychiatrist to treat every 30k individuals, what did we expect? When we leave the prescribing of over 85% of psychotropic medications to primary care, and have behavioral health network availability at less than 9% across insurance plans, what is the best that we could hope for? When our employee assistance programs don’t get the job done because it cuts too deep into their profits, where will people turn? I don’t have all of the answers, but I do know that 9 years ago, Jane gave me a gift. She revealed what I would be doing with the rest of my life, and for that I must thank her on this day, and all the days that follow.
Real Solutions
The reality is that within in the last 5 years we’ve crushed technological advancements in behavioral health. From telehealth tools that allows for quicker scaling of mental health networks, to revolutionary screening metrics that provide more precise treatment matching (Spring I see you), we are finally turning the tables on what has been an inexcusable failure.
One company, Spring Health a place that I call home, has created a virtual journey where patients can quickly interact with providers, figure out what treatment works best for them, and receive a concierge approach to mental health resources. Slowly, but surely, the pieces of the puzzle have come together, and after countless of boxes of pad Thai, Spring is officially throwing down the gauntlet to help people Feel better — faster.
So, this blog is a roll call for the early adopters, the change makers, and progressive leaders to join us on the journey. Every Monday, Spring will release content in an attempt to start a dialogue that will hopefully generate solutions. We invite you to join us, as we roll up our sleeves and wade in the deep end, just like Jane did … every Monday.
