Pam is dead. I got the call from her neighbor early one morning. She had killed herself sometime Wednesday which explained why my calls to her had gone unanswered and she hadn’t met me to go to the meeting as we’d planned.
She walked into the room but her dress, matching jewelry, and quivering smile could not hide her shakiness. As we all introduced ourselves and she said her name was Pam, I recognized her from years back when we had first met at an AA meeting. We talked after the meeting, and I listened as she sobbed out her account of the intervening years and of recent events in her life.
A middle school teacher who was beloved by her students and praised by colleagues, she loved teaching. The insidiousness of the disease of alcoholism and the debilitating depressions that she faced made it increasingly difficult to hide the despair that mark the aftermath of an evening, day or weekend spent drinking, and it eventually became evident to those who worked with her.
Inevitably she was dismissed from her position. With no income, the loss of her insurance, and trying to get sober again while in the throes of a major depression, she needed help. As one who has lived with serious depression all my life I knew, about a week after she had come back to AA meetings, through our frequent phone conversations, and in our talks during her few visits to my house that she was seriously considering suicide.
I offered to take her to the crisis stabilization unit in Gainesville, and she reluctantly, yet hopelessly acquiesced, being too weak and confused to even make a decision. A friend of hers agreed to care for her little dog, and a neighbor agreed to take care of her horse. Pam was terribly worried about money and not having insurance and was concerned about being able to pay for treatment, but I convinced her that Meridian, unlike other local psychiatric facilities, would not nor could, not turn her away if it was determined she needed help.
Walking through the cold-looking, unwelcoming doors would be a deterrent to anyone, especially one as vulnerable as Pam, and after the heavy doors slammed shut and locked behind us, we stood, there being nowhere to sit in the small intake area, until someone came out to get her information. Providing support, literally having to help her stand as she struggled through the initial interview, I assured her that she was doing the right thing and was in a safe place. Soon enough she was ushered through another door and into a place that I assumed would give her the help she desperately needed.
Two days later she was released, apparently deemed to no longer be a risk to herself. I picked her up and drove her home, first stopping to gather up her beloved dog. She told me that she had been given a prescription for antidepressants as well as a follow up appointment with a counselor in a couple weeks. She refused my offer to go get her prescription filled, saying she’d get it later. I knew, though, it was because she couldn’t afford it. We stayed in touch, talking on the phone and going to meetings, and one day she called sobbing and told me that her appointment had been postponed for another week.
The phone rang. Pam is dead.
The phone still rings. Does anyone give a Damn?
It’s too late for Pam. Her discharge from the Crisis Unit without being provided, at least, the option of longer term in-house treatment or at the very least being given immediate follow up care and the necessary medication in hand is a travesty. It’s easy to blame Meridian, the doctors, the drug companies, the health care system, the insurance industry, and there is plenty more blame to go around, and to my mind there is some complicity with all these people and/or entities.
States that rank higher in spending for mental health are probably facing similar difficulties in providing care to all those who seek and need help. Florida has the dubious reputation of ranking 49th in per capita spending, and we are trying our hardest to get to the bottom and gain the rank of 50th. I mean who wants the reputation of helping crazy people? Most other states spend almost twice as much as the measly $40.90 per person miserly Florida stubbornly metes out. Even Mississippi spends $108.96 per person, and I can’t imagine that people in Florida are less crazy than people in Mississippi. I’m tossing the word crazy around like crazy, and it is probably politically incorrect to sound so callous though sounding callous and acting callously are two different things. Plus I speak from the experience of a duly qualified and so-labeled crazy person.
Not too long ago I went to a forum on mental health in Gainesville where speakers from various organizations spoke about ways to meet the needs of the mentally ill people within the community. Some newer projects and policies designed to meet the needs of certain groups, such as people in the justice system, juveniles, and people without homes were discussed. Scant attention was given to people such as Pam who fall victim to the economic gulf between those who fit into a defined group, or who are economically in need and those who can afford to pay the atrocious costs for private care.
What I do know is that it is unconscionable that Pam could not get help for her depression despite every indication that she was suicidal. She killed herself. The very people most affected by the lack of mental health funding, by the lack of adequate, accessible, affordable community programs, and by the stigma towards mental illness are the very people who are least able to speak up for themselves.
I speak for myself when I say that when I am caught and swallowed in the gaping maw of depression, I am so desperate that I have to actually grasp onto the bed, my go-to retreat, so I don’t follow through with the need, not the thought – the need – to kill myself. Thinking about my kids and my grandkids, as much as I love them, is not always powerful enough to stay my hand, and it has only been the intervention of those close to me, including a wonderful group of professionals, that I am alive to write this.
During good times, I notice something spectacular or simply mundane and realize how grateful I am to have survived suicide attempts that were close-calls and to have been prevented from acting on others. Pam does not have the opportunity I have been granted, though when I’m depressed, I don’t consider it an opportunity. But she should have had the opportunity to get the help she needed before she made that final decision.
Pam is Dead
More spending on mental health would be a step in the right direction, but money can only go so far. More right steps and attitudes are needed as well. Foremost is having people that give a damn.
Nobody gave a damn about Pam.