Lessons in Mental Health Care Reform from a Student’s Experience

San Antonio, Nation Faces Daunting Gap in Educational and Post-Hospital Care Resources for Psychiatric Patients
by Jennifer Jussel

SAN ANTONIO, TX—The hard tile floor of the bathroom in San Antonio Behavioral Health Hospital was cold against the side of my face as I lay there, shivering and unable to get up.

It had been nearly twenty-four hours since my insulin pump, a device I need to wear at all times to survive, was confiscated from me, and I was losing my ability to function. I’d checked myself in to the hospital voluntarily only the morning before in January of 2016, my first year of college.

My lifelong struggle with major depression had come to a peak, and my university Resident Adviser (RA) and I thought the best way for me to get better was to seek a more intensive form of help and coping mechanisms. I entered San Antonio Behavioral’s doors mostly unashamed, a veteran of my mental illness on a mission to improve and get the extra help I was finally ready to admit I needed.

I didn’t feel crazy, or like a failure—just sick. Only twenty-four hours later, curled up by the toilet, clutching my stomach, feeling my tongue swell from dryness in my mouth, trying to differentiate between the flickering fluorescent lights of the bathroom and the shocks of color that burst in a brain struggling for consciousness: I felt crazy. I felt like the stereotypical “psych ward” patient, the one from horror films and scary stories that so many neurotypical Americans believe in.

I felt like a failure—as a daughter, as a friend, as a college student, and as a sane member of society. But more than that, I felt betrayed. I admitted myself to San Antonio Behavioral’s care in search of help, a way to cope, some kind of answer or solution for the worst of my depression. Instead, I was treated solely as a suicide risk, and had any belongings that posed a potential danger—my underwear, a sharpened pencil, and of course, my insulin pump—confiscated, and, after a brief interview with a psychiatrist who I saw only once during my stay, was left to reflect in my room.

I was blocked at every turn when I attempted to explain that I would not survive without any form of insulin at all, treated like an insubordinate child trying to get around the rules until I was discovered on that floor and transported to a private emergency clinic for treatment. It took my university counselor, my regular psychiatrist, my parents, and the threat of a lawyer to get me out “against medical advice” the next day. I returned to my university exhausted, sick, traumatized, and determined never to go back to a psychiatric hospital.

Almost three years later, significantly improved and preparing to graduate from college, I am prepared to recognize that in many ways, the people at San Antonio Behavioral were not entirely at fault for what happened to me in their hospital, at least concerning the lack of psychiatric improvement and extreme supervision I experienced there. There is, in fact, plenty of blame to go around, for my community all the way to the national healthcare system. There are several greater systemic issues in the way that psychiatric care is handled in the United States, ranging from lack of public education to availability of caregivers.

Despite my expectations, I spoke not with cold, detached business people but with caring, outspoken individuals and advocates in health care who recognize and are attempting to remedy the issues within their system. They are people who just want to help other people, but have  limited resources. While no one at SABH responded to multiple requests for an interview, several other health care officials within the city of San Antonio were available for comment.

Linda Aguero, the Business Development Manager for Laurel Ridge Psychiatric Hospital, says that the main goal for a psychiatric hospital patient is not to cure their mental illness entirely, but to make sure nobody gets hurt. “Like say they’re there for suicidal or homicidal ideation,” she explains, “our ultimate goal is to get them, of course, out of that crisis state.”

This is more or less what I experienced at SABH, although it went against the majority of my expectations. Having been in treatment for clinical depression for four years prior to my hospitalization, I’d had plenty of experiences with counseling and psychiatry. Typically, counseling took place one-on-one in a dim, quiet office with a certified professional, who would ask questions about what was bothering me and offer advice on how to improve. A psychiatrist visit could be expected to go much the same, except there would also be an in-depth discussion of whatever medication I was taking, and whether it was effectively treating my symptoms.

As is common for psychiatric patients, I was admitted to SABH after visiting my local emergency room, in my case San Antonio Methodist. I initially intended to admit myself to Methodist’s psychiatric unit, as was written in the university instructions for my RA, but they were out of beds, and referred me to SABH instead. When I asked the nurses at Methodist what I could expect from my stay at SABH, I was informed that I would be staying for three or four days, during which time I would see a counselor and a psychiatrist daily. When I agreed to admit myself, I was looking forward what I thought would be the same thorough, one-on-one care I received in my usual counseling and psychiatric appointments, except this time on a daily basis.

This was not the case. I spoke for five or so minutes over Skype on an ER computer to a psychiatrist from SABH before being admitted. I explained to him that my suicide risk was maybe a five or six out of ten at that point, and that mainly what I was searching for was an answer to the extreme uptick in depressive symptoms I’d seen recently (apathy, lethargy, self-doubt, self-isolation, thoughts of self-harm.) Having just started college and being in the middle of a messy breakup, I felt that I needed more in-depth and urgent help than could be provided to me for an hour a week, especially with the amount of commitments and responsibilities I was struggling to maintain at school. He recommended that I admit myself, with the promise that he and the staff at SABH would help me recover and get back on track. I did not see him again until my second day in the hospital, at which time we spoke for about twenty minutes. He confirmed the diagnosis that I already had—clinical depression and anxiety—and then took me off my Zoloft prescription with a promise for an eventual replacement, which I did not stay long enough to receive.

There never was any kind of meeting with a certified counselor, like I was envisioning. Instead, the daily counseling I was promised came in the form of daily group therapy. For an hour a day, everyone in the unit would sit in a circle in a small room and do a set activity, like listening to and reflecting on a song, or writing a few nice words about ourselves on a board, with a nurse or graduate student from a nearby college. The rest of the day was spent on distractions; we watched TV, colored in books, or read until we were encouraged to go to bed, all under close supervision by nurses and security officers. Although my experience was different in that it was cut short by my medical emergency and subsequent parental interference, it seemed to otherwise be the status quo for the average psychiatric patient. The goal at SABH was never to treat my illness, but to ensure that I would not succumb to it entirely. Had anyone along the course of my decision to admit myself, like the ER staff or SABH’s on-call psychiatrist, made this more clear to me, I might have decided differently.  

Like at SABH, patients typically stay at Laurel Ridge for five to seven days—enough time to stabilize them, perhaps, but not to “cure” them. “Once they are no longer in crisis,” Aguero says, “the goal is to set them up with a plan that can take care of them post-hospitalization.” Laurel Ridge is required to schedule a follow-up appointment with a licensed psychiatrist for all of their patients once they have been released.

“The patient doesn’t have to show up,” Aguero qualifies, “but we have to set up the appointment.” The idea is to significantly reduce the risk of suicide or homicide first within the hospital walls, and then to make progress toward managing each patient’s mental illness after they have been released. “The ultimate goal for that individual is to have normalcy, you know, happiness,” explains Aguero, “and hopefully get to a point where they can see their therapist once a week, or their psychiatrist, or whoever gives the care that they need so they don’t have to come back to a facility like ours.”

Before we can delve into whether the system Aguero outlined works for psychiatric patients, it’s imperative to recognize that many patients, like myself, were or still are unaware of this crisis-avoidance goal of psychiatric hospitalization.

Melisa Riley, an advocate for the National Alliance on Mental Illness (NAMI), explained the common misunderstanding to me. “I think many families want a cure, and believe that there is a finite trajectory of mental illness, as in crisis and then and end to the crisis—not that mental illness is chronic. This belief leads to the misunderstanding of the purpose of hospitalization, such as stabilization of acute episodes. Also, many times there is a lack of follow-up care after discharge, leaving many to believe the hospitalization was the finite end.”

Dr. Gary Neal, head of counseling services at Trinity University, agrees: “I think the public—certainly lay people—have a naive understanding of what’s feasible in a hospital setting: start them on medication, get them cured, or under control, or some such phrasing.” He attributes this understanding to a public desire to clearly define mental illness as an acute, curable disease, like the flu. “The lay public… wants mental health and mental illness to be black and white. You are or you aren’t, you have it or you don’t. And it’s not like you’re always going to have it. We know that, professionally, many phenomena exist on a spectrum. Take autism spectrum disorder for example. With autism and aspergers, we see increasing recognition. These things are on a continuum, it’s not black and white. And I think that’s arguably true for most any mental health condition that you can identify.”

In other words, the depression I and sixteen million other adult americans share exists on a spectrum as well. Most of the time, I personally am able to function normally with little to no assistance from medication or therapy, but very rarely, like in January of 2016, I find myself in need of greater help. In times like those, it’s up to me and my health providers to determine whether I’m in need of more acute psychiatric care. When I spoke to Dr. Neal about what determines whether somebody needs to go to a psychiatric hospital, he explained, “A clinical judgment of imminent risk of suicide is the key factor for us in terms of, you know, is the person experiencing not just thoughts of suicide, but the intent to die.” When I asked him how he drew that line, he responded with a nervous smile. “Exactly.”

Some of this misunderstanding surrounding the purpose of psychiatric hospitalization, then, is due to a societal misinterpretation of mental illness. When the general public believes that depression or any other mental illness exists not on a spectrum but is rather an easily curable ailment like a cold or infection, they may also believe that single hospital visit could be enough to cure that illness. This misunderstanding can easily lead to a false hope for the possibilities of inpatient care, and eventually to the same feeling of betrayal that I experienced when mental hospitals don’t make more of an effort to address the root issue, instead focusing solely on suicidal risk.

Still, some of the issue lies in a lack of educational resources for the public. Linda Aguero is herself one of these educational resources. So is Mariam Chokr, the Director of Behavioral Health Outreach for the San Antonio Methodist Health System. When asked about her typical work day, Chokr replied, “It varies day to day, but typically I’m in the community providing education on our services to physicians, clinicians, and community members.”

Her community work means communicating with various hospitals, public institutions, and even universities about the options available to people in psychiatric crisis. It also means explaining to the public what psychiatric hospitals are meant to accomplish, to clear up the stigma and misunderstandings surrounding them, and make sure the people admitted to their care can genuinely benefit from the services they offer. Had I been aware that the goal of the actual psychiatric hospitalization was not to provide me with the tools for a long-time recovery, but instead to prevent suicidal crisis, I might have felt differently about admitting myself. Instead, I might have sought extra counseling sessions, or made an effort to learn about outpatient programs that could give me the additional care I needed, as well as the tools to overcome the worst of my illness. At the time, however, nobody from the community or the ER told me that I had other options.

Dr. Neal says this is a common issue, at least for Trinity students. “Trinity students on their worst days look healthier than most chronically mentally ill people do,” he admits. “So I think that affects several things, including how our students get evaluated in the ER. So like, at your worst, your act is a lot more together than, say, a chronically schizophrenic person who’s been in and out of the state hospital five times in their life and has not been able to hold a job or function very effectively in society. So I think our students are a low priority because they’re not dramatically acting out.”

As I listen to him, a memory resurfaces. “They had a guard there outside my room in the ER when I was first being admitted,” I tell him. “And he kept asking me, ‘Why are you here?’ Like, ‘Go home, you’re fine!’”

Dr. Neal laughs sympathetically. “And you wanted to go home, right?” he says. “You didn’t want to be there!”

“I did,” I say, “but I really felt that I needed help, too.”

“Right,” says Dr. Neal, “and again back for us it is ultimately about safety. And that’s a very short-term acute decision. Most of our hospitalizations of our students seldom last more than two or three days, because, I think, several things happen. One is that our students stabilize pretty quickly, because they’ve got some resilience and coping skills. And the other thing is you kind of look around a psychiatric hospital and say, ‘I’m not like these people. I don’t belong here.’”

This brings back another memory for me, from within the hospital walls. I made a few “friends” during my brief time at San Antonio Behavioral. In such an emotionally charged environment, it was easy to find a few people willing to share their struggles and commiserate. They were the two or three men and women who showed me around on my first day there, sat with me for meals, told me about their lives, and kept some of the more aggressive patients at bay.

They told me that they felt a certain parental protectiveness over me; having just turned nineteen, I was the youngest person in the ward, and that made me a target for some of the older male patients. Still, despite their protectiveness, my friends were also openly envious. They frequently reminded me how lucky I was: I was going to college. I had a loving family. Most importantly, I had a future—something they didn’t feel they had anymore. They were all frequent psych hospital fliers, intimately familiar not just with San Antonio Behavioral, but with the other hospitals in the city as well. The more I spoke with them, the more fortunate I realized I truly was. I had the financial, familial, and educational resources available to me to overcome my chronic mental illness, but many others do not.

This is where the cracks in the psychiatric system truly begin to show. I may not have truly belonged at San Antonio Behavioral, but I still needed a more intensive form of assistance than a weekly therapy session. Where was I, or someone in a situation like mine, supposed to go? And why are people like the friends I made constantly finding themselves back within hospital walls?

“As a country we supposedly made an effort to deinstitutionalize people and stop putting people in long-term psychiatric care for the rest of their lives,” says Dr. Neal, “but we then failed to really develop a viable, adequate out-patient care system.” He argues that a huge gap in care has existed ever since the end of the Kennedy era, during which the nation’s attention was briefly shifted to the massive human rights violations taking place behind the closed doors of psychiatric institutions. Patients with illnesses and disabilities ranging from epilepsy to schizophrenia throughout the early 20th century were forced to undergo sterilization, insulin shock therapy, and lobotomies in psychiatric hospitals across America. Psychiatric doctors were also routinely allowed to perform unsubstantiated experiments on patients. For example, from 1907 to 1930, Dr. Henry Cotton of the New Jersey State Hospital regularly removed patient’s teeth, tonsils, spleens, and more out of the belief that mental illness was caused by untreated infections.

Since then, many old institutions were forced to close, and a new set of rules and regulations was introduced for psychiatric hospitals. Texas psychiatric hospitals, for example, are inspected each year by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) which ensures each hospital takes certain “accountability measures” to protect and serve patients. For example, Texas hospitals can now only keep patients involuntarily for five to seven days at a time, and can only extend that time with a repeat evaluation by a psychiatrist. While these measures prevent and punish the extreme abuse and negligence that was once levied upon psychiatric patients in the 60s, the shift to short-term care left much to be desired. “I don’t know personally anybody who doesn’t argue that the mental healthcare system—and in this case you could talk about the healthcare system in general—is broken,” says Dr. Neal. “It just doesn’t do what needs doing. We encounter that all the time here.”

Every professional I spoke to agreed with this sentiment of a gap in outpatient care, or the care available to psychiatric patients who are not being hospitalized. Most outpatients see a psychiatrist or a counselor once a week to discuss issues and goals for improvement, and to curate a medication plan, like I did before I was hospitalized. However, finding and paying for such counseling services can prove challenging for many people in need. Melisa Riley of NAMI said the challenge of working with insurance providers and accessing services with Medicaid hurts patients. Mariam Chokr of the Methodist Health System echoed this idea: “There are simply not enough psychiatrists/clinicians, resources, or education on mental health awareness to fill the needs of our community or across the nation,” she said.

Dr. Neal says most of these issues boil down to two things: availability of psychiatrists, and insurance. “In terms of psychiatry,” he says, “San Antonio, like most cities, is underserved with psychiatrists, and it’s gotten worse in the last five to ten years.” In Texas, a 2013 study revealed a ratio of 13,794 Texans per every 1 psychiatrist. The ideal ratio to allow for every person who is referred to a psychiatrist to actually see one is 4,000 to 1, a ratio met by only four counties in Texas: Kerr, Wilbarger, Howard, and Cherokee. 

This is especially troubling in San Antonio, where the 2013 Bexar county health assessment found that one of the largest proportions of hospitalizations in the city was due to mental illness, second only to poisoning, and that about 12.5 out of every 100,000 adults attempted suicide each year—an issue the study attributes mainly to financial stress. In Bexar county, a 2017 statistical study revealed a ratio of about 95,000 people to every 1 psychiatrist—nowhere near enough in such a high risk city. Despite San Antonio’s increased need and lesser professional availability, psychiatric care is still a prevalent issue across the United States, for which suicide was the tenth leading cause of death in 2016. A 2014 World Health Organization study found that there were about 12.4 psychiatrists available per every 100,000 people in the America, or one psychiatrist for every 8,065 people.   

Even with the introduction of the Affordable Care Act in 2010, which gave coverage for treatment of mental illness to 62 million Americans, paying for psychiatric services with insurance is increasingly difficult. According to Dr. Neal, in order to avoid the administrative hassle of convincing insurance companies to pay for their patients, psychiatric practices frequently stop filing insurance altogether. “And without filing insurance claims, they literally need much less office staff. So their operating costs are lower and their practice is simpler.” Patients are instead asked to pay via cash or credit card, and are then given a receipt which they can present to insurance companies for potential reimbursement. “But that essentially shifts the administrative hassle onto the patient and the patient’s family,” says Dr. Neal.

Basically, many patients without insurance can’t afford outpatient care, and many patients with insurance find it too difficult to coordinate payments to actually use it. The average price of therapy in the United States without insurance is $150 per session, which can add up quickly for patients being seen on a weekly basis. But even if patients can afford the therapy, finding a psychiatrist with availability can be an arduous process. “Increasingly we get into questions of access,” says Dr. Neal, “both cost-wise and transportation-wise, and finding therapists within the community that will file insurance, which are conveniently located and are open to accepting new clients or patients. And that latter one changes all the time. They have a waiting list or they just say call me back in a month or three and maybe I’ll have an opening. In our own psychiatry we have given up a referral list with used to be a list of psychiatrists specifically, because it became essentially useless.”

Even if the issue of awareness about the purpose of psychiatric hospitals was addressed for the general public, then, it is likely that many people without adequate funding, like my friends, would eventually find themselves back in hospitals anyways. The inability to seek outside care leads to the inability to acquire necessary prescription medication and counseling for handling mental illness, which ultimately culminates in a deteriorating mental state. Eventually as they slip back into crisis, hospitalization is the only option for such patients. But then they are faced with the same issues of limited scope of care that I faced, issues shared by other patients and their families, like Cindy A., the mother of a daughter who voluntarily admitted herself to Laurel Ridge in 2017. Ms. A left a negative review on Yelp near the end of her daughter’s stay, and agreed to speak with me about the experience.

At the time of her admittance, Ms. A’s daughter was suffering from severe depression, anorexia, and frequent self-harm. Both Ms. A and her daughter were seeking a more comprehensive care, not only to prevent her daughter from self-harming, but to give her the tools to improve and overcome her mental illnesses. They were disappointed by the acute crisis care they received.

They told her I revoked her rights and didn’t want her home with me, that I can’t care for her,” said Ms. A in her review. “What I said to them was she needs intensive treatment still and expressed concerns that she will not be getting it and I can’t handle her treatment without professional help.  She felt abandoned and alone and betrayed by me.” Like many, Ms. A was overwhelmed by the amount of care that her daughter needed, and turned to a psychiatric hospital for help. In turn, Laurel Ridge acted to get her daughter out of crisis and avoid liability, but not to give her any long-term solutions within their care—a process they begin for patients only at the end of their hospital stay by scheduling them with an outpatient psychiatrist or counselor.

The result was a stressful and emotional experience for Ms. A, and, like I had, a pervasive feeling of betrayal for her daughter. “I can honestly say it set my daughter back on her course of becoming a healthy individual,” Ms. A told me. “She had a lot of trust issues that arouse [sic] and compounded what was already going on.” Fortunately, Ms. A’s daughter was eventually able to find the help she needed, outside of the hospital setting. “My daughter is now a healthy weight and has found a mental health provider to keep her on path,” says Ms. A. Their story has many similarities with my own. I too eventually found the help I needed through regular meetings with a psychiatrist and a counselor, and was able to recover over time without the use of hospitalization. But the lack of easily accessible education available to me concerning psychiatric hospitalization, as my resulting disappointment and confusion with the acute care provided at SABH, set me back on my course to recovery.

But how can we ensure that all people find the outpatient care they need, like Ms. A’s daughter and I eventually did? Laurel Ridge, amongst about half of the ten or so other psychiatric hospitals in the city, is now doing their part to do more for patients that don’t need 24/7 observation, but still need intensive therapy. “We have a drop-down level of care, which is our partial hospitalization,” explains Linda Aguero. “It’s about a two week program that’s basically intense counseling. It runs Monday through Friday 8:30 a.m. to 3:00 p.m., then after they leave that program we set them up with an appointment outside of Laurel Ridge to continue their care.”

Outpatients in the program see a psychiatrist and a counselor every day to receive and monitor medication, and begin behavioral therapy to get the tools they need to manage their mental illness. The program is intended to maintain patient autonomy while ensuring more comprehensive care.  Both San Antonio Behavioral and San Antonio Methodist also offer similar programs, along with a few others such as the Nix Specialty Health Center and the Baptist Behavioral Health Center, although all are in limited supply due to the pervasive issue of lack of psychiatrist availability throughout the state. 

When asked about other methods to fill the psychiatric gap for outpatients, Dr. Neal replied, “We can’t do it easily, not quickly. Institutionally I think we are advocating for services whether it’s a more extensive scope of care here, which we’re trying to do, or looking for ways to identify resources to help facilitate getting people care off campus.” But Dr. Neal feels that part of the blame belongs to a communal mindset, an American unwillingness to take the burden of responsibility for fellow citizens in crisis. “It’s not quite like we’re willing to watch people die in the street, but metaphorically, if you can get the money you can get good care, but if you don’t, it’s gonna be hard. And how can any single institution fill that gap?”

Undoubtedly, what happened to me in San Antonio Behavioral Hospital should not have happened. Certainly, there is little excuse for the prolonged confiscation of an insulin pump, with no alternative medication offered for an entire day. But the blame for my lack of psychiatric improvement within the hospital lies not so much with individuals as it does with a broken system which fails to educate the public that depends on it, and to help the chronically mentally ill to enter a sustainable system of care.

While I agree with Dr. Neal’s sentiments that no single institution can fill the gap for patients seeking care outside of the psychiatric hospital system, there are a few solutions that can work towards alleviating it. First, and perhaps most difficult: our country needs more trained psychiatrists. If universities and the psychiatric industry can make clear just how vital and in-demand psychiatrists are in our nation today, perhaps more students would be drawn towards the profession. Second, the adoption of more lenient insurance policies towards appointments and prescriptions to do with counseling and psychiatry could provide needed care for many suffering individuals.

For example, Dr. Neal claims that many insurance companies refuse to cover counseling after the tenth appointment, even though many patients require more than ten sessions to fully address their issues. More cooperative insurance companies could also reduce the workload for office staff in psychiatric practices, making it easier for staff to file insurance claims instead of putting that pressure onto their patients. Finally, a greater effort within schools and communities by teachers, counselors, and health providers to educate people, preferably from a young age, about the fluid nature of mental illnesses and the treatment options available to those suffering from it would make strides towards a less stigmatic, more informed public.

Despite the increased faith I have in the professionals within the psychiatric field now, until such changes begin to take place, I will, like many others, have difficulty entrusting my mental health to such a fractured system. I tend to view professional psychiatric help as a last resort, instead choosing to rely on various personal coping tactics, like hobbies and breathing exercises, and the support group provided by my friends and family. However, this is not to say that professional counselors, psychiatrists, and even psychiatric hospitals should not be trusted; I am simply still recovering from my negative experiences, and will remain hesitant until there is more evidence of positive changes occurring.

Although no one from SABH responded to my requests for interview, the mental healthcare professionals I did speak to over the course of my research process were kind, hopeful people, equally as frustrated as I was by a lack of available resources for struggling patients. “What I love most about my job,” says Linda Aguero, “is being able to see a patient fulfill—you know—they come to us and they’re at the bottom, they are no longer living life…and then to see them get to a place where they no longer have those issues and then they start helping other people… it’s just rewarding to see a person go from that to happiness. So I’ve been doing this for ten years with Laurel Ridge, about thirteen years in the field in mental health, and there’s never a day that it gets old, every day there’s a different person, and so that’s why it’s rewarding.” Aguero and other mental healthcare professionals like her are doing their part to prevent situations like mine, and help people overcome their mental illness as best they can. Still, the onus does not lie only with the professionals, and the system in which they work.  

Aside from voting and advocating for better healthcare options for all, what can we do on an individual level to fix a broken system; to prevent yet more people with mental illnesses from feeling lost, betrayed, or even from getting seriously hurt, like I was? The first option is to speak up. For patients and their family members who have experienced injustices within the psychiatric system, it is imperative that they report such injustices whenever possible. Both Aguero and Chokr are patient advocates as well as community educators, and they emphasize that there should always be a hotline number available to patients who feel they have been mistreated, posted throughout the hospital as well as on each individual hospital’s website.

But the responsibility further extends to all people, whether they have experienced mental illness or not. According to Melisa Riley from NAMI, “It’s important to not refer to mentally ill individuals as their illness or as “they” and “us”.  This depersonalizes them and creates stigma and fear. It also takes away the autonomy of the individual. We would not take away the autonomy of people with heart disease or diabetes and we do not refer to these individuals as their disease, so we should not do that with the mentally ill either.” In order to be seen and heard, and in order to be taken seriously, people with mental illness and their loved ones must speak up as well. My own initial unwillingness to discuss my experiences with mental illness lead to an intense feeling of isolation, as well as a deep misunderstanding of the resources available to me in a time of crisis. In order to educate the general public, reduce stigma, and even prevent tragedy, it is imperative that the voices of people with mental illness are heard. “Continue to be brave and talk about mental illness like any other illness,” says Riley. “Be the example for other people to be brave.”

If you or a loved one are experiencing thoughts of suicide, please don’t hesitate to ask someone you trust for help, or call the National Suicide Prevention Lifeline at 1-800-273-8255, available 24/7.

Jennifer Jussel is a senior majoring in English from Trinity University. She is also the Managing Editor of The Contemporary.

The views expressed in this article are those of the writer. The Contemporary takes no position on matters of policy or opinion.

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