Laconia Daily Sun Managing Editor Roger Carroll experienced firsthand how New Hampshire’s mental health system works — and doesn’t work — when he went through a personal crisis last fall and sought help. He wrote about his experiences to shed light on that system and help remove the stigma surrounding mental health.
It was the week before Thanksgiving, and my world had changed from that of a working journalist with the freedom to come and go as I pleased to being held in a locked psychiatric facility where staff checked on me every 15 minutes to make sure I was OK.
I was in the designated receiving facility at Franklin Regional Hospital, one of a handful of such inpatient facilities in the state where patients go to be treated for mental illness. I was there for four full days and part of two others.
My journey started with a regularly scheduled Tuesday visit to my therapist at Lakes Region General Hospital in Laconia. About halfway through the session, she escorted me down a series of hallways to the emergency department.
“I think you need more help than I can give you,” she said as we prepared to leave her office.
“Have you had thoughts of hurting yourself?” a triage nurse asked me soon after.
I’d been thinking about it off and on for months. I had checked out guns online and identified a weapon that was big enough to do the job and within my budget. The day before my appointment, I had gone looking for the location of a gun shop. I found it, and that morning I had pulled into the parking lot, though I didn’t go inside.
Instead, I went to my appointment and told my therapist where I had been. I was scared.
I was no stranger to therapy.
I had my first session when I was about 11. My mother thought there was something wrong with me because I had been acting out in school. By then, I had endured years of physical abuse at the hands of my stepfather and mother, who each battled alcoholism and struggled to raise seven kids. I also was repeatedly sexually abused by a teacher at my elementary school.
Yeah, there was something wrong with me.
I told none of that to my first therapist, but I was perpetually angry. That anger manifested itself in various clashes with authority figures over the years, leading me to be declared a juvenile delinquent.
By then my mother had lost custody of her children and I was in foster care. I started weekly sessions with a psychiatrist and took an antidepressant through my high school years.
I graduated from high school — probably to the astonishment of some of my teachers — and went to college. I received my bachelor’s degree and happened into journalism, starting in radio before moving to newspapers.
Externally, at least, I appeared fairly well-adjusted. Professionally successful, I married and became a father to a beautiful, smart, funny little girl.
I was devastated when that marriage fell apart after just three years. I considered killing myself and, even worse, killing someone else — thoughts I shared with my estranged wife — though I never made a plan or took steps in either of those directions.
But for a couple of months, while living alone, I was often paralyzed by depression and an emotional pain so debilitating that there were days I never got out of bed. When I did make it down the stairs, I languished for hours on the end of my ratty little secondhand couch, wallowing in self-loathing.
Fortunately, I connected with a forensic psychologist, and for nearly three years I drove an hour each way from Lebanon to Concord for my weekly appointment. And for the second time in my life, I started taking an antidepressant.
The key to picking up the pieces, I discovered, was my relationship with my daughter. With my marriage over, I needed a new identity and I found it. Being Whitney’s dad was not only what I was — it became how I defined myself and allowed me to keep going. I felt like she had saved my life.
I told her that on the Saturday before I was admitted to the hospital, when I went to say goodbye.
After I informed the Lakes Region General Hospital triage nurse that I had formulated a plan to take my life, I was taken to a room down the hall. The sign outside said it was under audio and video surveillance.
A nice man came in — a nurse practitioner, I found out later — and asked me questions about my state of mind. I teared up when I described what I was feeling and told him about my flirtation with the gun shop.
A few minutes later an affable, burly man in hospital scrubs came in and introduced himself as Joe. He told me he was going to stay with me and asked a series of questions nearly identical to those I had already answered. As much as I wanted to hurt myself, I told him, I was not a threat to anyone else, answering a question he had not yet asked.
Joe parked himself outside my room, and for the first time in my life, I felt like I was not free to go.
I was waiting for a bed to open up at something called “the annex,” which is technically part of the Lakes Region General Hospital emergency department. It’s a six-bed facility where people are parked until doctors can make arrangements for patients to enter a facility and get treatment.
There is a bottleneck for people trying to access mental health treatment in New Hampshire, and hospital emergency departments are where the system backs up.
“The number of New Hampshire residents waiting in hospital (emergency departments) for admission to inpatient psychiatric treatment has more than tripled since 2014, exceeding 70 across the state on several days in the past year,” said the state’s 10-year strategic mental health plan, which was released the day after I got out of the hospital in November.
The reasons for that increase vary, but some of the factors include a shortage of psychiatric beds, a lack of step-down treatment sites like short-term residential facilities and a dearth of nurses.
There is a shortage of everything, it seems, except patients like me.
A few hours later, I was escorted to my room in the annex, which boasted a curtain where a door might have hung, a bed, a TV and a small sink. There was no window and no bathroom.
When I arrived at my room, one of the nurses talked to me for about 10 minutes in what seemed like an attempt to take my emotional temperature. When he departed, I sat on the edge of the bed, buried my face in my hands and cried — deep, body-wracking, convulsive sobs.
As if on cue, another nurse showed up with a box of tissues. It was then that I noticed the small video camera mounted near the ceiling, next to the television. I was under 24-hour surveillance.
“How did it ever come to this?” I wondered.
My case, in nonmedical terms, was “a can of corn” — an old-fashioned baseball expression for a lazy fly ball that is easily caught by an outfielder.
The technical diagnosis, according to my psychiatrist’s notes, was “adjustment disorder with mixed disturbance of emotions and conduct.”
The nurse practitioner who examined me recorded “Depression F32.9” in my records, a billing code for a single episode of major depressive disorder, unspecified.
That, in a way, was good news. The fact that mine was a straightforward case of depression meant that, rather than languishing in the annex for days, I was an easy “yes” for mental health facilities with open beds.
In this case, the “yes” came from my insurer and from Dr. Raymond Suarez. He’s the head of psychiatry at Lakes Region General Hospital and runs the designated receiving facility at Franklin Regional Hospital, where I arrived by ambulance on Wednesday, one day after my therapist appointment.
The early notes from the nursing staff said that I stayed in my room a lot in the beginning and described me as “standoffish” and a “gentleman.” They also noted that I was prone to rapid mood changes, sometimes confrontational, had poor coping skills and difficulty concentrating on a single subject.
Those assessments are accurate, I think, and speak to the fact that there was little that escaped the notice of the nursing staff.
On my first full day on the unit, nurses made the rounds to hand out medication. The nurse assigned to me gave me the dosages I regularly take, then gave me another pill with a name I didn’t recognize.
“I don’t have a prescription for that,” I said.
I was told it was Lexapro, and Dr. Suarez had prescribed it for me.
“I’m sorry,” I said. “I may be a little old-fashioned, but I think the doctor should actually see me before he writes a prescription.”
The nurse told me I didn’t have to take it, and I replied that I wouldn’t.
The prescription was a point of contention when I met with Dr. Suarez and the treatment team later that morning. The team included the nurse assigned to me, a nurse manager and a couple of social workers.
To his credit, Dr. Suarez let me vent about the prescription. I repeated my objection to being given a script sight-unseen, and argued that I should have at least been informed or consulted before it was written.
Dr. Suarez said he had written it after reading my file, and felt it was the right medicine for me.
I spent about 45 minutes with the treatment team, and returned to the unit feeling better. I also agreed to take the Lexapro.
“You’re going to be OK,” Dr. Suarez assured me later that week.
I was a can of corn.
Daily life at the Franklin designated receiving facility revolved around a robust schedule of group therapy, or “group,” as it was called. I was given a schedule of group sessions when I first arrived, along with a set of guidelines that said everyone was expected to participate.
The goal, as I understood it, was to come up with a self-help plan for recovery. Group also offered the opportunity to receive support from other patients, and a lot of encouragement and praise passed between us.
I was never happier during my stay than on Saturday, when I expected a visit from my daughter and her fiancé. Of greater importance to me was the fact that they were going to bring my granddaughters, 9-year-old Maddie and Gracie, 7.
A staff member had assured me earlier in the week that it would be OK for the girls to visit, but during a Saturday morning meeting with the psychiatric nurse practitioner, she said it was contrary to the rules to allow visitors under 18.
She listed off several reasons why they shouldn’t be allowed to visit. It might not be appropriate for the children, she said, and there were concerns about patient privacy.
I felt myself growing frustrated, but tried not to get angry. I countered that it should be left up to their mother to decide what was best for the girls; and as for privacy, who were they going to tell?
It was important for the girls to see that Grampa was OK, I continued. And not only that, it was important that they see me in this environment so they know that it’s OK to ask for help when you’re struggling.
I felt like the very system that seeks to remove the stigma surrounding mental illness was perpetuating that stigma by treating mental health care as something to be hidden from children.
I had a vision of going to visit my mother when she was institutionalized at New Hampshire Hospital in the early 1970s, when we were allowed to see her only through a small window in an external door at the end of a hallway. We stood outside and waved to her, and some of my siblings cried.
In the end, Dr. Suarez gave the OK to let the girls visit.
The visit started out with hugs and small talk. After a period of time, I asked the girls why I was there.
“Because you’re sad,” Gracie said.
“That’s right, sweetie,” I replied. “It’s called depression, and it happens sometimes. And when it does, it’s OK to ask for help.”
Then I joked that I was in the hospital because of a bad reaction to bad meatloaf.
They laughed, but there was a kernel of truth to it, too.
My meatloaf has always been the girls’ favorite, and they ask for it every time they come for a sleepover, which is about once a month. One of the joys of making it has been involving them in the preparation.
The plan when they visited me the previous Sunday in Laconia — the day after I had gone to say goodbye to their mother — was to make meatloaf, steamed broccoli and boxed macaroni and cheese.
“Is this enough ketchup?” Gracie had asked, holding the squirt bottle upside down.
“That’s fine,” I said, barely looking at the mixing bowl.
The depression had hit the day before like a tsunami, washing away thoughts of all of the things that normally brought me joy and leaving me feeling isolated and hopeless.
I managed to get the meatloaf in the oven, but everything after that seemed overwhelming.
That meatloaf was easily the worst batch ever. It also was a reflection of my mindset.
During the girls’ 45-minute visit at the hospital, I was able to live completely in the moment in a way I hadn’t done for weeks. I felt normalcy returning.
The group sessions and antidepressant worked, and my outlook improved quickly. I was discharged on Monday and returned the same day to my job, where I explained my situation to my boss and co-workers and was met with support. Everybody should be so fortunate.
I honestly don’t know if I would have killed myself. Given more time, I believe I probably would have bought the gun. After that, I think, it would have been a coin flip.
Instead, I sought help. I hope others in distress do the same, because help is out there.
I still have work to do. I continue to see a therapist, and a psychiatric nurse has been added to the mix, but I believe I’ll come out the other end in good shape.
The National Institutes of Health estimates that 1 in 5 Americans has a mental illness, but only about half seek treatment. Many don’t because they are afraid of being stigmatized.
I decided to write about my experience for the same reason I’ve written about being physically and sexually abused: because not talking about a subject doesn’t make it better.
I also decided to write about my experience because I agree with a movement started by former New Hampshire Supreme Court Chief Justice John Broderick, who has said we should end the stigma and make symptoms of mental illness as well-known as the signs of a heart attack or stroke.
With numbers like that, we all know someone afflicted with mental illness, so ask yourself who you’d rather live or work next to: someone who knows they are struggling and gets treatment, or someone who doesn’t.
It’s in everyone’s interest to remove the stigma that exists around mental health care. Talking about it openly and honestly is the best way to do that.
If you or someone you know is experiencing difficulties with mental health or suicidal thoughts, help is out there.
National Suicide Hotline: Call 1-800-273-8255 for free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals.
Crisis Text Line: Text 741741 from anywhere in the U.S. to text with a trained crisis counselor.
This story was produced by The Granite State News Collaborative as part of its Granite Solutions reporting project. For more information, visit www.collaborativenh.org.