The Swellesley Report

By Wellesley’s Caroline S. Fox MD MPH

I’m in the day room at McLean, a large space with a linoleum-tiled floor and well-worn chairs and couches. There’s faint light coming in from the weak winter sun, but it is overwhelmed by the harsh fluorescent lighting overhead. A television dominates most of the room, and movement detectors line the windows and glass doors. The doctors are making rounds, just as I have thousands of times, except this time, instead of being the doctor, I’m the patient.

A month prior, I was a successful, respected physician. I had never experienced anxiety or depression. But after a few weeks of acute onset incapacitating anxiety and delusions, I find myself dressed in yoga pants and a hooded blanket, embodying what can only be described as “psych ward chic.”

I’ve barely eaten because I’m certain the staff are poisoning my food. I believe they put “sprinkle dust” in my slippers to track me when I walk around at night. My roommate wants me out of our room, so she pulls pranks, putting an ice pack in my bed, which melts and leaks all over my sheets. The fear keeps me up all night.

Despite being in a locked psych ward, my phone is in my hand. With all the things we aren’t allowed to have, I’m amazed that we are able to access our phones. It’s the last day of 2021. I decide to text close friends and family – a bit of a holiday card. I let everyone know that I’m spending the winter holidays at McLean. I brag about achieving Level 3 privileges. I talk about hanging out with the other patients, my roommate playing pranks on me. I rant about the mental health care system, and vow to run the Boston Marathon to raise funds for better access to care if I ever recover. And then, as if this is a normal situation, I write “And how are you and your family?”

Fast forward three years.

I’m standing on a street corner, once again in the weak winter sunlight. My running clothes are damp with sweat. I’ve just run fourteen miles. I’m training for the Boston Marathon, raising money for The Brookline Center for Community Mental Health. After nearly losing my life, I am incredibly fortunate to have made a complete recovery. I’ve been back in the work force for two years, enjoying time with family and friends – free of the anxiety that was so crippling. My recovery took one year.

I’m “runner of the week” for my charity team, which involves being featured on our social media channels. I make a video, explaining why I’m running the marathon. I stare into the camera, my pink running jacket wet with melting snow. The noise in the background fades away, and I introduce myself, explaining that despite the blustery conditions, the snow and the ice, it was a great run. In fact, I tell the camera, there’s nothing else I’d rather be doing. Many people won’t understand this sentiment, so I explain what motivates me to log hours on the icy cold streets.

“It’s the patients,” I tell the camera. “The patients who are waiting for care. I was one of those patients. When I experienced an acute mental health crisis three years ago, I had nowhere to turn. I couldn’t get an appointment as my symptoms worsened. That’s why I’m running for The Brookline Center for Community Mental Health.”

The camera stops filming. I post the video to Instagram. What seems innocuous is a big deal. It’s my mental health coming out party.

One morning three years ago, I developed acute anxiety that seemingly came from nowhere. It quickly spiraled, resulting in confusion and delusions. It took months of hospitalizations, appointments, more than a dozen different medications, the loss of my job, and residential psychiatric care in Texas. Only after all of this treatment was I able to find a comprehensive care team back in Boston.

I faced roadblocks every step of the way in my attempts to seek psychiatric care. Initially, my only option to see a psychiatrist was to sit all day at the hospital, without an appointment, in hopes of being seen. When seeking a more reliable option, I was connected to a kindly psychiatrist who was not versed in the use of contemporary medications. Therapists who did not take insurance charged exorbitant prices, and when my insurance did reimburse, which was rare, they mistakenly sent the money to the provider. Anxiety treatment centers, preying on the desperation of patients, charged thousands of dollars for unproven approaches, and failed to provide even the most basic details for promised insurance reimbursement. The only comprehensive care I could get was in an out-of-state psychiatric residential, where coverage was denied due to “lack of medical necessity.” It was only with my own financial resources, out of reach to most people, that I was able to pay for the lifesaving care that restored my health.

My focus now is mental health advocacy. There are few people who are untouched by psychiatric disease. We need to improve access to quality mental health care. The United States is in the middle of a mental health epidemic. Since the COVID pandemic, visits to mental health practitioners have tripled (1). Unfortunately, this has been coupled with a reduction in the number of mental health care providers, leading to an access disaster (2). The difficulty in finding care is so apparent. Even though my husband and I are Harvard trained physicians with close ties to Boston’s best hospitals, I struggled to get timely appointments with qualified practitioners. If someone this medically privileged can’t get appropriate care, what about everyone else?

We have a long way to go toward improving mental health care. On April 21, when I’m running the Boston Marathon, I’ll be pacing myself for the real marathon that lies ahead.

References:

(1) Ettman CK et al. Prevalence of Depression Symptoms in US Adults Before and During the COVID-19 Pandemic. JAMA Netw Open 2020.Sep 1;3(9):e2019686

(2) https://www.aamc.org/news/growing-psychiatrist-shortage-enormous-demand-mental-
health-services

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