My dad, Glenn, spent a lifetime being viewed as a leader, counselor and outgoing friend to many. From his training and work in ministry to being named head of safety for one of the largest steelworkers’ unions in the country, his life impacted those around him in profound ways. At different points, Glenn was an avid golfer, competitive bike-rider (he owned an awesome Lemond custom bicycle), a hiker, a member of the Olympic alternate curling team, and writer of music. He was known for his kind nature, intense ability to listen, and for his remarkable command of the guitar.
Despite a life that looks idyllic on the surface, Glenn was suffering. Diagnosed with clinical depression at the age of 30, he spent 30 years on medications that essentially served as Band-Aids. Without medication, Glenn would crumble under the weight of nearly paralyzing depression. With the medication – his mood and emotions could become “watered down” to the point where we barely recognized the person we knew.
In 2013, it became apparent that his current long-term medication regimen was not working any more. He approached his primary care physician for help in “adjusting” his medications. During that same period, his 4-year-old granddaughter – was diagnosed with a brain tumor. We could see his anxiety mounting. He could see it too – and wanted to do something about it. Multiple medications were now being prescribed from several different providers. Any standards regarding cross-prescribing of different anti-psychotic and anti-anxiety medications were being either overlooked or lost to EMRs between different clinics and hospitals.
I know my dad felt like he was letting everybody down and things were never going to get better. He couldn’t see the way out. Things were bad enough for my dad to admit himself to the hospital two times in the spring of 2013. He had taken a medical leave of absence from his job. All the while, even his closest friends and colleagues were unaware of his condition. On Monday, June 28, my mom and my dad’s sister drove him to the hospital emergency department. He was able to articulate that his thoughts had become suicidal – and that he desperately wanted and needed help.
After 3 hours in the ER, he was discharged home. The attending physician had let the family know that no in-patient psychiatric beds were available to admit him. He walked out the door with a recommendation to start “taking Vitamin D” and to start doing volunteer work.
Less than 36 hours later, my father was found dead at an entry point to park where he and my mother and friends had spent countless hours playing Frisbee golf together just one summer earlier.
It would be days later before the family knew that my dad had quietly gone to his sister’s house to retrieve a shotgun that had been in storage at her home for years.
What’s clear about my father’s tragic death is that depression played only a small part in it. Multiple systems failures converged to seal his fate. Declining access to in-patient psychiatric beds has reached epic proportions nationwide, but particularly in the nation’s rural and community hospitals. By one count, the nation needs an additional 123,300 psychiatric hospital beds. The loss of those beds has left “the sickest of the sick” without treatment. A 2016 report from the nonprofit Treatment Advocacy Center reports that the nation’s psychiatric bed shortage has deteriorated to “beyond disastrous.”
Despite that grim reality, if the ER physicians that fateful night had simply checked their system, they could have referred by father to be admitted at one of two other hospitals, about 60 minutes away. We read his EMR notes from that night – and the months leading up to his ER visit. It was clear even to the layperson that this wasn’t a one-time bout of anxiety. The documentation was there. The previous visits, the litany and timeline of medications, many of which had notably dangerous drug interactions. The potential for self-harm.
The lesson we take away from my dad’s death isn’t just one of better diagnosis and treatment of mental health conditions. It’s about putting the human experience in front of the systems. Connecting all the health IT dots would have helped. But that alone would not have saved my dad. Given that 10 million Americans with mental illness are languishing without access to care, it should come as no surprise that 40,000 of them die prematurely from suicide each year. It will take some concerted efforts between researchers, hospital administrators, clinicians, technologists and health payers to address that gaps and end the epidemic preventable deaths tied to mental health diseases and disorders.