A journey through NH’s mental health system: Granite Solutions, Part 3 – Designated Receiving Facility

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Editor’s Note: This is the third and final part of a series by Laconia Daily Sun Managing Editor Roger Carroll about his experiences with the mental health system after going through a personal crisis that landed him in an emergency room, a placement annex and finally a designated receiving facility at Franklin Regional Hospital.  


Roger Carroll with granddaughters: ‘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 struggle.”

Part 3

The fact that mine was a straightforward case of depression meant that, rather than languishing in the Annex at Lakes Region General Hospital for days, I was an easy “yes” for mental health facilities with open beds. My case wasn’t complicated by addiction and I had no history of violence (my juvenile transgressions weren’t part of any record). If those had been factors in my case, that could have narrowed the options available to me, I was told by a practitioner, since not all facilities treat patients with addiction and some lack the security features needed to deal with patients who might be prone to violence.

In this case, the “yes” came from my insurer and from Dr. Raymond Suarez, who runs the Designated Receiving Facility at Franklin Regional Hospital, where I arrived by ambulance late on Wednesday.

The early notes from the nursing staff record that I stayed in my room a lot in the beginning and describe me as “standoffish” and a “gentleman.” They also state that I was prone to rapid mood changes, sometimes confrontational and had poor coping skills and a hard time 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. For instance, when I was given permission to ditch my hospital scrubs, I was impatient when my regular clothes weren’t ready, something mentioned more than once in my file.

My room had a desk and a chair and a real door with a window. While I lay in bed at night waiting to fall asleep, I noticed a shadow passing over the window at regular intervals. It was one of the nurses doing a well-being check.

There were five of us at the table for breakfast on my first full day on the unit, and we ate as the nurses made the rounds to hand out meds. The nurse assigned to me gave me the dosages I regularly take for high blood pressure and elevated cholesterol, then gave me another pill with a name I didn’t recognize.

I don’t have a prescription for that,” I said.

He told me it was Lexapro, and Dr. Suarez had prescribed it for me.

I stood up quickly, an act his notes indicate he interpreted as a sign of aggression. 

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.”

He told me I didn’t have to take it, and I replied that I wouldn’t. The notes also indicate that I apologized for my hostile attitude, though I don’t remember that part. 

The prescription was a bone 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 and given to me.

He said he had written it after reading my file, and felt it was the right medicine for me.

Why are you angry?” he asked at one point.

His notes report that, “Patient’s anger at the issues stem from a previous interaction with a psychiatric that he felt did not give him enough time prior to diagnosing him and giving him a medication.”

He was right. I told him about a psychiatrist who had once — wrongly — diagnosed me with bipolar disorder after meeting with me for just minutes.

I spent about 45 minutes with the treatment team and returned to the unit feeling better and agreeing to take the Lexapro.

Like the other patients, I had meetings like these every day I was there. I came to look forward to them. I felt supported and the sessions allowed me to get feedback on my progress.

You’re going to be OK,” Dr. Suarez assured me on Friday.

I was a can of corn.

Group

Daily life at the Franklin Designated Receiving Facility (DRF) 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 first group was a session about the importance of staying hydrated.

Others were more substantive: crisis prevention and management; four dimensions of recovery; coping with stress; the cycle of anger; recognizing protective factors in your life; building social support; battling depression and anxiety; negating negative self talk; boundaries and the end of hopeless/toxic relationships; building social support.

The goal, as I understood it, was to come up with a self-help plan for recovery.

I attended all of the groups, though not everyone did. Some patients slept instead — a lot.

And sometimes a scheduled group session wasn’t held for some reason, in which case we stayed in our rooms, hung out with each other in the dayroom or used the time to shower. Several patients colored with markers for hours on end. They worked on sheets of black and white coloring paper that included inspirational sayings and images. One featured a dreamcatcher with feathers and the words, “Only an open heart can catch a dream.”

Inspirational coloring page.

Even those who barely participated in group sessions found coloring therapeutic, and a bulletin board within the unit was decorated with patient art.

Coloring wasn’t my thing, but the groups were helpful exercises in self-reflection and offered the opportunity to receive support from other patients, who all seemed aware that everyone there had fairly tender sensibilities. A lot of encouragement and praise passed between us, though there were the inevitable conflicts, too. One patient seemed to take a particular dislike to another, and lashed out more than once, upsetting our delicate group balance.

That, however, was the exception, and I came to like and respect all of my fellow patients. I also made a conscious effort not to pry into the circumstances that brought us together, figuring they would share what they felt comfortable with.

It was impossible to tell who was there for what without being told. One woman, bright, creative and funny, was clearly struggling with a loss. Another said she had spent nine days in an emergency room after she tried to kill herself with a heroin overdose. She had hoped to be admitted again to New Hampshire Hospital, the state’s largest psychiatric facility with 168 beds, but was sent to the 10-bed Franklin facility instead. She was not happy about it.

No secrets

I, on the other hand, 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, ages 9 and 7.

A staff member had assured me earlier in the week that it would be OK for them 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 posited 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?

They know where I am and they know why I’m here,” I said. “We don’t have a lot of secrets in my family.”

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 struggle.

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 only allowed to see her 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.

The practitioner said she would consider my request and let me know.

Great, I thought as the meeting broke up, as long as the answer is yes.

In the end, it was. She consulted with Dr. Suarez, who gave the OK to let the girls visit.

As I walked up the hall toward the locked doors that led to the visiting room, I received words of kindness and encouragement. The other patients were happy for me and knew how much the girls meant to me.

I passed through the doors just as the security guard finished patting down my future son-in-law. The guard then turned to the two little girls with flowing long brown hair.

Do you have anything in your pockets?” he asked with a smile.

They shook their heads, and he gave them permission to enter the visiting area. I was grateful the guard had the good sense and decency not to subject them to a pat-down.

Bad meatloaf

The visit started out with hugs and small talk and, 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.”

I told them the doctor said I was going to be OK.

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 their 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. They crack the eggs, add the bread crumbs and liberal amounts of ketchup (the secret ingredient) and spices. Then they dig their little hands into the ground beef and mix it all up before spreading it out in a cake pan and glazing it. 

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. 

Maddie, the 9-year-old, begged off, so Gracie and I flew solo in the kitchen.

Is this enough ketchup?” she 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. 

Janis?” I called, and she came down the stairs and knew immediately that I was in a bad state.

She flew into action and we soon had broccoli and mac and cheese on the table.

The meatloaf, however, was easily the worst batch ever. 

In other words, it was a reflection of my mindset. I had been there physically but not mentally, and two days later I was in the hospital.

Now the girls and I joked about the meatloaf, which they admitted was horrid. More importantly, for 45 minutes I was able to live completely in the moment in a way I hadn’t done for weeks. I felt normalcy returning.

I hugged everyone goodbye and walked through the adjacent doors to the unit, where I saw the most uplifting sight.

Patients were in the hallway looking toward the external doors — like heads popping up in a prairie-dog village —hoping to catch a glimpse of my little treasures as they were leaving. It was further affirmation of just how lucky I was, a sensation I also experienced that night when I hugged Janis in the hallway as she was leaving. The other patients cooed and ooohed and aaahed.

Discharge

The group sessions and antidepressant worked and my outlook improved quickly. I was discharged 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.

My discharge from the psychiatric unit was not the end of my journey. 

As a friend of mine said recently, “introspection is the heaviest of lifting.” 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. 

I decided to write about the experience for the same reason I wrote in 2015  about being physically and sexually abused: Because not talking about a subject doesn’t make it better.

The National Institutes of Health estimates that 1-in-5 Americans has a mental illness, but only about half seek treatment, many because they are afraid of being stigmatized. 

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.

I also decided to write about it 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. Talking about it openly and honestly is the best way to do that, and I’ve tried to do that while also protecting the privacy of those I encountered along the way.


Need help? NH Resources:

NH Bureau of Behavior Health

NH Community Health Centers

National Alliance on Mental Illness NH

NH Mobile Health Crisis Lines

NH Community Behavioral Health Association

NH Bureau of Drug and Alcohol Services

NH Drug and Alchohol and Drug Treatment Services

NH ServiceLink


⇒Read Part 1 here: Emergency Room

⇒ Read Part 2 here: The Annex