When Daisy was a toddler, we had a fluffy calico cat named Scarlett O’Hairy. Daisy adored her and wanted to be just like her. She’d sleep like a cat, all curled up with Scarlett in a patch of sun on the floor. She tried eating like a cat (but even her love for Scarlett couldn’t convince her to take more than one bite of the foul-smelling food). Once, in the wee hours of the morning, Daisy saw Scarlett jump off my bed and decided to do the same thing. While Scarlett landed gracefully in the laundry basket, Daisy fell into the dresser and split her forehead on a sharp corner. This resulted in a trip to the pediatric emergency room, and four stitches. Another time, Daisy took up Scarlett’s favourite pastime – digging in the houseplants. She ripped leaves off the plants for Scarlett to eat and crammed mouthfuls of potting soil into her own mouth. This resulted in a call to poison control, and a decision that maybe a baby brother or sister would be a safer companion than a cat.
We’ve spent a lot of time in the emergency room over the years, for cat-induced and other ailments: ear infections, kidney infections, strep throat, croup, broken bones. Eventually, toddlers pass out of the Walking Germ Bag phase. Trips to the emergency room become so infrequent that the kids actually look back on them fondly: misty watercolored memories of being safe and warm, wearing brightly coloured johnny-shirts and wrapped in warm flannel blankets, and being treated by kind people who gave them popsicles and stickers and cool-looking bandages.
My memories of those visits are equally nostalgic. Maybe that sounds strange – I mean, what parent looks fondly back at illnesses and middle-of-the-night trips to the ER? But like my kids, I don’t remember the illnesses much. I’ve thankfully forgotten the vomiting, the search for clean sheets in the middle of the night, trips to the hospital through dark streets with time standing still. What I do remember is how we were all treated. My kids were treated with compassion and kindness. I was also treated so well. Everything was well-explained, follow-up instructions and appointments were clear, and the health professionals seemed as concerned with how I was coping as with how my kids were managing. Once or twice, I even got a popsicle of my own.
I’m nostalgic for that, because these days my visits to the ER are for Puck’s mental health crises — something that can’t be treated with stitches or antibiotics, and is a genuinely terrifying kind of pain. And when we get past this, my experience with the mental health emergency room is not a memory on which I’ll look back fondly.
You won’t see this part of the ER featured on the annual telethon. Children in mental health crisis sit in cold little grey empty rooms down corridors that are safely out of the view of families there for physical ailments. I understand that the spartan nature of the room helps ensure safety. But the grey walls with peeling paint, the cast-off furniture with springs and foam sticking out, and stained ceiling tiles are a shocking contrast to the exam rooms for children with physical ailments. If you weren’t feeling miserable when you entered the hospital, this room will give you the proper sense of worthlessness. Every bit of peeling paint is a billboard that announces: “You don’t matter, we’re hiding you, you should be ashamed.” It was as though we’d wandered onto the set of One Flew Over the Cuckoo’s Nest, Junior Edition.
The decor is merely a symptom of the more pervasive illness that infects our mental health system: stigma. Stigma should not be reinforced in the places we go to for help. Especially when vulnerable children, in crisis, are seeking help. But the stigma permeates the processes, the decor, the attitudes in our mental health system. It sends a strong message to both the patient and the family: you should be embarrassed to be here, and Something is Very Wrong With You.
There are so many ways the mental health system makes patients and families feel insignificant, not worthy of help, or abandoned. There is a lack of access to services, hoops families must jump through to access care, the insincerity of a system that claims to offer choice, but is really offering you one appointment to decide which of your issues you want to deal with, and if you aren’t okay with that…buh bye. Good luck coping on your own.
That’s not exactly client-centred.
Our local children’s hospital has done an excellent job at offering more client- and family-centred care. Physical care, that is. In none of my interactions with the mental health side of emergency services, or those of friends and family, have I witnessed anything close to client-centred care.
It feels client-avoidant, to be honest. It feels more like, “How quickly can I get this person out of this awful little room and hand their file to someone else who they’ll have to wait weeks to see, and then our algorithms will sort them out of our system altogether but we can still tick the box saying we offered treatment and thereby make our wait times appear lower?”
When physical exams are carried out in the ER, there are clearly protocols to be followed. Yet, it never feels like a doctor or resident is reading off a form on the chart. There is usually genuine interaction and human conversation, an attempt to engage the child while acknowledging their distress. Not so on the mental health side of the ER. Eye contact is avoided. Morose tones sound more applicable to a funeral director than to a mental health social worker. Children shiver in chairs that have springs poking out of them. There is nowhere for them to look except at the health professional, who all too often doesn’t look back at them. They are too busy reading the questions that MUST, it seems, be asked verbatim from the form (even though we answered these last time we were here, a month ago, and the ‘tombstone’ information hasn’t changed. It’s another way to give patients the message that they are forgettable, or a burden).
I can see how the lack of client-centred treatment makes Puck feel. He usually leaves the ER feeling worse than when we arrived. It takes him days to recover – not just from the mental health crisis itself, but from the silent message he’s received there that he doesn’t matter, must hide, needs to get out of the way.
It’s a world apart from popsicles and warm blankets.
When a child is having a mental health crisis, the parent is also in crisis. The child needs humanity and compassion. So does the parent. But each time I’ve gone to the ER with Puck, I feel I’ve lost a little of my own humanity. Because not once has a health professional on the mental health side called me by my name (not even the awkward time when the social worker was actually a former colleague from the Department of Health). Instead, without fail, I am called “Mom”. Not my given name. Not Mrs. So and So. Just “Mom” – as if they can’t be bothered to learn my name. As if I am just a cue on the forms they from which they read (“Insert female parent figure here”).
This might sound like a trite complaint, in the big scheme of things – not wanting strangers calling me ‘mom’. I’m proud to be a mother. Becoming a mother wasn’t easy for me, and being a mother certainly isn’t easy. Having my children call me Mama is one of this world’s sweetest sounds to my ears. Having a successive chain of middle-aged health professionals dismissively call me “Mom” makes me feel a bit stabby, to be honest. This is the thing that finally caused me to snap last time we visited the ER.
It was the most awful visit yet, and the situation leading up to our visit had left us all emotionally fragile and exhausted. As a parent to a child in crisis, I felt like a failure. I felt I should have been able to prevent this. As a parent, I needed support. I needed reassurance and compassion. Instead, I was treated like a ‘thing’, an add-on, an interchangeable female caregiver who wasn’t worth the effort to get to know. (Why get to know my name? They’ll be another “mom” through these doors in just a few minutes. Let’s just make it easier on ourselves.)
Being called Mom in this way made me feel invisible and hidden…like a generic avatar on a social media site. It also feels frankly misogynistic, as though all women that show up with kids in crisis are interchangeable, generic figures who only exist to fulfill a parenting role.
After the fifth mental health worker that morning called me Mom, I lost it. I was having none of it. I told them (very loudly): “I AM NOT YOUR MOTHER. STOP CALLING ME MOM”.
Blank stares. Crickets.
One meek voice: “Oh. We find that most women like to be called Mom”.
Me: “Really? Is there research? I’d like to see the evidence, because I’m pretty sure most people who come here would rather be treated as the complex individuals they are and not just a simple caricature that simplifies your note-taking”.
Awkward smiles. No acknowledgment of my concern or distress. One person said they had to go find some pamphlets, and they all left.
Just me and Puck, alone again in the dismal room, comforting each other, while the professionals look for pamphlets. That’s our mental health system, in a nutshell.
On our way out, we walked past another young boy who was leaving the physical ailment side of the ER. The resident offered him a cheery goodbye as the boy limped away on a bandaged foot, happily eating a popsicle.
What I wouldn’t have given for a popsicle.