Inside the human cost of a broken mental health system — and why we can't look away
There’s probably a cringey dad joke that starts, How does a kid from New York get caught stranded in a thunderstorm in Colorado’s high desert?
That was also the question my unapologetically New York shrink of a mother — think oversized shawl, whatever overpriced wool sneakers are now in vogue, jeans that have themselves traveled thousands of miles, round, like really, really, round tinted glasses — was asking me on the other end of the line when I got back to the hotel.
I tried to explain.
“You WHAT???”
I tried again.
“Oh, honey, can’t you just stick to medicine?”
But since the pandemic — or, more specifically, since April 2020 when fellow 2019 KHS scholar Matt DeButts and I co-published a story about low-income healthcare workers of color disproportionately dying from COVID — I can’t. Medicine has a way of revealing society’s ills; disease often derives from social pathology as much as from cellular biology.
So there I was, in Grand Junction, reporting.
Specifically, I’d come to that town — the largest between Denver and Salt Lake City — to investigate one hospital that had repeatedly broken federal law. Over and over, it had turned away people in the throes of mental health crises.
That hospital, my editor and I figured, was really a microcosm of a much larger story: Amid record rates of youth anxiety and depression, amid historic suicide and drug overdose death rates, amid struggles by people to get care through their insurance, which didn’t cover mental healthcare or covered it but wouldn’t pay for it or covered it and would pay for it but wouldn’t pay for anyone close or covered it and would pay for it and would pay for someone close but only if you got prior authorization, emergency rooms had become folks’ havens of last resort. Yet, hospitals like this one were turning people away, we’d found.
But a broken law alone isn’t a story. Nor is a hospital acting with impunity. Nor is a zillions-of-rows database like the one we’d built quantifying it all. We needed human beings to tell this story. And as such, I’d set off combing the town, asking anyone who would listen if they knew anyone that had happened to.
“Go to the desert,” one source told me. “When people feel like they don’t have anywhere else to go, they go there.” Hence: the thunderstorm.
About a year after that trip, our ProPublica investigation was finally published. We’d found that, indeed, dozens of psychiatric hospitals appeared to have flouted federal law by turning people away during emergencies. Yet, they faced scarce consequences from an enforcement system that appeared to be oblivious, broken, or both. Even when hospitals faced repercussions, we found, the fines were often “budget dust” to the multibillion-dollar companies that own the hospitals committing the vast majority of the infractions.
We’ve only scratched the surface, and there’s more to come.
For now, I guess there’s only one thing to say. Sorry, Mom.
Listen to an interview with Eli on NPR One about his investigation for ProPublica.
Eli Cahan (2019 cohort), MD, received a master's degree in health policy and is currently a neonatal intensive care fellow as well as co-director of the Health Equity Media Fellowship at Stanford School of Medicine. Outside of his clinical work, he is an award-winning investigative journalist covering the intersection of health policy and public health. His work has been featured in ProPublica, The Washington Post, LA Times, and Rolling Stone, among other publications.
Knight-Hennessy scholars represent a vast array of cultures, perspectives, and experiences. While we as an organization are committed to elevating their voices, the views expressed are those of the scholars, and not necessarily those of KHS.