Levels of Care

By the time Tomas turned twenty, his parents in Toledo, Ohio, had not slept a full night in nearly three years. Their son, who had been diagnosed with profound autism and intellectual disability at age two, had become physically dangerous to himself and to them. He weighed two hundred and ten pounds. He could no … Read more

Marcus was twenty-one years old, a junior at the University of Cincinnati studying mechanical engineering, when his roommate noticed him whispering to a corner of their dorm room at three in the morning. Within six weeks, Marcus had stopped attending classes, accused his mother of poisoning the family dog, and barricaded himself in his bedroom … Read more

Devon Pritchard had spent four years as a Cincinnati firefighter before the depression became something he could no longer outrun on a treadmill or drown at a craft brewery. The 33-year-old had failed sertraline, escitalopram, duloxetine, and a six-month trial of bupropion that gave him insomnia. His psychiatrist at the University of Cincinnati Medical Center … Read more

A Real Day in an Intensive Outpatient Program People hear the words “intensive outpatient program” and picture something between rehab and weekly therapy without a clear sense of what actually happens during the program day. The vagueness keeps many patients from accepting a step-up referral when their mental health care needs more than standard outpatient can deliver. … Read more

Sergeant First Class Daniel had served three deployments in Afghanistan with the Tenth Mountain Division when he came home to Watertown, New York, with a diagnosis of post-traumatic stress disorder, a marriage on the brink, and the kind of insomnia that turns three in the morning into a familiar enemy. After eighteen months of trauma-focused … Read more

Brian had eighty-seven days clean when he walked out of a Seattle outpatient program with a discharge folder under his arm and a Tuesday afternoon that suddenly stretched ahead of him with no scheduled groups, no morning check-ins, and no counselor down the hall. The folder included a list of AA meetings, a phone number … Read more

Marcus Halloway had been out of the Marine Corps for nine years when his wife Tasha, sitting in the parking lot of a community hospital ER in Tampa, pulled out her phone and called the Veterans Crisis Line instead. Marcus had been admitted to a private psych unit two years earlier after a suicidal episode … Read more

Tomás Reyes had been on Spravato for six weeks when the prior authorisation for his next dose got rejected by his insurer’s pharmacy benefit manager. He was sitting in a cubicle in Albuquerque watching his email inbox refresh, and on the other end of the chain was a dispenser at a specialty pharmacy in Memphis … Read more

Eleanor Whitcomb was seventy-eight when her daughter Marcy drove her from Asheville to a memory care unit that, within three weeks, asked the family to come collect her. Eleanor had not, as the admitting nurse first assumed, simply “wandered” into another resident’s room — she had crouched in the corner of it for six hours, … Read more

Donovan Pierce was twenty-six the first time his mother Eileen sat in a Sacramento courtroom and listened to the words “incompetent to stand trial” being spoken about her son. The petty theft charge that had brought him into the criminal system was almost beside the point — Donovan had been hearing voices for two years, … Read more