Mental Illness in Oklahoma – Seeking Help In A System Without Adequate Resources
At around 11 years old she started to notice the signs. Her parents brushed it off as puberty. A decade later, mental illness has left a lasting mark on her life.
Chloe Smith is one of the 700,000 to 950,000 estimated adult Oklahomans in need of services, according to the Oklahoma Department of Mental Health and Substance Abuse Services.
Nationally, Oklahoma ranks 42nd in overall access to care for mental health, according to the Substance Abuse and Mental Health Services Administration.
Since August, Smith has been in an out of inpatient treatment several times. She said that she has better access to facilities because of her private health insurance.
“In Oklahoma specifically, I know the hospitals aren’t so great,” Smith said. “A lot of them are state-funded and so a lot of people go in there and they come out worse than they were before because it’s such a traumatic experience.”
There are 122 facilities listed for the state of Oklahoma in the National Directory of Mental Health Treatment Facilities provided by SAMHSA. These include public and private entities offering both inpatient and outpatient care.
Smith said that at a relatively early age she felt the need for help. She experienced extensive fits of inexplicable and uncontrollable crying during her early adolescent years.
At the time, her parents disagreed with her, believing their daughter was experiencing the normal life changes of any preteen girl.
By 16, after taking some online tests, Smith was convinced it was something more and pressed her family for help.
“I told my mom and so she took me to the family doctor,” Smith said. “She took my brother the same day for his mental health because we believed that he was ADHD.”
The difference in how the two siblings’ ailments were handled was stark, according to Smith.
“At the time I also had stomach issues going on, so whenever I saw my doctor, I explained ‘Hey I’m having these stomach issues. I’m very depressed. I can’t eat, I can’t sleep, I can’t think right,’” Smith said. “After I was finished he said ‘Yeah well, I bet your stomach really bummed you out,’ so it definitely was not a serious concern for him.”
That day, Smith’s brother left with an ADHD diagnosis and medication. She left with a lack of faith in healthcare professionals.
“After that, for some time, I didn’t really talk to anybody about my mental health because I felt so betrayed by the fact that this had happened,” Smith said. “I went and I took the hardest step by reaching out for help and was told ‘No, you don’t need it.’”
Smith kept silent, fluxing between manic and depressive states for years, without fully realizing what was happening due to lack of an official diagnosis.
To those on the outside, Smith would likely look like any other 20-something. She was working to make ends meet, somewhat stressed about finances and trying to figure out her plans for the future, but things wouldn’t look terrible to most.
Smith said while that was true, the mania and depression had worsened over time. June 2019 marked the beginning of what would be a season of challenges for Smith.
“Whenever I turned 21, the mania got really strong again and then came the depressive episode where I came crashing down,” Smith said.
The episode was triggered by the simple act of an Oklahoma Gas and Electric (OG&E) worker entering her home to turn her appliances on, Smith said. However, because of past trauma related to DHS and unexpected flashbacks that occurred, she began to spiral.
“So it was a few weeks where I was just in tears all the time, having panic attacks. My brother and my fiancé just didn’t know what to do with me,” Smith said. “So finally, one day I was like ‘Look, I’m either going to kill myself or I’m going to go to the mental hospital.’”
Smith entered inpatient treatment for the first time in late August. Initially she was given a diagnosis of major depressive disorder, along with post-traumatic stress disorder from sexual and physical abuse.
“After treatment in inpatient, I actually went and saw a psychiatrist in outpatient, who then rediagnosed me with bipolar,” Smith said.
This psychiatrist explained to Smith for the first time what mania was, giving her a clearer picture and name for what she had been experiencing.
Armed with an official diagnosis and medication, Smith thought she was set for a path toward management of her mental health struggles. However, this would not be the case.
In mid-September she re-entered inpatient treatment. She went back again in mid-October.
Each time Smith entered treatment, she was there for a different amount of time and medicines were changed.
“It’s a lot of guesswork with medications and such because you don’t know what’s going to work for you,” Smith said. “I’ve kind of been on and off antidepressants, they’ve put me on and off antipsychotics, some made the symptoms worse, some alleviated them, but I felt very flat.”
Bryant Crothers, Smith’s fiancé said the guesswork has been the hardest part as part of the support system for someone struggling with mental illness.
“We have so many resources and testing available for the right meds, but they hold you for extended periods of time, not allowing you to get on with your life while they treat you like some kind of science experiment,” Crothers said. “It’s so frustrating to watch someone you love go through that.”
Smith entered inpatient treatment a fourth time in November, after some time in the intensive care unit at OU Medical. This trip was the result of a dissociative episode that led to an overdose attempt.
A dissociative episode can take place when a person with PTSD or another mental health disorder is experiencing stress or some kind of trauma trigger, according to the National Health Service. Disassociation can last for periods of time ranging from hours to months.
Medication adjustments and struggles with returning to care have been two aspects of Smith’s journey. A third has been therapy.
Cognitive behavior therapy, dialectical behavior therapy and eye movement desensitization and reprocessing therapy are all part of Smith’s weekly schedule.
CBT deals with a person’s thoughts and how they influence feelings and actions. DBT, which is Smith’s preferred method, focuses on interpersonal skills and stress tolerance. EMDR works on a different level, utilizing replicated REM sleep eye movement to retrain the brain to help deal with past traumas.
Smith said therapy has also encouraged her to develop other positive coping skills, such as art and cooking.
Despite getting help she needed, Smith said going into inpatient created new stress in her life. Since there is never any guarantee that the medications and therapies she is utilizing will continue to work, she may be unable to work for an extended period.
Smith was working full time for Dell prior to checking herself into inpatient treatment. While she had the ability and benefits available to take time off of work, it was not an easy decision.
“I feel like it has affected my accountability at work and I feel like others harbor resentment,” Smith said.
When a person takes off for a chronic illness, such as cancer, Smith said coworkers tend to be supportive and understanding. Mental illness, however, is different.
“There’s such a stigma around it still that people are like ‘Really? You’re really doing this?,’” Smith said.
Smith has no clear indication of when she will be able to return to work. She said that adds to the stress and anxiety created by her decision to seek mental health care.
When she first entered treatment, Smith stopped working and went on short-term disability. Part of being on short-term disability is a cut in income. Smith was only being paid 75 percent of what she was earning at Dell.
She said that as the main provider for her household, this meant the decision to check herself into treatment came with a lot of heavy options being weighed. And subsequently, a lot of uncomfortable conversations with her landlord, OG&E and other utility companies.
“That was so embarrassing and humiliating that I had to do that because at this time in your life, it’s just the time that you need to not focus on everything else, not focus on the worries of life but just focus on yourself,” Smith said. “And you don’t get that option because life keeps rolling on and you have to think about this.”
While some of Smith’s bills were able to be moved around, she said not everything was handled how she would have hoped during her time in and out of inpatient. She thought those she left in charge were managing finances accordingly, but after her last stay, she returned home to find her car had been repossessed.
Crothers and Smith have been together for the last six years. However, he said this experience was new and unlike anything the couple had been through before.
“I’ve had to learn how to be a better support system. Before, I got caught up on the little things and worried about myself a lot,” Crothers said. “When you watch someone you love go through this kind of thing, it totally switches your perspective. You learn to pay more attention to them and nothing really matters besides them getting better.”
Over the weekend, Smith received a denial letter. She’ll now no longer receive any money as part of short term disability, unless the appeal she has filed is accepted.
Smith said she may be forced to seek full disability for a period of time if her treatment does not help her get to a level where she feels confident to return to work.
Though it has been a tumultuous few months, Smith says there has been at least one positive outcome so far: an improvement in her relationship with her father. She’s been able to open up to him and share things with him about the past.
The hardest part of the entire process, according to Smith, was making the initial decision to seek help and truly be open about her struggles, past and present. But as hard as it is, she said she encourages others who may be struggling to reach out.
“Don’t be afraid to get help; I was afraid for so long after somebody had brushed me off and it wasn’t fair to myself to let myself live like that,” Smith said. “You have to be aggressive in treatment, you have to be your own champion because nobody else is going to.”
Smith also said those who notice a loved one struggling should know that much like in addiction, those struggling with mental illness can’t be forced to seek help. But she said having genuine care and support makes all the difference.
“When supporting people with mental health struggles, don’t try to rationalize what they are feeling,” Crothers said. “You may not understand, but that’s OK. Just be there for them no matter what and accept the problem at hand.”
If you or someone you know is struggling with mental health or needs more information, visit the University of Central Oklahoma’s Center for Counseling and Well-Being in the Nigh University Center Room 402 or view the list of Oklahoma facilities in the SAMHSA directory.