Dec. 13, 2013. Friday the 13th.
I've never been superstitious, but it was an unlucky day. I woke up at 6 a.m. after a week filled with intense panic attacks. I was sleeping in my parents' bedroom, something I hadn't done since I was a child.
I wanted to die.
I was a star student at the University of Florida home for winter break. I'd dealt with anxiety in the past, but never like this.
Things were getting worse, and I was desperate to feel better. Don't worry, my mom told me. We're going to get you help.
It turns out, it's very expensive to be mentally ill in America.
I had my first panic attack when I was 10 years old. It happened when I was in the shower. I got out, hyperventilating and scared. I felt dizzy and like I might faint.
What was that?
I didn't tell anyone.
My parents are upper-middle class, with well-paying jobs and good health insurance. My younger sisters and I wore braces to straighten our teeth and never missed our regular physicals.
I normally told my mom everything, but I couldn't find the words to describe the panic attacks. Soon they'd come all the time. At church, at school, while falling asleep.
My parents are two of the most accessible people I know. No health issue was too embarrassing. No scrape was too small.
But how do you let someone know your brain hurts?
The Substance Abuse and Mental Health Services Administration studied mental illness from 2009 through 2013. Their findings?
Nearly two-thirds of mentally ill Floridians don't receive treatment.
• • •
By the time I started my junior year at UF, things were looking up. I was attending school on a full scholarship. I had a boyfriend who really cared about me. I had friends in my sorority and in my journalism program. I even saw a counselor now and then and talked about positive coping habits.
But the panic attacks were still there.
Things worsened. By November 2013, I spent a lot of time crying in my apartment. I asked my parents to pray for me. My boyfriend would stay on the phone with me all night, making sure I was able to fall asleep. I saw my counselor, a registered mental health intern, more frequently.
But no one realized how bad it was. I didn't even realize how bad it was. I made it my goal to make it through fall semester. If I could make it to winter break, I told myself, I'd be okay.
In 2013, suicide was the second-leading cause of death for people between 15 and 24 years old.
• • •
I drove to Tampa for winter break on Dec. 9, 2013. I went to my counselor's office that afternoon. Things were getting worse, I told her. I didn't know why, but everything was becoming overwhelming.
She calmed me down and we scheduled another appointment for later in the week. We'd meet on Friday the 13th.
Things derailed pretty quickly.
I went to Starbucks with my boyfriend that night. He asked how therapy was and I panicked. I ran outside and he followed me and held me as I cried.
The next day, I told my parents I felt sick. When they asked me to elaborate, I told them I was really anxious and afraid to leave my bedroom.
My parents were alarmed. They called my counselor and asked for help. She recommended a few mental health crisis centers. That week was full of frustration. We visited one center, a beautiful facility that looked more like a resort, and decided against it because it was geared toward substance abusers. My parents made at least a dozen phone calls.
No one seemed prepared to handle someone who was in crisis but not in danger. I was told I couldn't be involuntarily admitted under the Baker Act because I didn't have a plan to harm myself or others, but I needed something more intense than talk therapy.
My mental health was deteriorating. I was terrified of leaving my room, even to shower. By Friday the 13th, we were all at our wits' end.
My mom helped me get dressed that morning and hand-fed me toast. She's always been a fiery woman, unafraid of speaking her mind, and she was determined to do whatever it took.
For her, the last straw came later that day. We visited our last option before the hospital, an emergency counseling center in Dade City. I told an intake counselor that constant anxiety attacks were making me suicidal.
We don't have any appointments available for weeks, she told me. Maybe I could give you some things to work on, and you can come back in the next few weeks.
My mom asked the counselor if she knew anything about Tampa General Hospital's psychiatry program.
"That's our next option for her," I remember my mom saying.
"That's a long drive," the intake counselor told us.
Looking back, it'd be funny if it wasn't so sad: I was suicidal and barely functioning. I was offered a homework assignment.
My mom was livid. Once we got in the car, she turned to me.
"Now I get why people start foundations," she said.
Lack of knowledge and fear of disclosure are two reasons why people with mental illness don't ask for help, according to the National Alliance on Mental Illness.
• • •
I picked at a fast food salad as I sat in Tampa General's emergency room. I'd lost my appetite earlier in the week –– I ended up losing five pounds in as many days.
After a long wait, I was told that I could voluntarily admit myself into the psychiatric unit. I'd have to stay overnight. Maybe my mom would be able to sleep in the room with me, I thought.
My first hint that things in the psychiatric ward would be unlike anything I'd experienced: A security guard arrived to escort me upstairs. I was told it was a safety issue. A nurse loaded me into a wheelchair and my mom and boyfriend whispered comforting words as I cried.
I cried harder when I found out the unit wouldn't allow my parents and boyfriend because it was past visiting hours. I felt like I was checking myself into jail.
A locked door separated the unit from the rest of the hospital. None of the rooms had television or Internet access. I had to leave my cellphone with my parents and couldn't bring in anything that might pose a danger to me or other patients.
There were communal showers and a community telephone. The unit had nearly two dozen beds, with two people per room. Plastic bags weren't allowed. I sobbed when I was told I couldn't have my bra because of the metal underwire.
There were not any secrets in the unit. Cameras in each bedroom allowed psychiatric unit staff members to keep constant watch on me. I had a curtain in front of my toilet instead of a door. My dad told the staff he'd pay more money to get me into a nicer room, something that's funny to me now –– upgrading your room in the psych ward like you might upgrade for a window view at the Hilton. (For the record, they told him it wasn't an option.)
I ended up spending four days in the unit. It was a weekend filled with neurological and psychological exams, along with group therapy with other people in the ward. I was given a schedule that included visiting hours, meal times and free time. I barely slept and ate. The whole thing is a blur.
By that Monday, a week after I came home for winter break, I was ready for discharge. I was sent home with three medications and appointments on my calendar with a psychologist and psychiatrist. I created a suicide prevention plan and listed steps I'd take if I thought about self-harm.
I received a diagnosis of general anxiety disorder and major depressive disorder. I returned to Gainesville for spring classes three weeks later.
• • •
That's what my parents paid out of pocket for my psychiatric care. Without insurance, it would've cost around $11,000.
It isn't cheap to be mentally ill in this country. Two years after my hospital stay, I take three medications every day: an antidepressant, an anti-anxiety medication, and a very low dosage of an anti-psychotic. I see a psychologist twice a month. Our insurance covers some. My treatment costs my parents about $400 a month out of pocket.
In a few months, I'll be marrying the boyfriend I started dating in college. He's stood with me through this ordeal. My parents have offered to pay for my mental health care until I can afford it myself.
But I realize how lucky I am. If I didn't have the support of my parents, my fiance and I would likely struggle to cover the costs of my medication and therapy.
Forty percent of people surveyed by the American Foundation for Suicide Prevention listed cost as a barrier to mental health treatment. How many people get inadequate treatment or none at all? How many bright and promising people fail to reach their potential because of mental health issues that stymie them?
Even if you can afford treatment, where do you go?
I received stellar care at Tampa General. But in April 2014, the hospital closed its 22-bed inpatient psychiatric unit. Hospital spokesman John Dunn said the unit closed because the number of patients was very low.
"At the time of closing, we were the only voluntary inpatient unit in Hillsborough County and not very busy," he said in an email.
Dunn added that St. Joseph's Hospital has 60 spots in its inpatient psychiatric units.
• • •
I have regrets. I wish I hadn't been afraid of sounding dramatic or people calling me crazy. I also wish I'd seen a psychologist or psychiatrist sooner. My counselor was wonderful but not equipped to treat me effectively.
I still cringe when people joke about needing to be institutionalized. I try to ignore jokes on social media about mental hospitals.
But I am doing much better. The panic attacks are now infrequent. I have a tattoo on my shoulder that says "brave." I graduated from UF with highest honors in May. My focus has shifted to wedding planning and life with my future husband.
My recovery has been a process. Healing is being able to look in the mirror and not have a panic attack. It is learning to process dark thoughts instead of freaking out.
Most importantly, perhaps, when I do feel suicidal, I know the thoughts will pass. This all felt impossible two years ago during my depressive episode.
I view it as a personal victory. But how many mentally ill Americans are still at a loss?
Ayana Stewart covers north Pinellas County for the Tampa Bay Times. She can be reached at [email protected]