In March 2010, Pam Lipp received the call she鈥檇 been dreading for months. She figured it would come from one of three places: the police, the hospital or the morgue. Instead, it was her husband, Doug, saying that he鈥檇 just received word that their 18-year-old daughter, Amanda, a freshman at Chico State University in California, was being held at a psychiatric crisis center after trying to throw herself in front of a moving car. Amanda had lost her grip on reality and fallen into a state of psychosis. She鈥檇 started selling off her belongings and believed that cameras were following her everywhere.
Doug was away at a speaking engagement, so Pam jumped in the car with a friend and raced to the crisis center two hours away. When they arrived, they found Amanda, curled up in a ball on the floor in a fetal position, sobbing. 鈥淚 was hallucinating. I thought I was a doctor. When my mom got there, I realized I was the one in trouble,鈥� says Amanda. 鈥淣othing prepares you for seeing your child in such turmoil. I felt helpless,鈥� says Pam.
Amanda was in the grips of psychosis and mania. Although the crisis provided a new direction to what had been an all-consuming journey for the Lipp family, it was just one stop on the bumpy road to navigating the mental health system. The Lipps are not alone: Nearly 1 in 5 Americans experience a mental illness in any given year, but fewer than half of them receive treatment.
Early Signs
Amanda first started acting out when she was in middle school in Fair Oaks, California. She had extreme mood swings and explosive arguments with her parents. Pam and Doug, who run a small business together, hoped it was typical adolescent drama that would soon fade. 鈥淲e never knew which Amanda we were going to get,鈥� Pam recalls 鈥� the edgy Amanda looking for a heated debate, or the down, depressed Amanda who would retreat to her room. Eventually, the intensity and unpredictability of her moods made them realize she needed professional help.
Amanda at her high school graduation with her brother and sister. (Courtesy of the Lipp Family)
They took her to the family doctor, who agreed that Amanda required more help but said that she didn鈥檛 have anyone to refer her to. Instead, the doctor recommended that Pam request a copy of all the therapists in her ZIP code who worked with her insurance company and call down the list. Pam called dozens of practitioners, leaving message after message. Not only was the list outdated, but most were too busy to even see her daughter and the ones who were highly recommended didn鈥檛 accept her insurance anymore.
For her part, Amanda was reluctant about seeing a therapist. She worried about what other people might think, and that it would change the image she had of herself. 鈥淚 was the popular kid who people looked up to,鈥� says Amanda. 鈥淚 thought that if my friends saw me as someone to be pitied, they wouldn鈥檛 lean on me anymore. Part of me wanted to get help, yet the other part of me didn鈥檛 want to admit I needed it.鈥�
She agreed to give therapy a try and Pam found someone Amanda was comfortable with. Yet, at an out-of-pocket rate of $120 per hour, the Lipps just couldn鈥檛 afford the amount of care she needed, which was about three sessions per week. She visited a psychiatrist and was diagnosed with depression and put on an antidepressant. Despite the treatment, Amanda continued to spiral downward 鈥� staying out late, self-medicating with drugs and arguing with her family.
During those years, Pam says, she and Doug were living one exhausting day to the next. They had three children to raise, but taking care of Amanda consumed their lives. 鈥淲e felt like we were in prison in our own home with all the hostility and upheaval.鈥�
By the time Amanda headed to college, she was barely speaking to her parents.
Fighting For Care
Amanda鈥檚 trip to the crisis center in college was a turning point 鈥� it meant that she could begin to receive the treatment she desperately needed. She was diagnosed with bipolar disorder at the time, though her diagnosis was later changed to induced psychosis and mania, she says.
But the right care wasn鈥檛 easy to find at first.
The crisis center would hold her for a maximum of only 72 hours, and Amanda needed much more treatment than that. When Pam asked where her daughter would be sent next, the doctor told her Amanda would be discharged and likely end up back in the center.
Amanda Lipp holds up one of her art pieces. Art helped her with cope with her depression. (Heidi de Marco/KHN)
So Pam spent the next day in the crisis center waiting room, desperately calling one psychiatric hospital after another to find a place to send Amanda. They were all full. She begged them to call her back when they had an opening, but they told her they couldn鈥檛 reserve a spot. Instead, they told her to call every half-hour in the hope that she鈥檇 be able to grab the next available bed. Pam plugged her cellphone into the waiting room wall and repeatedly called each one on speed dial. 鈥淵ou go into mother-bear mode, where you dig in and do what you have to do to protect your cub. I knew I couldn鈥檛 stop until Amanda had the help she needed,鈥� says Pam.
After eight hours of continuous dialing, Pam finally found Amanda an open bed at a hospital near their home. For Pam, it was a huge relief that her daughter was safe. 鈥淲e felt like we were finally entering a new phase of tackling her condition. In the hospital, at least we knew where she was and that she was under a watchful eye. We felt safest knowing she didn鈥檛 have a choice to leave.鈥�
But Amanda had a different perspective. She didn鈥檛 see her psychosis as a disease 鈥� she saw it as a transformation where she was finally able to face her vulnerability and deal with her issues.
鈥淚n the hospital, I felt like a prisoner,鈥� she says. 鈥淚 felt trapped in a space where people were always watching me and monitoring my behavior.鈥� Amanda is an artist who finds solace in creativity, but she says the staff in the hospital was more focused on trying to treat her medically and didn鈥檛 seem to value what she was doing with her art. 鈥淭rying to express myself and heal felt impossible,鈥� she says.
Figuring Out Finances
While Amanda was in the hospital, Pam was gripped with fear over the coverage of the treatment. 鈥淚 was terrified that insurance would run out and we鈥檇 lose our savings and everything we鈥檇 worked for.鈥�
Amanda Lipp (Heidi de Marco/KHN)
Fortunately, a federal law passed in 2008 guarantees that mental illnesses be covered 鈥渁t parity鈥� with any other disease, without special limitations. Her insurer informed Pam that any care Amanda needed would be covered. 鈥淚 was so relieved,鈥� says Pam.
After a month in the hospital, two months of a full-time outpatient program, the temporary help of an antipsychotic medication and years of therapy with a new psychologist, Amanda made an impressive recovery, learning to manage her condition.
A key point for her was a change in perspective. She went from seeing her symptoms as evidence of illness to seeing them as strengths that she could use to her benefit. For example, she could turn a period of introspection that she might have previously seen as 鈥渄epression鈥� into a piece of art.
Living Out Loud
Many families end up running into similar obstacles 鈥� they don鈥檛 know where to go for proper care or they鈥檙e worried about the cost. But there鈥檚 also the stigma of mental illness that prevents people from reaching out because they fear judgment or worry that it might affect their jobs.
鈥淲hen you break a leg, you get a cast and people sign it and put smiley faces on it. When you鈥檙e given a mental illness diagnosis, you鈥檙e cast out,鈥� says Amanda, who is now a 24-year-old college graduate and member of the board of California鈥檚 National Alliance on Mental Illness, an advocacy group.
It truly took a village and a community of friends to help Amanda heal.
Fortunately, Pam wasn鈥檛 afraid of the stigma, having learned from her own family鈥檚 mistakes. 鈥淚 grew up in an environment where everything was pushed under the rug,鈥� she says. 鈥淧eople were suffering from mental illness, but they blamed it on other things like migraines. In reality, they needed therapy. I wasn鈥檛 going to let that happen with Amanda.鈥�
Pam faced the stigma head-on and was completely open with her friends about what was happening. While this didn鈥檛 help the Lipps crack the code on their daughter鈥檚 illness earlier, it gave them strength when they needed it.
鈥淢ental illness is not usually a casserole disease 鈥� when you tell your friends that a family member is suffering from a mental illness, they don鈥檛 deliver a lasagna. But in our case, our friends did because we were open about it,鈥� says Pam.
People rallied around her. In particular, Pam was already part of a monthly mothers鈥� group that got together to make care packages for their children in college. The other women urged her to keep coming to the group and making care packages for Amanda throughout her illness. 鈥淭hey were my rock of friendship. It truly took a village and a community of friends to help Amanda heal,鈥� says Pam.
Pam鈥檚 Book of Appreciation, which she used when Amanda was in high school to list positives about the day. She would then leave it on Amanda鈥檚 pillow for her to respond. Even though Amanda often didn鈥檛 write back, she now says it meant a lot to her. (Heidi de Marco/KHN)
Finding Hope
Hard-won strides in the area of mental illness like the parity law helped Pam and her family get through the crisis intact, but it was a difficult road.
鈥淲e鈥檙e so proud of Amanda and everything she鈥檚 overcome,鈥� says Pam. That doesn鈥檛 mean she鈥檚 stopped worrying. 鈥淲e experienced a mental health emergency, an illness and a recovery, and now we鈥檙e stable. But every day I wake up and worry, could she relapse?鈥� For anyone with a history of psychosis, another breakdown is always a possibility.
Now armed with knowledge and experience, Pam feels more confident. And in the meantime, both mother and daughter are dedicated to raising awareness and helping other families find the hope and the care they need in a system that often seems to be working against them.
For women facing similar situations, Pam has this advice: 鈥淭reat mental health concerns like you would any condition. Don鈥檛 let the stigma be a roadblock to getting yourself and your family the care that鈥檚 needed. If your gut tells you there鈥檚 something going on with your child, look the issue in the face and get the help you need.鈥�
This article is part of an editorial partnership between聽Woman鈥檚 Day听补苍诲聽Kaiser Health News听补苍诲 is the first in a series focusing on mental health.