Today We Wait - Psychiatry in Puerto Rico



It's the name of the game.

It's Past Time to See a Psychiatrist

It has taken me four months to get to a psychiatrist in Puerto Rico. There are a few factors at play. Firstly, I’m scared to death of visiting new doctors. Secondly, Hurricane Maria made communication virtually impossible, so scheduling with doctors was not an option. Some phones are finally working, so now there’s no more excuse not to see a psychiatrist. 

I'll preface this by saying that I'm not in the midst of a psychiatric emergency. I am not particularly balanced right now, but I have been able to get most of my medications, and thankfully have the support of friends and confidants that have helped me through a difficult time. I fear for those who are on the brink and don't have the resources that I have.

A lot of patients are presenting severe mental health issues since the storm and the number of patients in our clinic has increased dramatically. Not one person that has lived through the storm can’t say they weren’t touched by what happened.
— Dr. Kenira Thompson, Director, Mental Health Services at Ponce Health Sciences University

According to Dr. Oxiris Barbot in his article, Puerto Rico’s Mental Health Crisis, “Among all the tragedy, what I found most disturbing was that every person I spoke to knew of someone personally, or within a degree of separation, who had attempted or completed suicide after the storm.“

There's no question that mental healthcare is a difficult topic, on the mainland and on the island, but there's also no question that suicide rates and mental crises are on the rise here, faster than the national average following a devastating event. 

 I knew to be prepared for something that I was unable to be prepared for. Lines of people. Lines have become commonplace in every facet of life here, and there are few things that give me more anxiety than waiting in line. Adding to my own anxiety was knowing that I was waiting with people in far more urgent life situations than myself.

Looking out from the hospital's elevator bay

Looking out from the hospital's elevator bay

Maybe if I had the money and could go to a private doctor, this wouldn't be the case, but in order to see a psychiatrist, I had to go through the process of receiving a referral from a primary care physician. I was referred to several who are no longer in practice, their phones don't work, or they no longer accept my insurance. Adding to the process, in order to see a primary care physician, you are assigned a day and told that the doctor will see patients between certain hours. For my GP, the start time is 8 AM. By arriving at the office at 6:30 AM, I was already in line behind 20 other people.

Psychiatry "Appointments" Are No Exception

I was assigned a day for my "appointment" and arrived just after 8AM. By the time I arrived, I was already 12th in line and the office wouldn't even open for almost an hour. I don't know how long people had been waiting this morning. There were people asleep on the floor in the hallway. When the office was opened, we were ushered into a refrigerated room barely large enough to hold 15 chairs. There was not enough seating for the patients and those that were accompanying them. As time wore on, more people arrived, and the line extended back into the hallway where at least it was blissfully warmer than the ice box of a waiting room. 

Five and a half hours later, exhausted, frozen, and completely disassociated, I was finally able to see the doctor. I introduced him to Izz, my faithful canine companion whose patience far exceeds my own. I explained to him that without her company, I would not have been able to endure the wait, and asked if he could help me in the process of registering her as a companion animal in Puerto Rico, as the rules are different than in the states. He told me that we would have to address that in a future appointment. In the current appointment, all he had time for was reviewing my list of medications, taking several phone calls, writing me a prescription, and telling me to come back in two months.

I wasn't expecting a miracle. I wasn't expecting any great relief of my current symptoms. I did however have hope of discussing my conditions and laying the beginnings of groundwork for a treatment plan. I feel as though I achieved nothing today except near panic and the dread of future "appointments."