Depression felt like I was constantly sleeping, and I wasn't always aware of what was around me. It got to the point where getting out of bed was the most difficult part of the day.

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Palo Verde readies patients for outside careGuest Opinion: Now's the time to make mental health a priority

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Story and photos by Melinda Phipps

Their pink and white exterior gleamed at me like jewels. I put one in my mouth. Instant gratification. Ecstasy flowed over my skin. Immediately, the screaming in my mind began to quell, silenced by my own submission to the tantalizing poison. One more, two more, three more. My mind yelled at me to take more. Pushing me, pulling me in their direction. Then it stopped. I lay there, a lover scorned, staring into the empty bottle. My eyelids began to droop and my stomach turned. I attempted to stand, but I couldn't move. I was paralyzed. The suffocating blanket of my own guilt covered me, tucked me in, and left me to the monsters of my mind.

Depression created the most intense loneliness I've ever felt. Every day was a waking hell. I would get up, not really wanting to move; feeling nauseated, I'd just lie there staring at my ceiling. I had no one to talk to because I pushed everyone near me away. I took isolationism to an extreme. Even when I was physically spending time with people, mentally I was by myself.

I knew it was time to get help when I could no longer handle being awake or do any sort of menial daily tasks: At my lowest point, I couldn't even get out of bed. The summer after 9th grade, when I was 15, I decided to check into Palo Verde Mental Health Services for help.

Over the five days I stayed at Palo Verde, I certainly gained the confidence to help myself. But I also left with a lot of questions: Why didn't I get help sooner? Why did I feel like I had no one to turn to? Why is information about depression and mental healthcare so hard to come by, especially for adolescents? I slowly began to realize that the mental health care that was available to me — the "affordable" health care — was maybe not the best care out there.

* * *

I remember sitting in the waiting room at Palo Verde, intensely reading a parenting magazine in order to keep from staring at the screaming man. Trying hard not to look, I kept my eyes on the page and listened to his screams. The waiting room, actually a small metal box that separates new patients from staff and visitors, is lined with metal fencing that keeps the new admits from throwing things out into the hallway. I looked up at the caged-in ceiling and saw a paperback book caught behind the wire. I wondered if it felt as trapped as I did.

"Are you sure you want to do this?" my mother questioned, confusion in her eyes. "We can go home and you can go to sleep."

"Yes, I'm sure," I told her and turned away, wanting to end the conversation. The man continued to scream, scaring a few other people waiting, including myself. Behind me I could hear my mother sigh, and I knew she was tired. I wondered why I was doing this to her, why I couldn't just be happy. But this only made me feel worse. I knew that I was letting her down and that she would blame herself. But this wasn't her fault. It wasn't even mine.

When I walked through the white double doors, I felt naked, vulnerable to everyone around me. I let one of the nurses lead me into an examination room where I stood on a scale while she wrote down my weight and took my height. The whole time she was talking about what would happen during my stay, her voice sounded muddled, like she was talking through a wall. She took three tubes of blood from me, which gave me a bruise in the crook of my arm — it stayed there for days. The nurse told me to strip down to my underwear so I could change into scrubs. I later learned that new admits aren't allowed to wear street clothes unless they've been "safe" — not hurting themselves or others — for at least 24 hours. I remember looking at the ring on my left hand, hoping I could keep it on. It was silver and had a heart-shaped mystic topaz in it; my boyfriend had bought it for me at the Tucson Gem and Mineral Show months before. Whenever I got nervous or upset, I would twist it around my finger.

"Can I keep my ring on?" I asked, hoping for the best. She looked at the ring, then at me, and smiled.

"I don't see why not," she said. My relief caused me to smile. "Well … unless you cut," she added.

My relief crashed to the floor.

"Oh, yes," I replied politely. "I do."

I took the ring off and dropped it into the small Zip-loc bag she handed me. Then I had to show her where my cuts and scars were while she marked them down on her clipboard. I felt tired, like my head was getting heavy. I wanted to sleep, but I was led out of the room instead.

When my mom hugged me and kissed me on the head, I could tell she was trying to be strong. I hugged her back and said goodbye, then watched her leave. I turned and walked back inside the doors to the waiting nurse. She led me to my room for my first night in institutionalized care.

* * *

After my mother left, the nurse who admitted me snapped a plastic bracelet onto my wrist and led me into a room with the rest of the kids. When I walked into the brightly carpeted room, I felt them all staring at me. I awkwardly glanced at their stack of empty pizza boxes; my stomach growled.

"Are you hungry?" a friendly-looking man asked me. I shook my head and looked over at a table of whispering teenagers. Unlike me, they weren't wearing scrubs. One pulled a chair out and motioned for me to sit down.

"Go ahead and join them," the man said. I sat down in the chair and attempted a smile, hoping it would do as a hello.

"Let me guess. Depression?" one of the girls asked me without looking up from her painting, smears of green across the page. I nodded and continued to watch her painting the picture.

"Oh, don't mind her. She doesn't like people," a boy to my right told me. "I'm here for depression, too." He was smiling and so were his eyes. I wondered how he could be depressed and look happier than most people I'd seen all day.

* * *

While I was staying at Palo Verde, I met a boy who told me about how he became involved with a gang after his cousin was shot and killed in front of him. This kid had been through a hard life and it seemed no one was there for him. His resolution was to try and kill himself. One day while we were having free time he got ahold of a pair of scissors. I watched him eye the blade and then look to his wrists. Desperately, I searched around the room for someone else to notice or for someone else to care. Quietly I stood up and walked over to the main desk.

Loudly I announced, "I have to use the restroom." When the nurse let me into my room I told her about the scissors and that I was worried about him. I edged back into the room hoping not to be noticed, but his eyes caught mine. He knew it was me who told. She took the scissors away from him, then took him away from us. I know that if I had not told the nurse about the scissors, he could have gone through with committing suicide. This worries me: How many times do incidents like that go unnoticed?

At Palo Verde, I also struggled to find the point of group therapy. Half of the time it would be one kid talking or all of us just sitting there, dead silent. We learned how to make friendship bracelets and coasters, we watched movies about illegal drugs, and we learned more about the medications we were given, but not once did anyone teach me how to deal with my depression. I had to figure that out myself.

The night my roommate left was the only time I cried during my five days there. Katie (not her real name), the forward girl I met my first night, turned out to be my best friend while I was there. She wanted nothing more than to get better, but it just seemed like she couldn't. That stay at Palo Verde wasn't her first. The doctors told her that they were running out of options and that her insurance wouldn't pay for any more time. I wanted her to stay with me, coach me through the rest of my time at the hospital.

* * *

After all of the medication and group therapy, I realized that my experiences at Palo Verde were not what they should have been. During my five-day stay at Palo Verde, there were a few things that unsettled me about the treatment I was given. First of all, I felt that no one really listened to me: As soon as I sat down to talk with a psychiatrist or therapist, I was usually cut off: "We'll see how you feel tomorrow," they'd say with a smile. I couldn't help but think, "I didn't even get time to tell you how I felt today."

Michael Letson, a spokesman for TMC HealthCare, which includes Palo Verde Mental Health Services, said in an email that admitting a patient gives behavioral health professionals a chance to observe the person away from his or her regular life routines.

But I didn't receive much actual therapy while I was there. As patients, much of our time was spent watching Cartoon Network or doing arts and crafts. Palo Verde only seemed to be a place for me to get away from what was causing my depression. But because my depression wasn't merely situational, just getting out of the house didn't help much. While I was there, I needed more information about my depression than what I received.

After I got home and had some time to think, I wanted to know about the changes that I hoped were being made at Palo Verde. This year I went looking for answers. The first place I went was back to Palo Verde, where I spoke with Tanya Lauer, a therapist in the youth wing. During our interview, I noticed a picture tacked up on a corkboard behind her. It was drawn while I was there by the boy with the scissors.

I asked Tanya about Palo Verde and if there had been any changes since I'd been there in 2005. She said that there had been quite a few: "Right now, cognitive behavioral therapy is mostly used, before it had been a lot more just behavior therapy. Palo Verde is a hospital, so its first [responsibility] is to medically treat and stabilize patients and to combine that hopefully with a positive therapeutic experience." The switch to cognitive behavioral therapy is, in my opinion, a very good change because it focuses on the causes of mental illness rather than just the symptoms.

Behavioral health care for young people has been leaning toward outpatient care that incorporates the family, instead of short-term hospital stays, Mike Letson said.

After I spoke with Tanya, I began wondering where the funding and money comes from to run organizations like Palo Verde — I wondered if a lack of money could have affected the quality of care. I interviewed Neal Cash, the CEO and president of Community Partnership of Southern Arizona, the administrative organization that channels taxpayer money to mental healthcare providers across Southern Arizona.

Neal told me that money that comes from the Legislature plays a large factor in what kind of care is offered by mental-health providers. "We have had no new state money in about four or five years for any of the population. Legislatively-appropriated state money for adults and kids has been very tough to go after."

When I asked about the reasons for the lack of state money, he told me, "Part of the rationale is just a mean-spirited, very punitive Legislature. We have people who feel like government shouldn't be involved — 'we don't want these programs,' 'they cost us money,' on and on and on."

According to Neal, the community can help draw more attention to mental health care: "I always encourage everybody to get politically active and to understand what's going on. I think that what people need to do is know who you're represented by and get to know and talk to the people who represent you. Some of them are very familiar with the behavioral-health community that they represent when they go to Phoenix."

Unfortunately, I feel that most youth my age aren't politically active, and that they don't care enough to have a voice in the Legislature.

* * *

Although I'm at risk for becoming depressed again because my illness was largely chemical and not just situational, I know that I've been one of the lucky ones when it comes to recovery. It took me until I was 16, but now I've finally pulled myself out of the hole that my depression created. I'm at a good place in my life and I'm pleased with the person I am today and the person I am becoming.

That said, my experiences at Palo Verde still haunt me. I worry about other teens who have heard stories like mine and who are hesitant or refuse to get treatment. I worry that even if these teens do get help that the treatment will be more traumatic and debilitating than the mental illness itself. I worry that most teens my age can't even afford to think about finding treatment in a country that doesn't provide adequate mental health care for everyone.

Even though mental illnesses are treatable, people who suffer from them — especially adolescents — don't know where to turn for help. My experiences at Palo Verde, coupled with the information I found about funding and mental healthcare, have shown me that if we want better mental health care in Tucson, we've got to fight for it.