Brandon Hayman
He couldn’t explain it at the time, but when Michael was a kid, he would often wash his hands until they bled. He wanted to stop; he wanted it so badly that he’d often break into sobs. But sometimes, he just couldn’t bring himself to step away from the sink. It was in those moments that Michael’s mother uttered the words that, in some respects, would come to define much of his childhood.
“Don’t tell anyone about this,” she said.
Michael (not his real name) grew up in Fort Worth in what he calls an “emotionally stoic” family. Talking openly about mental health — which Michael has struggled with since a young age — was simply never an option. Often, it was strictly forbidden, something Michael says caused him and his sister considerable shame. Nevertheless, the family took steps to get both children the help they needed; Michael started therapy at age 5, his sister at age 8. Eventually, Michael started taking Prozac for anxiety and depression.
Therapy helped, but it also created some dissonance at home.
“It made for a perfect storm of ‘explore how you feel about yourself’ but also feel shame,” Michael explains. “And the sad part is, mental illness runs in my family if you really sit down to track it.”
Which Michael did.
Over the years, Michael, now 26, has pieced together several stories from his family history. Most of the stories go like this: A family member starts struggling with their mental health; then, either “God heals it” or it’s chalked up to something temporary, “a moment in time,” as Michael puts it, in which the family member was momentarily challenged, yet ultimately overcame their struggles.
To Michael, this is a microcosm of what he considers a critical shortcoming in his home city.
“Fort Worth is bright and shiny,” he says. “My dad went to TCU, so he’s Mr. TCU, and my mom has lived in Fort Worth for 40 years. It’s a big little city, right? It’s a big city with a bunch of art and music and food, but it’s a little city because everyone still knows each other. And you have that Southern expectation that everything is polished, but at the same time, you have the gossip. ‘Did you know so and so did this and so and so said that?’
“It’s like there’s a bright and shiny layer of plastic over everything,” he continues, “and if there’s a problem, you should just smile, wave, and give it to Jesus.”
Michael wants to be clear: He loves Fort Worth. He loves its people, its restaurants, its music. But he also thinks the city has some work to do — and, just as importantly, it needs some help.
He’s not alone. Katelyn Donovan, another Fort Worth native and, like Michael, a person of color, shares his concerns.
Donovan, 33, recently returned to Fort Worth after living in California for seven years. While on the West Coast, she says she “hit rock bottom” multiple times and experienced homelessness. Eventually, she returned to her hometown with $50 to her name and a commitment to get help. She found it, but she also found some serious culture shock.
“We don’t talk about mental health here in Fort Worth,” Donovan says, echoing Michael without knowing it. Toxic masculinity — the idea of teaching boys that they can’t express emotion openly — plays a factor, she says, as does the conservatism and stoicism that Michael encountered at a young age. It’s a people thing, she says, but it’s also a Southern thing.
“I wish there was more accessibility,” she says. “I wish some people didn’t have to pay $200 to see a therapist. And I wish we had more programs and awareness.”
Some doctors are working on those very tasks. Amidst a pandemic that has shed more light on America’s mental health crisis and shaken Fort Worth residents — including Michael, Donavan, and countless children — doctors and counselors throughout the Fort Worth area are taking stock of the challenges ahead. In some ways, the future looks grim.
Compared to other states, Texas consistently spends less money per capita on mental health. Every doctor interviewed for this story conveyed a strong need for more money, more psychiatrists, and more funding for education, addiction, and employment support. A truly comprehensive approach, in other words. At the same time, there are occasional signs of progress.
Tarrant County recently used over $23 million in American Rescue Plan funds to fuel a mental health diversion center from the county jail (which, distressingly, is the largest local provider of mental health care).
However, it’s not just about money. Extra funding will certainly help, but the people interviewed for this story also spoke frequently of the persistent stigma surrounding mental health care. That’s something no dollar amount can solve, and doctors and therapists argue that confronting that stigma is a must if Fort Worth — and America at large — hope to make serious headway in the fight for better mental health care.
“There was already a mental health crisis going on before the pandemic,” says Dr. Kristen Pyrc, the medical director of Cook Children’s Hospital Psychiatry Outpatient Services. “I don’t think we’re going to just go back to normal, because there isn’t a normal to go back to.”
This story, written as the frigid winter months gave way to spring, is a snapshot of key players in Fort Worth’s ongoing mental health crisis. As the city enters year three of the pandemic, doctors, patients, therapists, and clients try to find hope and forge a path toward progress.
But as psychiatrists often remind their patients, in order to move forward, you must heal from the past.
Brandon Hayman
A Full-Blown Crisis
In the spring of 2021, a pediatrician told Dr. Pyrc something no psychiatrist ever wants to hear.
“They were seeing an increase in kids who needed help, and many of them were trying to harm themselves,” says Dr. Pyrc. “It was one of those moments where, after you take it, all you can think is, ‘I have to do something. I have to do something.’”
To be sure, this rash of self-harm and suicide attempts was not unique to Fort Worth. Years before the word “COVID” became part of everyday vocabulary, the CDC reported a near 60% increase in the rate of suicides for people ages 10 to 24. That figure spiked another 50% during the pandemic, and in October 2021, three pediatric health organizations united to declare a state of emergency in children’s mental health. According to Dr. Lee Savio Beers, president of the American Academy of Pediatrics, the declaration was “an urgent call to policymakers at all levels of government.”
“Young people have endured so much throughout this pandemic,” she said, “and while much of the attention is often placed on its physical health consequences, we cannot overlook the escalating mental health crisis facing our patients. We must treat this mental health crisis like the emergency it is.”
In Fort Worth, Dr. Pyrc and her colleagues were thinking of little else. Cook Children’s Hospital saw nearly twice as many suicide attempts in the first seven months of 2021 as it did in the same timeframe in 2020. It was, as Dr. Pyrc calls it, “a full-blown crisis.” And treatment alone wouldn’t cut it. So, she started a new form of outreach: a podcast.
“Raising Joy,” launched earlier this year, aims to educate parents and mental health providers on the ways they can support children. The hospital releases a new episode each Tuesday with each installment featuring an interview with experts on bullying, addiction, or distinct forms of trauma.
“The goal of the podcast is to catch kids early,” Dr. Pyrc tells me in early March. Before self-harm or suicide ever enters a child’s mind, she wants that child to be in a pediatrician’s office. She wants parents to be aware of the telltale signs that their kid needs help.
“Whenever you think about a typical teenager, part of their normal development is they want to be more private,” she notes. “Their friends are important to them, and parents are concerned because they feel like they’re starting to withdraw.”
However, when children begin to lose interest in the activities that once brought them joy, that’s when it could be time to consult a pediatrician — particularly if the change is sudden.
Dr. Dina Yousef, a therapist in Denton with a Ph.D. in counselor education, saw plenty of that at the onset of the pandemic. Her areas of expertise include play therapy and expressive arts, and as such, she sees a lot of young children and teenagers. When schools started going remote, many of them had trouble getting out of bed in the morning.
“Think about: This is their high school experience now,” she says. “No friends, no sports, nothing. They’re not supposed to be doing work at home. This wasn’t supposed to happen.”
That’s eerily similar to something Dr. Rachel Talbot, another psychiatrist at Cook Children’s Hospital, told me in late February.
“At the start of the pandemic, spring break turned into two weeks, and everyone was fine with that,” she says. “But then two weeks become four weeks, and four weeks becomes the rest of the year, and oh, by the way, you’re not allowed to do sports, you’re not allowed to see friends, and you’re not allowed to leave the house. If you do, you may die.”
Brandon Hayman
It’s no wonder children started withdrawing into themselves, she adds. That’s often what happens when children face trauma, and the pandemic was trauma on a mass scale.
It’s worth stopping here to note the difference between psychiatrists like Talbot and Pyrc and therapists like Yousef. One key distinction is inpatient care versus outpatient care: Therapists are often seeing people (in their case, they call them “clients”) on an outpatient basis, whereas psychiatrists are more likely to be treating a patient while they are in the care of a hospital. There are exceptions, of course, and as noted by Dr. Pyrc’s role, psychiatrists can indeed see patients on an outpatient basis.
The other key distinction is medicine. Psychiatrists, as doctors, can prescribe meds; therapists do not. As a result, psychiatrists often face an extra layer of scrutiny: Critics are not only quick to question the efficacy of their methods, but they also accuse them of overprescribing or, even worse, getting kids hooked on prescription meds.
Dr. Talbot has heard these concerns many times before, and her response is simple: She’s trying to help, and in some cases, a prescription is the best way to do that.
“Even at 4 or 5 years old, these are kids that are at risk of getting kicked out of daycare or preschool,” she says. “They’re constantly in trouble, and the detriments of that on their self-esteem and self-worth can be lifelong. So, what I say to the criticism is that I’m stepping in to interrupt that negative cycle. I’m trying to set them up for future success, because I’m interfering now when they’re young.”
According to multiple practitioners interviewed for this story, the pandemic and its attendant mental health crisis ushered in an era of heightened collaboration between psychiatrists, therapists, pediatricians, and even school counselors. On any given day, Dr. Yousef could be found checking in with a client’s primary physician to talk about their medication or talking to a school counselor about the progress one of her teen patients is or is not making at school.
“I’m only seeing the client one time per week for an hour,” she says. “Meanwhile, the doctor is seeing them maybe just one time a month for 20 minutes. I want us all to be on the same page.”
That heightened collaboration can also be seen throughout Cook Children’s Hospital. For instance, a psychiatrist like Dr. Talbot will work closely with pediatricians to determine which new patients may need closer attention. The pediatrician is more than equipped to support children coping with anxiety, but if their diagnosis is more severe, they’ll send the patient to Dr. Talbot. This approach gives psychiatrists even more time to focus on patients with the most immediate, persistent needs — and time is always in short supply. At least, it is for doctors: According to Dr. Talbot, some kids end up waiting six to eight months to see a therapist when they need one right now. Some adults have also found themselves on extended wait lists.
Over the phone in March, Dr. Yousef told me that she and her colleagues have seen an increase in willingness to seek help via therapy. On the one hand, it’s an encouraging sign. On the other hand, there aren’t enough therapists to go around.
Still, Dr. Yousef can’t help but wonder if the stigma surrounding mental health may be slowly receding, even just a little bit. Anecdotally, she notes that she has seen more commercials for therapy in the last two years than she ever saw before.
“I’ve had older clients, people in their 30s and 40s, who say all the time, ‘I had no idea therapy was even an option when I was kid,’” she says.
These ads, when legit, are a reassuring sign, especially to someone like Yousef, who grew up watching therapists on television and thought, “That’s what I want to do.”
“My story may be a little different from others in that I’ve known I wanted to be a therapist since high school,” she says. “I always did and do enjoy helping others, so becoming a therapist seemed like a natural way to go.”
Yousef clarifies that we should not turn on our televisions and expect to see realistic, professional therapist behavior being modeled. (TV therapists are way too friendly with their clients, she says.) But she’s also a big believer in media exposure as a normalizing force: The more people see, hear, and talk about therapists and the services they provide, maybe one day seeing a therapist won’t be seen as abnormal. Maybe one day kids like Michael won’t feel shame.
For that same reason, Yousef is a believer in podcasts. Even TikTok, she notes, has been intermittently useful as a space where users can find stories of anxiety and depression and realize they’re not alone.
“I say the word ‘normalizing’ a lot, but that’s truly the only way I know how to describe it,” Yousef says. “I want us to get to a point where we can talk about it without quieting our voices or being afraid someone is going to judge us. Imagine how much that will help our kids. Imagine how much that will help everyone.”
That’s the message Dr. Pyrc hopes to deliver through her podcast: Seeking help is normal. It’s a message parents need to hear, too. After all, patients aren’t the only ones who experience the pain of mental health’s stigma; parents feel it, too.
“If your child is suffering, parents are so guilty, they think ‘It’s my fault, it’s my issue. I did it,’” Dr. Pyrc’s co-host, Wini King, told KERA. “I’m hoping they understand that, no, baby, it’s not you. There [are] a whole host of folks out there who are dealing with this same kind of issue.”
Unfortunately, that guilt may manifest itself in cruel ways.
Around the same time I interviewed Dr. Pyrc about her podcast, I talked to a friend of a friend who, like Michael, preferred to remain anonymous. Over coffee, Alex (not her real name) was visibly shaking while telling her story, the latte taking the form of a wave pool in her trembling hands. She recounted a tragic irony: Her parents wanted her to see a doctor when she told them she was gay, but when she started plotting her own suicide, her parents told her she was going through “a moody phase.”
“Years later, after my dad had passed away, my mom broke down and told me that he thought all my problems were his fault,” Alex says. “I think he saw therapy as a kind of failure. It wouldn’t have even been a last resort.”
Yousef used those exact same words: “last resort.”
In her case, she was talking about parents who have brought her their children after exhausting all other options. Drs. Talbot and Pyrc have also seen their fair share of parental skeptics: Mothers and fathers so scared for their children, so shell-shocked by the turn of event their lives have taken, that they can’t believe they’re actually sitting in a psychiatrist’s office discussing the child who was in diapers just the other day.
When faced with this kind of skepticism, the psychiatrists interviewed for this story told me there’s really just one option: Convince them that what you’re doing can work.
“Improvements can happen,” Dr. Talbot says. “We see them every day. Even during this pandemic, in the darkest of times, we saw them every day.”
All this talk of skepticism, criticism, and crisis begs the question: How are these doctors and professionals coping with the vicarious trauma they’re undoubtedly experiencing on a daily basis? Unlike, say, oncologists, psychiatrists are in the unique and unenviable position of their work being constantly debated and politicized. Against that backdrop, who is there to take care of the caretakers?
Oftentimes, the answer is themselves.
“Part of my training as a psychiatrist is to recognize my emotions and determine when they’re off balance,” says Dr. Pyrc. “I know I have to exercise or spend some time with my husband or my friends. And when things get overwhelming, I take a step back and take a day off.”
She pauses after saying this, and I assume she is thinking of another example, another way she takes care of herself. Then she says something entirely different.
“It’s really hard sometimes when a patient is really struggling. It affects you. There’s no question about it.”
When interviewed for this story, the rash of suicide attempts was still fresh in Dr. Pyrc’s mind. But yet another troubling trend had recently emerged: children getting in trouble for drugs and alcohol and, in many cases, getting arrested.
“It’s strange, but I have seen more risk-taking behaviors,” she says. “So far this year, I’ve seen more patients in juvenile detention than I have in any other year as a whole. And it’s only March.”
Brandon Hayman
“I Thought These Were the Things You Hide”
Michael can relate to those kids whose “risk-taking behaviors” worry Dr. Pyrc. So can Donovan and Alex, who both say they have used alcohol to “mask their emotions.”
For Michael, the drug use began after Michael quit Prozac. He has a naturally addictive personality, he says, and that trait, mixed with what he calls “feeling everything so aggressively,” led to years of drinking and drugs that finally reached an apex in his early 20s. At that point, Michael decided to see a doctor, who diagnosed him with a bipolar disorder known as bipolar II.
Talking about it now, Michael is pretty blunt.
“I’m bipolar as hell,” he says. “If you give me a drug, I’ll take it.”
That diagnosis happened just a couple years ago, and in a way, it brought him a clarity he has long sought.
“When the doctor gave me that news, life started to make sense,” he says. “It felt like I had a new path.”
He now has a name for why he was “feeling everything so aggressively.” The Prozac he took as a teenager made it hard for him to develop relationships, he says. He fluctuated between feeling nothing and, in his words, “always feeling everything always.” But today, armed with a treatment plan for bipolar II, he feels more hopeful than ever.
“Before now, a lot of people would tell me they didn’t know which version of me they were gonna get,” he says. “You meet people in your euphoric state; then they see you again, and you’re the meanest person in the world. They think you don’t want them in your life, but really you’re just trying to figure out how to stay alive that day.”
Brandon Hayman
Bipolar II is characterized by highs and lows: A low, technically called a “depressive episode,” can last up to two weeks. Meanwhile, a high, in which the patient exhibits a kind of manic energy and excitement, can last up to four days.
Clarity aside, managing a new bipolar diagnosis during a global pandemic was no small feat. The widespread suffering he saw happening throughout his city — and the whole world — only amplified the intensity of his emotions. Sometimes this was a boon to his work in the restaurant industry. During his euphoric episodes, for example, Michael has a clear-cut outlet for channeling all his energy: simply go to work. But then he’d come home to the 500-square-foot apartment he shared with his girlfriend at the time.
Michael doesn’t go into details about the eventual breakup, but he says the pandemic, the small space, and his mental health all created another “perfect storm.” In retrospect, Michael talks about the split the same way he talks about his mental health: bluntly.
“I’ve made some really bad decisions that have made me a great person,” he says. “And one thing I’ve learned along the way is that I’m not alone. It’s taken me a while to be comfortable talking about this stuff openly, because I thought these were the things you hide. But we can’t hide them, especially not from ourselves. We need to do the work of getting prescribed medicine and getting the help we need.”
Michael’s recent journey is an example of the kinds of stories Drs. Talbot and Pyrc work so hard to write: Stories of successful young adults who defy stereotypes, who aren’t overcome by mental illness. Yet at the same time, Michael, Donovan, and all patients and physicians interviewed for this story know that mental illness does not occur in a vacuum. The story of Michael’s childhood — the shame, the hiding, the inner turmoil — is precisely what psychiatrists and therapists want to excise from our city and our society. To do that, they need help.
When those three pediatric organizations declared the state of emergency mentioned above, they paired the announcement with a clear call to action. Among other things, they want to increase federal funding to ensure all families have access to mental health services. They also want improved access to telemedicine and more support of school-based mental health care. As of this writing, it’s not clear if any of these calls have been heeded. If anything, Texas appears headed in the wrong direction.
In light of any consistent, concrete action, physicians and their employers have taken it upon themselves to create health care parity. Since December 2020, three licensed family therapists from Cook Children’s Hospital have been rotating through a series of neighborhood clinics each week. The goal is to increase access to outpatient counseling for the city’s underserved residents, and it appears to be working. In its first month, the initiative reached more than 100 patients. By spring of last year, that number had grown to nearly 400 patients in a single month.
As Dr. Talbot said, success is possible; it happens every day. And even greater success will take a comprehensive approach — one that includes investment in education, addiction resources, and more.
The Cook Children’s approach is addressing a key problem you’ll often hear discussed in any conversation on mental health: access. But they can’t do it alone. No doctor can.
“Partial and piecemeal remedies don’t address the entrenched problems tied to a lack of access to competent care in the United States,” Hannah Zeavin, a lecturer at UC Berkeley, wrote last year in The Washington Post. “Neither will public relations campaigns by public officials and celebrities reminding us to take care of ourselves for Mental Health Awareness Month each May. Only a comprehensive approach to the issue will — and that means addressing insurance parity for mental health care, funding clinical training, and ensuring access and continuity of care.”
On this point, the doctors — and Michael — agree.
“If you don’t actually address the problem, it’s very easy to get a city with no soul,” he says. “We can’t just throw money at something, and we can’t hide from our responsibility. We have a responsibility to each other.”
