By Anne C. Woodlen

(On February 5, 2009, the Post-Standard published a letter that read in part “[CPEP] was filled way beyond capacity, with patients lying on chairs, floors, anywhere they could find space. It was quickly clear to us that it was understaffed, dealing with an extremely difficult, diverse population.” The following piece was written Sept. 19, 2007. Despite repeated notifications, the NYS Office of Mental Health fails to properly oversee St. Joseph Hospital’s management of CPEP).

There was an old lady who was taken to CPEP after being raped. CPEP is the Comprehensive Psychiatric Emergency Program that is maintained by St. Joseph’s Hospital under the jurisdiction of the New York State Office of Mental Health. I don’t know why they took the old lady to CPEP. If I were an old lady—oh, gosh, according to the Onondaga County Department of Youth and Aging, I am an old lady—so, speaking as an old lady, if I get raped then I want to be taken to a hospital emergency department for a rape kit and I want the Rape Center to be called. I don’t want to be taken to CPEP, nor, I imagine, would the other old lady if she’d had the slightest clue what she was getting into.

When I met the Old Lady, she was announcing to everyone within earshot that if she ever got the urge to go to CPEP again, she would go out and get drunk instead. Way to go, Old Lady! All present nodded in agreement. What brings her to mind right now is that I’m thinking about CPEP and I’m drinking. It’s the only thing you can do.

CPEP is in a small, free-standing building that was constructed near St. Joe’s for the sole and solitary purpose of housing CPEP. Inside it has a “front” and a “back.” The front of CPEP is a waiting room and treatment area; the back is sort of an inpatient unit. One has to qualify it with “sort of” because “inpatient” in any other area of the hospital means you are being treated; in CPEP, it only means you are on hold.

Neophytes and other naive kinds of people have this vague notion that psychiatric emergency care is, well, care—nurturing nursing attention. Nothing could be further from the truth. Immediately disabuse yourself of the notion that emergency psychiatric care bears any relationship to compassionate treatment.

For starters, once you pass through the door of the waiting room, you cannot leave. If you go to a medical emergency room, you can walk out whenever you want to. You can walk out when you’ve been there six hours and still haven’t been seen by any treating professional and you have, consequently, decided you’re not really that sick and you’d just as soon go home to bed. You can walk out when the bleeding has stopped and you’ve had a chance to calm down, get a grip and decide you really don’t need stitches. You can walk out after you’ve sat there for four hours, watched and listened to four other people who have the same symptoms you do, and have become aware that there’s a stomach virus going around, and you don’t actually have an ulcer.

In short, if you go to a medical emergency room, you can rest, reflect, come to your senses and go home. Get up and walk out. Be a free and independent agent. Live your life as you see fit.

At CPEP, from the moment that you enter, you are locked down until a psychiatrist sees you. The receptionist—behind a Plexiglas window—orders you to sign in. She does not tell you that once you have done so, you will have surrendered all your rights of independent decision making. She also does not tell you that (a) you cannot smoke in CPEP and (b) you cannot go outside to smoke. The minute you enter CPEP, you are instantly treated to nicotine withdrawal—as if you didn’t have enough problems already.

The second thing that happens in CPEP is that you are strip searched. The average American goes through his or her entire life without ever being strip searched. The millions of human beings who go to medical emergency rooms every day are never, ever strip searched. Cardiac crisis, broken leg, asthma attack—you aren’t strip searched. Mental meltdown—which is to say, trouble with your psychological state consequent to the crippling of your endocrine, neurological or immunological systems, or environmental stress—and you get stripped and searched. Hey, is this fun, or what?

Next, everything you have is taken away from you. Your cell phone, telephone/address book, sweatshirt and Weekly Reader—all taken away from you and locked up.

You are now, unequivocally, in prison. This is not health care; this is lockdown. You have been stripped of all your rights, as surely as an Iraqi terrorist at Guantanamo Bay. Oh, heck, a whole lot more surely than a terrorist at Gitmo. And no, you don’t have the right to call a lawyer. If you weren’t an emotional basket case before, you certainly are now—and now you have to wait for the psychiatrist. You can’t leave without seeing him, her or it, remember?

Psychiatrists at CPEP commonly work sixteen hour shifts, for the simple reason that nobody in their right mind wants to work there. For years, it was understood that the complete loser who ran this horror house kept his job solely because nobody else wanted it. Any idiot can get the job and keep it. What kind of man wants to rule over hell?

There is only one psychiatrist on duty at a time. The patients come in at the rate of about one every twenty minutes. It is a total impossibility for one doctor to see a new patient, make a comprehensive assessment, design a treatment plan, and do the follow-up paper work in twenty minutes. It cannot be done, nevertheless, it must be. It is a rational absurdity.

Some lucky few get seen, screened and sent home with prescriptions for a ton of drugs that are guaranteed to make them numb, passive—quite possibly sound asleep—and non-combative for at least twelve hours, by which time the psychiatrist will have gone home and it will be somebody else’s problem. The rest of the patients are admitted to the back.

People throw around the word “hell” so casually. “It was hell.” “I felt like I was in hell.” “It was a hellish experience.” There is, classically, only one Hell, therefore I have made it a practice to describe really, really bad situations as “unpleasant,” “awful,” “dreadful,” “alarming,” “shocking,” or “vile.” I figure you need to reserve your worst adjective for the worst situation imaginable—no, no, for the situation that is beyond imagination.

CPEP is hell.

A pastor once described Heaven as “infinite options” and Hell as “no options.” I say again, CPEP is hell. By the time you arrive there, you have been denuded of all self-respect. Clearly, you have been strip searched and locked up because you are a terrible person. It is not about a doctor’s psychiatric diagnosis: it is about society’s moral judgment.

The staff stays as far away from you as they can, which means they refuse to come out of the nursing station. They are safe behind walls and no matter what is happening to you they will not come out. You are left alone with the other patients, who comprise the spectrum of human aberrations. Drunk and disorderly, sexual perversion, suicidal depression, behavioral problem, hallucinating schizophrenic, adolescent acting out, convicted killer, terrified ten-year-old, and—oh yes—Old Lady who’s been raped—they’re all in there together. And guess what?

There are no locks on the bathroom doors. Seriously. CPEP was designed without locks on the bathroom doors because, hey, somebody could lock themselves in and do something terrible to themselves. Or the Old Lady who’s been raped could be trying to pee and any one of the other patient for any one of a hundred reasons—disorientation, disregard, disgust—could walk in on her. Hey, are we having fun yet?

Let’s back up and take a look at the unit: on one side are the nursing station and locked offices; down the center are a television, a couch, and a couple tables and chairs; and down the outside are eight “bedrooms”—spaces about eight feet by ten feet, occupied by a bed, a night stand and you. Welcome to my world. This is an eight-bed unit. Last Tuesday night, it contained thirty-one patients. I want you to imagine the cardiac care unit. Picture a standard, two-bed hospital room. Now, in that room, put two people in the beds and six people on mattresses on the floor. Welcome to CPEP.