Rural patients struggling with mental-health issues often use the emergency room as their first point of contact with the medical system. But the next step in treatment is uncertain – or nonexistent – for patients without deep pockets.

I saw Jake in the emergency department of Tiny Memorial Hospital—both names have been changed for privacy—at 3 a.m. a few months ago. He was a spitting, screaming, muscular mess of rage. A local deputy brought him in handcuffs after his family called 911.

He had been at his mother’s home, banging his head on the wall and talking about suicide. He was drunk and cycling between rage and sobs. His young wife had left and taken their 2-year-old boy with her. Everything in Jake’s life was spiraling out of control. The cause of the split was not forthcoming from anyone.

The deputy knew Jake from high school. He knew that he was serious; a determined, stubborn young man. There were no charges against him. His mother, through tears, simply said, “Please get him some help!” So the officer brought him to us and offered to stay as long as needed to keep him under control.

Jake had never been depressed or suicidal before. According to his shaken mother, her son was a hard worker who made good money in construction. He could build anything and was sought after by contractors. But lately, since his family troubles, he had been missing work and losing interest in his job, fun, and even in food…

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