Priya Iyer 
Devon Rourke was sixteen the first time his mother Caitlin found the small, careful cuts on his upper thigh. They were in their kitchen in Worcester, Massachusetts, on a quiet Sunday evening, and she had only noticed because his pajama shorts rode up while he pulled a bowl from the dishwasher. Her instinct was to … Read more
The Phase Most Patients Underestimate Discharge from inpatient psychiatric hospitalisation is the moment most mental health care narratives end. The patient was in crisis, then in the hospital, then home, and the story is over. The clinical reality is the opposite. The discharge is the start of the most consequential phase of the recovery arc. The decisions … Read more
David Park sat across from his attorney in a borrowed conference room in downtown Phoenix and listened to the words “competency to stand trial” for the first time in his life. His twin brother Jonathan had been arrested on a weapons charge during what David recognized immediately as a manic episode, the third in five … Read more
Elena, a 38-year-old freelance UX designer in Austin, left a salaried role at a software company in March to go independent. She had been managing generalized anxiety with weekly therapy at $25 copays and a low-dose SSRI. Six weeks into self-employment, her COBRA continuation premium for the same plan ran $749 a month for individual … Read more
Karen from Buffalo had been dreading October since college. Every fall the same pattern would arrive on the same schedule. She slept twelve hours and woke up exhausted. She craved bread and pasta and chocolate at quantities that did not match her summer self. She gained eight to fifteen pounds between Halloween and St. Patrick’s … Read more
Marcus, twenty-three, walked into a corner store in the Bronx on a humid July afternoon and bought a small foil packet labeled “AK-47 herbal incense.” Twenty minutes later, his cousin found him on the sidewalk outside, frozen in a half-crouch, eyes locked open, drool tracking down his chin. He could not answer his name. By … Read more
The Conversation That Saves Lives For most of the twentieth century, mainstream advice in mental health care cautioned against asking people directly about suicide. The unspoken theory was that direct questions would plant ideas, lead to action, or destabilise a fragile person. Decades of research have decisively reversed that view. Direct questions about suicide reduce risk rather … Read more
Marcus, a 58-year-old retired postal worker in Louisville, signed up for a Humana Medicare Advantage plan during his initial enrollment period because his wife had used Humana for years. Two months in, his sleep collapsed. He started waking at 3 a.m. with chest tightness, replaying memories of a coworker’s overdose death from 2019. His primary … Read more
The Insurance Decision Many Self-Employed Americans Make Wrong For the millions of Americans who do not get health insurance through an employer, the ACA marketplace is the primary path to coverage that includes mental health care. Self-employed workers, gig economy participants, early retirees, recent graduates, and people between jobs all rely on the marketplace, often without … Read more
Linda was 64, a retired schoolteacher in Sarasota, when her cardiologist scheduled her for a triple coronary bypass. The surgery went textbook. The recovery did not. Two weeks after discharge, Linda’s daughter Janelle noticed her mother had stopped reading, stopped calling friends, and was sleeping 14 hours a day. By week four, Linda was crying … Read more