NASHVILLE, Tenn. (WTVF) — An exclusive NewsChannel 5 investigation into Tennessee's mental health system has revealed cries for help that often go unanswered.
Even people who can afford to pay are often forced out of psychiatric hospitals, with little follow-up care.
Now a long-time Davidson County judge says "the system is broken."
Judge Melissa Blackburn oversees Davidson County's Mental Health Court.
She also presides over court hearings in which people are involuntarily committed to psychiatric hospitals. Involuntary committals happen when a doctor determines the person is suicidal or a threat to others. They are not criminals, but people in a mental health crisis.
Every Wednesday and Friday inside the Davidson County Courthouse, a judge hears from doctors and patients about whether to commit people to a psychiatric hospital.
"We're seeing a lot more cases than when I started," Judge Blackburn said.
She was elected nine years ago and said mental health cases have soared.
"It's definitely a crisis. There's no question about that," Blackburn said.
In Davidson County alone, 23,441 people have been involuntarily committed since 2019.
The process usually starts in an emergency room, where people go when they are suicidal or in a mental health crisis. They then go to an available psychiatric hospital. A judge later decides how long they stay.
"We make a determination based on what they say and what the doctor says as to what we feel is best for the patient's safety," Blackburn said.
But judges started noticing they were seeing many of the same people over and over.
Judge Blackburn's office put together a detailed spreadsheet showing the county's repeat involuntary hospitalizations.
The data showed over a recent four-year period numerous people committed 20 times or more.
It also showed they often went to different psychiatric hospitals each time, and those hospitals were not communicating about the patient's history.
"No one's checking. No one's paying attention. No one's bothering to see where they have been or what they've been on or what the prior medication is - hence them going from hospital to hospital to hospital," Blackburn said.
Take 'Nataly' — not her real name — she was hospitalized 39 different times and went to five different psychiatric hospitals from 2019 until 2022.
"If they would communicate, they could cut down dramatically the number of times 'Nataly' is being hospitalized," Judge Blackburn said.
'Patricia' was hospitalized 26 different times.
Blackburn said each hospital sent her home after just getting her out of the immediate crisis.
"She's home for a week. A week and a half later something happens again. She's re-admitted through the emergency room at a different hospital, and we start over," Blackburn said.
Robin Nobling with Davidson County's National Alliance on Mental Illness (NAMI) said once someone gets out of a psychiatric hospital there is rarely enough follow-up care.
"We have a mental health system that says, 'call me when you're sick.' We don't have a mental health system based on recovery," Nobling said.
She said if follow-up care is done at all, it is done by phone.
"They used to go to their homes and check on them. I remember case management would make sure they were picking up their prescriptions," Nobling said.
The data from Judge Blackburn's office also showed how often people who have been committed have gone to jail.
'Cameron' was jailed 24 times for low-level crimes.
He was also committed eight times at four different county hospitals.
And 'Kane' was jailed seven times.
But he was committed 28 different times at four different psychiatric hospitals.
"There's no reason for that happening. Somebody is not bothering to take the time to figure out what is really wrong with him and get him the right medication," Judge Blackburn said.
She is now telling doctors where a person has been treated before when they testify in committal cases.
She's hoping to reverse the revolving door of committal and release through more communication.
But there is also the reality of limited space in psychiatric hospitals — a problem made worse by the lack of qualified staff.
Judge Blackburn agreed there is a desperate need for follow-up care. That can mean supported housing where people get help getting medications.
But the bottom line is we are seeing more and more severe cases, and more help is needed.
