Originally published on Vox.

My boyfriend Scott and I had just broken up. This boy who’d once brought me flowers had turned possessive and controlling. Sleep-deprived from constant drama and isolated from friends, I fell into despair.

This would lead me to seven days of hospitalization and saddle me with $16,000 in debt. After my hospital stay, after I voluntarily admitted myself for making plans to kill myself, I was released with only a referral for a psychiatrist and a prescription for sleeping pills.

The National Alliance on Mental Illness reports that one in four adults in America experience bouts of mental illness in one year, resulting in $193.2 billion in lost earnings per year. A 2011 study published by the American Association of Suicidology found a connection between attempted suicide and bankruptcy, concluding that “individuals admitted to a trauma center following an attempted suicide were just over twice as likely to become bankrupt within 2 years compared to those who were admitted following an accident.” The Kaiser Foundation reported that medical bills contributed to 62 percent of personal bankruptcies in 2007, and many insurance plans don’t cover suicide attempts.

Mental health care is seen as a luxury, and not affordable for the impoverished when they are the ones who often need it most. But when mental health issues amount to a crisis, like mine did after months of enduring a boyfriend’s abuse, nobody thinks about the financial consequences. I didn’t consider that getting help would mean thousands of dollars a day. I didn’t consider it would mean being bankrupt by the time I was 27.

For six months, he’d made sure I had fresh roses. He’d moved in quickly, pulling me into his dreams of living off the land. Then I came home from work one night, and he was on the phone. I flinched when he said his ex-girlfriend’s name. Lily. He had a framed picture of them with red-cheeked smiles, holding snowboards, on his dresser. She’d returned for the summer. Our arguments escalated.

To show me how important she was to him, he brought out a small, tattered suitcase from under our bed, filled with every memento from their time together. For three straight nights, he went through each of these items in detail and their meaning. I couldn’t sleep. If I slept, it meant I didn’t care.

I continued to work through 10-hour shifts. He’d show up at the coffee shop, looking concerned and telling me I should get some sleep, but at home he’d yell at me, faulting me for not being like her. He’d break things. My things.

Our arguments revolved around how many people I’d slept with. He made me burn my underwear and buy new ones. Lily didn’t whore herself around, he said. “I mean, look at this pillow Lily made me,” he said on night two, holding up a small square that smelled of lavender.

When I came home the fourth night, I found our cabin empty. I called Scott. “Where are you?” I said. “I’m at Lily’s,” he said quickly. Then he hung up and didn’t come home.

My mind sped through stages of anger, panic, then despair. I hadn’t slept in days, and the thought of the relationship ending broke me. I couldn’t sleep. I sat on my porch, smoking cigarettes, eventually throwing up wine, and writing journal entries that drifted toward suicide notes.

I found someone to cover my shift the next day, and woke up not knowing when I’d gone to sleep. Scott still wasn’t home. I called my mom and admitted to not wanting to live anymore but needing to make a few plans first. She made me promise to call her back, but in the meantime she made several calls from her home halfway across the world, including the police. They found me sprawled out in bed with my face buried in a tear-stained pillow. Scott stood out in the kitchen. My mom had called him, too.

They couldn’t arrest me for daunting sadness or force me to check myself into the psychiatric ward, but they highly recommended it. I refused. My catastrophic insurance didn’t cover heartbreak and sleep-deprivation-induced psychosis. I had no idea how much a hospital stay would cost. I knew it’d be somewhere in the thousands, and I’d have to pay immediately. There was no way I could come up with that kind of money, especially after missing work.

“I’ll find a way to pay for it,” my mom had said. “I’ll put it on a credit card or something.”

Scott drove me in his truck. He was silent, and I stared out the window, defeated and ashamed, like a teenager caught trying to run away.

We walked into the emergency room. I told the lady at the intake counter that I wanted to harm myself and didn’t feel safe. A nurse ushered us into the psychiatric patient intake room, with its fixed bed, solid walls, and a locking door, where I had to change into hospital-issued scrubs. A large man stood outside the doorway. “Okay, Ms. Land,” said the nurse. “Curt here will escort you up to the fourth floor.”

I sank back to the bed, staring at my feet encased in nubby purple fluff with the nonslip soles.

The sound of the nurse’s tapping foot pounded in my ears. I glanced at Scott, looking down on me. It was Curt or him. I chose Curt.

He delivered me to a woman for an intake interview, who told me the minimum length of stay was a week. I said I couldn’t stay that long. That I needed to work. She smiled, said it was late, led me to my room, and gave me a pill to help me sleep.

My dad flew up from Washington the next day. I faced his weighted gaze during visiting hours, an awful reflection to Scott’s humiliating look of shame on you, look what you did.

Group therapy sessions gathered midmorning. Craft time in the afternoon. Friends came to visit. Scott spoke with them in hushed tones. He was, of course, a model boyfriend during visitation hours. Some of my friends brought me flowers, like I had an illness. I guess I did.

hey allowed me to leave after seven days, but I didn’t transition back to the real world well. My boss at the coffee shop I managed had fired me for the unexpected time off, and I stewed in my shame of being unemployed. Scott delighted in his new responsibility of doling out my Ambien. It’d be months before I slept naturally again.

I tried going back to school over the next few months, and worked at another coffee shack, but I couldn’t avoid my lack of emotion or caring. I teetered from moping around to curling up in a ball and staring at objects that didn’t move. The therapist I’d begun seeing after my release tried to ease my shame, telling me he’d “never trusted someone who could honestly tell me they’d never considered suicide.” I didn’t tell him I still fantasized about death. I’d make to-do lists just in case I felt like I needed to leave for good.

I’d done this radical, drastic thing that defined me. The humiliation of the hospital stay consumed me. I didn’t know anyone else who’d willingly checked themselves into a psych ward.

Then I started getting the bills in the mail.

Sixteen thousand dollars for a bed, some sleeping pills, and a few meals. It was more money than I usually made in a year, working two or three jobs. For the next six months I’d have a tear-filled relationship with the hospital’s billing department. They granted me some relief: When I repeatedly told them I couldn’t pay for it, the hospital cut my bill from $16,000 to $12,000. I still couldn’t afford it.

I called my mom to ask if she could follow through with her promise to help. She laughed and denied ever saying anything close. When I’d checked myself in, I thought I’d stay for a night or two, but it turned out to require a seven-day stay, the most expensive “vacation” I’d ever had.

Six months later, in late January, I moved to Washington state. I needed to get away from the darkness of winter and the insomnia, and from Scott. We’d broken up again, and he’d busted down my door and given me several bruises because he’d wanted pictures of us off my computer. The police visited my house again, taking photos of the damaged door, phone, and computer, and the bruises on my ribcage that had already started to turn a dark purple.

Almost a year after I’d entered the psych ward, the women from the hospital’s billing department (they were always women) got more demanding. They threatened to garnish my wages or report my outstanding balance to creditors, who’d have the power to keep any income I made that wasn’t under the table.

“What wages?” I said. I made minimum wage or a little better, waitressing or selling bread at a market, or playing with dogs at a doggy day care. Between rent, utilities, credit card payments, student loans, and whatever I could send to the hospital, I had nothing left. I worked six days a week for 12 hours a day and had almost nothing left for food. I ate at work and had ramen and cabbage for dinner with hardboiled eggs. Shift beers were my solace.

Around that time, in the late summer of 2005, it was in the news a lot that President Bush had changed bankruptcy laws. Chapter 7 bankruptcy, which offered a “fresh start” by totally discharging most debts, would become near impossible to file, and would only be available to very low-income qualifiers.

I debated it for a few months, found a lawyer who’d do it for “only” $900, and borrowed money from several friends and family members to pay. I knew it’d taint my credit report for 10 years, but that seemed like an unimaginable amount of time. I was in my late 20s, and had no idea what bankruptcy on a credit report really meant.

Without major credit cards with ample available balances, I couldn’t rent cars or pass credit checks for apartments. I lived in cheap trailers, worked customer service, and thought my life wouldn’t amount to much more than that, because I was the epitome of irresponsibility by declaring bankruptcy. In my self-destructive path, I couldn’t envision my life. I didn’t want to. I couldn’t dream anymore. I felt tarnished. Damaged goods. Carrying around a huge suitcase marked “baggage.”

I did everything I could to build up my credit score again. Eventually I qualified for “high risk” credit cards with 30 percent interest rates and $100 membership fees but $400 available balances. This went on for several years until I’d built up enough “good” credit for regular credit cards. I got excited when I started getting the junk mail urging me to sign up and get a fancy new card with a balance over $1,000.

The experience made me hide a kind of shame that none of my peers could even empathize with. I’d spent a week in a psych ward. I’d declared bankruptcy. These two events in my life were a huge red flag to anyone I dated. I felt marked by my decision, forever crazy, broken, and with an impossible future. While most of my friends settled down, got married, bought houses, and had kids, I drank heavily in an attempt to cope with the feeling that marriage just wasn’t in the cards for me anymore.

Over the years, I knew not to apply for store financing on a laptop or the smallest of payment plans. I still accrued more debt from student loans and credit cards while putting myself through college, but I’ve never fallen behind on payments again. I worked with hard-nosed determination to be a contributing member of society, financially speaking. I worked almost impossibly hard doing that as a single mother.

It’s been a long enough time now that I can share my story about it. The psych ward has always been something I rarely tell people about. When I do, I talk about it like a past life. I have to distance myself from it. For years, I blamed my mom for not following through on paying the bill: “I wouldn’t have checked myself in if I’d known I’d have to pay $16,000.”

But what does that say about this environment that is set up to help people? Did all those people in morning group therapy end up with medical bills even higher than mine? In the grand scheme of things, I was lucky.

When I was able to take out a small loan on a used car a few years ago, the salesman who drafted the paperwork said it was good I’d declared bankruptcy. “Months or years of no payment would have been much worse,” he said. “Bankruptcy at least wipes the slate clean in that respect, even if it stays on your credit report for 10 years.”

I’m still angered over the experience. I never forgave my mom. I haven’t had much of a relationship with her since, and haven’t spoken to her in more than a year. I’m 37, and that time in my life is ancient history, though the bankruptcy still shows on my credit report. It should come off this year. I was fired from a job once for not telling them about it. I didn’t think it mattered.