PsychiatRick Podcast

PsychiatRick
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PsychiatRick explores the intersection of mental health, politics, culture, and power through the lens of a PMHNP, combat veteran, and bluntly curious observer of American dysfunction. psychiatrick.substack.com

  1. 7h ago

    A Public Health Doctor Just Won a Senate Seat. Here’s Why That Matters for Your Mental Health.

    Before we begin, if you appreciate independent writing that takes mental health, politics, war, trauma, and moral accountability head-on, please subscribe to PsychiatRick. New articles are always free to read, but a paid subscription helps support the work and keeps this publication independent. Now, let's get into it. I woke up Wednesday morning and checked the results before I checked my coffee. Bad habit. Good morning, though. Abdul El-Sayed won the Michigan Senate race. He beat Mike Rogers, a former chairman of the House Intelligence Committee, and he'll be the first Muslim ever elected to the US Senate. And Democrats took control of both the Senate and the House. I want to talk about why that first part matters to me as a psych NP. Not as a pundit. As the guy sitting across from people who are falling apart for reasons no prescription can touch. Who He Is, and What He Survived Quick background. El-Sayed earned his medical degree at Columbia but didn't practice. He went into epidemiology instead, taught it at Columbia as an assistant professor, then came home to lead public health work in Detroit and Wayne County. He ran on Medicare for All, higher taxes on the wealthy, and getting corporate money out of politics. In a state Trump carried in 2024. The money thrown at him was obscene. AIPAC alone spent nearly $30 million against him in the primary, its biggest single-race investment ever. After the primary, the race drew well over $100 million in advertising. Then, two days before the election, Haley Stevens, the Democrat he beat in August, stood next to Rogers after a church service and endorsed him. He won anyway. Health Is Social. It Always Was. Here's the thing most people don't get about public health people. They don't look at a sick person and ask, "What's wrong with you?" They look at a sick neighborhood and ask, "What's happening to you?" That shift is everything in my field. A systematic review in The Lancet Psychiatry pulled together the evidence on what drives mental disorders and landed right where you'd expect if you've ever worked a clinic. Poverty. Unemployment. Housing. Food insecurity. Violence. Social isolation. The stuff that lives upstream of my office. It shows up in hard outcomes, too. One study in the Journal of Epidemiology and Community Health found that each $1 increase in the minimum wage was associated with a 3.4% to 5.9% drop in suicide rates among adults with a high school education or less. Observational, yes. But it points the same direction as everything else. And loneliness? The Surgeon General's 2023 advisory said it raises the risk of early death by nearly 30%, comparable to smoking about a dozen cigarettes a day. So picture a composite patient. Let's call her a 40-something single mom. Two jobs, no benefits, rent just jumped again. She comes in for "depression." She's right. She is depressed. I can adjust her SSRI. I can get her into therapy if I can find a therapist who takes her plan. But I cannot write a script for a landlord with a conscience. That's not a pharmacology problem. That's a policy problem. When the people writing policy actually understand that, you get different policy. That's the whole point. What Coverage Actually Does to a Brain People hear "Medicare for All" and think it's about hospitals and surgeries. It's also about whether my patients can get through the damn door. We have real data on what coverage does for mental health. The Oregon Health Insurance Experiment, one of the only randomized studies of insurance we've ever had, found that getting Medicaid cut rates of depression by about 30% and virtually eliminated catastrophic out-of-pocket medical spending. Thirty percent. From a card in your wallet. Then there's suicide. A 2022 study in JAMA Network Open looked at more than half a million suicide deaths and found that states that expanded Medicaid saw a smaller rise in suicide rates than states that didn't. The authors estimated about 1,818 suicides averted between 2015 and 2018. It's an association study, so it can't prove cause. But those are people. Actual people who might have been someone's mom. Now let's talk about what my patients run into today. The shortage. As of the end of 2025, about 137 million Americans lived in a mental health professional shortage area, with only about 27% of the need being met. The ghost networks. A 2024 JAMA secret-shopper study called prescribers listed as taking Medicaid in four big cities. Only 18% could actually be reached, took Medicaid, and offered an appointment. In Los Angeles, the median wait was 64 days. Two months, while you're in the worst stretch of your life. The exits. Older data showed only about 55% of office-based psychiatrists accepted insurance at all, versus nearly 89% of other specialists. Why? Low reimbursement and endless paperwork. Which is how you end up with the 15-minute med check. Not because clinicians think fifteen minutes is enough to understand a human being. Because the billing math says so. The gatekeeping. I've had patients with treatment-resistant depression who were good candidates for TMS, and the insurance company made them fail medication after medication first. Step therapy. You don't get the thing that might work until you've suffered through the things that didn't. A single public payer doesn't fix the workforce shortage overnight. Let's be honest. But it guts a hell of a lot of that gatekeeping, and it means people stop losing their care when they lose their job. Which, for a lot of my patients, is exactly when they need it most. Hope Is a Clinical Variable I'm going to say something that sounds soft. It isn't. Hopelessness is one of the things I screen for when I'm assessing suicide risk. It matters. When people feel like nothing they do changes anything, they stop doing things. They stop calling. They stop showing up. For their own lives and for each other. For the last couple of years I've watched a lot of my patients carry the news like a weight on their chest. Collective dread is real. You can feel it in a waiting room. So when a community organizes, gets outspent by tens of millions of dollars, gets knifed by a member of its own party two days out, and wins anyway? That's not just politics. That's evidence. Evidence that effort connects to outcome. That's the opposite of learned helplessness. And your nervous system notices. Don't Get Cocky. Do the Work. Now the cold water. A Democratic Congress still has to deal with a Republican president who has a veto pen. Overriding a veto takes two-thirds of both chambers. Nobody has that. Medicare for All isn't landing on anyone's doorstep in January, and anyone who tells you otherwise is selling something. What a Democratic Congress can do is hold hearings. Use oversight. Fight on budgets. Put bills on the record so we know exactly who stands where. And build the case for the next election, when the math could change. That only happens if people stay in it. So here's your homework: * Call your senators. Tell them mental health parity, coverage expansion, and the workforce shortage matter to you. Be specific. Staffers count calls. * Organize locally. Tenant unions, labor unions, mutual aid. Upstream is where the leverage is. * Pace yourself. I mean this one clinically. Pick one or two issues. Take breaks from the feed. Sleep. Burnout isn't a badge of commitment. It's how movements lose people. You don't have to carry everything. You just have to carry your piece. One night doesn't fix a broken system. But it proves the damn thing can be moved. Everything I write here is free. Always. Paid subscribers are the reason it stays that way, and they get extra stuff from me: Ask the Psych NP, From the Chair, and a private chat where I actually show up. Get full access to PsychiatRick at psychiatrick.substack.com/subscribe

  2. 1d ago

    Not Everybody Needs a Pill

    Before we begin, if you appreciate independent writing that takes mental health, politics, war, trauma, and moral accountability head-on, please subscribe to PsychiatRick. New articles are always free to read, but a paid subscription helps support the work and keeps this publication independent. Now, let's get into it. A couple of weeks ago I posted a note that said this: "Unpopular opinion from a psych NP: not everybody needs a pill. Some people need sleep. Some need a job that doesn't treat them like a vending machine." I figured a few people would nod along. It got more than 5,100 likes. Hundreds of people restacked it. And the replies just kept coming. A woman who said she'd been overmedicated and misdiagnosed for 26 years. Another who was told, while she was in an abusive marriage and grieving a miscarriage, that she'd be on antidepressants for the rest of her life. She wasn't depressed. She was in danger. A guy who said he didn't need his meds anymore once he got out of the life that was crushing him. Somebody with a sleep disorder who couldn't hold a 9 to 5 and kept getting handed new prescriptions instead of a schedule that fit her body. And a few people who pushed back, rightly, and said a pill saved their life. They're all right. That's the point of this article. First, let me be clear Medication saves lives. I prescribe it every day. I'm not going to stop. If you have bipolar disorder, schizophrenia, severe depression, or panic that keeps you from leaving the house, medication can be the difference between living and not. Please don't read this and quit your meds cold turkey. Stopping suddenly can be dangerous. Talk to whoever prescribes them first. And the research backs up what I see. A big 2010 analysis in JAMA found that antidepressants worked best, by a wide margin, for people with very severe depression. For milder cases, the benefit over a placebo was a lot smaller. So the question was never "pills, good or bad?" The question is: what's actually making this person sick? Because a lot of the time, it isn't their brain chemistry. It's their life. Sleep I can't tell you how many people come in for "depression" who haven't slept right in years. Insomnia isn't just a symptom of depression. It's a cause. A meta-analysis of 21 studies found that people with insomnia were about twice as likely to go on to develop depression. And the first-line treatment for chronic insomnia isn't a sleeping pill. The American College of Physicians recommends cognitive behavioral therapy for insomnia, CBT-I, before anything else. Then there's sleep apnea. Untreated, it'll leave you exhausted, foggy, irritable, and flat. That looks a whole lot like depression from across a desk. One of my readers said getting hers treated changed her mood completely. I believe it. I've watched it happen. Fix the sleep, and sometimes the "depression" walks out the door with it. Work Here's the vending machine part. A lot of my patients work jobs that treat them like equipment. High demands, no control, no say, no break. Researchers call that job strain. A 2017 review in Psychological Medicine found that people with high job strain were significantly more likely to develop clinical depression. You can't SSRI your way out of a boss who schedules you for clopens, cuts your hours when you ask for a day off, and watches you on a camera to make sure you don't sit down. I can treat the symptoms. I can't fix the schedule. Money Poverty doesn't just come with mental illness. It causes it. That's not my opinion. A 2020 review in Science laid out the causal evidence: financial shocks cause depression and anxiety, and cash transfers and anti-poverty programs improve mental health. It goes both ways, too. Mental illness makes it harder to work, which makes people poorer, which makes them sicker. Think about what it does to a nervous system to never know if the rent is covered. To ration insulin. To get a medical bill you can't pay for an ambulance ride you didn't choose. That's not a chemical imbalance. That's a rational response to an irrational situation. Your body and your people Movement is medicine. A 2024 review in the BMJ looked at more than 200 studies and found that walking, jogging, yoga, and strength training all helped with depression. The authors said exercise should be treated as a core treatment, right alongside therapy and medication. And then there's loneliness. It's the most common thing I treat that doesn't have its own diagnosis code. People come in sad, tired, and anxious, and when we dig, there's nobody. No one to call. No one who'd notice if they didn't show up. A pill can't fix that either. So why does everyone leave with a prescription? Because that's what the system is built to do. Insurance pays for a 15-minute medication check. It doesn't pay for me to help you find housing. It doesn't pay for a sleep coach, a gym membership, or a union rep. Therapy waitlists are months long. TMS, which works really well for some people, often isn't covered until you've failed a list of medications first. So the fastest, cheapest, most "billable" thing a provider can do is write a script. That's not a doctor problem. It's a design problem. And it was designed by people who profit from it. What I want you to ask If you're seeing someone for your mental health, here are some questions worth asking: What else could be causing this? Have we looked at my sleep? Could I have sleep apnea? Is my job part of this? What would help besides medication? Is therapy an option, and can you help me find one? If I start this med, how will we know it's working, and how long will I be on it? A good provider will be glad you asked. If they get annoyed, that tells you something. And to my fellow providers: ask about their lives. Ask about their jobs, their sleep, their money, who they go home to. The answer is in there more often than it's in the DSM. This is political. It always was. I'm writing this the morning after the election. Whatever happened last night, here's what doesn't change. Paid sick leave is mental health care. Affordable housing is mental health care. Medicaid is mental health care. A union contract that stops your boss from scheduling you into the ground is mental health care. A living wage is mental health care. When politicians cut those things, they're not saving money. They're shifting the cost onto your nervous system, and then onto mine, when you end up in my office. I'll keep prescribing when you need it. I'll keep fighting for the stuff that means you won't need it as much. Some people need a pill. Everybody needs a life worth waking up to. Everything I write here is free. Always. Paid subscribers are the reason it stays that way, and they get extra stuff from me: Ask the Psych NP, From the Chair, and a private chat where I actually show up. This Substack is reader-supported. To receive new posts and support my work, consider becoming a free or paid subscriber. Get full access to PsychiatRick at psychiatrick.substack.com/subscribe

  3. Oct 29

    Your Nervous System Wasn't Built for Election Week

    Before we begin, if you appreciate independent writing that takes mental health, politics, war, trauma, and moral accountability head-on, please subscribe to PsychiatRick. New articles are always free to read, but a paid subscription helps support the work and keeps this publication independent. Now, let's get into it. Half my patients right now are anxious about the election. Not "a little on edge." Not sleeping. Jaw clenched. Checking their phone at 2 a.m. like it owes them money. People who've been stable for years are suddenly back in my office asking if they need to go up on their meds. I get it. I'm a combat vet and a psych NP, and I've been grinding my teeth too. You're not crazy. You're paying attention. Back in 2024, the American Psychological Association found that 77% of adults called the future of the nation a significant source of stress. Sixty-nine percent said the election itself. Seventy-two percent were worried the results could lead to violence. That was before the last two years happened. So this isn't an article telling you to calm down. I'm tired of being told to calm down too. This is an article about how to keep your body and brain working well enough to get through the next week, and still have something left to fight with on Wednesday. Five days. Let's get you through them. Know what's coming, so it can't ambush you Anxiety feeds on surprise. So let's take the surprise away. Election night is probably not going to give you an answer. In some swing states, including Pennsylvania, counties can't even start processing mail ballots until Election Day morning. That means the early numbers can look one way and the final count can look completely different days later. That's not fraud. That's math. Mail ballots take longer to count. And here's the other thing you already know is coming: somebody is going to stand at a podium before the counting is done and call it rigged. They've already told you that's the plan. When it happens, I want you to recognize it for what it is. A move they announced in advance. Not a sign that it's over. Predictable isn't the same as hopeless. A storm you saw on the radar doesn't knock you over like the one you didn't. Stop feeding the machine After the Boston Marathon bombing, researchers looked at people across the country. The ones who watched six or more hours a day of coverage in the week after had higher acute stress than people who were actually at the bombing. Read that again. Watching it on a loop hurt people more than being there. Your brain doesn't know the difference between a threat on a screen and a threat in the room. Every refresh is another hit of adrenaline. You're not staying informed at that point. You're re-traumatizing yourself in 30-second increments. So here's what I tell my patients: Pick two trusted sources. That's it. Not twelve. Not whoever's screaming the loudest on your feed. Pick your news windows. Morning and evening. Thirty minutes each. Outside those windows, the phone goes in another room. Turn off push notifications. All of them. Nothing that happens at 1 a.m. requires you to know about it at 1 a.m. And on election night, don't watch the count like it's a heart monitor. Go to bed. The votes will still be there in the morning, and so will you. Your body comes first You can't think your way out of a nervous system that's on fire. You have to calm the body first. Then the brain follows. Breathe like you mean it. In a Stanford study, people who did five minutes a day of something called cyclic sighing had a bigger boost in mood than people who meditated for the same five minutes. Here's how: take a slow breath in through your nose. At the top, sneak in a second, shorter inhale to fill your lungs all the way. Then let it out slow through your mouth, longer than you breathed in. Repeat for five minutes. It feels stupid. Do it anyway. It works. Protect your sleep. Sleep is where your brain processes stress. Cut the screens an hour before bed. Same bedtime every night this week, even if it feels pointless. Watch the drinking. I'm not your mom. But I've seen this movie a thousand times. Alcohol feels like it takes the edge off, then it wrecks your sleep and you wake up at 3 a.m. with your heart pounding. Anxiety comes back worse the next day. Election week is not the week to find that out. Move. Walk the dog. Walk without the dog. Your body is loaded with stress chemicals that were designed to make you run. So let it. Eat actual food. Not a sleeve of crackers over the sink while you refresh a map. Name it to tame it When you're overwhelmed, say it. Out loud, or on paper. "I'm scared." "I'm furious." "I feel helpless." It sounds too simple to matter. It isn't. UCLA researchers found that putting feelings into words calms the brain's alarm center, the amygdala. Labeling the emotion actually turns the volume down on it. Bottling it up does the opposite. And a lot of you have been bottling since 2016. Action is the antidote Here's the most important thing I'll say in this whole piece. Hopelessness is a symptom, not a forecast. Anxiety and helplessness feed on each other. The more helpless you feel, the more anxious you get. And the fastest way I know to break that loop is to do something. Anything. With your hands and your feet. There's research on this too. Psychologists Malte Klar and Tim Kasser found that activists reported more happiness and fulfillment than non-activists, and that even one small act of activism left people feeling more energized and alive. So turn the fear into a to-do list: Vote early if you haven't. Make a plan if you're voting Tuesday. Where, when, and who's driving. Check your mail ballot status. If it says anything other than "received," call your county clerk. Drive somebody to the polls. An elderly neighbor. A friend without a car. Text bank, phone bank, or hand out water in line. Every one of those is a dose of medicine. And it actually changes the outcome. Don't do this alone The same APA survey found that half of Americans said political tension makes them less likely to want to connect with people. I understand why. But isolation is exactly the wrong move right now. We're wired for each other. A scared person alone in a dark room with a phone is a scared person getting more scared. Watch results with people who love you. Or don't watch at all, together. Play cards. Make dinner. Call the friend you've been meaning to call. And check on your people. Especially the veterans. Especially the survivors. Especially the folks who've been quiet lately. Quiet doesn't always mean fine. When it's more than stress Some of you aren't just stressed. You're not sleeping for days at a time. You can't work. You can't eat. You feel like you're coming apart. That's not a character flaw. It's a signal. Call your provider. Tell them what's going on. And if you're having thoughts of hurting yourself, call or text 988. It's free, it's 24/7, and the people on the other end know what they're doing. There's no shame in reaching for the rope. That's what it's there for. About Wednesday Here's what I need you to hear. Tuesday is not the last day. Whatever happens, there's going to be a Wednesday. And a Thursday. Maybe a long count. Maybe court fights. Maybe people in the streets. If that happens, we show up peacefully, all of us, and we don't hand them the excuse they're looking for. None of that works if you've burned yourself to the ground by Tuesday night. So pace yourself. This is a long fight, not a sprint. And the people who win long fights are the ones who learned to rest without quitting. Breathe. Vote. Sleep. Check on each other. And then get back up and keep going. I'll be right here with you. This Substack is reader-supported. To receive new posts and support my work, consider becoming a free or paid subscriber. Get full access to PsychiatRick at psychiatrick.substack.com/subscribe

  4. Oct 26

    Who Are They Protecting?

    Before we begin, if you appreciate independent writing that takes mental health, politics, war, trauma, and moral accountability head-on, please subscribe to PsychiatRick. New articles are always free to read, but a paid subscription helps support the work and keeps this publication independent. Now, let’s get into it. Last week I wrote about a brown American who shouted “Release the Epstein files!” at a JD Vance rally in North Carolina. Vance answered with a joke about sneaking across the border. I said then that whatever’s in those files, people are working awfully hard to keep it there. And I said Epstein was an article for another day. Today’s the day. Congress passed the Epstein Files Transparency Act 427 to 1 in the House and unanimously in the Senate. You can’t get 427 members of Congress to agree on lunch. They agreed on this. The law took effect last November and gave the Justice Department until December 19 to release the files. They missed it. The final dump came 42 days late, on January 30. About 3.5 million pages, out of more than 6 million they reviewed. Democrats on House Oversight say the department is still sitting on more than 2 million pages. Two million pages. Ask yourself what’s on them. They protected the men and exposed the girls Here’s the part that made me want to throw my phone. When the files finally came out, a Wall Street Journal review found personal information for at least 43 victims had been exposed. Names. Identifying details. Out in the open. Meanwhile the financial records, the stuff that shows who paid for what and who flew where, stayed buried. Eighteen survivors put out a statement saying exactly that: their names got exposed while the men who abused them stayed protected. Read that again. The government had one job: protect the victims, expose the abusers. They did it backwards. That’s not a clerical error. That’s a choice. A federal judge says they broke the law You don’t have to take my word for it. In June, U.S. District Judge Emmet Sullivan ruled in a case brought by journalist Katie Phang and wrote this about acting Attorney General Todd Blanche: “The Attorney General has conceded that he is in violation of the Act.” Conceded. He didn’t even fight it. The judge ordered the department to unredact more files, including emails about a “torture video” and interview notes with a woman who told investigators Trump abused her when she was a minor. Days later, the DOJ said it wasn’t releasing anything else because it had “already complied.” A judge says you broke the law. You say you’re done. Imagine trying that with a speeding ticket. Even Vance admitted it on Joe Rogan: “We did mishandle it.” Mishandled. That’s what you call it when you lose the remote. Not when you sit on two million pages about a child sex trafficking operation. What’s already in there Let’s talk about what we already know is in those files. Because it’s bad. An initial New York Times review found at least 4,500 documents that mention Trump. Not one. Not a dozen. Forty-five hundred. And in March, the DOJ finally released FBI interview notes from a woman who told agents that Epstein brought her to meet Trump when she was somewhere between 13 and 15 years old, and that Trump sexually assaulted her. She said she fought back. Thirteen. The FBI sat down with her four times. Four. You don’t interview someone four times if you think she’s a crank. Miami Herald reporter Julie K. Brown, the one who blew this whole thing open years ago, reported that the DOJ officials who talked to her found her credible. So what did the Justice Department do with those interviews? They left three of the four out of the January release. Their excuse? The memos were “wrongly treated as duplicates.” Duplicates. A woman tells the FBI the President of the United States assaulted her as a child, and the memos get filed under “oops.” The White House called her a “sadly disturbed woman” and the claims “completely baseless.” Trump denies all of it. Nothing’s been proven in court. That’s the law, and I respect it. But here’s what I know as somebody who’s spent years listening to trauma survivors. Innocent men don’t fight this hard to keep files closed. If those two million pages cleared him, he’d have them printed, framed, and hung in the Oval Office by now. He’s not hiding them because they’re boring. I’d bet my last dollar there’s worse in there. And he’s working overtime to make sure you never see it. He’s a sick f**k, and he knows exactly what those pages say. Follow the money, and the favors Then there’s Ghislaine Maxwell, the one person actually convicted in all this. She’s serving 20 years for sex trafficking. Last year, after a private meeting with Todd Blanche, she was quietly moved from a low-security prison in Florida to a minimum-security camp in Texas. No reason given. House Democrats say she gets custom meals delivered to her cell and a private visiting area with snacks. And she’s been preparing to ask Trump to commute her sentence. A convicted child sex trafficker meets with the number two at Justice. Then she gets a nicer prison. Then she asks the President for a get-out-of-jail card. I’m a psych NP, not a prosecutor. But I’ve sat across from enough people to know what grooming a relationship looks like. The states aren’t waiting Here’s the part that gives me hope. New Mexico’s attorney general, Raúl Torrez, reopened the state’s investigation into Epstein’s Zorro Ranch this year. Back in 2019, the DOJ asked New Mexico to stand down and hand over what it had. They did. Then nothing happened. So this year Torrez sued the Justice Department for the unredacted files. DOJ’s answer? Giving them to a state prosecutor “would be to break federal law.” Funny. Breaking federal law didn’t seem to bother them in front of Judge Sullivan. Then, this week, New Mexico sued Epstein’s longtime lawyer and accountant under racketeering law, alleging they helped run the “Epstein Enterprise.” The suit points to more than $3 million paid from Epstein-related accounts to girls and women between 2003 and 2013, with no business purpose anybody can find. Their attorney says they “emphatically reject” the allegations. And 18 state attorneys general are now pushing a second transparency law with teeth. It would let states, survivors, and members of Congress sue the Attorney General for withholding files, and bar DOJ from hiding behind privilege. The states are doing the job. The federal government is blocking the door. What this does to survivors Let me put my clinical hat on for a second. I’ve lost count of how many women have sat across from me and told me about a man who hurt them. Not one or two. So many I stopped being surprised. The 19-year-old who came in for “anxiety” and, forty minutes later, told me about her mom’s boyfriend. The grandmother who’d never said it out loud to anyone until she said it to me. The teenager who couldn’t sleep, couldn’t focus, and couldn’t figure out why, until she could. Different ages. Different towns. Same story. And the data backs up what I see in the office every week. According to the CDC, about 1 in 4 women in this country have experienced a completed or attempted rape. Almost half have experienced other unwanted sexual contact. And nearly half of women who’ve been raped, 48.7%, were first raped before they turned 18. Read that one again. Half of them were kids. Our women and girls are being victimized at a staggering rate. And a lot of them are carrying it alone, because every time they look up, they see powerful men get away with it. So when the government sits on two million pages about a man who trafficked children, it’s not some abstract Washington fight to the women in my office. It’s one more message that nobody’s coming. There’s a body of research on something called institutional betrayal. Psychologists Carly Smith and Jennifer Freyd found that when the institutions people trust fail to protect them after sexual trauma, or actively make it worse, survivors’ trauma symptoms get worse too. It i… Get full access to PsychiatRick at psychiatrick.substack.com/subscribe

  5. Oct 20

    It Doesn't Filter Up. It Rolls Downhill.

    By Rick Leach, MSN, APRN, PMHNP-BC Before we begin, if you appreciate independent writing that takes mental health, politics, war, trauma, and moral accountability head-on, please subscribe to PsychiatRick. New articles are always free to read, but a paid subscription helps support the work and keeps this publication independent. Now, let’s get into it. Nicole Amor was almost home. Sergeant First Class. Army Reserve. Thirty-nine years old, from White Bear Lake, Minnesota. She was a logistics soldier with the 103rd Sustainment Command, one of the people who make sure everybody else has food, fuel and equipment. She had a husband and two kids waiting on her. She was days from getting on a plane. On March 1, one day after the United States went to war with Iran, a drone slipped past air defenses and hit the command center she was working out of at Port Shuaiba, Kuwait. Six soldiers died. The youngest, Sgt. Declan Coady, was 20. Within days, three military officials told CBS the soldiers had been working in a makeshift office. A trailer. Shielded by concrete barriers. The officials questioned whether the place had been fortified at all. Weeks ago, soldiers told the Associated Press the Pentagon didn’t take Iranian threats to that port seriously enough. So that’s the record. It’s been public for months. Then on Saturday, her husband stood up at a CBS News town hall in Michigan and asked the Vice President of the United States a simple question. Joey Amor said the Iranian drone was the weapon that killed his wife, but a lot of mistakes and fundamental failures put her in front of it. He said there was a failure in the leadership. He wanted to know how this administration planned to hold those leaders accountable. JD Vance told him it was literally the first time he’d heard of it. He said the job is an honor, but you live in a bit of a bubble. Sometimes information doesn’t filter up to him. Read that again. Seven and a half months into a war his administration started, the second most powerful man in the country had never heard that the first six Americans killed in it may have died because somebody didn’t take a threat seriously. CBS reported it. The AP reported it. A grieving husband in Minnesota found out. He didn’t need a security clearance. He just needed to give a shit. Shit Rolls Downhill I was Army infantry. You learn real quick that shit rolls downhill. Private screws up, the sergeant hears about it before lunch. Then the lieutenant. Then somebody gets smoked in the dirt until the lesson sticks. Accountability in the military is fast and loud and it points straight down. What almost never happens is the reverse. When the failure lives at the top, when somebody up the chain decides a trailer behind some concrete is good enough for a war zone, it doesn’t roll uphill. It doesn’t filter up. It just sits there. It sits there until a husband carries it up to a microphone himself. That’s what Joey Amor did. He did the chain of command’s job for it, on national television, eight months after burying his wife. Vance said he didn’t doubt there were failures. He said he wanted to fix it. He called Nicole a precious human being who served her country honorably. Nice words. Words are free. But “I didn’t know” is not a defense. In the Army it’s a confession. If you’re in charge and you didn’t know, not knowing is the failure. One Isn’t Bad, Right? Want to know how much he meant it? Watch what he did two days later. On Monday, Vance was working a rally in Hendersonville, North Carolina. About ten minutes in, a man standing right behind the podium yelled “God bless our children!” and “Release the Epstein files!” The crowd chanted USA over him. Security hauled him out. Vance smiled and told the crowd he had to amend something. He’d said there were zero illegal border crossings. Then: “But one isn’t bad, right?” They laughed. The man was brown. That’s it. That was the evidence. On the video of him being walked out, he says he’s an American citizen. So follow the logic. Ask about the Epstein files while brown, and the Vice President jokes that you snuck across the border. You’re not a citizen with a question. You’re a punchline. That’s not a bubble. That’s a choice. The same man who told a widower it was literally the first time he’d heard of it had a joke loaded and ready for a guy asking about the sexual abuse of kids. I don’t think Vance lost sleep over Nicole Amor. I think he lost a news cycle. And the Epstein files? Whatever’s in them, people are working awfully hard to keep it there. That’s an article for another day. Soon. What Grief Does When Nobody Answers Now let me take off the helmet. I’m a psych NP. Grief is supposed to hurt. That’s not the problem. The problem is when grief has nowhere to land. Sudden deaths are hard. Violent deaths are harder. Deaths that didn’t have to happen are the ones that get stuck, the ones I see eat people alive for years. Because the brain keeps working the problem. Why was she in a trailer. Who signed off. Who knew. Every unanswered question is a loop that never closes. There’s a term we use for soldiers when the people they trusted to do right by them don’t. Moral injury. It’s not fear. It’s betrayal. And it doesn’t stop at the soldier. It moves into the house. It sits down at the kitchen table with the widower and two kids who are never getting their mom back. Families can survive loss. People have been doing it forever. What wrecks them is a question nobody with power will answer. Every “I’ll look into it” is one more wound. Joey Amor wasn’t asking for sympathy. He’s been getting sympathy since March. He was asking for accountability. Those are not the same thing, and anybody who’s ever sat with a grieving family knows it. Meanwhile, in San Diego On October 8, the USS Abraham Lincoln pulled into San Diego after a 321-day deployment supporting the war with Iran. Three hundred twenty-one days. That’s almost a year of missed birthdays, missed first steps, missed everything. Almost a year of launch cycles, alarms, sleep in pieces, and watching the news from the Gulf knowing it’s about you. Some of those sailors left as teenagers. Over the weekend, Gov. Gavin Newsom announced California would connect returning sailors and Marines with mental health care through the state’s Veterans Health Initiative, which has up to $38 million in grants for community-based services. Outreach. Outpatient care. Case management. Peer support. And he said out loud why the state was doing it: federal cuts to veterans’ mental health care. Good for California. Seriously. But sit with what that means. A state government has to stand up its own safety net for federal troops coming home from a federal war, because the federal system that’s supposed to catch them is being hollowed out. If you’re a sailor docking in San Diego, you get a lifeline. If you’re a soldier going home to a state that doesn’t do this, good luck. Your mental health care should not depend on which port you pull into. The Bill Is Coming Due Here’s what those sailors are coming home to. Since the start of this administration, the VA has lost more than 300 psychologists and 700 social workers, and reportedly around 200 psychiatrists, according to a July letter from Rep. Judy Chu and her colleagues. The department has shed roughly 30,000 jobs. In September, the VA’s own Inspector General reported 4,712 severe staffing shortages across the system for fiscal 2026. In 2024, it was 2,959. Nurses. Nursing assistants. Psychologists. The people who would actually sit across from a sailor who can’t sleep. In January, Senate Democrats reported the national average wait for a new patient’s first individual mental health appointment was more than 35 days. At one California clinic, it was 134 days. The VA disputes those numbers and says new patients wait closer to 19 days. Fine. Take the VA’s number. Nineteen days. I’m a psych NP. I can tell you nineteen days is a long time when you’re not okay. Thirty-five is an eternity. A hundred thirty-four i… Get full access to PsychiatRick at psychiatrick.substack.com/subscribe

  6. Oct 12

    Tell Me Where He Sleeps Tonight

    By Rick Leach, MSN, APRN, PMHNP-BC | PsychiatRick Before we begin, if you appreciate independent writing that takes mental health, politics, war, trauma, and moral accountability head-on, please subscribe to PsychiatRick. New articles are always free to read, but a paid subscription helps support the work and keeps this publication independent. Now, let’s get into it. Before you tell somebody sleeping on concrete to get their shit together, tell them where they can sleep tonight. Not a slogan. An address. A bed they can physically reach. Some reason to believe it will still exist after the first bad week. Then we can talk about responsibility. Not before. America has a favorite hobby. We hand people a list of assignments and refuse to give them a single condition required to complete it. Get sober. Take your meds. Show up on time. Find a job. Be stable. We bark these instructions at people whose afternoon is spent finding a bathroom and whose night is spent guarding everything they own from being stolen. Then they fail, and we call it a character flaw. Convenient. It means we never have to look at ourselves. I am a psychiatric nurse practitioner, an Army combat veteran, and a former police officer. I have been the guy giving the command. I have been the guy writing the treatment plan. I have never once seen the command fix the diagnosis. So I ask the question nobody at the podium wants: what happens after the transport, after the scene is cleared, after the cameras leave? Where does the person go? What care actually exists? What is different by tomorrow morning? A cleared sidewalk is not an answer. It is a photo op. What Trump is doing to the people who can least afford it On August 17, 2026, HHS and HUD announced that the Trump administration was abandoning Housing First for something it calls Treatment First. The press release declared Housing First a failure and promised recovery and self-sufficiency, two words that sound great in a press release and mean nothing on a sidewalk at 2 a.m. The direction was already set in Trump’s July 24, 2025, executive order. It encouraged expanded civil commitment, told agencies to consider funding preferences for jurisdictions that enforce camping bans, and called for making treatment a condition of housing assistance for certain people. These are directives subject to applicable law, not yet a single nationwide rule that has already gutted every local program. Give it time. That is the whole plan. By September 30, 2026, Associated Press reporting described providers scrapping housing projects and considering converting permanent apartments into temporary ones. Providers warned that residents with serious disabilities would never become financially independent inside the proposed time limits. Read that again. People who literally cannot do the thing are going to be punished for not doing the thing. From the same man who has never in his life been told no by a landlord. Calling this compassionate does not make it work. Putting “treatment” in the name does not put a clinician in the room. I have watched this administration brand plenty of cruelty as care. This is just the latest coat of paint. So here is the question. What happens to the person whose recovery takes longer than the program allows? What happens to the person whose disability makes market rent a fantasy? Does that person keep a place to live? Or does the government take an unmet treatment goal and manufacture a brand new housing crisis out of it? I already know the answer. So do they. Maslow, for the people in the back In his 1943 paper on human motivation, Abraham Maslow laid out physiological needs, safety, love and belonging, esteem, and self-actualization. His argument was simple enough for a cabinet secretary to follow: urgent unmet needs hijack attention and motivation. Hunger and fear do not politely wait while you pursue your goals. He also acknowledged exceptions, overlap, and partial satisfaction. The hierarchy was never an iron law that every lower need gets fully met before the next one matters. Use it as a tool for asking better questions. Not as proof that one housing policy must succeed. Applied to homelessness, the questions get concrete fast. Physiological needs first. Where does this person eat, drink water, wash, and sleep? Try improving your concentration after a night of waking at every footstep. Before you call that a lack of motivation, I want to know if the person has had a realistic chance to rest in the last month. Safety. Where do they put their belongings without standing guard over them? Can they return to the same bed tomorrow? A treatment plan that assumes a stable routine should at least check whether a stable routine is physically possible. Most of them do not. Belonging. Who knows this person’s name? Who notices if they vanish? When an outreach worker finally makes contact, moving the person somewhere that worker cannot find them is not a safety strategy. It is sabotage with a city budget line. Esteem. What does this person get to decide? Are we talking with them about their goals, or talking about them as an inconvenience to somebody else’s afternoon? Rebuilding a life should include some authority over that life. Handcuffs do not confer authority. Self-actualization. Work. School. Creativity. The chance to become something other than a person surviving until sunrise. Those are worthy goals. They are a hell of a lot easier to talk about when the immediate question is no longer whether the person has a place to sleep. None of this means someone living outside cannot love, create, seek treatment, or change their life. People do it every day, and they deserve more credit than any politician will ever give them. The question is why public policy should require heroic resilience just to obtain ordinary necessities. Housing First was never “a key and a wave goodbye” The phrase Housing First gets treated like it means handing somebody keys and walking off. That is a lie told by people who either never read the model or are counting on you not to. A 2020 Community Guide systematic review spells it out. Housing First provides permanent housing alongside health, mental health, and other supportive services, without requiring people to prove they are “housing ready” first. The review compared it with Treatment First approaches that demanded psychiatric treatment and abstinence before and during permanent housing. Across 26 studies in the United States and Canada, the authors concluded Housing First improved housing stability and reduced homelessness more effectively than Treatment First. That is the evidence base this administration just called a failure. Without citing anything. The premise is not complicated. A person should not have to finish recovering before they qualify for the stability that would help them recover. That does not eliminate treatment. It changes what treatment is attached to. Picture two versions of the same appointment. In one, the patient has an address, knows where they are sleeping tonight, and has a drawer for their medication. In the other, they have to leave my office and go find a new spot because last night’s spot is gone. I will treat the psychiatric symptoms either way. I would just like the treatment plan to admit how differently those two afternoons are going to go. Treatment First pretends they are the same afternoon. What the research actually says A 2019 systematic review and meta-analysis of randomized trials found that participants receiving Housing First were about 2.5 times as likely to be housed at 18 to 24 months as participants receiving comparison services. Fewer emergency department visits. Fewer hospitalizations. The authors included four studies and rated their risk of bias as high. Effects on mental health and substance use were less clear, and benefits varied across studies. Those limitations belong in the discussion, and unlike the people running HHS, I am going to put them there. A home does not cure schizophr… Get full access to PsychiatRick at psychiatrick.substack.com/subscribe

  7. Oct 8

    The Mental Health Cost of Waiting for November

    Rick Leach, MSN, APRN, PMHNP-BC | PsychiatRick | October 8, 2026 Before we begin, if you appreciate independent writing that takes mental health, politics, war, trauma, and moral accountability head-on, please subscribe to PsychiatRick. New articles are always free to read, but a paid subscription helps support the work and keeps this publication independent. Now, let’s get into it. Donald Trump spent October 6 promising surprises, and I think we can all guess what the f**k he means. In a morning Truth Social post bragging about his rallies and Republican prospects, he wrote, “Watch for the ‘Midterm Surprise!’” Later, speaking in Sparrows Point, Maryland, he turned to Office of Management and Budget Director Russell Vought and said, “We have some big surprises coming up in another few weeks, right Russ?” He didn’t explain either one. Those remarks don’t establish a specific plan to interfere with voting, but I’m pretty sure the Orange A*****e intends to find a way to cheat or call off the election altogether. I can’t read his mind, but I can read his record, and it isn’t subtle. The record On January 14, he told Reuters “we shouldn’t even have an election” while boasting about his administration’s accomplishments. The White House called it a joke, and I don’t give a shit how funny they think it is, because joking about whether voters get a say stops being funny when the guy telling it runs the federal government. Then on September 23, the OSCE’s election-observation bodies announced they hadn’t been invited to observe the 2026 midterms. They’ve observed 12 US federal elections since 2002, six of them midterms, and this is the first federal election since they started observing here for which they haven’t received an invitation. That doesn’t establish fraud or mean every election observer has been banned, but it’s a departure from an established practice of independent observation, and I want to know why. If this administration wants public confidence, it can start by explaining why those independent eyes weren’t invited. So here’s what we’ve got: a president who says we shouldn’t have an election, an administration that hasn’t invited these independent observers, and now, four weeks out, a wink at his budget director about big surprises. To me, those pieces form a pattern that deserves scrutiny, and I’m done letting every unsettling remark disappear under another excuse about his sense of humor. The people who can read So far I’ve talked about Trump like he’s the one with a plan. I don’t think he is. The man can’t get through a rally without wandering off to talk about sharks, and nobody’s handing him a 900-page policy document and expecting him to read it. They don’t need him to read it. They need him to sign it. That’s where Project 2025 comes in. The Heritage Foundation led it, more than 300 people contributed, and the result was a 900-plus-page blueprint for his second term. During the campaign, Trump swore he had nothing to do with it, and his campaign said its demise would be “greatly welcomed.” Then CNN found at least 140 peoplefrom his first administration had worked on it, including more than half the listed authors, editors, and contributors. Remember Russ, the guy Trump winked at in Maryland? Russell Vought didn’t just contribute. He’s one of Project 2025’s principal architects. He personally wrote the chapter on the Executive Office of the President, calling OMB the president’s “air-traffic control system.” He’s argued that no agency, the Justice Department included, should operate outside the president’s authority. And in a 2024 speech obtained by ProPublica, while he was helping lead Project 2025, he said, “We want the bureaucrats to be traumatically affected.” I treat trauma for a living. I don’t hear that as a figure of speech. When CNN pressed him on it, he said he meant the bureaucracy. Funny thing about the bureaucracy. It’s made of people. Now look at the Justice Department chapter, written by Gene Hamilton, a former Trump DOJ official. It calls on the department to investigate state election officials over their voting guidance, pointing to Pennsylvania’s 2020 decision to let voters cast provisional ballots after their mail ballots were tossed for minor errors. Fact-checkers have noted the document is light on voting details, and that’s fair. But you don’t need much detail to scare the shit out of a county clerk. And here’s what’s actually happened. The Justice Department has filed 31 lawsuits against states and DCdemanding unredacted voter rolls, driver’s license numbers and partial Social Security numbers included. It hasn’t won a single case where a court has ruled. More than 20 trial judges have turned it down, some of them Trump appointees, and so has a federal appeals court. The administration has also confirmed DOJ is sharing state voter roll data with Homeland Security. I can’t prove the voter roll fight came straight out of Project 2025, and I’m not claiming the midterm surprise did either. But when a president who can’t explain his own riddle turns to one of the main authors of a plan to remake the executive branch and says “right, Russ?”, I want to know what Russ has been writing lately. Trump is the mouth. These people are the hands. Watch the hands. I’m a psychiatric nurse practitioner, and I care about this because I care about the conditions people are trying to function under. With the midterms scheduled for November 3, I want us to pay attention to the burden of waiting while the president keeps hinting at something he won’t explain. What the waiting does to people A 2025 study in Psychiatry Research looked at 778 young adults using the PHQ-8 and GAD-7, standard depression and anxiety screens. Stress about election news was linked to higher odds of moderate-or-worse depressive and anxiety symptoms, while anticipatory election stress, the dread of what’s coming, was linked to depressive symptoms. Here’s the part that matters: stress about the election result itself wasn’t significantly linked to either outcome, so reducing the whole subject to sore losers misses what these researchers measured. The waiting and the watching deserve attention, especially when Trump keeps giving people another unexplained possibility to consider. It’s observational, so it can’t prove the news caused the symptoms, and a screening score isn’t a diagnosis either. But it flags symptoms that deserve attention, and I’m paying attention. Waiting isn’t empty time, because you still have to work, sleep, raise your kids, and make decisions while the question hangs over everything: what the f**k is coming next? You don’t need to know exactly what Trump means to want him to explain it, and you shouldn’t have to put the rest of your life on hold while he enjoys being mysterious. That’s the burden I want us to take seriously before November, while people are still trying to prepare for possibilities they can’t define. A February 2026 paper in Personality and Social Psychology Bulletin followed 623 Americans across seven survey waves, from three weeks before the 2024 election to 16 weeks afterward. Democratic supporters reported drops in well-being, optimism, perceived personal control, and institutional trust, with some changes lasting four months; Republican supporters generally moved the other way. These are measures of well-being and beliefs, and they don’t establish a nationwide psychiatric diagnosis. They do make it harder to wave away sustained political distress as something everyone quickly gets over, and they give us reason to ask what another month of presidential riddles is doing to people who already feel they’ve lost control. It gets especially personal when the policy concerns your kid. A 2026 study in Psychological Science examined 167 parents and 160 adolescents, drawing on assessments from 2022 through 2024 and additional assessments around the January 2025 inauguration. In preregistered analyses, parents of transgender youth had steeper declines in menta… Get full access to PsychiatRick at psychiatrick.substack.com/subscribe

  8. Oct 6

    They’re Three Years Old. Why the F**k Are We Giving Up on Them?

    Rick Leach, MSN, APRN, PMHNP-BC | PsychiatRick | October 6, 2026 Before we begin, if you appreciate independent writing that takes on mental health, politics, war, trauma, and moral accountability, please subscribe to PsychiatRick. New articles are always free to read, but a paid subscription helps support my work and keeps this publication independent. Now, let’s get into it. Imagine being three years old and getting kicked out of the place where you are supposed to learn how to be three years old. You cannot manage your frustration yet. You struggle to explain what you need. Something overwhelms you, and you hit, bite, scream, or fall apart. The adults write down what happened. Your parent gets a phone call. Then someone decides you cannot come back. You still need help. You just lost the place that was supposed to help you. That is what bothers me about the Trump administration’s proposed overhaul of Head Start. Published August 7, 2026, it would remove the federal prohibition on behavioral expulsions and restrictions on suspensions in Head Start Preschool and Early Head Start, leaving discipline policies subject to state and local requirements. As of today, October 6, this remains a proposal. The existing protections are still in place, and the public comment period ends today. The choice it presents is real: how much protection should a young child have when their behavior becomes difficult for adults to manage? My answer is a hell of a lot more than an invitation to find somewhere else. Before you kick the child out, find out why As a psychiatric mental health nurse practitioner, I want to know what is happening beneath the behavior. Writing “aggressive” on an incident report describes what someone saw. It does not explain why it happened or what the child needs. Has anyone assessed the child’s language and communication? Their hearing? Their sleep? Are there developmental concerns, anxiety, or signs of trauma? What is happening at home, and what is happening in the classroom? Is the behavior persistent across settings, or does it appear around particular demands, transitions, or interactions? Those questions belong in an assessment. Clinical guidance on disruptive behavior in preschoolers calls for examining developmental abilities, family and environmental factors, and possible medical or mental health contributors. It specifically identifies hearing, vision, feeding, sleep, language, and social communication as areas to consider. Frequency, intensity, duration, and impairment matter, too. A child should not have to become easier to manage before someone investigates what is making life difficult for them. And investigating does not mean deciding that every tantrum is a disorder. The same clinical guidance distinguishes ordinary developmental behavior from patterns that warrant further evaluation. We need adults who can make that distinction, with time and support to do it. The American Academy of Pediatrics’ policy on early childhood expulsion emphasizes that children with communication difficulties or disabilities can have needs adults misinterpret. It also identifies adversity and trauma as important considerations and calls for developmentally appropriate support. Consider the difference between “this child refuses to listen” and “this child may not understand what we are asking.” Or between “this child is trying to cause trouble” and “something about this situation is overwhelming them.” Neither question excuses hitting another child. Both questions help us decide what to do next. Boundaries and curiosity can exist in the same room. We can stop harmful behavior, protect the other children, and investigate its cause. That is the work. Calling a preschooler a problem and closing the door leaves that work unfinished. The classroom keeps moving without them When a child is expelled and left without a comparable educational placement, their classmates keep learning. The removed child loses that instruction, those relationships, and those opportunities to practice. The school day does not stop while a parent searches for an opening. In a 2024 study of more than 20,000 four-year-olds, higher preschool attendance was associated with greater growth in language, literacy, and mathematics. The association was stronger for children who began with lower skills. It was an observational study of attendance, but it reinforces the stakes of lost instruction: children who start behind have a particular need for the learning opportunities exclusion can take away. Children are hearing stories, learning new words, working through routines, and practicing how to share a space with other people. A child already struggling with those skills needs opportunities to build them. Taking those opportunities away can put the child further behind in the very areas adults are concerned about. Head Start’s own guidance on expulsion makes this point plainly: children can lose chances to learn, socialize, interact with supportive adults, and practice social and emotional skills. Families can also lose support and face financial strain while trying to arrange replacement care. There is a particularly ugly logic in excluding a child for lacking a skill while removing the place where that skill is supposed to be taught. “You are having trouble learning how to participate here. Therefore, you cannot participate here.” What exactly is the educational plan after that? A 2025 exploratory study of families’ experiences after preschool exclusion surveyed 218 parents whose children had received behavioral warnings. Nearly a quarter of the excluded children did not attend a subsequent program. That was a retrospective parent survey, not a national estimate, but it documents a consequence that deserves attention: some children leave a program and do not enter another one. Children are not doomed because one placement ends. In that same study, parents often rated subsequent programs as comparable or better. A thoughtful move to a setting that can meet a child’s needs may help. But a supported transition and a family left searching for somewhere that will accept their child are very different experiences. The missed learning is real. So is the risk of arriving at the next classroom with needs that still have not been identified or addressed. We should be reducing that risk before kindergarten, not creating another obstacle and hoping a parent can solve it. And consider the parent who has a shift tomorrow morning. Who watches the child? Who makes the calls? Who takes time off for an evaluation? Who covers the income lost while everyone waits? The administrative decision takes a moment. The family has to live through what follows. Teachers need help, too I do not want a preschool teacher getting bitten, hit, or left alone to manage a classroom they do not have the resources to support. I do not want another child getting hurt. Supporting the child who is struggling has to include protecting everyone around them. That requires trained staff, access to specialists, workable classroom conditions, and a plan adults can actually carry out. The American Academy of Pediatrics identifies inadequate teacher support, training, compensation, and access to mental health consultation among the factors associated with early childhood expulsion. Its recommendations include stronger working conditions, family partnerships, and specialist support. So give teachers that support. Give them someone to consult before a situation becomes a crisis. Give them training that goes beyond telling them to remain patient. Give them enough help to implement the plan they are handed. Praise does not fill a staffing gap. Calling someone a hero does not make an impossible assignment manageable. Mental health consultation has evidence behind it. In a randomized trial involving 176 children and 88 preschool classrooms, children whose classrooms received consultation had improvements in several teacher-rated behavioral measures compared with the control group, … Get full access to PsychiatRick at psychiatrick.substack.com/subscribe

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About

PsychiatRick explores the intersection of mental health, politics, culture, and power through the lens of a PMHNP, combat veteran, and bluntly curious observer of American dysfunction. psychiatrick.substack.com

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  • Creator
    PsychiatRick
  • Years Active
    2026
  • Episodes
    18
  • Rating
    Explicit
  • Copyright
    © Rick Leach PMHNP
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    PsychiatRick Podcast