An ER Psychiatrist Analyzes The Pitt’s Mental-Health Struggles

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As a movie enthusiast, I must say that “The Pitt” has undeniably taken the small screen by storm in 2025, and deservedly so! It masterfully reimagines the procedural genre for the streaming era, offering an unflinchingly realistic glimpse into the chaotic world of a bustling hospital emergency department. The portrayal is striking medical professionals across the board, while serving as a gentle reminder to all viewers that Noah Wyle continues to be a heartthrob extraordinaire.

However, like the dedicated doctors and ambitious med students navigating Dr. Robby’s ER, “The Pitt” isn’t without its own set of imperfections. For instance, the show’s approach to mental health is questionable at times, whether it’s using a pejorative nickname for an unhoused patient with schizophrenia (“the Kraken”) or casting doubt on the mental state of a beauty influencer experiencing psychosis induced by mercury poisoning. It’s crucial that such sensitive topics are handled responsibly and with the utmost care.

Dr. Kayla Simms, an emergency psychiatrist and faculty member at the University of Ottawa’s Department of Psychiatry, expresses a concern she has about the show The Pitt. Despite appreciating the series, she feels it somewhat overlooks mental health issues, which is a point she believes the show aims to address but doesn’t fully execute. With eight years of experience in ERs, focusing on suicide risk assessments, involuntary stays, and de-escalation techniques, Simms notices a conflict between the show’s intention to portray the genuine stigma towards psychiatric treatment found in emergency rooms and its presentation of mental health stories that don’t solely serve the character development of the doctor.

Does The Pitt’s depiction of an emergency room resonate with you? For me, the characters – from the medical professionals to the students and charge nurse – felt incredibly realistic, as did the medical details. As a psychiatrist, I found it particularly striking how they portrayed the mental stress experienced by the staff members, which seemed very authentic to me.

In my opinion, the show doesn’t seem to give enough attention to mental health issues, and this is something I’ve noticed quite often in media. As a healthcare provider, I understand that there is some truth to this portrayal because the stigma around mental illness is indeed real. However, given how accurately other aspects of the show are represented, it feels like a missed chance to present mental health care more authentically and align with the standard of care that we strive for in reality.

How about rephrasing it like this: “The first complex situation I can recall is when a homeless individual appears, carrying a group of rats hidden beneath his coat. Later on, he’s shown to have schizophrenia, but he also seems unsettling. What were your thoughts regarding this predicament?”

And for the second sentence: “From the beginning, this character is portrayed as a menacing figure, like the Kraken, a sea monster lurking in the shadows. He’s not seen as a person in need but rather a problem to be addressed.

In this scenario, we find a man who’s clearly in need of help, yet the narrative presents him as an overlooked issue in the background. It seems like the staff are attempting to ignore or forget about his predicament. There appears to be a delay in addressing his emergency compared to their usual prompt response to other crises within the emergency department. One nurse admitted that they had neglected to administer medication to him, and now there’s discussion among them on how best to control him.

In our view, Dr. Robby comes across as a considerate and empathetic individual who swiftly offers aid, but when the head nurse attempts to involve him in this particular case, he chooses to withdraw. Consequently, medical student Dennis Whitaker (played by Gerran Howell) is drawn into the scenario, somewhat unwillingly, and finds himself being equipped with a syringe. What follows next is an entrance into the patient’s room without any verbal exchange, at which point Dennis administers the injection to the patient, exclaiming as he does so.

It’s quite over-the-top and melodramatic, not at all what we strive for during psychiatric crises. In my opinion, it felt very impersonal and inhumane.

How would you describe your role as an emergency psychiatrist within a real ER setting?

In such scenarios, patients are initially assessed by a nurse who begins their care, and an emergency physician takes the lead in managing them. If the physician suspects there’s a need for psychiatric intervention, be it explicit or implicit, they would consult us.

If a person appears to be in distress, whether it’s evident through signs of suicide, extreme mania, or psychosis, they will be directed to see an emergency psychiatrist. However, there are instances when the symptoms might not be immediately apparent. For example, a patient may initially report chronic back pain, but upon closer examination, a doctor discovers they harbor numerous delusions such as believing an alien inhabits their stomach or their brain has been replaced by a computer. In such cases, they will be referred to psychiatry for further evaluation and treatment.

In most hospitals, emergency psychiatrists are located within the Emergency Room (ER) for immediate response. However, not every hospital has an ER psychiatrist on site. In such cases, the psychiatrist who oversees the inpatient unit and whoever is on call would need to attend to patients in the ER. We often collaborate with ER physicians, serving as consultants to offer a psychiatric perspective on treatment options. Our role includes deciding if a patient can be discharged or requires admission to an inpatient mental health unit.

As a movie critic, I would rephrase it like this: “When encountering an unhoused patient in a hospital emergency room, my approach would prioritize non-violent communication to de-escalate the situation. Ideally, coercive measures such as chemical or physical restraint should be avoided and used only when verbal strategies have proven ineffective.

If The Pitt portrayed the patient with a greater emphasis on humanity, it would result in fewer resources being directed towards him. In the depicted scene, no less than six staff members were called away from their posts to restrain him. However, opting for verbal engagement with the patient could lead to more personalized interactions instead.

One approach we strive for is presenting options. Individuals experiencing an acute psychiatric emergency may be unsure of the alternatives at their disposal. For instance, “Would you prefer the door open or closed? The lights on or off? Do you fancy a chicken sandwich or an egg-salad sandwich? (Nobody likes tuna.) Giving them control over such decisions can make a significant difference, as recalling the distress of waking up restrained on a gurney underscores a loss of control.

In a different scenario, when Dr. Taylor Dearden (previously known as Dr. Melissa King) attends to an autistic patient who’s distressed by the stimuli in his room, I was curious about how you perceived that interaction on the show was handled? Since Dr. Patrick Ball, the senior resident, lacked those skills, it seems he learned from Dr. Dearden. What she does isn’t complex like rocket science, but it appears difficult for him to grasp, despite his expertise in emergency medicine: this fundamental task of being present and understanding a person’s unique needs and communication styles.

What was your take on how Whitaker handled his encounter with the homeless patient?

In my opinion, it was intriguing. The story ends with Whitaker confronting the patient, accusing him of drug use. But the patient clarifies that he is actually sober and struggling with housing instability and affordability issues for his medication. The social worker (Krystel V. McNeil) advises Whitaker to understand the patients’ circumstances better and consider joining the street team to assist them in a more effective manner.

The ending is well-wrapped up, yet the narrative primarily focuses on Whitaker’s personal growth and academic success. However, it’s crucial to remember that outcomes for psychiatric patients aren’t usually so tidy. He lacks a permanent place to live and can’t afford his medication. This scenario is often referred to as “revolving-door care,” where individuals leave the hospital in a better mental state but are unable to continue their treatment due to unstable housing, leading them back to the emergency department repeatedly with similar issues.

As a movie critic, I found myself contemplating the portrayal of Dr. Robby’s interaction with the schizophrenic patient. It seems plausible that the show intended to reflect the often challenging relationships ER teams encounter when dealing with mental health situations. Emergency departments are not designed to handle acute mental health crises, yet they frequently do due to systemic issues and resource constraints. So, I can understand Dr. Robby’s character’s perceived lack of competence in handling such cases, which might stem from a sense of helplessness rather than ill-will towards patients with mental illness.

In essence, the series goes beyond simply portraying reality; it sets a high standard for consideration when addressing issues like gender and racial disparities. For instance, consider the scene where Dr. McKay (Fiona Dourif) and Victoria (Shabana Azeez) attend to a transgender patient. Towards the end of their encounter, Victoria takes the time to update the patient’s pronouns in the system. Many trans and gender-diverse individuals have shared that such healthcare interactions can inflict significant trauma. However, it’s not often we see such tender care and representation in a bustling ER setting. This series seems to be an exception, taking the time to ensure these experiences are handled with sensitivity and empathy.

In awe, I find that The Pitt transcends mere authenticity in certain scenes, showcasing the potential of human resilience. This leads me to ponder, Why has mental illness been unfairly overlooked? For we are well aware that representations of mental illness on TV can significantly influence how patients perceive themselves, their loved ones, and their inclination towards seeking help. Consequently, I believe there are detrimental effects stemming from both accurate and inaccurate depictions.

As a film enthusiast who appreciates shows like The Pitt, I’d venture to say that in real life, a typical ER shift would see many more patients with mental health issues than what we witness on screen. Of course, since it’s a trauma center, these patients might be redirected to facilities focusing more on mental health care. However, considering the daily influx of individuals dealing with psychological distress, the exhaustion portrayed by the staff members seems quite plausible.

In my local area, there seem to be more instances of individuals struggling with suicidal thoughts, daily life challenges, addiction, and significant substance abuse problems. Interestingly, The Pitt tackles these issues quite effectively, particularly the storyline about a group of university students who unknowingly took Valium laced with fentanyl, leading to an overdose. This storyline was thought-provoking as it illustrated the far-reaching impact of the opioid crisis across various socioeconomic demographics, not just the majority we usually see affected by substance abuse.

In the later part of the season, a patient who’s known as a beauty influencer is admitted and seems to be grappling with significant mental health issues. This situation creates an ongoing disagreement between Dr. Robby and Dr. Mohan (Supriya Ganesh): He suggests she should consult a psychiatrist, but she resists. This dispute highlights the show’s perspective on psychiatry, as it’s previously shown that Dr. Mohan is being judged by her colleagues for working more slowly than they believe she should. Additionally, Dr. Robby makes a comment suggesting that Dr. Mohan might be better suited to psychiatry, which can be seen as an insult because it implies that psychiatry is considered less valuable or challenging compared to other medical specialties. This exchange emphasizes the misconception that psychiatry requires less skill or dedication than other areas of medicine.

I also found it intriguing as she’s hesitant to make the call to psychology due to his insistence. She’s aiming for a comprehensive understanding. This often arises in emergency rooms and psychiatry: A patient enters who seems acutely psychotic to the ER doctor, yet no blood tests, imaging, or urinalysis have been conducted, and this is their initial episode. In such cases, we refer to it as ensuring there are no underlying medical issues. Before labeling this as psychiatric and potentially prescribing lifelong antipsychotics, we want to verify and exclude other possible causes for the symptoms, right?

In the end, it turns out that Dr. Mohan correctly diagnoses an uncommon case of mercury poisoning. That moment validates her decision to conduct a comprehensive medical examination rather than giving in to Dr. Robby’s suggestion to consult psychiatry first. However, there isn’t a full reconciliation between them; he merely acknowledges her with a nod and possibly says “Well done,” but the importance of her discovery is significant.

It appears that the lack of reconciliation between individuals might stem from Dr. Robby’s tendency to swiftly move on to new tasks instead of dwelling on past events. After all, there’s only so much time for celebration. However, it’s important to acknowledge that while Dr. Mohan is generally competent, she occasionally falls short, such as when she secretively provides Suboxone to an opioid-addicted patient who denies his addiction. This action rightfully draws criticism from Dr. Robby. The characters in this scenario are complex and their imperfections become evident in their handling of mental health cases.

As a movie buff, I’d rephrase it like this:

“In the heart of this series lies a compelling narrative centered around David (Jackson Kelly), a student whose actions concern Drs. Robby and McKay due to potential threats he poses towards his classmates. It seems they had the opportunity to keep him under observation for 72 hours just based on the threatening list he compiled. But, it’s not always straightforward – different states have varying rules when it comes to such situations. In this case, we’re dealing with an ethical gray area where you might not even be their official patient, but you’ve uncovered something about them that requires mandatory reporting and leaves you torn between professional duty and individual rights.

In that particular scenario, there are many intriguing aspects to consider. I have my doubts about the mother’s well-being. A person going to such lengths as making themselves ill to get their son, who they fear may be dangerous, to the hospital, suggests a level of desperation that is profound. It seems likely that she requires extra assistance herself. However, David’s case is precariously balanced: the evidence against him, the list, the mother’s genuine fears that he might harm those on it. In instances like these, I often ponder, If I don’t intervene and he does harm the women on that list, what kind of outcome would I be responsible for creating?

I’m careful and safety-conscious when practicing, always keeping these factors at the forefront. If I can keep him under observation for 72 hours, evaluate his condition, and potentially assist him, that would be great. However, if he resists help, the intervention will be limited. His stay in the hospital might not yield significant results, but perhaps I’ve prevented a considerable amount of unnecessary harm and potential deaths.

A common perception or portrayal exists, as underscored by the nickname “the Kraken,” suggesting that psychiatry is cruel, imprisoning individuals against their will, restraining them, and detaining them. However, this stereotype arises because involuntary hospitalization is sometimes the only effective method for providing care to those in need. I’ve witnessed instances where such measures led people suffering from severe schizophrenia, who were once homeless, to find stability and employment. In some cases, these interventions truly provide the necessary treatment and care that individuals deserve.

Are you looking forward to finding out how David’s story unfolds in season two? Absolutely! I’m quite intrigued by this. I hope that the consequences for all the characters are significant and justified. The show seems to focus heavily on mental health issues, and right from the first scene, we see Dr. Robby and Dr. Abbot (Shawn Hatosy) discussing suicide on the rooftop, hinting at their inner struggles. Despite these open discussions, most of the mental distress depicted in the series occurs discreetly. Characters like Dr. Robby shed tears in private, Dr. Langdon battles addiction secretly, and his colleague contemplates suicide behind closed doors. It’s only occasionally that these hidden emotions are brought to light. I believe this portrayal of emergency physicians dealing with case after case without time to process their feelings is quite accurate.

I’m wondering: Is the emergency care in Canada superior to that of the U.S.?
The Pitt does an excellent job portraying the reality of wait times and ER congestion in the U.S., and we, too, face those challenges. In Canada, we have a public healthcare system, which is indeed a blessing, but it can sometimes result in unbearable ER wait times. Frequently, I observe patients who have waited for 14 hours before they’re attended to by a physician.

It’s amusing because there seems to be a widespread belief among Americans that the Canadian healthcare system is idealistic. In reality, it has its advantages and disadvantages. One advantage is that individuals don’t receive hospital bills upon discharge. However, time acts as an unspoken currency in this scenario. If someone spends 14 hours waiting to see a doctor, they are essentially paying with their valuable time.

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2025-04-15 19:55