Adam Aurand spent nearly a decade of his life stuck in a loop: emergency rooms, psychiatric hospitals, jails, prison, and the streets in and around Seattle.

During that time, he picked up diagnoses of schizophrenia, bipolar disorder, and schizoaffective disorder. He also used opioids and methamphetamine.

Aurand’s life is an example of what happens to many people who experience psychosis in the US: a perpetual shuffle from one place to the next for visits lasting hours or days or weeks, none of them leading to longer-lasting support.

This week on Reveal, reporters who made the podcast Lost Patients, by KUOW and the Seattle Times, try to answer a question: Why do America’s systems for treating serious mental illness break down in this way?

The answer took them from the present-day streets of Seattle to decades into America’s past.

You can find Lost Patients wherever you get your podcasts:

NPR: https://www.npr.org/podcasts/510377/lost-patients

Apple Podcasts: https://podcasts.apple.com/us/podcast/lost-patients/id1733735613

Spotify: https://open.spotify.com/show/1avleoc5U4DA7U37GFPzIH

This is an update of an episode that originally aired in July 2024.

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The Churn