Mental Health Awareness Month: You probably didn’t know there was such a thing

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May is Mental Health Awareness month. I didn’t know that when I started jotting down my thoughts for an article on the barriers people encounter with the mental health system here in America.

If you search the topic in Google, there are countless articles claiming that “stigma” is the biggest block to effective treatment. Respectfully, they’re wrong. To put it more plainly, they might even be blatantly lying.

I wish stigma was the reason behind our national slowness in treating the mentally ill with dignity and respect. If only pride were the reason people “didn’t seek treatment.”

Give me a break.

People get over their pride fairly quickly when they’re homeless, missing work or unable to use electronic devices due to overwhelming depression, paranoia or anxiety. Their families might reach out. They might be too skeptical or too burnt out to seek treatment. They might be hopeless, angst-filled or desperate to the point of disorientation. They might not even know they’re sick, but they know life is miserable. And stigma is not even close to being the main consideration.

While getting stuck with a label can still cut deeply into your sense of self, it is nothing compared to the beast of navigating the mental healthcare system, even in your calmest state.

In my humble opinion, here are a few of the big issues to consider in this systematically flawed system:

(1) Insurance

This is the Hydra — cut one head off, a million more sprout up. Depending on the type of insurance you have, you may qualify for one service but not another. You may be eligible in one network, but that network doesn’t offer the services you need. You may not be able to easily access services in networks that offer suitable treatments or psychiatrists or therapists. Even if everything is gravy, there’s always that chance that your insurance could lapse. That either puts everything on hold, or the detail is neglected by you or your treatment provider, but never your insurance company. The buck has to stop somewhere, and that bill may reach you if a termination in insurance doesn’t catch the right person’s attention.

mental health word cloudFurthermore, the necessity of treatment doesn’t match the insurance plans offered. Medicare, for instance, is probably the biggest joke in mental health coverage on the scene at the moment. Without supplemental or state-funded assistance, someone with severe mental illness is unlikely to get the proper care and coverage.

(2) Clinical Turnover and Burnout

Psychologists and social workers are not miracle workers, and (good) psychiatrists don’t just deal out drugs without a thorough evaluation process. Due to the nature of their job, and the fact that they are rarely paid enough or given adequate time with low enough caseloads, these professionals rarely stay in one place for a long time. Even when they do, the rate of burnout while continuing at the same clinic in the same industry is, admittedly only by my estimation, probably quite high.

Not only that, but the effects of licensure requirements often allow for clinicians to stay at one place just long enough to “make it,” and then move on … leaving an array of patients behind. Establishing care for complex issues of the psyche only to be handed off from one therapist to another wouldn’t just be disheartening, but may worsen the mental health symptoms that brought a person into services.

(3) Lack of federal uniformity in prescription laws

Similar to the Insurance clusterfuck (not the clinical terminology), the laws and regulations around prescribing psychiatric drugs is all over the place. In some states, the process of seeing a psychiatrist is fairly simple, no matter who you are and what your diagnosis. In others, it’s a process that may take months, and even then not yield any results. If this was all done in the name of caution, this would be a complimentary “problem” to have. After all, I’ve made no secret of my distain for Big Pharma and its ilk, and some of the newest medications appear to merely mask symptoms while adding a hoard of possible side effects due to the monetarily driven research. That’s hardly progressive.

But caution is not the force pushing down on the brake pedal here. If it was, initial prescriptions would be the problem, rather than the current situation, where many who were prescribed drugs that have kept them stable for years suddenly find themselves lost at sea when their psychiatrist moves or retires. Rather than a mere transfer of former services after a period of reasonable evaluation, many run out of medication and find themselves back in the hospital after years of stability. (Remember that time you gave up caffeinated beverages for Lent? Yeah, just try going cold turkey off Lithium.)

Now, the good news is that plenty of mental health agencies seek to combat all these problems. The bad news is that they frequently fail, because these shortcomings are truly systemic at their root.

You can’t change the way insurance decides to conduct billing, and you can’t run a mental health agency without money. You can’t convince people to be proactive about their mental health when their psychiatrist makes noises about retiring. You can’t pay that plucky social worker what they’re worth, because your budget probably wouldn’t allow you to pay anyone else even half of what they’re worth after that first paycheck went through.

While the recent insurance changes have made mental health services more accessible to the very people who most often need it (those with low or no income, single parents, those without stable housing, et cetera), it has also shone a light on just how badly we need to improve upon the quality of services rendered and the consistency of those services. However, that means people need to care on a national level, otherwise any hope of reliability is lost. Unreliable care is hardly caring, just as unreliable customer service is worse than no service at all.

Improvement isn’t necessary because we should improve; it’s necessary because we have to. Just don’t ask me how yet.