One of the many frustrating things about mental health issues is that it is a lot harder than it ought to be to get help. This difficulty can be thought of as hurdles that need to be jumped. Unfortunately, the hurdles appear at nearly every point in the process of seeking help. They can be broken into three categories: the confusion surrounding mental illness, the healthcare system, and the insurance system.
I don’t think the confusion needs a lot of explanation. It’s the main reason I feel compelled to write about these things. But there is one specific aspect of that confusion that is a huge barrier for people who need help. People who have never experienced a mental health condition don’t necessarily recognize what is happening to them. There are rarely cut and dry measures for mental health. It’s not like with a fever where you can check and see that your body temperature is over 100 so there’s something to be concerned about. Mental illness is usually a cluster of related symptoms. Unlike nausea or pain, it’s really hard to describe what the conditions feel like. Unfortunately, that means many people are suffering without even recognizing that they are sick.
I know before I was first diagnosed with depression, I didn’t know what was going on. I knew I didn’t feel right. I felt downright lousy. For the longest time, though, I figured I was having a bad day. Even though it was dozens of bad days in a row, it didn’t occur to me that there was more to it than that. When I finally called my doctor, all I could tell him was that, “I don’t feel like myself.” I struggled for a lot longer than I had to, all because of the confusion surrounding mental health.
That leads nicely to the next hurdle to jump, the healthcare system. When I did tell my doctor that I wasn’t feeling good, it still took a long time to get diagnosed. Mental health, psychology and psychiatry, is a specialty. Even if I had known what was happening, I can’t just call a specialist. Everything starts with either your PCP, a walk-in clinic, or the emergency room. Understandably, they all try to treat you in the best way they know how, by trying to treat your physical symptoms. I was complaining of sleep issues, changes in appetite, sluggishness, low mood and things like that. So, my PCP checked my thyroid and tested me for mono and on and on. It was only after he ruled out everything he could think of that he recommended a psychiatrist.
Now, that leads to the next hurdle, finding a psychiatrist that is accepting new patients and takes your insurance (which I’ll come back to in a bit). Mental health is the only area of healthcare I’m aware of where this happens. You don’t get a cancer diagnosis and then have to spend weeks or months searching for an oncologist willing to help. Can you even imagine that? But when a PCP decides you may have major depressive disorder, you get a bunch of phone numbers or websites and have to start making calls. It’s crazy.
A similar, but worse, thing happens with therapists. Many mental illnesses are best treated with talk therapy or a combination of medication and talk therapy. Most psychiatrists only deal with the medication, so you have to find a separate therapist. There are the same problems of finding someone taking new patients and taking your insurance, but, with a therapist, it’s also important that your therapist is the right fit. I’ve often said that finding a therapist is like dating. You go to a few sessions, decide it’s not working, try someone else for a few sessions, and keep going until you find one that works for you. It’s the “works for you” part that’s important. Just because it doesn’t work out with a therapist doesn’t mean they’re a bad therapist. Mental health is intensely personal. If you can’t open up in the right way to your therapist, there’s nothing the therapist can do for you. But it’s an exhausting, frustrating process finding that fit.
Finally, we get to insurance. What I’ve already mentioned, the fact that not all doctors accept all medical insurance is completely ridiculous. It’s amazing to me that this wasn’t a provision of the Affordable Care Act, but an insured patient should be able to seek treatment from any licensed provider in good standing. It’s more than hard enough finding a psychiatrist and therapist to have the insurance company say no when you find someone you like. And it doesn’t stop there. The insurance companies dictate treatment. I just ran into a scenario where I was prescribed 60 mg of a medication. It comes in 60 mg pills, but the insurance won’t cover the 60 mg pills. So, my doctor had to prescribe me 20 mg pills and 40 mg pills instead. It’s hard to imagine anything stupider than that. The insurance companies will also dictate how many therapy sessions you can have per year, how often prescriptions can be refilled, and things like that. And god forbid your doctor prescribes something for an off-label use.
This is just scratching the surface. When you are suffering from a mental health issue, the last thing you want is to navigate a byzantine system. I’m lucky in that I’ve found a psychiatrist and therapist that I like and both of them accept my insurance. If you are in the beginning of this process, you have my deep sympathy. And if you know anyone at the beginning of this process, please give them all the support you can.