We Need Equitable Treatment for Mental Illnesses

There’s a giant sucking sound that involuntarily came out of my body, “Thwamp!”  It didn’t come out of the blue, it was trying to get out for weeks, maybe even months.  When it finally came out, I thought I’d get relief, but no relief came, not even a little, I think it made it worse. That sound just confirmed what had been building for all that time.

I’ve lived through family strife. I’ve lived through multiple cancers. I’ve lived through financial crises, but that, that was absolutely the worst time in my life.  It was the most painful, life sucking experience I’d had to date. To my fortune, I’ve never had such a horrible experience since.

So what caused it? What was it like? What was it?

Although we can never know the full cause, I believe it stemmed from a combination of crap that was circumstantially happening in my life.  What was it like?  It started with some mild anxiety.  It was the normal kind of stress we all sometimes experience when we’re going through the crap of life. Granted, it was more than my usual crap, but it was crap just the same. I’m not really sure what caused me to go over the edge, but I did. The mild anxiety turned into a fear of leaving home. I had an overwhelming desire to not only stay home, but to stay away from any social activity including phone, text, and e-mail. Soon enough home wasn’t good enough, I had to stay in my bedroom, then my bed, then under the covers. I just didn’t feel safe unless I was under the covers. Even then, I didn’t feel good, just safer, I knew this wasn’t normal for me. I knew this wasn’t normal for anyone.  So what was it?  

It was depression.  

Do you have any idea how hard that is to admit? Depression. The stigma attached is overwhelming. I’ve never had a problem reaching out for help when I’ve had cancer, I have shared my illness with my friends and family, and I’ve gone to multiple doctors for treatment. I’ve never had an issue getting my health insurance company to cover treatments. But mental illness?  Mental illness was different.

With mental illness, often, the sick person has to advocate for himself. With other illnesses, most of us have the fortune to have someone help advocate for us. I had to do the homework to find a therapist, then I had to confirm the therapist was in my insurance network, and then I had to wait weeks for my first appointment.  When I finally started seeing someone for help, I booked two appointments a week, and after ten weeks, the insurance company was done paying for my health care, I had reached my limit.  My limit!  It didn’t matter that I still needed more treatment.

Compare this to all the cancers I’ve had,  it didn’t matter how many treatments I needed.  If my bills went over a certain maximum, I reached my “maximum out-of-pocket” expense for the year, and my insurance company covered 100% of my care; but not mental health, if I needed more treatment, it was financially all on me. When the Affordable Care Act came along, it changed a lot of this.

The ACA now provides one of the largest expansions of mental health and substance use disorder coverage in a generation. The ACA covers parity. Parity means that mental health care must be treated comparably with medical health care; therefore, if medical treatments can’t be limited until the patient has had full treatment, then mental health treatments can’t be limited either, AND they must be covered.

Although the ACA made huge leaps in the advancement of health coverage for mental illness, we still have a long way to go.  Many of the appropriate facilities to care for patients with these illnesses simply don’t exist.  Although with the opioid crisis, we do now have many substance abuse facilities, most of these facilities are not equipped to handle any other mental health treatments. If I felt I had a heart issue, I’d go to the doctor, run some tests, and if I found that I had heart disease and needed say, a stent, I’d have it put in, and I’d have a choice of doctors and facilities to go to. I certainly wouldn’t wait until I had a heart attack and then end up in the emergency room.  

Unfortunately, it doesn’t work the same way with mental health.  Let’s say I felt anxious and that I was spiraling into a depression, it may take weeks or even months to get in to see a psychiatrist who is in my network. Once seen, it may take weeks for any medication to work (if it works), meanwhile, I’d be suffering.

If I go to the emergency room, unless I can say that I definitely want to kill myself or harm someone else, they cannot admit me, they have no treatment for me. Basically, I have to go home and wait until I’m so depressed that I DO want to hurt myself or someone else. Then, and only then, can I get help. In some states, if I go to the local emergency room, I may have to wait as many as twenty-four hours for the county sheriff to come and verify that I am mentally ill enough to be admitted to a hospital with a psychiatric ward. Yes, I said the sheriff, not a doctor.

The psychiatrists can only see patients who have appointments. Perhaps I already saw the doctor last week. Perhaps my next appointment is next month.  Most psychiatrists will tell me that if it’s an emergency, I need to go to the emergency room, otherwise, they’ll see me at my regularly scheduled appointment. So basically, many folks with mental illness have to wait until the shit hits the fan to get help, even if they know where they’re headed. There are no stents for mental health.

Think about it.  I’ll make a bet that you know someone who has, anxiety, or depression.  Some of you may know someone who is bipolar, schizophrenic, or has some other personality disorder. I’ll bet you also know someone who has cancer or heart disease. Now that we finally have all these illnesses covered by parity, maybe now we can work on the stigma of having a mental illness.

Would you believe that in the early twentieth century, people who got cancer felt they had to keep quiet about it? There was a stigma associated with cancer that the person who got it must have done something terrible in their lives to have suffered from cancer, today, thank goodness things have changed and it is commonly understood that cancer is random, good people get it, and bad people get it.

Mental illness is random too!  Mental illness is not a character flaw.  You do not have to be a bad person to get it.  Now that we’re in the twenty- first century, I still hear people whispering about taking anti-depressants and anti-anxiety medications. They whisper to only their closest friends and relatives that they are bipolar, they do this because they still feel that even in 2018, people will make judgements about them that are untrue.

As we begin 2018, my hope is that we not only make a resolution to improve our own health, but that we also make a resolution to treat all illnesses with equal compassion.  My heart breaks when I think about all the people in this country who will hear a giant sucking sound coming out of their bodies this year, and they have no one to talk to and nowhere to turn. If they turn to you, will you judge them, or will you treat them the same way you would treat them if they told you they had cancer?  Think about it.  This year, may we all get out from under the covers.