How do you think of the mental health system in the United States? Is it everything we need it to be? Is it far behind research and the mental health needs of patients? Or…is it a failed mental health system? For many of the clients that I have had the opportunity of working with over the years, our mental health system has been characterized as a BIG failure. For someone who feels honored to work with others and loves the field itself, I must agree. The reason for failure is mainly due to the politics of the field which often includes but is not limited to: how much treatment a client can receive before insurance stops paying, how much a type of therapy or medication will cost, how long a client can see a therapist before they have to move on (due to managed health care promoting brief, solution-focused therapy), who a client can see due to the type of insurance a client may have, and limited access to higher levels of care such as group home or residential treatment facilities due to the high expense of this care. In fact, a residential treatment facility or group home can run as high as 140,000 + a day! It’s sickening. This article will discuss and explore some of the challenges faced by many clients and their families in the mental health system.
It’s sad to acknowledge all of the problems in our mental health system. It’s even more hard to believe. So many people are angry with the system and those who are leading it and passing laws. Thankfully there are a few good people in legislation, in the mental health field, and other fields reaching out to make the necessary changes. As I continue to provide therapy to a very disenfranchised population (ethnic minorities, lower socioeconomic status, children/teens, parents, families, and caregivers), I recognize the multiple issues that keep them held down. Below you will read about most of them:
- Client’s don’t feel heard or understood: It’s sad to think that there are healthcare professionals who simply don’t care of just don’t have the capacity to listen. One of the most important traits, often emphasized and highlighted by Carl Rogers (humanist psychologist), is the ability to care for another person. He termed this unconditional positive regard (UPR), which is showing complete support, acceptance, and concern for the individual and avoiding being judgmental, confrontational, and closed-minded. Rogers held that the most effective type of therapy is the therapy that places UPR at it’s foundation. This is one of my most prized therapeutic techniques. But sadly, many therapists (based on their training, lack of exposure, personality, their own mental health challenges, personality, burn-out or compassion fatigue, etc.) neglect to exhibit compassion for their clients.
- There are too many “professionals:” For many of the families that I work with, the most common complaint is “who do I turn to when there are so many people to turn to?!” Think about it. You have mental health therapists (who often have different training experiences, styles, and theoretical orientations), occupational therapists, mental health workers (who are sometimes not licensed by the state and only have a college degree with no clinical training), crisis workers (who run the gamete), first responders (who could be crisis workers but also individuals trained specifically in responding to emergencies like suicide attempts), doctors (who also run the gamete in clinical psychotherapy), etc. One parent asked me a very good question that I certainly, at the time, could not answer. She said “what’s the difference between a psychologist with a PsyD (Doctor of psychology degree) and a PhD (Doctor or philosophy)?” She went even further and stated “what’s the difference between a Masters degree in counseling and a masters degree in social work?” These are legitimate questions with somewhat complicated answers.
- There is not enough insurance to go around: Sadly, since managed health care became a thing of modern times, clients and patients have complained about the level of access they have to healthcare services. In fact, one of the main goals of modern healthcare under the managed healthcare system is to get a patient or client into treatment and out as fast as possible. For mental health professionals, we are challenged to engage clients in brief therapy focused on solutions. We have to have clear and targeted goals and plans for treatment. We have to have a goal for every individual, family, or group therapy session with the ultimate goal of discharging the client from treatment ASAP. The most popular mental health programs of our current time are those programs that keep client’s for a short period of time such as 28-30 day mental health and drug and alcohol programs, outpatient clinics, and hospitals who favor the 72 hours only “rule.” All of this is being done in an effort to keep costs down and some people believe it’s to keep client’s out of the healthcare system for long period of time.
- Insurance could care less: Did you know that insurance will stop paying for your treatment if they don’t believe you need it? Therapists have a very tough job in trying to convince insurance companies that client’s require the care they need. Some therapists have to do what are known as Continued Stay Reviews (re-authorizations) in which they speak with an insurance care manager who asks a set of pre-written questions to explore whether a client is improving (so they can stop treatment) or declining (so they can continue to pay). Most therapists, such as myself, have to watch the language they use because one wrong word can encourage insurance to stop paying for a client’s care. In fact, many care managers make their own decisions on a client they have never met based on what they think about a client’s progress.
- Fourteen year olds have way too much power: It’s a known fact today that when a child turns age 14 they have the legal right to make decisions on their mental health care. Many of my adolescent client’s become arrogant and tell their parents that they have the right to “revoke” all of their parents rights and access to their mental health file and treatment. When I worked in a juvenile delinquent center with youngsters who were on probation and receiving mental health care, one client said to me: “I’m so sick of my mother making decisions for me. I am turning 14 on Friday and I would like to take her off of my file as someone who can ask you questions about my care. I don’t think she needs to know what I do.” I was sick to my stomach. This was a young man who didn’t have the ability to make appropriate decisions for his life. He needed his mother and yet, he blocked her out. Could I refuse to allow him to do this? No! Because of state law, I had to grant him his wish and walk a very thin line of what I would report to his parents and what I would not report.
- There is too much psycho-babble: Have you ever met a therapist who gets a kick out of their own level of intelligence? Many mental health professionals like this are psychiatrists who enjoy throwing BIG words around. One psychiatrist once said to one of my clients “you are suffering from a serotonin syndrome in which high levels of serotonin has caused your system to build up too much neurotransmitter.” What?! My client looked overwhelmed by it all and the family filed a complaint stating that they were uninformed about their child’s care because the language was too complicated.
- There are too many wannabes: It’s sad to admit that there are many therapists and other mental health professionals who simply want to be another Carl Rogers or sadly…Dr. Phil. Many new graduates into the field struggle with identity confusion and only know how to mimic what they have seen from others. Many new graduates mimic a professional they had over them during their internship or volunteer experience, a professor, or a predecessor they admire. It’s sad because so many client’s and their families do not receive appropriate treatment because of this. What’s even more disturbing is that new graduates are not the only wannabes. There are many seasoned professionals who will watch, for hours and days, other professionals perform certain types of therapy via DVD or video and will attempt to immolate it.
- Too many parents and families are kept in the dark: Again, the age of an individual is often used against many families and parents to keep them in the dark. But aside from this are those therapists who just don’t like working with families or parents because they are so complicated, needy at times, and frustrated. By the time parents and families pursue therapy, a child or teen’s mental health challenges have become greater and more complicated. Families and parents are tired and hopeless, often requiring someone to hold their hand and guide them. This makes some professionals feel overwhelmed and even burned out at times. So…the families and parents are left in the dark. At other times, a professional may not know how to communicate with families or parents. They can be intimidating, demanding, and sometimes extremely rude.
- The field transforms compassion into politics: It’s so easy to graduate from school with a degree in clinical psychotherapy, counseling, or clinical psychology and feel a high calling to provide as much compassion and care as you can to people who need you. But for those professionals who are not sure of themselves or lack an identity, they sometimes get caught up in the politics of the field and begin to operate only on politics. For example, some therapists will agree with insurance companies that a client can stop therapy, simply because they want the acknowledgement of their superiors or they want to be “friends” with insurance companies. Other professionals are not aware of the fact that they are taking sides. It’s tricky.
- Hospitals don’t want to care for chronic conditions: Almost every state hospital has closed across the nation and hospitals no longer accept patients (or clients) who have chronic conditions and require longer term care. For example, a client who is suffering from schizophrenia and is hallucinating and suffering from delusions, will most likely not be admitted based on this alone because these kind of symptoms require longer term care and medication management. But for someone who is in “acute crisis” (experiencing suicidal thoughts with a plan and who has access to weapons or pills or who has already swallowed the pills) will be admitted for 24-72hrs and then released. Hospitals don’t want the responsibility of caring for chronic clients anymore. They are currently a “drive-thru” option.
- Children and adolescents are a marginalized group: Believe it or not, most children and teens struggle to receive appropriate services and are often misdiagnosed and overlooked completely. When we, as a society, think of children, we do not think of kids who want to kill others or themselves, are seeing and hearing things that aren’t really there, or are suffering from strong delusions. We often imagine kids who are free-spirited and happy. But reality is that kids and teens are becoming increasingly more complicated and are requiring more mental health services than in previous years. About 20% of children and teens suffer from a mental health condition that is diagnosable.
- Ethnic Minorities are a disenfranchised group of individuals: Ethnic minorities of all kind are another marginalized group within the mental health system. Most mental health hospitals and clinics are located in areas where most people have to drive or use public transportation. For those individuals who live in the rural (country-like setting) or urban (inner-city) areas, trying to get to a mental health hospital or clinic is tiring and often draining to one’s bank account. Even more, most therapists are highly uneducated to the cultural and socio-economic stressors that interfere with ethnic clients attending therapy regularly. We cannot forget that most inner-city youths or youths from the rural areas have parents and families who do not have transportation, income for travel, or time.
I’m sure you can think of a million other problems with the mental health system. If you think there is something that perhaps I missed, feel free to share in the comments section. I love discussing these issues with you and bringing light to the darkness. If you are interested in hearing my radio interview with a National Alliance on Mental Illness (NAMI) chapter Mental Health Matters, click here.
As always, I wish you well
Photo by @boetter