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?
This article will highlight a few issues I have noticed and my own clients have noticed about our 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.
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.
What I believe is wrong
- Some clients don’t feel heard or understood: It’s sad to think that there are healthcare professionals who simply don’t care or 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 client. It also includes avoiding being judgmental, confrontational, and closed-minded. Rogers held that the most effective type of therapy is the therapy that places UPR at its foundation. This is one of my most prized therapeutic “techniques.” But sadly, some therapists (as a result of 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 is not enough insurance to go around: Sadly, since managed health care became a thing of modern times, 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 the goal of discharging the client from treatment ASAP once the problem has been resolved. The most popular contemporary mental health programs are those that keep clients for a short period of time such as 28-30 day programs, outpatient clinics, and hospitals (who favor the 72 hours only “rule”).
- Insurance has bigger concerns than covering you: 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 clients require the care they ask for. 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 in a program or not. Most therapists, such as myself, have to watch language because one wrong word can encourage insurance to stop paying for a client’s care. In fact, some care managers make their own decisions on a client they have never met based on what was told to them by the therapist.
- Fourteen-year-olds have way too much power: It’s a known fact that when a child turns age 14 they have the legal right to make decisions on their mental health. Some of my adolescent clients become rebellious with family and tell their parents that they have the right to “revoke” all parental rights and access to their mental health file. When I worked in a juvenile delinquent center with youngsters who were on probation, 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 could not make appropriate decisions for his life.
- Too much psycho-babble: Have you ever met a therapist who gets a kick out of their own level of intelligence? Some mental health professionals feel empowered by what they know. This intimidates clients and may cause them to never return to therapy. 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. This is a tragedy because originality is rare. There are many graduate students and early career professionals who will watch, for hours and days, other professionals perform certain types of therapy via DVD or online and later attempt to immolate it.
- Too many parents and families are kept in the dark: as stated above, the age of an individual is often used against many families 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 too complicated, needy at times, and frustrating. Although I can agree that some parents are overbearing, some therapists will see the child or teen but avoid or limit communication with the parent. Is this true therapy for the child? Probably not. Everyone should be involved at some point.
- The field transforms compassion into politics: Sadly, there are new professionals who are unsure of themselves or lack an identity and get caught up in the politics of the field. As a result, they begin to operate only on politics. For example, some therapists will begin to see most if not all of their suicidal clients as having borderline personality disorder if other, more seasoned, clinicians drop hints or share their opinions on a client. New therapists have a hard time using their own knowledge-base because they are too new to the field and are learning on the job. As a result, compassion gets lost because “I need to put up boundaries with people diagnosed with BPD.”
- Hospitals don’t want to keep you in treatment too long: Almost every state hospital has closed across the nation and hospitals no longer accept patients who have chronic conditions and require longer-term care. For example, a client who is suffering from schizophrenia and is hallucinating or suffering from delusions will most likely not be admitted based on this alone. Hospitals will admit you if you are currently unable to care for yourself or are harmful to self or others.
- 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. 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 really isn’t there, or are suffering from strong delusions. We imagine kids who are free-spirited and happy. But the reality is that kids and teens are becoming increasingly more complicated and require 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: 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 people of color 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.
What do you think?
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 below. I love discussing these issues with you and bringing light to the darkness. If you are interested in hearing my radio interview with National Alliance on Mental Illness (NAMI) chapter Mental Health Matters, click here.
Photo by @boetter