A few months ago, Robin Williams’ suicide sparked a rash of posts on social media urging those struggling with mental illness to “get help.” This was massively frustrating to me because, while well-intentioned, the people who posted and re-posted these pleas clearly had no idea how hard it is to access mental health treatment in this country. It also assumed that Mr. Williams had not sought help for his condition which is not an assumption I’m willing to make without knowing the man.
What I do know about Robin Williams, though, is that he was in the elite class of people who would have had no problem accessing or paying for mental health services. He had plenty of money, was white, and lived in an urban area. Take any one of those things out of the equation and his chances of accessing good treatment would have been much lower.
The problem of access begins with the high cost of care and the lack of insurance coverage (one in five people with a serious mental condition are uninsured), but extends further to lack of providers in low-income and rural areas (89 million Americans live in federally-designated Mental Health Professional Shortage Areas), low numbers of providers who are trained in issues specific to minority communities, high numbers of psychiatrists who either limit the number of Medicaid patients they will accept or transition to private practice so they don’t have to at all. I could go on. And on. And on.
To give a specific example, the health system that my insurance covers here in town has 15 psychiatrists on staff. The hospital serves a geographic area of nearly 500,000 people and has close to 2 million outpatient visits per year. You do the math. That’s just not enough. I am in that privileged area of intersection of money, insurance, race, class, and geography and I still only get 15 minutes every three months with my psychiatrist. We discuss medications, he orders prescriptions and tests, and that’s it. He’s a great man and I adore him, but that’s just not enough. I’m sure he wishes he could do more.
Of course you can always hit up the emergency room in a real psychiatric emergency. I did, and I was admitted to their in-patient facility for about three days back in 2006. But again, I had insurance and the money to cover what insurance didn’t pay. The in-patient facility I was in doesn’t accept Medicaid, flat-out. It is a non-profit, faith-based hospital system so they will work with charity cases, but imagine for a moment that you’re feeling suicidal and you have no insurance, no Medicaid, no money, and a family to support. I can guarantee you that figuring out a way to pay for mental health care is going to factor high in the decision about whether to “get help.” In fact, my guess is that a lot of mentally ill people go right on ahead and kill themselves, rather than saddle their families with debt resulting from an extended in-patient stay. That is so horrible and wrong it makes me ill to type.
There is so much more I could go into about lack of access to mental health services. I could probably write a book. Maybe I will write a book. Some day. But for now, having laid out why “get help” is an utterly inadequate response to someone struggling with mental illness or suicidal thoughts, what can you do to help change things and improve access to services?
Advocate. Write letters. Call your congressman. Adopt mental health care as one of your top political causes. Donate money to organizations that advocate for the mentally ill (NAMI is the bomb). Please do that last thing. There is no pink ribbon campaign for suicide prevention. Nobody runs in a “please don’t off yourself” 5k. College-age folks? Consider training to be a therapist or LCSW. It’s a tough, but rewarding career and the need is so very high. Offer hands-on assistance in navigating the existing system to someone you know who is struggling (I will expand on this in a later post).
In other words, stop forwarding, re-posting, and allowing Facebook to serve as your social conscience and get out there and make some change. We need you.