Why is it Still so Hard to Get the Mental Health Help One Needs?

Therapy these days seems to be a buss word. The American public attends therapy for just about everything from stress management, marital and pre-marital counseling, and for help coping with trauma, among the any other categories. Psychiatry and psychology have become multi-million dollar industries with steadfast followers, practitioners, and research sponsorship. Yet despite this massive professional growth within the industry, it's still far too difficult to obtain the services that one may so desperately need. Who can we blame for this? Should we blame the industry, the practitioners? Should we blame the insurance companies? The private practices? ...Well, it is not my purpose here to diagnose the problem. However, it is my goal to draw awareness to those individuals who are slipping through the cracks. I recently had the amazing, yet extremely disturbing privilege of following one individual in the undertaking of a journey through the mental health system. For the purposes of anonymity and privacy I'll refer to this individual only as Jane Doe; likewise, her insurance company will only be referred to as HMO.

Jane is a young adult, 24 years of age. She works, attends school, pays rents and bills expediently, she even takes care of little pocket pet. However, what most people don't know about Jane is that is sad, she experiences horrific nightmares nightly, she drinks on a daily basis to self medicate and induce a sleep that might wipe away the nightmares. As if that were all, Jane has also been a "cutter" since she was 18 years of age, and practiced other methods of self harm from a far younger age. She has weak support systems, although she is fairly well endowed with acquaintances from work. Her health is generally poor due to lack of sleep, mild anemia, and a weak immune system. After nearly eight months of suffering through endless nightmares and increasing fatigue Jane decided to seek out professional help. But it wasn't only this that drove her to call her insurance/hospital for an appointment. Her thoughts and inclinations toward more serious self-harm and suicide were getting stronger, harder to resist.

The sound of the phone ringing made her heart beat quickly. She wanted to very badly to speak with someone that day, right away, but knowing she was making an appointment would be enough. When someone finally answered she nearly hung up, but braving her way through a hello, and a statement of her name, she found herself holding the phone more firmly and surely. She stated that she wanted a psychiatric appointment; she gave her medical number and her social and let out a sigh. "...And what is the appointment for? What is the reason for the visit?"

Jane almost choked, she was silent, unable to say a single word about the issues at hand she merely "I...I can't." She opened her mouth to speak, as though she wanted to answer and scream that she was ridden with nightmares, scars and open wounds, that she daily contemplated suicide or the possibility of a serious accident. However, she couldn't say any of those things. Instead she simply noted "it's personal," as if all psychiatric appointments weren't personal. It was evident that the man on the other end of the line was not ready for such reluctance, but he booked an appointment nonetheless. Unfortunately, the appointment was for nearly three weeks later. Three more weeks before Jane would even experience an initial interview and be able to express all the things that plagued her mind during days and terror-filled nights. I was shocked...

I spoke with Jane several times during the course of her wait for her first experience with therapy, or at least preparation for it. At times she seemed eager to step into the office, other times she was extremely reluctant. She claimed on several occasions that it would be better for everyone if she simply didn't go. Several times she even talked about just "ending it." Irregardless, she made it through the three weeks and through day before jitters. The day before she changed her mind on six separate occasions, she'd go, she'd not go, and then she'd settle on going all over again.

The day of the appointment she arrived late, she struggled again that morning with whether to actually attend. To my relieve she arrived in the reception area where I waited for her. She had given me permission to sit in on the session. We waited only two minutes after checking in and then we were shown into a therapy room by a LCSW (a social worker with a license in counseling), not a psychiatrist as we were told we'd be seeing. Jane didn't seem to mind initially, she was too nervous. She clasped her hands tightly together, sat down on the couch right on the edge and began to bounce her leg slightly as one generally does when they are anxious. Her heart must have been jumping from her stomach. The therapist began by introducing herself and the policy of the HMO on confidentially. She asked whether Jane was homicidal or suicidal, both of which Jane nervously answered "no....mmmmm....well....sort of." She clarified that she often thought of suicide. The therapist asked for more clarification, was it something she was prepared to act on? Jane shook her head, thought for a moment and slowly and unsurely answered "no." However, it rather clear that she was unsure as to how exactly to answer that question, she obviously wasn't sure herself. The therapist didn't seem to take note, in fact she only gave a quick "okay" and then moved along in her line questioning.

The one session was quite scattered with information. Jane answered half honestly, half not, and it was clear that after the thee phone calls received during the session that the therapist answered (highly unprofessional if you ask me!) Jane was no longer interested in the session or taking the therapist seriously. As I watched I felt sincerely saddened. The therapist, in take her three phone calls when her phone so obviously should have been off, had alienated a client who so desperately needed her attention and help. She broke any change of trust and a caring and comforting environment in which the client (Jane) could have felt comfortable and free to share her thoughts and feelings. Jane was no longer trying and instead turned her head downward or around the room to examine her surroundings, which were obviously of more interest to her than the therapist. By the end of the session Jane was agitated, and upon my asking her what she thought of the session she quickly reply that it was "a waste of time." She later added that the therapist "didn't care for what I had to say, didn't listen, and didn't understand me at all. She wasn't concerned that I want to die, and she wasn't concerned that I'm 24 and still cutting myself everyday."

Jane was recommended for a med-evaluation (evaluation for medication made by a medical doctor). She made the appointment reluctantly, especially after finding out that the med-evaluation wouldn't take place until a month later. She shook her head in dismay as we walked out. I could hear her sadly mutter "another month without sleep and another month of nightmares." When I asked her if she'd attend the med-evaluation, she merely shrugged and muttered "maybe." Jane had also been recommended for therapy. We were told that she'd be called the next day in reference to setting up an appointment with a therapist.

Just as predicted, the call came in the afternoon of the next day. However, it was only another frustrating lesson on the ways of the mental health system. The therapy session was scheduled for over a month later. Jane declined to schedule, however, I was not inclined to give up so easily. I called when I heard the news and explained in very general terms that an appointment was needed right away to begin the healing process and deter any serious harm coming to Jane. However, no appointment arose any sooner and the HMO insisted that five weeks later was the soonest anyone could get in.

I wish I could say that I was able to solve the problem. I wish I could report that Jane is healthy and attending therapy now, but that simply isn't the case. Jane decided to schedule the therapy appointment, but is still waiting to attend. Likewise, she is still waiting for the med-evaluation and trying to get the time off work to go. However, this is where the good news ends. Jane has started to increase her alcohol intake in an effort to meet with her growing tolerance. She's also taken up the habit of downing pills when the alcohol won't work. Sometimes this means over-the-counter sleep aids, often it means painkillers such as Vicodin or Percocet. Furthermore, she's reported to stop to the cutting and that she believes she is only getting worse and that her lack of proper sleep doesn't seem to be helping much. She reports feeling groggy all the time, absent minded, constantly on the brink of tears, overly sensitive, aches and pains in her body, and a severe anxiety that's hard to shake even with the help of alcohol or social interaction. She admits to still having suicidal thoughts, but also conceded that she hadn't tried anything, only serious contemplated it.

It seems to me that Jane is an example of the population that seriously needs the aid of our mental health professionals, but will have to battle up hill all the way to get it. I often wonder if she'll be able to make it due to her state of mind and being; and why the mental health system would toss such a maladapted and needy individual back home to wait in such a fragile state. I still wonder why the therapist took her so lightly. I still wonder why she thought it okay to answer the phone as I feel she lost so much of Jane and her problem at that point. For now, I can only say that I will continue to follow Jane throughout her journey, and that I hope that journey is a long and successful one.

I also sincerely hope that our mental health system improves in such a way as to be more readily available for those that need it. That someday soon individuals like Jane won't have to wait months on end to get the help they need.