• Tue, Jan 15 2013

What Prevents People From Seeking Mental Health Treatment? Everything

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This morning, a PsychCentral article titled “What Prevents People From Seeking Mental Health Treatment?” caught my eye. The author cites a range of reasons, from the continuing stigma surrounding mental illness to the cost of therapy to well-meaning loved ones who discourage mental health care. In other words: Just about everything involved in getting proper mental health care is a possible deterrent. And as someone who’s recently been struggling to maintain my own mental health care, I vehemently agree.

I don’t mean to whine about my predicament; I’m in a lot better shape in terms of ability to seek and afford care than many. Rather, I hope this catalog of impediments drives home just how much effort and obstruction is involved in seeking and getting adequate mental health treatment.

1. Lack of insurance. Obviously, not having health insurance puts you at a major disadvantage when it comes to affording any kind of treatment, including mental health services. One thing I don’t think everyone realizes, though, is that some doctors or health centers won’t even take patients who are “self pay,” which makes finding a doctor that much more difficult.

2. Lack of poverty or a trust fund. The disadvantage in the latter is obvious, but why is not living in poverty a medical disadvantage? In the broad sense, it isn’t, of course. And I’m certainly glad that I’m not living in poverty. But I’ve also found that health care clinics have little use for a single adult making somewhere around $30,000 a year. That’s wayyyy to much money to qualify for any sort of discounted services, I’ve learned. But when you’re paying all health care costs out of pocket, it’s not enough to afford all but the most urgently necessary care.

3. The psychiatrist/psychologist divide. For me, the most urgently necessary treatment is medication. In the past few years, antidepressants have made more of a difference in treating my depression than 27 years of willpower, soul-searching, cigarettes and long-talks with friends did. So I see a psychiatrist, who can prescribe me antidepressants and/or other psychiatric drugs (more on that in a sec) but doesn’t do counseling. I think counseling would help. Possibly a lot. But if I want counseling, I’d have to see a separate doctor — a psychologist or licensed counselor — and pay another $100+++ per month.

[I should note that another reason drugs are easier than counseling in our current system is that often, after initial visits, psychiatrists will let you come once every 2-4 months for 15-minute 'medication management' sessions, whereas talk therapy requires weekly or bi-weekly sessions.]

4. Long wait times for appointments. There’s just about nothing worse than feeling despondent, finally working up the courage to see someone new, researching doctors that will be a good fit, finding one that will — and then being told it’ll be 6 weeks before they can fit you in. Now imagine repeating this scenario about four times.

5. Emotional exhaustion. Say you need blood pressure medication, and you’ve recently moved, and your prescription is almost up. What do you do? You make a doctor’s appointment, maybe have your old doc send your records and, after a brief test/talk, probably walk out with your needed medication. Not so with mental health drugs. Every time you see a new doctor, they want to hear your whole mental health history before dishing out some drugs. I understand that the nature of mental health problems and drugs may necessitate more background than blood pressur issues, but it can also be difficult, embarrassing and emotionally exhausting to rehash your whole mental health history all the time.

6. Medication hurtles. When you move around a lot (and I do), it can be extremely difficult to keep up a regular prescription drug regimen. Even if you use a big, national pharmacy chain like CVS, they frown on filling your prescription at pharmacies in different states within a short period (and by frown on I mean sometimes won’t do it without a lot of extra hassle and special permissions from your doctor). And while psychiatrists will write you long-term prescription for, say, Prozac, no such luck with others. With adderall, for instance, you can only get a one-month prescription at a time. Each month, when it came near time for an Adderall refill, I had call my psychiatrist’s office, wait 1-2 days for her to write me a new 1-month prescription and go physically pick it up at the office building. Then I’d have to take it to a pharmacy which may or may not fill it; Adderall shortages are common, but more annoyingly, pharmacies won’t allow you to refill an Adderall prescription less than a full month from your last refill. One day short, and you’re making a trip back the next day.

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