(post continued from Mental Health Failure Part 1)
My next mental health professional was a gender identity specialist who I began seeing to get my letter for top surgery. He was kind, but I lied to him. I wanted the surgery, and was irritated that I had to be certifiably sane to get it, so I made sure that nothing weird came up when I talked to him. He did not accept any insurance, so I paid his hefty office visit fees out of pocket.
A year later, I was struggling once again. I decided to try out Cognitive Behavioral Therapy. I began seeing a therapist, not fully covered by my insurance, who was ultimately unhelpful. After a few sessions, I stopped seeing her. A year later, my wife and I split. It was horrendous. The day after she left home, I spent nearly the entire day on the phone with crisis hotlines. Our breakup was messy and confusing, and I had trouble explaining it to the well-meaning women on the other end of the line. Somehow I got through those first few weeks, and reached out to the former therapist, the one I had lied to in order to get my surgery letter. I saw him for a few months, once again paying his hefty fees out of pocket, and decided to pursue medication again. The psychiatrist he referred me to suspected I might be bipolar, so we tried a medication that would provoke symptoms if I was. It was a very strong anti-anxiety/anti-depressant medication. It made me sick as a dog for the entirety of the two months I took it. I lost my job a month later and couldn’t afford any more therapy or meds, so I stopped going to my therapist and didn’t go back to the psychiatrist. The meds, but not the psychiatrist or therapy, were covered by insurance.
I’m lucky not to be one of the 51 million uninsured American citizens, (let alone one of the 6.8 million undocumented immigrants with no health insurance), but as far as mental health coverage is concerned, I’m not in much better shape. I’m twenty-four now, with a long history of mental illness. I have no diagnosis, no mental health care provider, and less than two years left on my mother’s insurance plan. The only way for me to access care would be to see an out of network provider (small pool, even in the large city I call home), since my mother is insured through the state and I live out-of-state. Only 20% of the cost of each visit would be covered. Intake appointments would not be covered. My medication might be covered, if I’m lucky enough to respond well to the generic version of whatever the psychiatrist prescribes. And that’s only with pre-authorization, which is a complicated process that involves me spending at least a day on the phone playing phone tag with doctor’s offices and my insurance company. This is unacceptable.
There are millions of people who haven’t had access to even the minimal care I’ve experienced. Even worse, many of these people have illnesses that prevent them from leading even a semblance of a normal life. This lack of access to care stems directly from our inability to accept that mental illness is not the fault of those who struggle with it—like diabetes, and cancer, it affects a variety of people across race, class, and geographic boundaries.
Revamping the health care industry so that we treat and insure mental illness like any disease of the body is essential. The APA released a statement in 2008 stating that every American had a right to “a comprehensive evaluation and an accurate diagnosis which leads to an appropriate, individualized plan of treatment,” and that “There must be full parity of psychiatric treatment with the rest of medicine and utilization management must be the same for people with mental illness as well as for other medical illnesses.” The APA does not speculate on why we are nowhere near covering mental health care the way we should. I believe that we don’t prioritize mental health care because we accept the stigma. And since we think mental illness is such a mysterious and shameful thing, we relegate it to the shadows—mental health, we believe, is not to be talked about. The mentally ill are not us, are “other,” have brought it on themselves, or are failures for not fixing their disease on their own time, preferably in private.
What can we, as feminists, do about this terrible oversight in American health care? We can stand behind health care bills that expand coverage, like the Excellence in Mental Health Care Act. We can start tearing down the stigma associated with mental illness. We can strike “crazy” and “insane” from our language. We can refuse to relegate mental illness to the list of topics verboten to discuss in polite company. We can stop saying “he must have mental health issues” every time a man commits a violent act. We can express our feelings without shame. Laws do not get proposed or supported by powerful politicians, until they are relatively sure that they won’t be crossing public opinion in doing so. We can change this conversation.