On World Mental Health Day, Finding “Free Therapy” After College, And the Problem with Awareness

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I think it’s a safe bet to assume that most of us are aware of the fight against stigma surrounding mental health in our current culture. We now acknowledge World Mental Health Day on social media, right after National Donut Day.
We’ve all seen those billboards, watched those videos, read those articles. There seems to be a cyclical nature regarding these things: a tragedy happens; people cite mental health struggles; people wonder what could have been prevented; people beg for awareness; videos, posters, articles surrounding mental health start circulating; people click, nod, shake their heads; people move on. And the cycle repeats.

My point is, it’s so easy to click those links, skim those articles, scroll past those posts, and go on with your day. What isn’t easy is sitting with a deep sense of discomfort, struggling to understand the complexities of mental health, and wonder what can be done to help change the course of the cycle.

As a disclaimer, I’m not proposing I have all these answers. I just think that there is a difference between Raising Awareness, and Creating Change. It’s easy to be aware of a problem. It’s not easy to do something about that problem.

Like most people, I know many people who struggle with mental health issues, so the subject is not merely a societal quandary on which I muse, but one with intimate relevance. And like many people, (around 19% of adult Americans), I also have personal struggles with mental health. Although I am not an expert in psychology or mental illness, I do have entirely personal anecdotal evidence that I’d like to share to illustrate a few of my points — and also some facts, because those do come from experts. I’ll explain:

Last spring, I experienced my first post-graduate struggle with my mental health. It was not the first time I have ever experienced a state like this, and it won’t be the last, either, but it was the first time I felt like I was dealing with it completely on my own. I was aware of my problem, but addressing it wasn’t an easy task.

About a year ago, I packed up my things and moved from a small town in Missouri to Los Angeles, CA. For more on how that transition shaped my life, you can read my previous post:

Welcome back! Now that you’re up to speed, let’s resume.

In my time as a student at Missouri State University, I was afforded the opportunity to seek free counseling services through the University’s Counseling & Testing Center. College is a major life transition and at times can be extremely stressful, and many students experience what could be considered their first “breakdown,” thus making the services rendered by the University extremely necessary and in high demand.
However, college was not when I experienced my first “breakdown.” Rather, it was when I was finally able to recognize what had been happening for a long time, and trace those old patterns into the present. I learned to articulate my psychology for the first time, how to maintain a state of balance and equilibrium, and how to seek help when I needed it. I had been struggling with issues of anxiety and depression since early adolescence, and I started to recall memories from my childhood that pointed towards a trend of anxious tendencies from an early start.

I utilized the Counseling & Testing Center’s services many times, of varying duration, throughout college. Most often I would find myself revisiting their offices when I was under a high level of stress without adequate rest in my schedule and a poor balance of work, school, and my personal life. It was a recipe I concocted all too often; I would inevitably collapse under all this pressure, and instead of feeling motivated by stress to complete all the work I had yet to do, I just could not will myself to start or complete tasks, and I would fall even further behind.

I know now that this is a common experience for people who are typically high achieving and struggling with depression. However, at the time, I was deeply ashamed of my perceived inadequacies. I chose to isolate myself instead of seek help for fear that my peers, classmates, and friends would see what a flawed, weak, and lazy person I was, and disassociate themselves from me. At the height of my struggles, when I was at a new personal low, I couldn’t help but feel I was the only one who couldn’t keep up. It was excruciating.

My entire life, I was a good student. I excelled in school and valued my sense of work ethic. But suddenly, I felt like a deadweight loser who had no self discipline or ability to self motivate. I felt like a failure.

It’s not a coincidence that my self-esteem was highly impacted by the effects of my depression on my academic experiences. My role as a student, and as a child of two second generation educators, had been extremely formative and significant in my confidence and sense of identity. It’s not that I blame my challenging academic environment for my struggles with depression and anxiety, I just know that it’s not uncommon for “high achieving” young people experiencing mental illness to cite academic pressure as a main source of stress in their life. It’s highly unlikely that this is the cause of all instances of mental illness in smart young people, but it is possible that it’s a contributing factor.

There are many studies that link high academic stress to a high level of anxiety and depression, and we also know that people participating in competitive academic communities tend to also engage in extracurricular activities and extra responsibilities that are time consuming and add stress to the typically already tense college schedule.
If you add in the financial stressors that come along with college, particularly if you are someone who needs to work to afford your education (nearly 70% of students today), it’s easy to see how this all piles up. And of course, that’s not even considering students who are predisposed to mental illness through hereditary genetics, or survivors of trauma or abuse, student veterans, or other contributing factors.

It is for these reasons, among others, that college tends to be a common time when mental illness arises or manifests amongst students. In fact, 75% of cases of chronic mental illness begins by age 24. I feel so fortunate that my alma mater had proactive and accessible resources for students to utilize, as I realize this is not the case for everyone. I found tools and strategies to cope with my symptoms, had access to psychiatric care, and generally felt able to pursue my treatment without shame or embarrassment from my academic institution.

But What Happens After College?

This is the part of the story where you’re not surprised to hear that eventually, I graduated and had to leave my University, and all the resources I had access to. This is also the part of the story where I have the least amount of answers, partially because I’m still treading through it, but also because I’m not sure there are very many answers for this out there. Maybe it’s the kind of story where we have to make the answers happen after we ask the questions.

After I graduated, my psychiatrist knew I would be moving to Los Angeles and need to locate another doctor. He wrote me several refills of the prescription I had been taking to buy me some time once I made the big move and would still be adjusting to the transition. My decision to try anti-depressants was not easy; I was battling a lot of fears rooted in misconceptions, misinformation, and ignorance surrounding psycho-pharmaceuticals, brain chemistry, mental illness, and psychiatry in general.
I was grateful to have the ability to speak with a professional who explained things to me in terms I could understand, presented me with all the facts, associated risks, side effects, and left the power in my hands once I had the information. I never felt pressured, judged, or belittled.

My decision to take anti-depressants is extremely personal, and it does not feel easy to describe this decision to an open audience. And although I am opening this very private story to the public, the decision still remains that of my own personal journey that I do not have to defend. If you find yourself tempted to influence or judge the way another person handles their own experiences with mental illness, including shaming someone with misinformation surrounding anti-depressants, I personally recommend that you ride off into the sunset on your high horse until you fall off the edge of the world, which you probably believe to be flat.

Moving on.

Anti-depressants have helped me immensely. I don’t know if I will always take them, (that’s up to me and my doctor to assess) but I do know that right now, I still want to take them. I also know, through a set of unfortunate circumstances, that it’s not a good idea for me to stop taking them right now.

Last October, my parents got a letter in the mail stating that my mother, though she had worked and retired in the same school district as my father for close to 30 years, and paid into their insurance policy alongside my father for all of those years, would now be required to leave their policy if she were eligible for insurance through her employment. They considered her a “leeching spouse.
My mother retired from our public school district, but has since returned to work for a private Catholic school, which allows her to work full time without affecting her retirement pension from the State of Missouri. My brother and I were still on our family insurance (thanks, Obama!), which listed my father as the main policy holder. I could go on about how sexist and criminal I believe this was, but it wouldn’t change the fact that my mother still had to leave our insurance and open her own policy through her job, effectively doubling my parents’ cost of insurance since the monthly premium of my father’s plan did not change once she left. Long story short, it was minimally cheaper for my mother to pull my brother and me onto her plan as dependents, so that’s what she did.
Now, we had a new insurance network, new copays, and I was in an entirely new city with no clue how to sort through the thousands of doctors to find my new primary care physician.

I had enough refills on my prescription to last a little while once I had moved, and finding a doctor immediately didn’t seem necessary. I was busy, doing well, and happy with the way things were going, and to be honest, it fell to the bottom of my to-do list.

Fast-forward a few months — the novelty of moving to Los Angeles was beginning to wear off, and the loneliness and homesickness was really starting to settle in. I took on an internship in January in addition to working full-time at my day job, while also managing auditions and my other creative pursuits. I had a new environment, pressure for achievement and approval from my new professional responsibilities and relationships, a stressful 7-day-a-week schedule with no time to rest, a living situation that was beginning to grow toxic, and very few intimate friendships I could rely on in this city.
If this sounds like a recipe for disaster, you would be correct! It didn’t take long for my symptoms to start showing up again. I was exhausted, constantly anxious, my self-esteem was declining, my energy levels and moods were always low, and pretending to be positive and cheerful at my workplaces was incredibly draining.

I know myself pretty well by now, so I knew that my body was sending some warning signs. I knew I needed to do something, but this time I wasn’t sure what that something was. In the past, I would have just called the Counseling & Testing Center and made an appointment to see a counselor and assess the stressors and symptoms I was experiencing. I would have felt responsible and proud that I was helping myself and gaining control of something that can make you feel so totally helpless and useless against your own will.

But this time, I didn’t know who to call. I tried to do research on the psychiatrists in my insurance network, but there were so many, and I had no personal recommendations from people I trusted. I knew that as a queer person, it would be comforting to have access to specifically LGBTQ-sensitive counseling. It was something I didn’t have access to in Missouri, and something I always had to explain in exhausting detail to every counselor or psychiatrist I saw.
The Los Angeles LGBT Center had counseling services, but was not in my insurance network. I figured that my income might qualify for a reduced cost, and I should try to make an appointment anyway. Unfortunately, when I called to make that appointment, I was informed that all new patients must first go through an income screening appointment, and then are able to make an appointment to see a counselor, who can then recommend the patient to see a psychiatrist or not.
It was a long and complicated process, but I figured it would be worth it in the end. However, there was a problem — their next financial screening appointment wasn’t until May. I couldn’t wait that long. I was beginning to run out of my prescription; I had around two months tops before I would be completely out.
I had the option of showing up on standby starting at 8:00am Monday-Friday, in hopes that someone would miss their appointment and I could take their place. For the next couple of weeks, I tried to will myself to get up early, prepare myself for the day of work, and drive the half-hour to the LA LGBT Center. But for those of you who have experienced depression, you’re probably familiar with the feeling of inability to get out of bed or motivate yourself to do things that you know will make you feel better. It’s a cycle of disappointment and self deprecation, and once it starts, it’s very hard to escape.

I just couldn’t will myself to go to the LGBT Center. I figured that starting a psychiatric process would be too lengthy and complex, and I had better chances of seeing a primary care physician who could refill my prescription to buy me some more time.

Cue more research into hundreds of doctors, and mostly relying on internet reviews that have no guaranteed credibility. Lo and behold, I finally found a doctor who seemed amazing, was in my network, and was relatively close to my apartment. I called to make an appointment for a general check up — the next available appointment wasn’t until mid May.
My heart sank. How was anyone supposed to do this? Who can possibly afford to wait 3–4 months for an appointment that they’ve already been pushing off? I took the appointment out of desperation and defeat, but I knew I couldn’t wait that long.

I called my University pharmacy in hopes they could authorize a refill on an urgent circumstance. Unfortunately, my psychiatrist had retired, and I was no longer enrolled at the University, which meant I was not eligible for any medical treatment from their on-campus clinic. I began to do some math; if I started spacing out my medication, I could make it last about twice as long. It would almost get me to my appointment, and wouldn’t be as bad as a sudden withdraw if I ran out.

I probably don’t have to tell you that it didn’t work. My depression got worse. I could barely do the absolute minimum to get through each day. I was pretty much a walking shell. I absolutely could not lift my mood, couldn’t eat, could barely even talk about what I was feeling. I didn’t want to kill myself — I just didn’t have any energy to keep going. I was desperate but defeated.

In the end, I found a way to get my prescription refilled. I had tried almost everything, short of going to the ER, which I didn’t feel like I could do because I wasn’t physically hurt or attempting suicide. I tried a telephone doctor service my insurance offered, but unfortunately did not include mental or psychiatric coverage. I found an urgent care clinic specifically dedicated to people with mental illness, but they weren’t in my insurance network, and I was informed the first visit could cost upwards of $2,000 out of pocket. When I thought my only option was to find an in-network urgent care clinic, by some miracle my insurance provider suggested I just call my doctor’s office and ask them to authorize a refill.
I hadn’t even met my doctor yet, so I didn’t know if it would work, but I gave it a shot. To my extreme relief, it did. I couldn’t believe that the easiest solution was the last thing I tried. I felt sort of foolish for not thinking of it first, but I had never been in that situation before.
I just didn’t know what my resources were.

This was my experience. I know it pales in comparison to other people’s struggles with mental illness; I have a (relatively) happy ending to my story, while so many do not. Even with insurance, a stable job, and a roof over my head, I still had a difficult time finding care. I can’t imagine what it’s like for those with less support and resources at their disposal.

In some ways, I think we’re making progress. Awareness is sign of progress. But awareness is not action, and action is the agent of change. What can we actually do to change this situation and its current obstacles? It’s not enough for me to click “Like” on a post that shows support of people with mental illness. We need more than digital awareness, more than short-lived sentiments of support or sympathy, more than media coverage after a mental illness-related tragedy.
So what can we do?

We can vote for candidates of political office who are proactive and supportive of expanding mental health resources.
We can donate to worthy foundations, such as
NAMI, IMHRO, or Mental Health America, or any local non-profit organization of service.
We can vote in favor of legislation in support of expanding mental health care coverage on insurance policies.
We can donate our time by volunteering for crisis hotline services.
We can educate ourselves on
warning signs of mental illness and suicide, and know when to reach out when a friend or loved one needs help.
We can support our local homeless shelters, either by financial contribution or a donation of time.
We can vow to speak up when we hear insensitive or inaccurate information surrounding mental illness and the people it affects.

I’m thankful we have World Mental Health Day and Mental Health Awareness Week. Raising awareness is a powerful tool we have for fighting stigma surrounding mental illness, but it’s not the end of the story. If we want things to be better for those affected by mental illness and their loved ones, we need to take our awareness further, and vow to take action to help create change.

Written by

Jill is a queer actor residing in Los Angeles. You can find Jill on Twitter and Instagram at @inbetween_queen, or at www.jillkamler.com

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