Taming the Hidden Beast: Mental Illness in America

Sharon Downer
Jul 25, 2017 · 10 min read
Art by Karolin Schnoor

The National Institute of Mental Health, the US’s lead federal agency for research on mental disorders, conservatively estimated the total annual costs associated with mental illness exceeds three-billion dollars based on data collected in 2002.

This staggering number includes healthcare expenditures, disability benefits, and loss of earnings directly or indirectly attributed to the symptoms of mental illness. Since then, a greater public focus on healthcare has made it somewhat easier for people to access information and treatment for their conditions, but every day individuals fall through the cracks- and some never get back up. Nearly 30,000 Americans commit suicide every year, and each one of those intimately affects at least six other people, be they friends, family members, or coworker.

So what exactly constitutes a mental illness? How is something most people can’t even see capable of disrupting so many lives?

Mental health itself is deeply involved in daily activities such as work, school, or caregiving and affects our relationships and ability to deal with adversity. Mental illness refers to conditions involving significant changes to thinking, emotions, and behavior that disrupt an individual’s ability to function in those daily activities. While three-fourths of all conditions manifest by the age of 24, mental illness does not discriminate. People of every race, age, gender, location, sexuality, social status, background, and cultural identity can be affected; although the cause of these disorders isn’t exactly clear, researchers believe it is a combination of genetic, biological, and situational factors that create the right conditions for an illness to develop- not a defect of character or personal weakness. Approximately one in five adults in the US experience mental illness in a given year- that’s 43.8 million people, just a few folks short of the entire population of New Zealand. Often, that one in five doesn’t even show symptoms, so it’s easy to gloss over and downplay the serious implications of such a high number.

Imagine the agoraphobic, who cannot leave her house due to her crippling fear of having a panic attack in public. She cannot work and gets her groceries delivered to her front door in a desperate effort to avoid the rearing heads of nausea, rapid heartbeat, and hyperventilating that she knows will overcome and humiliate her in front of all those people. She wonders daily why she is like this, as she used to be outgoing and adventurous, but remains unaware that her agoraphobia stems from a deeper panic disorder that surfaced after a traumatic accident a few years back. Because she had been out of work and society for so long due to these symptoms, she has no health insurance, few friends, and doesn’t know where to turn for help.

Just over half of adults who suffer from a serious mental illness receive treatment for their conditions; most receive a combination of outpatient services and prescription medications, though about 7.5 per cent require some level of intensive inpatient treatment. Those who do not seek help or cannot afford it face an increased risk of chronic medical conditions, and they die on average 25 years earlier, largely due to treatable medical conditions. According to research estimates, nearly one in five children suffer from a psychiatric condition, and unless they are living in an urban area it can be extremely difficult to find a psychiatrist qualified to work with a younger demographic. An estimate by the American Academy of Child and Adolescent Psychiatry states that there are only 8,300 specialists in the US compared to the 15 million children who need treatment- considering the chronic nature of most mental conditions, many of these kids will carry their symptoms onward into adulthood where it will continue to disrupt their lives.

One of eight visits to the emergency room involve a mental health condition or substance abuse, and those who need inpatient treatment often end up waiting for days to receive treatment. This is not only unhelpful from a medical standpoint, but the bills that rack up from an extended hospital stay can be financially crippling to people and their families. This delay of treatment could be attributed to staff or facilities that are not equipped to handle people with serious mental health issues, and organizations around the country are working to address this unmet need by establishing specialized psychiatric emergency departments designed to accommodate patients failed by traditional ER services.

Every year, about two-million jail-bookings involve a mentally ill person, and one in four people killed in officer-involved shootings suffer from a diagnosable mental condition. Labelling millions of people with psychosis or addictions as dangerous, dirty, or bad is a huge blow to millions of people who share those conditions; because officers are often the first responders to someone having a breakdown or loss of control, they can be forced to contend with something they don’t understand or have not previously experienced. Some departments are taking steps to train their officers with techniques and protocols that prioritize the safety of both the individual in need and those who respond- while adoption of a new outlook on the mentally ill has been slow in departments throughout the country, a gradual shift towards a care-taker approach will end up saving taxpayers millions by curtailing use-of-force incidents, unnecessary arrests, and officer injuries.

So when does a person with a mental illness end up in crisis? How does that happen? Why can’t they catch it before it gets out of hand?

It can be difficult for someone suffering from a disorder to recognize what they are experiencing, which can delay treatment indefinitely or culminate in a life-threatening crisis (this is where law enforcement gets involved). Traditionally, mental illnesses such as depression, substance abuse, schizophrenia, and others have been treated as a “family diseases”, which were not to be discussed in public or private. Those who are told to “buck up”, “get your shit together”, or “cheer up” feel guilty for being unable to do so- they shy away from asking for help, fearing the judgement of their families and their peers. They don’t want their coworkers or relatives to judge them as weak, dangerous, or incompetent- how could they possibly tell anyone about this beast that no one else can see? The memory of housing the severely mentally ill in deplorably de-humanizing conditions runs deeply through our society despite the vast improvements that have occurred in the treatment of mental health over the past fifty or so years.

Many people suffer for years in silence, unwilling to burden others with their own pain or subjugate themselves to the real or perceived judgment of their peers. It’s pretty easy to tell your friends about your problems, but that’s a two-way street and you don’t keep friends by dumping all of your problems onto them. It’s far more effective to see a therapist whose time and attention is dedicated to you and your life and trained in therapeutic techniques. Those who do speak up and seek proper treatment are not out of the woods until the therapy is completed and the file is closed, and there are a lot of bumps on the road to getting better.

One in five people with a mental illness report that they are unable to get treatment for a variety of systemic reasons, including inadequate or non-existent insurance, lack of available treatment providers and treatment types, and insufficient finances to cover copays or treatments not listed on their insurance company’s roster. Some practices employ a sliding scale based on income to provide service to people without insurance, but for many even that fee can be prohibitive. Some people don’t have reliable transportation to make their appointments, and others cannot find or afford suitable childcare- it can also be daunting or simply impossible to ask an employer for time off, especially when he or she asks why that time is being taken. Companies are slowly getting better about how they handle their employee’s mental health by offering access to company-paid counselling services, ensuring their health plans include coverage for mental health, and even just letting people take a day or two if they need it. This movement, however, is slow and far from universal at this point. Additionally, there are providers who offer mental health coverage as a separate entity from their health plans; it is not uncommon for someone to assume that their treatment will be covered only to discover that they need a distinctly different plan to pay for service.

Because therapy is such a personal experience, individuals usually choose a practitioner that vibes well with them and “feels right”. It can be extremely discouraging to research the practices in your area, find someone you like, and then call to find out that your insurance won’t cover your time in session. For example, Mike is a twenty-two-year-old male suffering from severe bouts of depression that he’d been contending with since his late teens. After several dismal months of floundering and apathy, he finally makes the choice to seek help. He’d never been to therapy before and doesn’t really know what to expect from himself or his future clinician. After a quick Google search and checking on his insurance information, Mark realizes that the only place that will accept his insurance is a Christian-based clinic.

His heart sinks further than it ever had before- there is no way he wants to re-live his experiences growing up in a strict Christian household. Hell, he’s pretty sure that’s where all the guilt and anxiety stems from. He makes a few phone calls to other practices nearby, just to see if they will take him without insurance, but he has no luck. His girlfriend is threatening to leave him if he doesn’t get his shit together, so he bites the bullet and makes an appointment at the only place that is covered under his plan. He knows immediately it is not a good fit, but tries to muddle through the therapy anyway- after a few months, Mark stops going. What little progress he did make wasn’t enough, and the experience leaves him with a sour taste in his mouth- how is he supposed to heal when he can’t find the right counselor who isn’t focused on bringing any more Jesus into his life?

On the other hand, some folks respond very well to therapy that conforms to a particular religion because they share a language and culture that both parties understand. They want to confide in someone who doesn’t challenge their faith or consider it a pathology as early behaviorists had; some people believe that a counselor who shares the same ethical beliefs and world views will understand what guides the client throughout their daily lives.

Diverse populations like that of the US need diverse treatment options, or people simply won’t be able to find a therapist who understands them and fits their needs.

Therapy, be it religiously-affiliated or otherwise, can be beneficial even to those who aren’t necessarily suffering from any particular illness. It’s not just for crazy people, contrary to many misconceptions; anyone who feels “stuck” may be able to find ways to change their lives that they hadn’t even thought of before. It’s about learning strategies that help cope with the vagaries of living in a hard world, about building self-esteem by making choices conducive to a healthy, productive life. It allows people a time devoted solely to themselves, something that is extremely hard to come by in a society driven by constant activity and a perpetual sense of urgency.

There are a lot of things that need to change before we will see any reduction in that three-billion-dollar figure offered by the National Institute of Mental Health. While much improved- especially within recent years- our society as a whole will need to re-evaluate our understanding and perception of mental illnesses. Advocacy groups such as National Alliance of Multi-Ethnic Behavioral Health Associations, National Mental Health Association, and Bazelon Center for Mental Health Law (among others) work to better the lives of those with behavioural health issues through education, research initiatives, and leadership in the field. Celebrities are talking more and more about their personal experiences with mental illness, and while they receive criticism for “airing their dirty laundry”, those men and women who speak up do great work by letting others know that they do not suffer alone and that anyone from any walk of life can find themselves in the dregs of any given condition.

Individual states are starting to pass laws intended to facilitate more comprehensive and accessible mental healthcare for their constituencies, though these measures are often nullified by the thick haze of insurance and the high cost of uninsured services. Healthcare is in the spotlight of the political debate that is currently raging, and many people fear that they may lose their only access to the treatment they need to get better. It is up to the people to speak up and vote on these topics, to call their state reps and local police departments and get involved with advocacy initiatives. It is time to crush the stigma of mental illness by talking about its very real presence in our society and by researching how we can empower people to see the help they need.

If you yourself suffer from a mental illness, don’t be afraid to speak out or get help. You should talk about it with the goal of educating others; help those around you understand the reality of living with a condition They might genuinely have no concept, or perhaps they have a skewed view of what it’s like to struggle with an invisible foe. You can get better. You can live a full, productive life once you take control of the beast in your mind. Seek a therapist who understands you and your background- sometimes it helps to consult with several counselors to decide who will be the best fit. Stick with it, even when you fear the pain will be too great. Most importantly- never, ever give up hope for a better life.

You are incredibly brave.

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