Most people now realize that the persistent decline in US life expectancy is primarily caused by individuals taking their own lives, as many drug overdoses are the inevitable result of long-term severe depression and suicidal ideation. We are witnessing a pandemic of the acute despair and self-murder of Americans, and yet no one is exposing the dirty little secret, that psychotherapy is mainly for the super-rich.
For the overwhelming majority of us private mental health care is often unavailable. And the situation is only getting worse. There is infrequent enforcement of the Mental Health Parity and Addiction Equity Act of 2008 with respect to the conduct of outpatient psychodynamic treatment, as the Act does not apply when the hospital psychiatric department or private office practitioner simply refuses to work with your therapeutic coverage plan.
This creates the reality that there are masses of people who are in mental agony, but who have, for all practical purposes, been designated as expendable.
One week ago, I began my quest for a psychotherapist in Gotham, in the hopes of helping a friend of my daughter Jenny who was too overwhelmed to do this on his own behalf. This young man, Mike, has a health insurance plan that is a form of Medicaid. I called almost all the hospitals, both the patrician and the plebian. I expected to be naturally selected out, by those whose operations serve only the financially fittest, but I was, nonetheless, confident that he would be approved by the traditional medical monoliths of the people.
I was shocked when none of these organizations accepted his insurance.
I had a flashback to waiting for Jenny outside the psych emergency room of an elite establishment some 7 years ago. At that time, the middle-aged son and daughter of a father in his 90s with a broken hip had been told that their dad would have to stay as he lay on a stretcher in the human herding area, likely for 3 days. If they wanted, however, to pay more than $10,000 a night for a room “in the tower” he could be accommodated immediately.
When I finally reached a well-known therapy institute whose representative promised me that they took Mike’s insurance, I breathed a great sigh of relief. This lovely sounding person told me to call another line right away to reach the appointments booker. After these assurances, it was extremely jarring to receive a recorded message at that number stating that this treatment center was no longer admitting patients. And I was greeted with the same routine and recording at other locations. This 1–2 punch communique is a way of saying that de jure these facilities participate with your insurance, but then subsequently informing you that de facto they do not, no conversation or questions possible.
Greatly concerned for Mike’s welfare, I then dialed a multitude of private practices.
At each office, one was addressed only by an answering machine and instructed to leave requested personal data. Why was no one picking up the phone, even at those places with multiple clinicians and numerous secretaries? The reason, I came to realize, is that the therapists are screening their calls.
Then it hit me. They would only contact potential patients who they deemed to be people like them — well-educated, not too old, socially smooth, articulate, able to pay out-of-pocket.
Unlike the practice of physical medicine, therapeutic sessions last some 45 minutes, 2 or 3 times per week, for years. This is an intimate process that establishes deep, long-standing relationships, with most analysts interested in developing such intensely personal associations solely with persons they consider their peers or better.
Although these professionals had supposedly committed themselves to the alleviation of psychological anguish, they were not engaging in real therapy of the “hoi polloi.” They were holding the hands and stoking and stroking the egos of the uber-wealthy in an elevated cocoon of mutual admiration.
During my efforts to find a therapist for Mike I realized that these cold and phony healers were traumatizing the already traumatized who find it very difficult to even seek therapy, let alone be made to jump through countless hoops, only to suddenly crash, exhausted, into a wall of rejection loaded with spikes.
My research then led me to discover that the percentage of psychiatrists who take insurance of any kind is significantly lower than that of other physicians.
Many reasons have been cited for this, including that psychiatrists receive reduced reimbursement and each session is longer than the average non-psychiatric office visit, so the volume is less. However, my own observation is that the average rate for a well-credentialed psychiatrist is approximately $500 per appointment in an upscale metropolis. And the crux of the matter is that the demand for mental health care far exceeds the supply, while our free market is driving up the price of therapeutic treatment to stratospheric levels.
So how do we fix this? How do we ensure that all people receive the quantity and quality of individually supportive relief that they require?
1. Provide full scholarships to psychiatric, social work, and psychology students who will commit, for a period of at least 10 years, to accept all types of medical insurance, both in facility and in private practice.
2. Require that all hospitals that receive federal and state funds arrange that their psychiatric divisions use all categories of therapeutic coverage for the periods of time necessary to achieve patient cure.
3. Place reasonable caps on the pricing of medical and psychiatric/therapeutic inpatient and outpatient regimens as, hand in hand with affordable health care, we require a limiting of the skyrocketing increases in medical costs.
4. Fund the training and practice of pastoral counselors in the treatment of trauma, PTSD, and sexual abuse, who may provide both spiritual and psychological sustenance. Churches, synagogues, mosques, and temples should establish “psycho-spiritual” listening posts, available throughout the day and into the evenings, where people may come, without the imposition of a fee, to pour out their troubles, and know they will be heard and that someone will try to help them. These listening stations should also be taken to the streets, in pop-up form, reaching out to those in need.
5. Extend grants to legitimate organizations for the establishment of community programs that serve as mental health treatment centers, holding meaningful group meetings for individuals and their families, and arranging for communal activities such as gardening, art work, book clubs, musical participation, theatrical productions, knitting, quilt-making, baking, etc.
6. Furnish quality housing for persons afflicted with mental distress, PTSD, trauma, and abuse, coupled with vocational training and job securement.
There was another friend of Jenny’s who, last August, did not make it. He was only 24 years old, brilliant, kind, and sensitive. He was raised by his single mother, devalued by his father’s extended family and half-siblings, and bullied throughout his school years. He used heroin to self-medicate his deep feelings of sadness, alienation, worthlessness, and exclusion while maintaining a job that required high mental acumen, training, and skill. He thought he could control his narcotics habit, but one night he succumbed. Where was the help for him? To whom could he cry out for the love and acceptance he needed so badly, being forced to eat his pain in a heartless society? Where could he turn for altruistic affection, compassion, salvation, and promise?
We should live in a country where the one-on-one human caring and healing therapeutic relationship he needed is available right around the corner and free of charge. A place where one is certain to be welcomed, listened to with empathy, validated, consoled, and reassured. In a nation where no one is disposable.
Vivian Percy, Esq. is the author of Saving Jenny: How to Rescue Our Youth from America’s Opioid and Suicide Epidemic