A Mental Health Crisis is a Terrible Thing to Waste
Mental health care can be life altering, and in this country it is far too difficult to access. It’s time for that to change.
I remember the first time I sat in the attic-office of a therapist with a boy I was caring for. The building was probably a hundred years old, and it sat in downtown Vancouver (WA) among other similar historic buildings that were probably once homes. I sat gingerly in a chair below a small window, trying to ensure the blanket slip-cover didn’t shift too much as I did so. There was a kid-sized table between us and a young woman named Anna who spoke in a gentle, even voice. I remember how she taught me how to play with him, to attune myself to him. “Narrate everything he does while he plays,” she told me. “Like you’re calling the super bowl.” At first I felt awkward saying things like, “The man is riding the shark,” and “It looks like the dolphins are diving,” as he dipped plastic figures into the sand tray. Anna was patient though, and she set us both at ease. Soon it felt natural. He began correcting me if I got something wrong or explaining what was happening in the pretend scene he’d created. “They’re saving the guy,” he’d say. “The dolphins are helpers.”
I always left Anna’s office feeling better equipped to parent my child than I had when I walked in. Kiddo would hold my hand to the car with a warm glow of connection shining out of his face.
I’d never been to see a therapist for myself, not really anyway. The one time my mom took me when I was ten probably shouldn’t count since I refused to answer any question with more than a single syllable. I can still feel the tension in my lips and jaw, the way I was determined not to tell her a thing. I never went back. It was amazing, though, the magic Anna did with him, with us. When she went on maternity leave, we only saw her replacement a few times before we moved to a different city.
When I did finally go to the therapist for myself, I walked into her office and instantly recognized the plastic figurines and sand trays of the other child therapists offices I’d been to (I’d been in two or three by then). She quickly became comfortable and familiar. However, I had another child who needed therapy, and after months of looking high and low for someone in our area who took both children and my insurance, who also happened to be taking new patients, my own therapist started seeing my child. I was a little worried about how that would go from the beginning — her seeing both of us — and it went okay for a few months. Then when it stopped going okay, my child was the one with a greater need, and with fewer practitioners in our area who could or would see kids, I decided to bow out of that therapist’s practice so my kiddo could stay.
The therapist isn’t as amazing as Anna — I’ve not met a therapist in the years since we moved that came even close to being as helpful as Anna — but kiddo trusts her and having another safe, trusted adult my kid can confide in can only be a good thing. Just like I did for my child when they needed a therapist, I’ve looked high and low to replace mine. I’ve scoured the Psychology Today therapist finder and my insurance carrier’s website for people in the area. Every time I find someone I think might work for me, I call them only to find that they are full right now, the listings I’d looked at were mistaken that they were taking new patients.
In our country, crime has increased since the vaccine for COVID-19 became readily available and things started to open back up. When the first post-COVID-shutdown mass shooting happened, people called for gun control, and politicians ignore them (per usual), and then they gestured vaguely in the general direction of mental health (I think I’ve heard this song before). They don’t think about the fact that people can’t pay their rent and can’t feed their families. They don’t ever consider that maybe when people’s physical needs aren’t being met, they’re more likely to act out in anti-social ways.
Yes, mental health is an issue, but why do we feel like we can just gesture toward it or “raise awareness” and all of our mental health problems will go away? I don’t know how many campaigns I’ve seen to raise awareness or fight the stigma for mental health disorders, but I haven’t seen many that are doing the concrete work of improving access. Millions of Americans are underinsured and can’t afford the out of pocket cost for mental health counseling with any kind of regularity. I’m fortunate enough to have good insurance and the means to pay for mental health counseling, but I live in a small market where the need for all health care, including mental health care, far outpaces the community’s ability to provide such care. Where are the incentives for therapists to come to towns like mine? Where are the scholarship programs and/or tuition reimbursement programs for people going into social work or mental health counseling? Where are the non profit orgs and fundraising efforts to help pay for people’s therapy when their insurance won’t? In a quick Google search, I found no organizations doing this work.
My family is fortunate that we have mainly needed low-level, outpatient mental health support, but we have definitely had some situations that were headed toward acute pretty rapidly if that first line of support didn’t happen. Those who need ongoing acute mental health care aren’t just at risk of having a hard time or committing crimes (and spiraling through the further traumatizing effects of being put through the carceral system), their very lives are on the line.
For example, this summer a Salt Lake City woman named Shawna Wright died of heat exposure due to her unhoused status which was caused by the negligence of authorities to help her with her acute mental health care needs. According to an article by Katie McKellar and Katie Workman published in the The Deseret News, Shawna had nearly every possible advantage that one can have in this society — she was white, cis, middle class, and had the support of her family. Though she refused to shelter with her siblings when offered after her aging parents died, they tried to help her find housing that would be acceptable to her, and they planned to help her pay for it. But when they went to the housing authority, they found little help and an unwillingness to allow Shawna to apply for housing in a way that was accessible to her. McKellar and Workman report that she spent a few nights in a homeless shelter before checking out, and a few days later she was found dead in an alley during a heat wave.
Often a mental health crisis presents an opportunity to help someone before they harm themselves or someone else, and fumbling the ball can be lethal. In Shawna Wright’s case, the ball was fumbled by multiple systems. If even one of them had provided her appropriate help, her life might have been saved. The day before Daniel Prude was murdered by police during a mental health crisis, he had been seen in the emergency room and released back to his brother’s care with no additional support provided. When his brother made an undoubtedly desperate call to police for help when his crisis continued, they shot Daniel, killing him. We love to post hotline numbers and encourage people to reach out if they’re having a mental health crisis. Too often people do reach out for help only to be turned away or shamed/blamed to the point of having no choice but to suffer on their own.
We know Shawna’s name and circumstances because her supportive family recognized the injustice and published an obituary calling out the injustices in the system that ultimately led to their sister’s death. They also went to the media with her story. We know Daniel Prude’s name because his death happened during the height of Black Lives Matter protests that brought national media attention to murders of Black folks at the hands of police. Certainly Shawna’s mental health situation placed her at the margins of our society, and Daniel had multiple factors placing him even further to the edge. There are certainly countless other marginalized folks losing their lives whose names we’ll never know, because we have decided as a society that they don’t matter enough to bother with. They don’t matter enough to be housed, or to have appropriate care. They don’t matter enough to be admitted to the hospital or in-patient programs by caring family members (though the threshold for whether a person is a danger to themselves is certainly a conversation of its own).
Shawna’s and Daniel’s stories make me feel ill because they were people and they did matter. Every single person who dies from the negligence of our society to support them matters, and those who are currently struggling matter also. It is time for us to make mental health care and support for the disabled and mentally ill a priority.
While psychology is historically rooted in misogyny and white supremacy, there are many people in the field who are currently doing compassionate, trauma-informed work. The more people we have entering the counseling & mental health professions from a Critical Race Theory (CRT) perspective, the better job we can do of meeting people’s mental health needs. While dismantling the systems that create a lot of the mental health problems people are dealing with today is key, access to services that help people process their feelings and ongoing trauma gives us all better footing for fighting that fight.
It is still a privilege to go to therapy in this country. I’m a very privileged person in many regards, and yet accessing mental health for myself and the traumatized kids I parent is still extremely difficult. Shawna, too, held more privilege in our society than many, and she was still left for dead by those in authority to help. Of course people who are in less privileged positions are not doing very well. Every person who experiences trauma deserves the comfort and connection of high quality, trauma-informed mental health care, but the vast majority of them are not getting it. Every person with an acute mental health diagnosis deserves quality, acute care, but most of them are not getting it.
To modify a saying from Dr. Ross Greene, I believe people do well when they can, but for some reason when people aren’t doing well in our country, we don’t ask, what was going wrong, and how can we support them in getting their needs met in ways that don’t cause harm to themselves or others? Instead, we ask how we can punish them for their wrongdoing. If only the consequences had been worse, we postulate in comments sections, maybe they wouldn’t have done an anti-social thing. I’ve spent enough time with traumatized people to know that punishing them when they are having a hard time will do nothing but cause more trauma. When kids are having a hard time and acting out, punishing them might yield short-term results, but the only path to long term change is to support their physical, emotional, and mental health needs.
The sad thing is, these aren’t unique thoughts that I came up with on my own: Experience is a powerful teacher, of course, but more powerful than that is the knowledge I’ve gained from reading experts on the subject and getting expert coaching from qualified therapists and social workers. Stories like Shawna’s and Daniel’s further reinforce these ideas. This is common knowledge among behavior and mental health professionals. We know what we need to do. We can meet people’s basic physical needs for food and shelter. We can provide incentives for mental health professionals to work in underserved areas. We can offer tuition reimbursement for people who want to work in mental health professions (or better yet, offer everyone a free or affordable education). We can provide medical insurance that includes mental health care for everyone in America. If Jeff Bezos can go to outer space for funzies, then we can find a way to pay for these things. We know how to meet people’s needs, and in the United States we have the resources to do it.
Whether it is a need for first-line support or acute care, it’s time to acknowledge the humanity of those in mental health crisis by making these services available to every single person who needs and wants to utilize them.
