The Illusion of Accessible Mental Health Care
There’s an illusion that mental health care is available for those who need or want it. Unfortunately, in my experience, and in observing many families over the last 10 years, this is not the case.
Here in my county, Orange County, California. There are several agencies and organizations that appear to be the answer we’re looking for when we, or our loved one, need treatment for a serious mental illness.
I chose one to use as an example (without naming it). Their website says:
“Access to responsive, compassionate care is essential when mental health or substance use issues arise. At ____________, we offer help and support with respect, dignity and compassion. Our multidisciplinary team provides an integrative approach designed to fit the needs of our clients.”
This sounds great. So does everything else they say on their website. But in reality, they only provide a Band-Aid to a gaping wound. They offer 24-hour stabilization for someone in crisis, they offer an assessment team that will transport a client to the hospital, and they provide support in finding resources for mental health. That's pretty much it.
“Our Crisis Residential Program is a positive, temporary alternative for people experiencing an acute psychiatric episode or intense emotional distress.
The program provides crisis stabilization, medication monitoring, and evaluation to determine the need for additional services. The safe, accepting environment operates under a flexible, social rehabilitation model that adapts to the client’s needs. It connects people with the resources to remain as independent as possible and develop an actionable recovery plan. Stays in the program are generally 30 days or fewer.”
It sounds so hopeful, doesn’t it? But 30 days or fewer is not enough to provide the kind of care someone with an ongoing, debilitating mental illness. All of the organizations I know of in OC offer similar help, Band-Aids.
Where do you go when you need long term evaluation to correctly diagnose, medicate and stabilize someone with major depression, severe anxiety, Bi-polar or schizophrenia? Here are some examples of people I know personally where the family felt lost and scared and had no idea how to get their teen or adult child long term help:
A sweet 16-year-old girl who out of nowhere has a psychotic break and starts stabbing her father with a butcher knife.
A young man who hears voices telling him to do things, including harm others and himself.
A 35-year-old who has to live with his parents because he is not able to function as a responsible adult due to severe depression and anxiety.
A woman who goes into a blackout due to her mental illness and wanders the streets aimlessly for weeks unaware of what she’s doing or where she is.
These people need more than a 30 day or less program. What if someone could stay for 60 days, or 90 days and be stable on medication before they left. What if the program helped them learn how to integrate into society? Why isn’t there somewhere like that?
I researched this and all the articles I found agreed on the "why", this is from one of them:
For the majority of these untreated or under-treated individuals, the main barriers to mental health treatment and access are:
Financial barriers to mental health treatment
Lack of mental health care professionals and services
Limited availability of mental health education and awareness
Social stigma of mental health treatment and conditions
Racial barriers to mental health care access and treatment
When mental health issues and illnesses go untreated, they affect a person’s ability to live a fulfilling life and carry on with school, work, or family responsibilities.
Ensuring that individuals have access to mental health care can improve lives and communities. For many, removing these barriers to mental health treatment can dramatically reduce or eliminate the risk of suicide, legal issues, family conflict, unemployment, and substance abuse.
People with mental illness are often treated like criminals (because sometimes they have manic episodes that cause them to do things that get them arrested). If they are a threat to others, they have to be taken into custody, and if they're lucky, the arresting officers know how to handle mental illness, which isn't always the case. Just ask my friend Stephanie who lost her son when the police thought he had a weapon, but he didn’t, he was in a mental health crisis and they shot and killed him, her story is in my new book.
Then they are:
Kept in jail for awhile, or
Sent to prison if it's a violent offense
Let back out on the streets
Released to their family that has been struggling for years to get them the right care
OR
Here in OC they may get sent to one of our collaborative court programs: Opportunity Court, Drug Court, or WIT program (WIT = whatever it takes)
Some people who go through these court programs are able to turn their lives around.
There are organizations out there that imply they offer help, but in reality, they provide information, resources and education on mental illness - some with added "services" such as out-patient therapy or hotlines.
NAMI is a well-known national organization. They are good at what they do but I can't tell you how often people refer others to NAMI for HELP. They don't HELP. They offer support groups and educational classes. There is no facility associated with NAMI or any of these other places we get referred to time and time again. They are advocates and educators. That's it (please go check this out for yourself on their website).
I took NAMI's intense 12-week course on mental illness, "Family to Family." It taught me a ton about mental illness. I can tell you all about the five types of schizophrenia (Paranoid, Undifferentiated, Hebephrenic, Residual, Catatonic) or the four types of Bi-Polar, but having that knowledge didn’t help my son get better!
What we need is an affordable inpatient hospital or facility that can correctly diagnose, medicate and counsel and keep you safe until you have a stable living environment and/or job to return to.
There is a place in Costa Mesa, CA where Keven went for this type of treatment and they kicked him out after two days because he wasn't cooperating with the program...no kidding, that's why he needs the program, he's all messed up in the head! I've heard terrible things about that place, so it was probably a blessing in disguise.
I recently sat through a presentation put on by a well-known Mental Health Services organization. It's been around for years, it's a non-profit and the heart behind what they do is sincere. I will not name them; I’m using them as an example of why people THINK there is help because there are many of these types of places but very few places that offer the type of services needed to actually help someone suffering from mental illness.
Upon finding their website or hearing about them you may think, "great I found something to help my loved one who is depressed, anxious and can’t function in life." But what do they really do? Here is what they offer:
24/7 bilingual Crisis Line and Disaster Distress Helpline
Crisis Chat
Therapy and Support
Training and Education
They don’t have a facility for inpatient help. They only have out-patient therapy. They have a crisis line (phone and chat) and they offer education about suicide prevention, substance abuse and “continuing education”.
Another organization sends out a crisis intervention team of experts to evaluate someone in their home (or in public) if they are having a mental health crisis or are in psychosis etc. There are two issues here:
1) If they bring you to a hospital's behavioral health unit, the max hours you can stay is 72. Not enough to correctly diagnose or help.
2) They always bring a police officer with them for protection which is understandable but, in many cases, could escalate the issue. I called this place several times and begged them to leave the officer out of site because Keven threatened "suicide by cop". But they couldn't, so they were unable to help me get him out of my house and into a hospital setting.
I know of one place in Orange County that offers long term (if you consider 90 days long term) care. ONE PLACE in all of my county. It requires PPO insurance. I have a friend who went through their program and did very well, until she had no place to live and moved back in with a friend who used drugs. Her family didn’t want her to live with them because of her past behavior. She tried but couldn't get a job. Her choices were the streets or a friend that used the same drug that was her drug of choice. I don’t know how she is today but considering she won’t answer my calls, she's most likely not doing well. This is common, her story is not unique in any way!
There is one more frustration related to mental health care: stigma. People (including me) throw that word around a lot when talking about substance abuse disorder, mental illness. What does it really mean? What is stigma? It’s a “mark of disgrace associated with a particular circumstance, quality, or person” - a mark of disgrace against someone with an illness that makes their quality of life terrible, at no fault of their own.
I know a lot of people will disagree with me. Some people say “it's their own fault.” which is ignorant and judgmental. Others have never lived with or loved someone who suffers this way. And trust me - it is suffering. Their families often suffer even more than they do because they have the capacity to fully comprehend how terrible the system is and how little help is available.
Sometimes I wonder what would have happened if President Reagan hadn’t abolished mental health institutions. They released all the patients back to their families by establishing conservatorship. Having conservatorship does nothing to help the person in need. Instead of trying to treat the illness the family is left responsible with nowhere to turn.
If you're read this far, you either sincerely care or you can personally relate. I know this is long, I appreciate your time. I had to get this out, my writing usually comes from passion or frustration, this one is a combo of both.
I will leave you with this info I got from here:
In the U.S., mental health issues are far more common than many realize. According to the U.S. Department of Health and Human Services, one in five American adults have experienced a mental health issue, and one in 20 Americans live with a serious mental illness, such as schizophrenia, bipolar disorder, or major depression.
For many, mental illness can be challenging to manage on one’s own. Access to mental health care is crucial to helping individuals receive the necessary support to address their illnesses. However, today, more than half of adults with mental illness in the U.S. (a total of 27 million people) do not receive the mental health treatment they need.
For the majority of these untreated or under-treated individuals, the main barriers to mental health treatment and access are:
Financial barriers to mental health treatment
Lack of mental health care professionals and services
Limited availability of mental health education and awareness
Social stigma of mental health treatment and conditions
Racial barriers to mental health care access and treatment
When mental health issues and illnesses go untreated, they affect a person’s ability to live a fulfilling life and carry on with school, work, or family responsibilities.
Ensuring that individuals have access to mental health care can improve lives and communities. For many, removing these barriers to mental health treatment can dramatically reduce or eliminate the risk of suicide, legal issues, family conflict, unemployment, and substance abuse.
Thank you for listening. If you want to share a story I will create a "Part 2" as a follow up to this post. Please email me. Of course, it can be anonymous.