DepressionHealthcareNew York

Finding Mental Health Care Drives New Yorkers Insane

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by Hannah Harkness

A year after moving to NYC, I tweeted out “I have an NYC therapist and a Philly therapist because only a Philly therapist understands what 30 years of living in Philadelphia does to your mind.”

Like a lot of jokes on my Twitter feed, this was less of a joke and more of me trying to micro blog something that was deeply not funny in a way that wouldn’t blow up my phone with concerned phone calls when I wasn’t ready to talk.

I was having so many problems finding adequate mental health care that I had been commuting back to Philadelphia for a year to get talk therapy with my old therapist. I had been going through hell hiring and firing incompetent mental health providers in NYC. The process of finding a competent psychiatrist and a competent counselor was grueling.

On my one-hour lunch break of a 40-hour-a-week job, I would sit in the park or hunch down in the corner of my office with a print out of psychiatric practices from my insurance companies website and call every phone number on the sheet trying to find one person to take me. This was the only time I had that lined up within the typical business hours of a doctor’s office, and I was often unable to answer any call backs after my lunch break was over.

The process was the same: I’d call, and they were a) not accepting new patients b) accepting new patients but not for another 2 months/leave a voicemail and we’ll call you back when you can’t answer the phone c) no appointments available that did not conflict with my work schedule (and I was already taking too much time off because I was, well, not receiving adequate mental health care) or d) available… but terrible.

I would find an appointment with someone from option d, because what else could I do?

I’d  land myself in situations like the one with the psychiatrist who I had to argue with about what my copay was even though I was the benefits administrator at the company that my insurance was sponsored by… I ended up giving up and paying $80 more than my copay was supposed to be because I desperately needed my medication.

Later, when I went in for a medication maintenance appointment, I was directed to not my new doctor, but his assistant who kept me in the room with unnecessary personal questions and was staring… too much. I ended up begging my old primary care practice in Philadelphia to talk to my former psychiatrist I had through student services at Temple University to verify my prescription and start sending it to Brooklyn.

I went through multiple incompetent talk therapists before finally getting one from a personal referral. The most glaringly bad example was the woman who did not get out from behind her desk/computer the entire time and cut my appointment by 20 minutes because her secretary failed to let her know I was in the waiting room when my appointment was supposed to start. Then I’d be back to square one, hoping that I could manage to eat my lunch *and* be able to get someone on the phone that would give me a goddamn appointment.

At the time I was experiencing this, I had a mid-range salary and company sponsored insurance that covered mental health care. I was supposedly one of the “lucky ones” – not like the majority of my friends with no insurance at all or insurance that was barely accepted by anybody. And yet there I was, repeatedly taking the Chinatown bus to Philadelphia with my tail between my legs to have therapy appointments that largely consisted of me talking about how much trying to find mental health care was draining me. And my BiPolar 1 symptoms were getting worse. 

It’s true that mental health care access is much better than it used to be in NYC, but “much better” really just means “not completely a ghoulish dickensian nightmare all of the time.” Previously on this website, I’ve written about how NYC had a history of placing psychiatric hospitals on islands in the middle of the East River to separate them from society. One of these hospitals, a women’s psychiatric institution on Roosevelt Island, was where journalist Nellie Bly had herself committed in order to write an exposé on the poor conditions and abuse there called “10 days in a mad house” which led to a major push for healthcare reform in NYC. I read this, and the degree to which some of the quotes resonated with me made me a little sick seeing as it was written in 1887:

“I would like the expert physicians who are condemning me for my action, which has proven their ability to take a perfectly sane and healthy woman, shut her up and make her sit from 6 A. M. until 8 P. M. on straight-back benches, do not allow her to talk or move during these hours, give her no reading and let her know nothing of the world or its doings, give her bad food and harsh treatment, and see how long it will take to make her insane. Two months would make her a mental and physical wreck.”

(quoting a worker at the hospital)

“Well, I don’t care about that,” she said. “You are in a public institution now, and you can’t expect to get anything. This is charity, and you should be thankful for what you get.”

Of course I was in better conditions, but I felt the sting of being driven further insane by the providers that were supposed to be helping me. I also felt the warm glow of a gaslight from American society whispering “Hey, at least you *have* insurance. Be grateful!”

And I know I’m not alone. I’m a creative type, so comparing mental health provider horror stories is a regular pastime. I asked a friend of mine (who wishes to remain anonymous) to relay some of her experiences:

“I’ve had multiple doctors nearly kill me because of stupid medication-related mistakes, not doing enough research/tests to find out what was wrong with me at the time, and have had my health deteriorate because I couldn’t find help I could afford. If I did find it, I was told the psych/therapist/etc wasn’t taking new patients and had to keep looking. Many times I gave up and tried to do my best on my own.

 I have gotten worse because of medical “professionals” …insurance issues, being told I’m fine, told I’m “not sick enough” to to back to an inpatient program I was in the year prior (EDU, my weight wasn’t low enough …it soon became that), told I’m making issues up, that I’m not sick,  that I’m just anxiety-ridden, and I need to just “rest more.”

How often these things have happened is sickening. Even if you have medical care access, it doesn’t mean you’ll get it, and if you do it may not be good.”

I also asked for input from a friend of mine who is a housing court advocate who often has to work to obtain these services for clients (also anonymous):

“The fact is, the city has money allocated to help people with mental illness, but it’s so poorly mismanaged and terribly regulated that it often leaves the most vulnerable people absolutely fucked. The roadblocks in place between people who need help and the resources they’re entitled to by law (and, you know, basic humanity) are STAGGERING. There are good people working in the system, and lots of people who do goddamned miracles to get around the labyrinthine bureaucratic mazes set up between people who need help and ACTUAL help/resources. I’ve seen them working in the messes that are APS, HRA, SPOA, etc, and on the ground in various community-based centers and initiatives. But when it comes down to it, despite Mr. Rogers’ imperative, “the helpers” aren’t always there, and people fall through the entirely avoidable cracks.”

As my friend said, the city has money allocated for mental health care, most notably into Thrive NYC. Thrive NYC, launched in 2017 is a combination of new and previously existing programs focusing primarily on preventative care and public education. While many cities do not allocate money to these resources, and this is considered groundbreaking in some ways (look how lucky we are! They are trying!), this kind of approach is riddled with holes. The New York Post commented on this in an article:

Prioritizing prevention over treatment may sound savvy, but it is, in fact, an old idea that has never shown much promise, particularly with regard to the most severe thought and mood disorders. Firsthand accounts of dealing with a psychotic or deeply depressed family member often report seeing little advance warning of their illness prior to its emergence in the late-teen/early-adult years.

The sad truth is that there is no way to prevent serious mental illness, because the “root causes” are largely unknown.”

As a cynic, it is hard for me to ignore that these kinds of efforts are also less costly for cities to implement rather than providing the assistance needed for those with severe psychiatric issues. It only took a quick Google for me to confirm what I’d been hearing from friends: While public health initiatives are going up, if you actually need to be in a psychiatric hospital, good luck finding a bed – they are being cut. 

A report from the Manhattan Institute stated :

“In the 1950s, public mental health-care systems in New York and across the U.S. began shifting focus from inpatient to outpatient modes of treatment, a process often referred to as deinstitutionalization.”

Much of the public is familiar with its basic outlines. What’s less well known is that, in some jurisdictions, deinstitutionalization is an ongoing process.

Under the “Transformation Plan” for New York State’s Office of Mental Health (OMH), Governor Andrew Cuomo’s administration has been working to reduce both the average daily census and the total number of beds in state psychiatric centers. In the words of the Cuomo administration, by “reduc[ing] the need for unnecessary inpatient hospitalizations” and relying more on outpatient mental health services provided in a community setting, the Transformation Plan is designed to achieve the “better care, better health and better lives for those whom we serve—at lower costs.”

Listen, I’m all here for not institutionalizing people unnecessarily. I’ve heard plenty of horror stories of friends being committed by other people against their will when they were healthy who were unable to advocate for themselves. But half of my friends can’t seem to find a bed in a psych ward unless they are a severe threat to themselves or others. They need those beds and they shouldn’t have to have the mental equivalent of a gunshot wound in order to get one. Those beds need to be in a safe, well-funded hospital. And it’s impossible for me to ignore that it is much more expensive to add beds than it is to roll out free yoga classes and staff support hotlines. Cutting beds before the outpatient programs supposedly replacing them are fully rolled out is irresponsible. 

On January 8th, 2019 Mayor Bill DeBlasio announced the rollout NYC Care – a healthcare initiative that will guarantee insurance to all New Yorkers. According to the press release, NYC Care will launch in summer 2019 and will roll out geographically, starting in the Bronx. It will be fully available to all New Yorkers across the five boroughs in 2021. The program will cost at least $100 million annually at full scale. Additionally, MetroPlus will announce a series of enhancements throughout the year(primary, specialty, and mental health care services).

That’s all well and good, although I find myself muttering “You don’t get a cookie for doing the right thing.”

But what good is providing insurance for mental health care when mental health care barely takes insurance or makes it a nightmare? A 2017 report by Milliman, a healthcare consulting and risk management company, addressed this. Some key findings:

  • In 2015, behavioral care was four to six times more likely to be provided out-of-network than medical or surgical care.
  • Insurers paid primary care providers 20% more for the same types of care than they paid addiction and mental health care specialists, including psychiatrists.
  • State statistics vary widely. In New Jersey, 45% of office visits for behavioral health care were out-of-network. In Washington D.C., it was 63%.

We’re living in a traumatizing period of history and need mental health care more than ever. Catastrophic storms are wrecking communities and robbing people of everything that they have, forcing them into a new life of poverty somewhere unfamiliar. People are having family members detained and deported. Children are being separated from their parents and videos of them in cages are being shown on the news. Mass shootings barely even make headlines.

Ironically, mass shootings are frequently attributed to mental health (Hello, government! If you’re not going to put gun laws in place, by all means, expand mental health care! I’m waiting! But I don’t think the overhaul the system needs is going to happen fast enough to slow the body count!).

All of this is just what happens on the news. When you add all of your personal neurosis, traumas, and general stresses that go with living in an anxiety-ridden city with skyrocketing rent, you have a city that needs therapy.

I don’t want to be a “lucky person” with insurance. I want to be a regular person getting the same quality mental health care that everyone else is getting. This is not “Charity.”

This is a human right. 

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