If there's one thing we can all agree on, it's that mental health care in the United States is as broken as a Trent Reznor sad-off with the Cure. Being the "quickest, simplest fix we can muster" creatures that we are, we decided that we should patch it with one simple law and then never talk about it again.
But that's not enough, because mental health is an astronomically vast and complex issue with wildly varying degrees of severity. Our current system can't even begin to tackle the library-length definitions because we're still fumbling around at the most basic levels. For instance ...
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If you're lucky enough to have generalized anxiety/PTSD/phobia/obsessive compulsive disorder (to list the most common disorders), you may already have a pretty solid understanding of this entry since, statistically speaking, no one has ever helped you. Just because your brain has turned on you faster than your drunken aunt at Christmas dinner doesn't mean you're actually going to get a ticket on the treatment train to Curesville.
Of the 46 million Americans with a mental health problem, only 38 percent end up getting treatment. Among those who don't, 7 percent don't want anyone to find out they have a problem, 17 percent don't know where to go, and 50 percent just plum can't afford it. Doctors who specialize in making sure your brain doesn't have a demon shitting in it are the hardest doctors in the country to find: Almost 90 million Americans live in "Mental Health Professional Shortage Areas." What does that mean? Well, take a look at this chart:
I FUCKING SAID LOOK AT IT!
It means that in parts of our country, there is one psychiatrist for every 30,000 citizens. Considering that 1 in 4 Americans has a diagnosable mental disorder, that's roughly the equivalent of a single NFL referee explaining the last call to each person in the stands individually.
But that's just the numbers-icing on the can't-get-treatment cake. The real problem here is shame, which I guess is trans fat in this metaphor. Christ, I'm hungry. The thing that sets mental health problems apart is that no one's ashamed of getting the flu, and fighting something like cancer even wins you some social bonus points. But aside from the occasional Oscar-bait Ron Howard flick about triumphantly overcoming your cartoonishly simplified version of schizophrenia, insanity is just comedy fodder. Once you're diagnosed as mentally ill, if you're not the butt of some joke about acting weird ("You total nut job!" or "That's mental" if you're Ron Weasley), your entire experience will be dismissed as something quirky ("I have such OCD about not wanting dog poop in my pasta!"). And since most mental illnesses are easy enough to hide, it can seem simpler to just not tell anyone and suffer alone. And that's the problem: If you skip your cancer treatment, everyone will think you're crazy. If you skip your psych meds, no one will.
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You're sad because someone made you wear that sweater, right?
Besides, treatment is expensive, and not just in how much you pay: Being mentally ill makes it harder to keep a job, so a diagnosis gangbangs your wallet from both ends. But unlike the flu, you can't just get over most mental illnesses. They're like the One Ring of Power: The longer you keep one around, the worse its hold over you gets. So you decide to take off your shoes and walk your creepy-looking feet to the local volcano to finally do something about it. But when you show up, you find 17 different pools of lava and 20 different volcano guides telling you you're at the wrong one, because ...
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When you hear the phrase "mental health care system," you probably imagine a bunch of organizations passing files around and wearing fancy suits and using big businessy words with each other, but in reality, there's pretty much no inter-departmental coordination in mental health care. According to experts, they all just stumble around like visiting family members in the kitchen over the holidays: They're ostensibly working toward the same goal, but doing so in totally different ways, stubbornly insisting that theirs is the only way that makes sense, utterly refusing to talk about it, and drinking lots of cheap red wine while calling your cousin a worthless whore. If you're a kid with an illness, the school you attend, your counselor, and the juvenile justice system (which you will most likely become acquainted with) are all likely to recommend totally different things -- or even repeat treatments just because paperwork hasn't been exchanged properly. Experts insist that "system" isn't even an appropriate word to describe it, but I suppose "clusterfuck" isn't entirely appropriate for textbooks and government reports.
And every part of the system is specialized. An emergency room, for example, can help someone who is on the verge of hurting himself, but once that immediate problem is treated, they're done. The patient is sent home with a stern "don't try to kill yourself again," and nothing treats severe depression better than a stranger in a white coat making perfunctory professional remarks.
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"I'm writing you a prescription of 'stop being depressed.' Take one a day, forever."
It's such a mess that people in desperate need of help have no idea what to do or who to contact. Parents have actually called the cops on their own kids to get them arrested, hoping that throwing them headlong into the system would actually get them the help they need. That might help explain why half the people in prison have mental health problems. I (briefly) taught a poetry workshop in a federal prison, and to me, that fraction seems a bit small -- but it helps explain why so many people in prison end up reoffending when they get out. No matter what fucked up game your brain is playing on you, being locked in a tiny room isn't going to help.
Again, the differences between mental illness and physical illness are thrown into sharp relief: Breaking the law to pay for your cancer treatment is a TV show. Stealing to eat because you're too anxious to work isn't even a headline.
Sometimes, it just takes a person with a clipboard yelling at you in an alley to get your ass back in gear.
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While many physical illnesses are recurring, most mental illnesses last forever. No matter your treatment, you never get to slay that final boss and teabag his smoldering corpse because there are no cures for mental illnesses. That pill you take? That therapy? Whatever it is, there's no solution you're working toward -- you're just trying to make it as easy as possible to live with and manage your affliction. It's part of your life now. Forever, like a bad case of "I'd like to hear some funky Dixieland" echoing in your thoughts until the day of your sweet, mortal release. Even after your symptoms disappear.
What sets this apart from most recurring physical illnesses is that the stigma stays with you, too. That difficulty finding a job we mentioned earlier? That's not something that goes away once you get treatment -- you just learn how to manage it so you don't end up rotting away in your apartment as, one by one, the utilities disappear. The best you can hope for is going into "remission," but since "the lack of symptoms alone is not an adequate gauge of remission," lots of people will never feel like they have any control over when that remission happens, or what it even is. You're just waiting for someone else to tell you that your brain is working again. Forever.
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"That'll be $4 million."
So what does that mean in terms of the system? Well, with regular physical health care, unless your problem is ongoing like diabetes or terminal like the self-punch virus, patients will show up, collect their cure, and then disappear for the next half a year. It's why physical doctors can take on so many patients. It's in-and-out.
Mental health care, however, is oftentimes a lifelong commitment involving not only medication, but counseling and psychiatric evaluations that require more frequent trips to the doctor and close personal interaction. Treating a cold is easy because the symptoms are always the same and it goes away on its own. Treating any of the five types of schizophrenia is an ongoing process that requires constant medication and professional monitoring. Just getting a correct diagnosis of the problem can take months. Sometimes, years.
"Just relax and breathe deep. We're going to remove your brain to see what's wrong."
Speaking of which ...