Treating Mental Health in America is a Privilege, But it Shouldn’t Be

Illustration: Hannah Daisy / @makedaisychains on Instagram

(Essay originally appeared in Slutmouth Magazine on October 18, 2018.)

Therapy and other mental health treatments, particularly in the United States, are a privilege.

Not all insurance companies cover mental health services, and if they do, they often make you go through your deductible before allowing you to use the specialist copay rate, or they may limit the number of visits you can have per calendar year. For example, if your therapist recommends that you have weekly sessions, you may not be able to do that without incurring high out-of-pocket costs.

With deductibles, they reset each year so you’ll find yourself repeating the process of paying high out-of-pocket costs to seek mental health services.

That is, if the therapist even accepts your insurance. Many therapists do not take certain private insurance plans or Medicaid, or any insurance at all. A few years ago – when I first started seeking therapy services – I ran into this problem. After cross-referencing the information I found on a “find a therapist” website and my insurance company’s “find a doctor” function, I called a number of therapists only to find out they weren’t actually covered under my insurance because they went out-of-network and the information hadn’t been updated.

Another problem with trying to find a therapist or a psychiatrist is that many times they are not accepting new patients because they are already stretched too thin due to lack of providers in the area. According to Mental Health America, “there’s only one mental health professional per 1,260 people” in Alabama.

For me, it took several weeks to be placed with a counselor where I currently seek therapy. There isn’t a shortage of mental health professionals in my area, but they are still stretched thin. I am supposed to have weekly sessions but there have been weeks where I have not been scheduled sessions because they were simply too booked and had no availability when I was available for a session.

And forget if you have to work a standard 9-to-5 schedule. Not many therapists or psychiatrists have late hours and if they do, they are often always booked which is another roadblock that makes treating mental health conditions a challenge.

Sure, there are telehealth options such as Talkspace and BetterHelp, and moodgym for online self-help, but they do not provide the same benefits as in-person therapy. I used BetterHelp for about a year and although there were many pros to using it such as flexibility in being able to contact my therapist and lower costs compared to traditional in-person therapy, I found that I personally would benefit better from face-to-face therapy. I am not knocking these types of counseling, because I think for some people they are really helpful and a great stepping stone. It was helpful for me for a time, so I would not call it a bad experience. It worked until I outgrew it.

My current therapist, who I see most weeks once per week, uses a combination of Cognitive Behavioral Therapy and mindfulness techniques to help me understand my thoughts and behaviors. I have bipolar disorder, anxiety, ADD, and recently went through (and in some ways still am going through) the grieving process of losing a close loved one. I also have some past trauma as part of being an adult child of an alcoholic. Being able to speak to someone, see their reactions and work together on therapy worksheets instead of just completing them on my own, has been incredibly helpful already. I know I have a long way to go on my journey to managing my conditions, but I am grateful that I am able to make it work despite the high cost.

I am one of the patients whose insurance company wants them to use the deductible first before any copay rates. I have a deductible of $1,500. I doubt I will meet my deductible before the end of the year, and it will reset in January (and the premium will go up too but that’s another story). I consider myself lucky that the rate to see my therapist is not as high as some other therapist’s offices in the area where I live. I pay $100 for the first visit of the calendar year, and $86 for subsequent visits. Don’t get me wrong, these are still pretty high costs for therapy visits considering I was paying $90 per month after financial assistance for unlimited access to a therapist through BetterHelp. In some ways, because I do not work full-time, being forced to skip a week due to lack of availability on my therapist’s end has been a blessing in disguise… at least for my wallet.

Access to therapy and other mental health services is incredibly important, whether you have a mental health condition or not. Simply going through a life change and having a therapist to talk to can be incredibly beneficial. I think that everyone can benefit from therapy at some point in their life, whether it is individual or group therapy.

I have gone through several therapists. I had a therapist in high school, a counselor at the first college I went to and a couple of BetterHelp therapists before seeing my current therapist. I tried out a therapist who was part of my primary care physician’s medical group, but it didn’t work out because I would have gone three weeks between sessions because she was that overbooked.

Some folks have to vet a therapist and make sure their views line up with their beliefs, values, and identities. If you are LGBTQIA you definitely do not want a therapist who has views that are harmful to your identities and values. That is an extra step that can be costly both in time and money (but unfortunately necessary) to do.

Once you have found a therapist and – when appropriate – you have a diagnosis, you may be recommended to see a psychiatrist or other doctor who can prescribe you medication to help manage your conditions alongside therapy. The process of finding a doctor to prescribe medication is similar to finding a therapist: Where are they located? Do they take my insurance? Are they accepting new patients? What are their views on X subject?

Location is also incredibly important. Some people travel up to one hour for their appointments. The most I have ever traveled to see a doctor was 2.5 hours on public transit. At the time, they were the closest doctor who took my insurance and was accepting new patients. My current doctor may be going out-of-network, or at least was considering it, which will mean that I have to start the process of finding a doctor all over again. Or maybe my doctor won’t go out of network and I won’t have to pay $150 per month for a 5 minute appointment. Who knows. I surely don’t.

Access to mental health services should not be a privilege, but it is. It requires a lot of time and out-of-pocket costs. The stigma around mental health has decreased over the years, so why is our access to these services not improving? In MHA’s report, over 43 million American adults have a mental health condition and 56 percent of American adults with a mental health condition did not receive treatment. Access to care for youth is limited too, with 7.7 percent of youth having no access to mental health services through their private insurance.

Mental health services should be as accessible as going to a primary care physician’s office. We should not have to jump through hoops to take care of ourselves. A lot of times it is easier to get treatment for bronchitis than it is for anxiety or major depressive episodes because you can just walk into an urgent care office or (usually) easily schedule a doctor’s appointment. Why make mental health services so much more difficult to gain access to? What is the benefit of doing so?

Health insurance companies, lawmakers, I’ll be waiting for your response.

Words Matter: How ‘Harmless’ Comments Have Affected My Body Image Over the Years

Photo Source: Pexels

(Essay originally appeared in Slutmouth Magazine on Sept. 23, 2018)

I grew up plus-sized. I have always felt uncomfortable with my body and how I looked, and the comments I heard or read often made it worse. From a young age, I struggled not to internalize those comments and use them for my own self-destruction and self-sabotage, but failed.

I never really understood why the people who said these comments ever thought they were helping or that the comments were okay. It’s the equivalent of punching someone in the face and then having the audacity to ask them why they’re bleeding – why would you say these comments to a person and then ask why they have a negative body image or (in a potentially extreme situation) have an eating disorder?

Here are just some of the comments and interactions that have stuck with me throughout my life:

1. “Why don’t you look thin like X?” (age 11)
   This was said to me when I was in the 6th grade. I would later look up pages on how to lose weight fast and got redirected into the world of pro-ana/pro-mia websites. Although I never actually developed anorexia or bulimia, I did binge eat a lot whenever I got upset and thought about this.
2. Finding out that there were several blog posts dedicated to me and my weight. (age 13)
   Several classmates befriended me in 7th and 8th grade. I thought nothing malicious of it, but oh boy, was I naive. I later found their Xanga blogs (I’m dating myself here by mentioning Xanga), and saw they would refer to me as “Momo Jiggles” because I guess I …jiggled when I ran in gym class. I never said my classmates were original or creative, so I suppose it could have been worse. However, this was a devastating blow to a kid who had already been showing early signs of mental health issues. I would sink deeper into my depression for a few years and go undiagnosed until I was a junior in high school, but that’s another story for a different day.
3. “If you lost some weight you’d feel better.” (age 26 through present day)
   Several people have told me this. A variant from a doctor: “the edema in your leg is probably weight-related,” implying that I needed to lose weight and my edema would be magically cured. I’m not saying I’m anti-exercise or healthy eating, because I’m actually fairly healthy for someone who is overweight. I know, I know, what I just said is super controversial so I’ll say it again. I’m actually fairly healthy for someone who is overweight. I have a high ANA (antinuclear antibody) panel, have had some inflammation in my liver likely from the advil I took the day prior to the blood test and had Fifth Disease (parvovirus) as a kid, but other than that? Healthy. As. A. Horse. Not diabetic (knock on wood). No high cholesterol. No high blood pressure. Okay, fine. I’m also constantly fatigued and have chronic pain. I also have lost 15 pounds in the last months, but guess what? I’m still fatigued and have chronic pain. Go figure. 
4. “If you lose some weight, you could have better luck finding a partner,” and “Think about how you’ll look on your wedding day if you lose some weight.”
   Oh, so the end goal for losing weight isn’t health or self-love or happiness, it’s to find a partner? Right? That makes no sense, and yet it was said to me all-too-frequently in high school and college. When I got engaged I thought that would die down, but it only transformed into a comment about how I will look on my wedding day. I’ll let you all in on a secret: I look great in my wedding dress and actually have to have it taken in a bit. Probably a little more since I’ve lost that weight since I last tried it on. 
5. “She has broad shoulders like a linebacker.” (age 10?)
   I never wanted to make myself appear smaller than when I heard that descriptor used on me. I used to hate how broad my shoulders are because it meant that I could (at the time) never pull off dainty, feminine clothing. Nowadays, I wear whatever I want and don’t really care as much about how my shoulders look. The only exception being when I’m trying on some sort of fast fashion article of clothing. They always run small. 
6. “You don’t want to build more muscle in your calves; they’re already big enough.” (whenever I have expressed a desire to take exercise seriously)
   Whenever I would go to the gym, which would be a big feat in and of itself because of my weird relationship with my body, gyms and losing weight, I always had someone – usually a person who wanted me to lose weight to begin with – telling me not to develop too much muscle in certain areas. It’s almost as if I can’t win. Listen, either you want me to lose weight (which may result in the development of muscle as the fat gets burned) or you don’t want me to lose weight. Also please stop telling me to lose weight. I’m working on it, okay?

There are probably more comments and interactions but these are the ones that have stuck out the most. I may have forgiven the people who have said them, but I don’t really see myself forgetting their words any time soon. I have spent years internalizing these comments and experiences, that I cannot and will not just flip a switch and pretend they were never said.

Rather than use these comments and situations as weapons against myself, as I have done for so long, I am going to try to undo the negative thinking. One way I am going to do that is through daily positive affirmations. I am going to make the habit of building myself up, rather than tearing myself down. Words matter. What we tell ourselves matters. I don’t like negative comments about my appearance (regardless of intention) said by other people, so why should I let myself get away with saying these things about myself? It’s imperative to hold ourselves to the same standards that we hold others. I recently told a friend who was struggling with self-love, “you wouldn’t like it if people say those things about you, so why would you say those things about yourself?” It’s a tough pill to swallow, but thankfully I have a tall glass of water.

I can learn to love myself no matter how I look, and it doesn’t matter if I’m thin or fat. What’s important is that I feel – at the very least – okay with myself. Sometimes, some days, I can get there. I am going to strive for more days like that. Are you with me or against me?

Breaking Free from ‘Blank Page Syndrome’

(Originally published on Medium on Feb 11, 2018)

Blank Page Syndrome.

You have probably never heard of it before because my partner made it up while working on a blog post for a coding project, but it is the perfect description for the writer’s block I have been experiencing. Depending on what project we’re talking about, I have been a long-term sufferer of Blank Page Syndrome — approximately four years and counting.

I have two major projects that I have been trying to work on since I graduated from college in 2014: a personal essay collection and a short story collection. When I decided to take on these projects, I pictured myself to be somewhere between David Sedaris, Raymond Carver and Sloane Crosley. Minimalist but funny and appealing. However, whenever I try to pick up pen and paper or open up a document on my computer I find myself at a loss. I haven’t written any fiction pieces since 2013 nor have I done anything I feel is remarkable enough to chronicle in a personal essay collection.

Ignoring my major projects, it’s near difficult to write an article for publication. The last article I wrote for The Mighty, for example, was in November. I do have pitches written up but I struggle to turn them into actual content that people might be interested in reading.

And I think that’s the problem.

I don’t write for myself and instead write for others’ enjoyment. Writing has simply become a chore.

This realization alone will not fix my Blank Page Syndrome, however. There is more that needs to be done, but this is a start.

Here are some other ways to combat Blank Page Syndrome once and for all:

1. Create a designated work space.
   I live in a small, one bedroom apartment and find that the kitchen table is a good work space for me. I try to stay out of the bedroom, even if it’s the most comfortable space in my home, when it comes to work.
2. Keep a notebook beside your bed, in your handbag/backpack, etc.
   That being said, I believe that journaling, free-writing your thoughts onto a piece of paper can be extremely helpful in the creative process. Keeping a notebook by your bed and journaling when you first wake up (or before bed) can be help not only the creative process, but help ease any worries you may have about the day. Have downtime on public transit? Write.
3. Use writing prompts for creative free-write sessions.
   Not sure what to write about? Look at writing prompts to get ideas of what to write about. There are plenty of resources for writing prompts, including this Medium article that provides six different websites you can use to find writing prompts.
4. Have set hours for working.
   I have a routine where I am out of bed and ready to work on job applications by 10 a.m. Why not have set hours to work on writing as well? On a good day I tend to finish my 20 job applications by 1:30/2 p.m. and have the rest of the afternoon to devote to other activities while my partner works on coding coursework. Rather than browse social media, constantly refreshing my screen for updates, I could spend a two or three hour block writing instead. It doesn’t sound like a lot of time, but to get back into the groove of writing it’s important to start small.
5. Don’t write every day.
   Now this one sounds a bit different from advice you may have read in the past but hear me out. I don’t believe that you should write every day. Journaling, yes, but actual fiction or non-fiction writing shouldn’t be done every single day. I believe that that is how burnout can happen. Sure, if you’re on a writing spree by all means go for it, but for those who are getting back into the groove of writing should have designated days off much like you do at a regular 9-to-5 job. It will help decrease the chances of burnout and hating everything you’ve ever written (that last part was more for myself than anyone else).
6. If you work best with music, choose songs that don’t have lyrics.
   My partner has a playlist of songs that he refers to as “coding music.” It also helps me get into the mindset to tackle whatever it is I am trying to work on at a given moment. I find that if there are lyrics in the songs, I can’t focus as easily as I could if it were just instrumental.
7. Don’t give up.
   Getting back into the swing of things likely won’t happen overnight. It could take weeks or months, but the important part is that you don’t give up and you fully commit yourself to whatever writing project you’re working on.

I think that’s a good place to start.