I sat on our couch, with Shoes on one side of me, Dog on the other, sobbing quietly while we watched hours worth of news coverage. Shoes teared, too. There came a point where he softly said, "We have to get out of this house for awhile."
Because we knew we couldn't not watch. (And even as we left, we were fully cognizant that we had the choice to leave this pain for a bit.) As we drove away, we talked about when the words "mental health services" and "gun control" would pop up.
This post is about mental health services.
Gun control might be a different post.
I might skip gun control altogether.
We'll see.
The phrase that brought on this posting is the phrase: "We need better access to mental health services in America."
So before we start, let's be honest about myself as a writer. This post is in no way unbiased. I am a 34 year old, Caucasian, middle class, heterosexual woman who holds a Masters Degree in Social Work, specializing in community outpatient mental health. As a human being, I hold a ridiculous amount of privilege and cultural capital. I say that because I recognize it and I want to invite you to honestly call out my biases as you see fit if you choose to comment. I am completely open to that.
I know some of my readers have counseling backgrounds, but for those of you who might not, community outpatient mental health translates to: I provide counseling services to a population who is assisted by Medicaid/Medicare.
When Adam Lanza heartbreakingly caused so much pain in Newtown, one of the first things I heard was, "Isn't it a shame, the state of mental health services in this country."
1. Yes.
2. Let's be careful.
Let's be careful because the coroner is still waiting on the results of Adam Lanza's toxicology report to see if there might have been any psychiatric medications in his system. Initial reports seem to have initially suggested that Adam had Asperger's. Let's be careful - AND - let's be clear. Disorders on the Autism Spectrum are not mental health disorders. Disorders on the Autism Spectrum are developmental disorders. Violent behavior is not a characteristic, necessarily, of people who have disorders on the autism spectrum; while violent behavior may occur in people who have an autism spectrum disorder, the aggressive behavior is often directed towards the person him/herself and is often a result of being unable to effectively communicate needs, wants, frustration, etc.
Ok. We're good with that distinction, right? We can move on? It was slightly tangential, but it irritated me to no end to hear news sources incorrectly link autism to mental health disorders.
Now. Let's talk about the state of mental health services in my area. (Because I don't know what it's like, but I might be able to guess, in Wyoming. Or Texas. Or New York. Or Delaware.)
My agency is drowning. We are drowning in a crush of people who need mental health services. Our intake numbers are high. After intake, there is most often a waiting list to get on a therapist's caseload. Often times I have 6, 7, or 8 back to back appointments of ongoing therapy clients a day, which often get CANCELLED because we all cover crisis mental health calls as well. Here's the shocking thing: there are only 22,000 people who live in the county I primarily work in and just 2,000 people who live in the other county we serve. The State of Washington estimates it takes between 2 and 3 years for mental health workers to gain enough of the required hours to apply/test for mental health licensure. At my clinic, we average about 1.5 years. Even though the population is so low, the need is so very high. We have a disproportionately high number of people who live below the federal poverty line, are addicted to drugs/alcohol and who have severe (SEVERE) trauma histories.
Mental health services work best when there's a wraparound component, right? We do have a chemical dependency team at our agency. They are truly fabulous. We do not have a detox center in all of the county or a homeless shelter. Remember Maslow's hierarchy of needs?
So, tell me, in this rural county that has almost no services, how exactly I am supposed to address higher order cognitive thinking errors when what many of my clients are truly focused on is where they are going to sleep tonight in the 5 degree weather. (This is when I start to miss Portland, because, even though the homeless shelters could be difficult to get in to, they still existed. They were there. And many churches opened warming centers in the winter.)
Here's another thing. The clients we help qualify for Medicaid or Medicare (either food stamps or medical or TANF or SSI, etc.). There's an entire population of people we have to turn away because they exceed our limited income / state assistance requirements, yet, they find the cost of a private counselor to be overwhelming. We have a tiny grant to assist us with people who barely exceed the financial qualifications but can't afford a private counselor; I don't feel like talking numbers, but even that is insufficient.
The state of mental health services in America?
It's in shambles, dear hearts.
The boat is sinking and we're using teaspoons to try to empty out the water that's pouring into said boat.
I work with a talented group of mental health therapists. Seriously, show-stoppingly talented. Sometimes we work 32 hour shifts. We do not get paid well. We barely have benefits. We try to work on re-paying our student loans, but ... ha ha. We want to meet with our on going clients. We want to do the work.
There are barely any resources to do the work.
Often it seems like there are barely any benefits to doing the work.
Reaching 2 years as a therapist at my current agency is considered a true milestone.
So what do I do?
I write letters to congresspeople. I am there for my clients. I am there for my co workers. What do I do? I keep going to work every day, 12 hours a day. I pray a lot. I believe for the best a lot. One of the scriptures I hold on to from my old church days reads, "I would have lost heart had I not believed that I would see the goodness of the Lord in the land of the living." And so I believe that the goodness is for the living. The here and now. That change is possible now.
I want to end on what might seem to be a random note ... and that is: who is it that is needing mental health services in America? Who are those people who need therapy?
I would like to introduce myself as a consumer of mental health services. I have struggled with anxiety intermittently for years (currently doing well with a combination of relaxation techniques and mindfulness approaches). Had therapy on and off in the past. Have taken a medication in the past (I almost identified which one, but then, remembering one of the goals of this blog is to NOT diagnose, treat or recommend, decided against it) for anxiety. I come from a family who struggles with severe depression. Many of my dear, many, and sweet friends have had: anxiety, depression, bi-polar, trichotillomania, ptsd, adjustment disorder, schizophrenia .... Who are these people who need mental health services?
It is all of us. We all do well when we all do well. So when we talk about the state of mental health services in America, I would like to remind all of us that we are not just talking about people I serve in community outpatient mental health (people who are - quite erroneously - all to easy to demonize and blame for their problems). I am speaking about myself. My family. Possibly you. Possibly your family. Your neighbors. Your friends.
The state of mental health services doesn't look too hot. (I went to graduate school to be able to construct that well educated sentence.) But those of us on the inside do it anyway. And many of us will continue to do it. But if you yourself are concerned and you're wondering what could be done, do me a favor.
Do not get caught up in fear. Do not get caught up in demonizing people with mental health issues. (After the shooting, I had a FLOOD of calls from my regular clients, in tears, mindful of the fact that they have been consumers for years, asking if people really believed they were going to hurt them.) Do not suggest that all mentally ill people be hospitalized. Or jailed. If you'd like to be constructive, contact your state assembly-people and ask them, as they look at what budgets need to be cut, to consider the long range impact of cutting mental health services. If you'd like to be constructive, call some of your local mental health agencies (county mental health is often a good place to start) and ask how you might help.
And be well. And speak kindly. And act lovingly. To others, and also yourself.
That is also constructive.
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Being sandwiched between great need and limited resources is an extremely stretching place to be. I appreciate everything about this post, especially your admonitions to be constructive, not demonize and avoid the trap of fear. I love your transparency and honesty, and I love that *you* are one of the amazing, compassionate people on the front lines. Well done my dear, well done xo