I’m coming off of another hospitalization due to severe depression and finally decided to write about something that has concerned me for years. When people discuss the flaws in the mental healthcare system they are often referring to access issues, insurance coverage issues, and other barriers to treatment. What is missing from this conversation is the issue of the lack of qualified mental health professionals. By qualified, I don’t mean degrees, certifications, and the like. I mean their personalities, temperaments, attitudes, and ability to treat clients as individuals and whole human beings.
I’ve been a mental health client for over 20 years and have also been a provider while working in group homes and as a behavioral assistant. I’ve seen how providers have treated myself and other clients. While I’ve worked with some great psychiatrist, counselors, and social workers I’ve also worked with some abhorrent people in the same fields. One thing I’ve noticed is that the better providers are far from accessible to the average person. I’ve wracked up thousands of dollars of debt going to some of the best because most do not accept insurance because insurance companies don’t value their skills. So even though they are amazing doctors and therapists, they also lock out those that are most in need of their services.
The aforementioned providers are what I would consider top tier in terms of categorization. They quite often have the personalities and compassion required to work with such a delicate population. They also have the time and problem-solving skills to really flesh out treatment plans. They approach clients problems from multiple angles and utilize their professional resources by referring you to other professionals with specialties specific to your diagnosis and needs.
The tier beneath them is mental health professionals at mental healthcare clinics. This isn’t to say that all providers at these clinics are bad, but from my own experience and the experiences of others I’ve talked to, they have far from the best staff. Mental healthcare clinics became more popular around the time when states were pushing to empty state psychiatric hospitals in a misguided attempt integrate those with severe mental illnesses back into the community. The failings of this are a whole other post in itself so I won’t get into the details of it here.
However, due to the fact that these clinics are often state funded and mental health budgets continue to be cut year after year, particularly in NJ where I reside, the turn over rate and the quality of staff that works there can often be abysmal. Many of the psychiatrists are there just long enough to be able to open their own private practice. Their schedules are so packed that you are lucky to get a full 10 minutes to speak with them during your appointment. If you are someone like me who doesn’t respond or cannot tolerate traditional treatments using psychopharmacological medication then your basically shit out of luck, to put it bluntly. The social workers and counselors tend to be recent grads and their uncertainty and trepidation are palpable. So it’s difficult to put your trust in someone who has less knowledge of the system than you do.
Due to the opioid epidemic, inpatient psychiatric treatment facilities are gradually turning into short-term rehabs and the line between the separation of co-occurring disorders and psychiatric disorders is blurring. What I mean by that is that units that were specifically constructed just for people with psychiatric conditions are taking on the overflow of people with co-occurring disorders or just addictions, and are slowly turning into detox facilities, and stopovers to actual rehabs.
While my issue with this may seem callous to those struggling with addiction, it is actually where I begin to illustrate how the stigmatization of those with addictions effects all mental health patients. Addiction comes with a heavy stigmatization and mental health professionals are not resistant to internalizing these biases. After handling more and more cases of addiction, which often is not their field of expertise, many hospital psychiatrists do not adapt their treatment strategies for different patients. You can also feel and experience their contempt for addicts from their attitudes when you sit down with them one on one, without actually having a substance abuse problem.
Pysch hospital psychiatrists are often very dismissive and speaking with them feels more like an interrogation than a consultation. Over the past few years, it seems as if they don’t take “No I don’t drink heavily or daily and I don’t do drugs, illicit or prescribed” as an answer. Doesn’t matter if the mandatory urine screens you complete on intake come up negative. I’ve had doctor’s try and trip me up by saying “someone told me you said you were drinking on XYZ day” although I’ve said no such thing. On reading my treatment plan on a previous discharge one of the goals was “to get patient to admit to substance abuse” because I had been admitted after PURPOSELY overdosing on Xanax that I had been prescribed. I wasn’t trying to get high, I was trying to kill myself. But it seems as if those realities do not register with hospital psychiatrists anymore.
They then spend so much time trying to get you to admit to a substance abuse issue that they don’t actually treat the issues that brought you to the hospital. Trying to advocate for yourself while inpatient is virtually impossible. Take my last admission. Remember how I said the doctor tried to trip me up so that he could diagnose me as having a substance abuse problem? That was this past inpatient stay. Also, no matter how much I tried to explain my situation regarding my insurance not reauthorizing my TMS treatments, my inability to take most medications, and my aversion to ECT because of the severe memory loss that still impacts me I may as well have been talking to a brick wall. It took my mother calling and telling him the exact same thing before he believed what I said.
There was also the issue of trying to get medical care while inpatient because it had to be signed off on by him. I had just been diagnosed with a UTI the day I was admitted and wasn’t home by the time the prescription of antibiotics was called into the pharmacy. My mom brought the prescription to the hospital when she visited Wednesday evening, but they were not allowed to give them to me. I stated this to him Thursday and Friday. Told the weekend psychiatrist who was supposed to order another urinalysis but didn’t, although my original one from when I was admitted showed abnormalities. I then told the regular psychiatrist again on Monday and he looked at me and said “What infection? You didn’t mention this before.” I almost lost it, but was able to hold it together long enough to request to see a medical doctor since he refused to listen to me. I spent 3 weeks in pain and not being able to sleep more than an hour at a time because it takes a few days to get results of a urine culture, then by the time it came back I was in the hospital, then it took almost another full week before they would even listen to me and I could start treatment.
There seems to be an intentional agitation of patients to elicit negative reactions. Patients rarely leave the psychiatrists office calm or feeling indifferent. We are often aggravated, angry, and frustrated. If you ask why you will get similar responses. We don’t feel like we were listened to or believed. The doctor spoke over us. The doctor was hostile and/or rude. The doctor was arrogant, insulting, and/or patronizing. A whole list of traits that no one working with people with mental illnesses, particularly those who have reached the point of hospitalization, should display.
A misconception, one that you would assume mental health professionals didn’t believe, is that all people with a mental illness have no grasp of reality and that their words cannot be trusted. This is far from the reality for many people living with a mental illness. The thing is that when you have certain illnesses you learn to be acutely aware of your moods and introspective. You learn what your triggers are, what the best ways for you to cope are, and most importantly when you need to seek help. That’s why not all hospitalizations are involuntary. Many people check themselves in, like me, because we know that we need an extra layer of help. Not everyone in the hospital has delusions, hallucinations, or a detachment from reality. Sometimes are extreme awareness and sensitivity to reality becomes too much to handle. But you are hard pressed to find doctors on inpatient units that work from this understanding.
Working my way through the mental health care system these last 20+ years has put me in contact with some horrible doctors, therapists, nurses, etc. Had I not had a strong support system of family and friends who advocated for me and helped me advocate for myself, I probably would have given up on seeking treatment a long time ago. It’s emotionally exhausting to try to be open and vulnerable with people who don’t see you as an individual with valid feelings and worthy of dignity and respect. I’ve also been extremely lucky to have found my current treatment team comprised of an excellent doctor, nurse, and therapist. It’s just disheartening to know that not everyone will find that.
If I could offer any advice for mental health advocacy groups looking to improve conditions and mental health professionals, I would say this. Listen to clients. Put your academic knowledge and egos to the side and see us as people and not diagnoses. Realize that you can’t possibly know more about us than we know about ourselves and then govern yourselves accordingly.
