Current State of Mental Health Care:Finding Help

If you believe physical health care is in a state of disrepair, then you have not attempted to enter the mental health care system. It is in a far more chaotic and dysfunctional state than any portion of the medical health care system.

In my community, a moderately sized city, if one requires mental health services for a serious mental health crisis, for instance, severe depression, worsening of a bi-polar condition, or schizophrenia, there are several choices.

First, if one is insured, there are two private psychiatric hospitals. They can admit patients who are in crisis, that is, one is "a danger to self or others."  If one is not suicidal or homicidal, getting an out-patient appointment with a psychiatrist may take more than six weeks, especially if one does not have a previous relationship with the physician. A psychiatrist may admit a patient who does not meet the criteria for a crisis admission, but insurance companies may deny the admission in favor of out-patient treatment. If the insurer does permit admission, the length of stay will likely be limited to less than ten days.

Second, there is a state psychiatric hospital. The admission criteria is the same as the private hospitals, with one important exception. The state hospital must admit and evaluate anyone arrested for a violent or serious property crime, if a judge suspects they are mentally ill. Most such persons will eventually stand trial and, if found guilty, will be incarcerated.

If one requires out-patient services, there are non-profit mental health clinics where one might see a counselor or clinical social worker. A psychiatrist will supervise the care and will schedule a brief appointment if medications or substantial changes in medications are needed. Fees are generally on a sliding scale. Such non-profit clinics are extremely busy and wait times for an appointment may be several weeks.

There are also a number of counselors and therapists in private practice. Their credentials range from Clinical Psychologist, Licensed Professional Counselor, Clinical Social Worker, Nurse Practioner, Licensed Substance Abuse Counselor, or  Pastoral Counselor. All of these persons have training and legitimate credentials, but since any one may call themselves a counselor in Tennessee, it pays to ask questions. Many well creditaled therapists (counselor and therapist are often used interchangbly) may file for insurance reimbursement, but insured visits are limited, even if one is referred by their employer's Employee Assistance Program. Reimbursement may not cover the over $100 an hour fees of many therapists. However, most private practice therapists can see clients in less than two weeks.

There you have it. Not many good options. My community is probably not substantially worse or better than most communities, with the exception of a state hospital which gives one additional option. Small wonder so many people are not getting appropriate care and continue to suffer, as do their families. Suffering may be a part of life, but much of it is optional and as a nation we have chosen not to invest the resources to relieve the suffering of those we call mentally ill.