Why Is It Hard For Severely Mentally Ill People To Get Mental Health Care?
One very frustrating systematic problem
In this post, I’m going to talk about “severely mentally ill” people. “Severely mentally ill” is a fake category, even for psychiatry, which is unusually full of fake categories. But it still gets at a real difference in experience. There are people who hear voices and see things and have delusions, who can’t hold down a job, who get involuntarily hospitalized, who can’t usually leave the house or maybe the bed, who starve themselves, who are violent, who can’t live independently without a caregiver, who are incapable of things that everyone considers normal parts of adult life like managing money or running errands or having friends.
And then there are people who aren’t like that. On one side, there are your people with crippling social phobia or OCD or ADHD or depression that leaves them, technically, able to function and carry out the basic requirements of their lives. On the other side, there are people who are having a hard time adjusting to college, or who got fired, or who are going through a divorce, or who are the Regional Manager Of Adjusting Tiny Numbers and have a hard time focusing on the tiny numbers for eight hours a day.
I don’t mean this as a “severely mentally ill people Really suffer, mildly mentally ill people don’t.” “I can have a job and live without a caregiver, also I reliably participate in consensus reality” is really quite a low standard, and you can suffer a lot while reaching it. I don’t like the phrase ‘worried well’: it implies that your problem is hypochondria, when in fact divorce and getting fired and adjusting to adult life are real problems that cause real genuine pain that happens to not be caused by your brain being messed up.
I also don’t mean to say that mildly mentally ill people or even the neurotypical shouldn’t have access to mental health care. It would be absurd to say that I shouldn’t get my chlamydia treated because there are people with HIV. Besides, even mild or moderate depression is an incredibly painful condition; I can’t imagine anything worse than an impairment in your ability to be happy.
As for the neurotypical: I’m a transhumanist. If you want modafinil to help you focus on the tiny numbers or an SSRI to smooth out your feelings while you figure out how to cope with the dissolution of your marriage, I’m all for it. And a lot of people don’t need therapy per se, but they need an outside view of their problems, or someone to talk to who isn’t caught up in their social drama, or even just a friend. I think it’s very very good that people who don’t have enough emotional support can pay money to have someone to get emotional support from!
But there is a systematic problem. Treating severely mentally ill people sucks. They miss appointments constantly. They hurl false accusations at you or curse you out or yell at you or even physically attack you. One minute they love you, the next minute they hate you. They might be totally incoherent. They refuse to tell you important facts for no apparent reason. When they get better, it looks less like “they’re okay now” and more like “they are no longer going to the mental hospital once a month.” You don’t even get paid more for dealing with all this shit, because severely mentally ill people don’t have any money.
On the other hand, people who aren’t severely mentally ill are more likely to have money, and show up on time to appointments, and will tell you about what’s going on in their lives, and have fixable problems, and don’t physically attack you even a little bit.
So, obviously, a lot of therapists are going to look at this and go “…actually I would rather help the neurotypical people who are sad about their divorces and not the psychotic or personality-disordered people.” And so it is incredibly hard to get mental health care if you’re severely mentally ill. Forget high fees or long waitlists or the dread phone calls. It can be impossible to solve even the basic problem of finding someone who has ever worked with a severely mentally ill person since grad school.
It sucks.