The Mental Health System Is Broken – and Fighting Stigma Won't Be Enough


I am a counselor at a university, and we can’t do our job right now. We can’t see all the students that need to be seen in the way we were trained, in the way we believe in or in the way we know works. We can’t do therapy. We are doing triage. Universities and post-secondary institutions across the board are reporting this. Demand is exceeding resources across the board.

Honestly, I would tell mental health advocates at this point to just stop trying to raise awareness and reduce stigma right now, which goes against everything I have ever stood for and everything I have ever worked for. It breaks my heart, but here is why.

I have spent my entire counseling career arguing and advocating for mental health services. I’ve focused on reducing stigma and championing messages like, “Anyone who needs support should get support,” and “It’s OK to talk about mental health and go to counseling.” I have spent countless nights and weekends working for free, planning events and volunteering my time championing this message. I have rallied, I have cheered, I’ve made posters and I have planned and run events all around the topic of reducing stigma.

I have worked hundreds of hours in one-on-one counseling sessions to help people realize that their problems aren’t “too small” for them to come in to counseling. If it feels big enough to them, then it is that big, period. No questions, no guilt, no shame about it. People’s problems are not to be compared or judged. If it is impacting your life, then you have every right as the next person to seek support.

I have based my entire shift from a teaching career to a counseling career on the basis that we need to be proactive about youth mental health. We shouldn’t wait until people are “sick enough,” are in crisis or are having suicidal thoughts before they get the care they need. We should be focusing on proactive mental health strategies, skills and talk therapy. Doing “damage control” counseling and keeping people out of hospital beds isn’t the right answer and it doesn’t work long-term. We need proactive services and we need immediate support available for people before things get “that bad.”

I, and most other counselors and mental health workers, have worked more overtime than we will ever be paid back for. We have worked faster and harder than we probably should for our own personal and mental health. There are more lunches that we have given up than we probably care to remember. We do all of this because this job and these people we help mean a lot to us. And because people need the service, deserve the service, and they certainly aren’t getting it anywhere else, so we show up and go above and beyond as much as we can before burning ourselves out. Luckily, a lot of the time, I really have felt like I’m actually helping and making a difference.

Yet, it’s falling apart. Everything I have fought for, advocated for and have been working to support is completely and utterly falling apart. The systems are breaking, and no one is doing anything meaningful about it. And certainly not fast enough. Every single mental health service is oversubscribed and underfunded. Every single person seeking help, whether they are what is deemed a “high priority” or not, is waiting an absurd amount of time to get some kind of relief.

And really, the term “high priority” is a problem all by itself. What does that even mean? We see tears and breakdowns as high priority. We see suicidal thoughts and attempts as high priority. And they are. But let’s also consider that a huge proportion of people who die by suicide do not show these signs. They are quietly struggling. They already feel they aren’t worthy of getting help or asking for help, and they are constantly feeling like they don’t want to “burden people.”

They aren’t going to show up in this triage system. They might even be too intimidated to try to begin navigating it. These are the people who aren’t going to knock down our doors for help. They will be the ones who disappear away from the broken system, and we will lose more lives. Did you read that? We will lose more lives. This isn’t a “we might.” This is a “we will.” And across universities and colleges, we already have.

How is a counselor supposed to look a student in the eye and say, “You’re not ‘bad enough’ for me to see here in counseling?” How do we get through the feelings of insinuating to students that their problems and their concerns “aren’t important enough” for regular counseling just because our system says so? Many of these students may not be at risk of dying or hurting themselves – but they are still in need of help, of support and of care. And we are having to cut proactive care services, across the board. We are having to wait until people are “that bad” before they get weekly, or even bi-weekly appointments. The system, across the board, is functioning in a backwards, damage-control fashion.

So I sit here, after hours, at work, again. Tired and miserable, crying over my keyboard as I type this because I’m now part of the problem. I’m part of the reason that students hold rallies and go to the press about the rising mental health issues on campus and the lack of services. I will be the person they tell their next therapist about (the one who actually gets to help them because they have the time to do so), about how bad or disappointing their first counseling experience was because they couldn’t get in to actually see someone.

They will talk about how they felt dismissed, and how their needs weren’t met, and they didn’t feel important enough. I will be the person who weighs on their hearts with disappointment as they struggle in silence because the one person they reached out to tell their story to couldn’t do enough to help them because the system is broken. I’ve become the person I never wanted to be in the mental health system, and it’s not my fault. It’s not who I am, and there’s nothing I can do about it.

So here is my call to each one of you reading this. Reducing stigma is only part of the message we need to focus on. Rallying people together to support stigma reduction is only half of the battle. It is only part of the work that needs to be done.

If all we ask our hardest working mental health advocates and supporters to do is reduce stigma, then we’re going to end up increasing stigma at the end of the road. Why will this happen? Because we are going to get people energized and finally ready to go to counseling. Then, they are going to take the difficult but important step to go out and to tell someone their story. Then, right about at that moment, they are going to be monumentally disappointed with the services. They will be disillusioned, and they will be hurt. What do people do who feel disillusioned, disappointed and hurt do? They turn away from or they rail against the thing that hurt them. Right now, the very thing that has hurt them is counseling. This is the exact counterpoint to the messaging we want to achieve around reducing stigma. We are trying to save lives, not make them worse.

If people come to seek support and are turned away, if they have to wait, if they aren’t helped or if they can’t actually get connected to someone with whom they are a good fit, then they are going to continue to struggle. They now have the extra burden to navigate one of the most complex health systems that currently exists, on top of everything else they already have on their plate.

For those who we had to convince that it was a good idea to come in to counseling? They are going to feel like, “I knew it. I knew counseling wasn’t going to help me at all.” Right now, they probably wouldn’t be wrong. They then might tell their friends, and then, all of this effort to reduce stigma is going to end up hurtling back toward us with a whole host of hurt, disillusioned and disappointed people. People who believed us when we told them they could and should talk about their mental health. People who sought out support and were let down. It could keep them from trying again when they really need it. It could keep them from telling a friend to get support if they really need it, and more people are going to struggle.

If we are going to reduce stigma, I mean really, really, successfully reduce stigma around mental health, then we need champions of the service. We will only have champions of the service if people have a good experience. Let me tell you, right now, that often isn’t the case.

People coming through our offices are not going to be champions of the service. Not within these restraints. I am booking appointments in for students four to five weeks away during peak times (midterms, final projects, and exams). That’s a lifetime for a student, and there’s nothing I can do about it. We offer walk-in services to try to compensate, and it helps – but it’s not enough.

It’s not the university’s fault, either. In fact, the university where I work has one of the highest counselor-to-student ratios out there. We could have five more counselors and still not be able to meet the demands because, the fact is, mental health can’t be served by the few services that do exist right now. It’s bigger than us. It’s bigger than any one of the small, Band-Aid services that exist right now. There needs to be intrinsic, permanent change on a broad, complete spectrum. We can’t have more Band-Aids.

So mental health advocates, please, please, add this to your message: We need more service and we need more funding. Please, don’t just go out and tell people, “It’s OK to talk about mental health and to go to counseling.” That’s simply not enough. We need a service on the other side of this message that can actually serve people when they do come to talk about mental health. We need somewhere for them to go once we open up their hearts and their minds that it’s OK to talk about mental health.

We need you to go out there and demand change in the system. We need you to petition the government that we need funding. We need you to go out there and ask that insurance companies and benefit programs provide real and meaningful mental health coverage, which would require a lot more than what is currently covered by these programs. $500 at 80 percent coverage for only certain designations doesn’t cover people’s needs.

We need services, not just stigma reduction. Because right now, nobody is winning. Not the people who we are trying to get help, and not us, the therapists, who do this job. Because we care, and we want to help people, but we are so limited with what we can do.

So please, help us. We want to do better. We just can’t do it in this system. We need your voice. We need the ability to provide real care and we can’t. Please help.

References:

Depression, anxiety and suicide on the rise at Canadian universities

Crisis on Campus: the Untold Story of Student Suicides

The mental health crisis on campus

You can contact Good2Talk, a free, confidential and anonymous helpline for Ontario’s post-secondary students at 1-866-925-5454.

If you or someone you know needs help, visit our suicide prevention resources page.

If you need support right now, call the Suicide Prevention Lifeline at 1-800-273-8255. You can reach the Crisis Text Line by texting “START” to 741-741.

Image via Thinkstock


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