When Mental Health Insurance Is More Harmful Than Helpful
One year ago, I found myself in the worst mental health crisis of my life. I have always struggled with anxiety off and on. It has come in waves throughout my life, always present in one form or another, but sometimes peaking to a tidal wave’s intensity. This was one of those moments. I tried desperately to use coping mechanisms I had learned in therapy several years prior. But my best practice of mindfulness and meditation only kept me at a bare minimum level of functioning and didn’t seem to make any forward progress against the constant, relentless panic that was threatening to thoroughly swallow me up.
My husband works for a university with an incredible hospital and a wonderful psychiatric institute. Our medical insurance coverage is some of the best in the nation and our doctors are similarly top notch. We have been nothing but pleased and blessed with our medical coverage. But for all of the excellence of our medical coverage, our mental health coverage falls short. While our medical coverage is the envy of most of my friends and family, our mental health coverage is archaic and damaging. I am, of course, grateful we even have mental health coverage, but accessing our benefits seems to be designed to harm rather than help.
Problem #1. The employee assistance program (EAP).
Our EAP is structured with the idea of short-term counseling and that most problems can be resolved within a matter of months. One therapist we saw there essentially said they pride themselves in getting people better quickly. He mentioned all those people we know who sit in therapy for years and never seem to get any better and explained it was his goal to have us out of there quickly.
What happens to the patient when the provider has this attitude? Ever since then, I’ve felt there is something a little bit “wrong” with me because I can’t figure out how to cope with my life in a matter of months. I must have very severe issues, or our EAP doesn’t fully understand how lifelong chronic mental health issues actually work. The fact an entire institution can be staffed with providers who don’t understand the core way mental health issues function is baffling to me.
So what happens when you are done with the EAP or if an EAP provider thinks you need more help? They refer you to an outside provider. In fact, the only way for me to see an outside provider is if an EAP refers me. I have to go to them first. I have to visit an institution whose thinking about mental health is fundamentally flawed.
The benefit of an EAP is that you have access to counseling quickly, usually within a week of calling. That is — on the outside — a good thing. It addresses one of the main problems with mental health care, that it takes months sometimes to see a provider. However, when the providers have this attitude they can fix you in a matter of weeks, I’ve found it overall is a negative. I’m not someone with a problem that can just be “fixed.” I’m someone struggling with a lifelong chronic disorder that needs method, care and periodic check-ins throughout my life to stay in good shape.
So, back to me. Last year, I was in bad shape. It felt like I was drowning. My husband and mom were both seriously worried about me. I was worried about me. I knew I needed to see someone — anyone — in the medical profession. I called my EAP and explained I had already received a referral from them for outside care several years ago, but that that therapist no longer accepted our insurance. I asked if they could send me a list of providers so I could find a new therapist.
I was referred to someone else. I left a voicemail. I didn’t hear back for several weeks.
Problem #2. Someone else is trying to “match” me with a therapist.
When I finally got a call back, it was from a very kind woman who assured me my old referral from EAP was all that was needed. She asked me a few questions about my location and the type of therapy I was interested in, and then said she would get back to me when she could with some possible providers I could see. All of the sudden, I felt like I was being set up on a blind date. My control of my own mental health was minimized. I couldn’t just look up providers and find out who was covered by insurance and do my own research on who I’d like to see. I was dependent on a third-party who didn’t even know me to find providers for me. I couldn’t believe our coverage functioned this way. How incredibly archaic. But at the same time, I was desperate to see anyone, so I let the cards fall where they did.
She called me back with three potential providers. Two didn’t return my calls. And the third was a major miss. After laying my soul bare, he suggested mindfulness technics I was already using. When I explained I was already doing that, he said, “Well I’m sorry you think all my ideas are stupid.” I was floored. Someone claiming to be a mental health provider being passive-aggressive in this way? Not OK. And it destroyed what little fight I had left in me. What was the point of therapy if I was just going to be attacked?
I started to feel like our mental health coverage was designed to be a deterrent rather than a help. I felt like the designers of our coverage had intentionally made it as difficult as possible to access good mental health care so all of us would just give up and save them money. I hope that is not the case, but that is certainly how it made me feel.
Problem #3. Lack of easily accessed information.
I started searching online about our insurance and in the printed materials I had at home. Surely there had to be a better way to access mental health care. I didn’t want to call the EAP back and get another blind date list. I didn’t want to visit an EAP and see an incompetent counselor. Surely I could go to the renowned psychiatric institute that was housed on the university campus? It wasn’t clear online or in the printed materials what I could access with my benefits. All it said was to visit the EAP and have them refer you to an outside provider if you need long-term care. There wasn’t even a phone number I could call to ask questions. Maybe there was, but in the state I was in, I wasn’t functioning at the level of a bloodhound. I needed easy-to-find information, not hidden information. So, I took a risk. I visited the same-day clinic at the psychiatric institute. It was covered. And so was the outpatient clinic, but getting an appointment there wasn’t easy.
In January of 2019, I was experiencing a severe mental health crisis. In February, I visited the same-day clinic designed to help people in crisis. In May, I finally saw a provider my insurance covered. It took me five months to figure out how to jump through all the hoops and get an appointment scheduled. Fortunately for me, I was able to just hold on. I had a great family support system who kept me grounded enough. I had enough coping skills from past therapy to keep me functioning just enough. But if any of those elements hadn’t been there, it frightens me to think of what could have happened. And even more it frightens me to think of what does happen every day in this country.
People need to have control of their mental health. We need to be able to see a list of providers. We need to be able to see a provider without jumping through referral hoops. The whole process needs to be streamlined and designed to help someone who can barely get out of bed in the morning. Phone numbers or email addresses of people who can help you find providers and answer questions about care need to be clearly posted. These people need to be trained to answer voicemails and messages promptly and not leave people waiting weeks for a response.
Sure, maybe there are some people who just need a little bit of help, but in my experience, if someone is reaching out and searching for a therapist, it’s because they are experiencing sincere, horrific, inner turmoil. To those in the insurance world, take a second look at your process and remember while you are looking at your bottom line, we are fighting for our lives. Give us the tools we need to make that fight a little bit easier.
Unsplash image by Eli Defaria