Mental Health System Failure



There is a lot of talk about gun control these days. This post is not about that. However, the debate on guns has brought up the subject of overhauling the mental health system. But how many people really know what the mental health system looks like?

As the mother of a special needs child, I have some insight into the positives and failures of the mental health system. I for one, am very thankful for the therapist and doctors we currently have. They genuinely care about us as a family because most of them have experienced the effects of mental health issues in their own families in one way or another. They see us as humans who struggle for various reasons and not just another patient. But it has taken us a long time to find such a great team.

The biggest problem we’ve faced is with insurance. Since our son was adopted, he has access to state Medicaid, which if you read over the details, sounds like a pretty sweet deal. The problem is, the programs that have the highest possibility of having a beneficial impact to our son are not covered by insurance and every single one of them costs much more than we make.

For instance, one such program is designed to last 12-14 months. State Medicaid doesn’t cover it because they have too many beds, or don’t meet the many other requirements that Medicaid requires of these programs in order for them to be covered. Private insurance will cover anywhere from 6 weeks to 2 months, which means the rest has to come out of our pocket. The cost for the program? Roughly $400 PER DAY! About $150,000 for one year of treatment. Day and Residential programs cost anywhere from $2,000 - $4,000 PER MONTH and are designed to last anywhere from 4 months to 2 years!

Most of the programs covered by Medicaid and private insurance are made to be a one-size-fits-all type of program. Which means a child who is struggling with social skills, is placed into a program with children who struggle with impulse control, or behavioral issues. All of which need different types of care.

Often the result of this is a program staffed with people who care about the people they serve, but have so many restrictions on how they can help that it almost becomes an unhelpful environment as someone who is trying to learn social skills picks up behaviors from the outgoing child who struggles to keep himself calm whenever he doesn’t get his way.

Or, you end up with a program who cares more about the money they make off the insurance company than they do about helping the people they’re supposed to serve. Those programs really like it when a child comes in who is covered by their parents insurance as well as Medicaid. They’ll work with whoever will pay more, and as soon as either insurance company starts pushing back, you’ll soon find yourself talking about how your child is ready to graduate from the program even though a few days before your kid displayed the very issues you sent him there for.

Then you have the all-in-one companies. They have most of the staff you’ll ever need. Psychologists, Therapists, Psychiatric care, Respite services, and sometimes even a Pediatrician. Those can truly be wonderful services. However, one major flaw of this type of program shows up when the staff in one department doesn't fit your needs anymore. For example, if the therapist on your team decides to take on a different role, or quits, the all-in-one program will assign you a new one. If the new therapist, or any of the other therapists in the program are not trained to meet the specific needs of the person needing therapy then you have a choice to make.

You can either continue using all of the other great services the company provides while accepting that the therapy component is going to suffer, or you can choose to find a new one outside of that company. If you choose the second option, there is a very great chance you'll be searching for a whole new set of doctors because these all-in-one programs don't like working with professionals outside of their circle, even if it's the best option for the patient.

Over the past five years my husband and I have called SO many different types of mental health facilities in an attempt to get our son the best care possible. Just this past week I’ve called SEVENTEEN different locations to find a program that might possibly be able to help our son with a specific set of issues that have recently popped up. Many of these programs look great, but they aren’t covered by insurance and we can’t afford them. Some of them don’t treat the issues we need help with. Only one of them has both the potential to be able to meet some, (not all) of his needs and be covered by Medicaid.

But I don't want to simply talk about the problems my family has experienced with the mental health system. So, what changes would I like to see in a mental health system overhaul?

  • I would like to see the cost of programs not covered by insurance be affordable to working and middle classes.

  • I would like to see more programs covered by insurance.

  • I would like my son to be treated by a trained mental health facility at the pace he needs, not at the pace the insurance companies dictate.

  • Easier access to information about different programs.

  • Staff who are trained to recognize that treating mental health issues is their job, while remembering that they are helping people who are often hurting, not dealing with another case number.

  • An effort by all programs, companies, doctors offices, and insurance companies to reach across lines and work together to get mental health patients the treatment they need.

All of the examples I used above are experiences my family has faced. I agree that our mental health system needs an overhaul, but if those who can make changes don’t understand what families face day in and day out, then we won’t get a system we can be proud of. We will continue to have a broken system that either can’t see, or can’t help those who need it. Or we’ll have families who have no clear path to help when warning signs appear.


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