The month of May is dedicated to mental health awareness. I decided to use this opportunity to frankly discuss the mental health care system in the United States and what many families and patients have to go through and often not receive any help. Unfortunately, this is very common that many teenagers and adults fail to receive mental health care or receive inadequate mental health care.
Many people assume that the United States provides the best physical and mental health care in the world. However, this is not the case. One example of this fact comes from the ABC News Show 20/20. An Olympic Athlete had been living with Bipolar Disorder for over 20 years and never diagnosed. She had been reporting difficulties with depression for years, but her complaints were dismissed. The alarming fact is that even though her brother committed suicide due to being Bipolar her symptoms were dismissed. We know that Bipolar Disorder is inherited and suicide tends to run in families. In other words, if a family member committed suicide it puts you at a higher risk for suicide. The family never discussed the brother’s suicide due to shame associated with suicide and mental illness. Therefore, clinicians treating her may never have been told that her brother committed suicide. The Athlete and her husband asked for help for 10 years and despite the fact she had all the symptoms and a family history of Bipolar, no one diagnosed her. She lives in the United States, her brother committed suicide because he was Bipolar and it still took 10 years for her to be diagnosed with Bipolar Disorder and not dismissed by psychiatrist as someone who was over reacting. Now that she is diagnosed she is dealing with the shame of being Bipolar. However, the shame associated with mental illness and suicide might have contributed to her not being diagnosed earlier. Often patients come in to my office for help, but I may not get all the vital information for months because the patient is embarrassed and worried how I might react to their family history.
We often hear parents complain that their teenager is driving them crazy or a teenager complaining how unfair their parents are to live with on a daily basis. Many people assume this is normal life with a teenager. However, according to the CDC, one out of five teenagers have a diagnosable mental health condition and would benefit from psychotherapy. The parents of these teenagers are begging for help, but they are ignored. Many people assume they are over reacting. Furthermore, there is a strong negative stereotype about mental health in our Country and people prefer not to be associated with someone who has a mental health issue. Many people act like mental health issues are catchy and a sign of weakness and lower intelligence. None of these ideas are true. In fact, many very famous people have mental health issues themselves or in their families.
Therefore, you have some parents begging anyone who will listen for help. You also have teenagers who are crying out for help by cutting themselves or acting out trying to get people’s attention. Many of us assume if the parents are begging or the teenager is cutting themselves that they will receive mental health care. Unfortunately, this is not how our world works. I have been working as a psychotherapist who treats teenagers for over 20 years. There have been many times I could not have a suicidal teenager hospitalized because the hospital had no beds for a suicidal teenager or the insurance refused to authorize the admission to the hospital.
This is a very important point for people to understand. As the psychotherapist, I do not determine the treatment plan for a teenager or child. Your insurance company dictates the treatment plan. They have decided what diagnosis they will cover and what treatment modalities they will pay for. Additionally, they decide how much they will pay. I have seen some teenagers and the insurance would only allow $25 per session. Many people assume the insurance company pays psychotherapist or hospitals their entire fee. They pay the psychotherapist or hospital the rate they decide. If the psychotherapist wants to work with that insurance company they must agree to accept the insurance company’s rate. This is why health care providers always ask for your copay. The copay is part of the rate. If the insurance rate is $50 and your copay is $25, if the provider does not collect your copayment, the insurance only pays $25. This is why many providers do not accept insurance. They dictate the course of therapy even though they no nothing about the teen and they under pay the provider. Insurance companies make a great deal of money by charging high premiums and refusing to pay for treatment. This is not fair or appropriate.
Therefore, parents are seeking help, but they are told they need to contact someone else, they have contacted the wrong place. For example, one Thanksgiving I had a mother have my answering service page me and she was begging me for help because her teen was suicidal. I referred her to the County hospital because based on what she said the teen needed to be hospitalized. She told me the County hospital gave her my telephone number because they had no more beds for anyone who was suicidal. The parents tell me they feel like no one cares. She did everything she should have, but she could not get help. Her son needed to be hospitalized for his safety, but the hospital refused to admit him.
Again, some people might believe this is an isolated case. Sadly this is not an isolated case. As I said, I specialize in treating suicidal, bipolar and teens who are trauma victims. There have been a number of times I have sent a suicidal teen by ambulance from my office to the County hospital only to have the teen released in less than an hour because the hospital had no beds. I had one person on the Psychiatric Crises Unit tell me on the telephone unless the person had a shotgun in their mouth not to send them to the Hospital because they had no beds for suicidal teens. The hospital only has a couple of beds for suicidal teenagers based on the State budget. Anytime cuts need to be made to the State budget, mental health is always the first area to be cut.
As a result of budget cuts and insurance companies denying treatment, the therapist in a difficult position. Do you just discharge the teen or do you continue to treat the teen for a low fee or for free? Remember 1 out of 5 teens have a psychological condition that needs treatment, what do you do when treatment is denied or there are no treatment options? Besides 1 out of 5 teens needing mental health care, the CDC has recently moved suicide from the third leading cause of death to the second leading cause of death for children 10 to 18 years old. Therefore, there are many teens who desperately need mental health care and may die without it. Also, when you examine the results further you find that teens who need therapy but fail to receive it are more likely to get involved with drugs, crime, are more likely to drop out of school, more likely to get pregnant or father a child and that child is more likely to become a foster child. These teens are also more likely to end up on probation, homeless and on welfare.
As a society we do not place much emphasis on mental health care. Mental health care programs are always some of the first programs cut when the budget is cutback. Our priorities need to be examined. I find I t very interesting that Contra Costa County had enough money to build a new Juvenile Hall, which is three times the size of the old Juvenile Hall, but there was not enough money to fund a large number of mental health services which had to be cut.
We often look at teens who are acting out and blame their parents. We ask why don’t they get their child the help they need? What stops them from helping their teenager? Why is the teen always getting involved with drugs or not going to school? The answer could be because the teen needs mental health care and the parents have been and continue to try to get their teen help but their is no help. The teen may be acting out because they are tired of asking for help and being in pain so they start looking for the easiest way out of pain.
If we want our teenagers to grow up to become productive members of society then we need to provide them with the mental health care they need. If we want parents to be responsible parents, then we need to provide parents options for how to get their teens help when they ask for it.
With the number of mass shootings, the significant increase in the number of children with anxiety disorders and the epidemic of teenagers cutting and teenage suicide, I am surprised we have not made it easier and more affordable for teenagers to get adequate mental health care. In addition to the issues I stated above, the Coronavirus has created a number of mental health issues for children and teenagers. Grief due to the death of family members, drug use and overdoses have increased and so have anxiety and depression increased due to the pandemic. However, I don’t see any plans to deal with the large number of teenagers who are going to need help. I have seen a significant increase in the number of teenagers needing mental health care since the Pandemic started. I have also seen insurance companies refusing to cover mental health, so what do we do?
I have been treating teens for over 20 years and it is still a problem to get a teenager residential care if they need it. Also it is still difficult to get teens medication at an affordable price. I had a teen the other day who needs medication but they had no medical coverage to see a psychiatrist. The parent made an appointment but the fee for the visit was $450 and they would not reduce the fee. So again what do they do?
We can write our Congressmen and Senators and demand that they fund community mental health centers. We can also demand that private insurance companies be required to offer teenagers and their families adequate mental health benefits based on what professional therapists are recommending. The professional treating the child knows what the child needs not some clerical worker with a Bachelors degree who is answering phone calls at the insurance company.
In short, if we want our teenagers to survive their teen years we all need to act together and demand that our children receive the treatment they need and deserve. Mental health care is not a dirty word. There is no difference between mental health and physical health. Therefore, they needed to be treated the same and we need to eliminate the stigma associated with mental health issues.
Finally, private insurance companies make huge profits and drive the cost of health care up based on how they do business. If we don’t start to speak up for our kids, they will never receive the care they need. Look at your next pay stub and look at how much you pay for health insurance and compare that to the benefits you receive. When you take your teenager to a psychotherapist most insurance companies only pay the therapist $75. Your copay is part of the payment. Your premiums are high, but they do not pay it out to providers they keep it.
Dr Michael Rubino has over 20 years experience treating children and teenagers dealing with anxiety, depression and trauma. To find out more about Dr Michael Rubino and his private practice visit his website at www.RubinoCounseling.com or his Facebook page www.Facebook.com/drrubino3 or his podcasts on Spotify and Apple