Let's talk about how we manage mental health care in this country. You can look up the statistics, and we'll avoid the weeds like gun violence and terrorism. Lets talk about how our mental health policies work for people like you & me. Okay, people like me. I am the great gray, the unspoken. I'll likely never kill anyone, including myself, and the Universe in all its wisdom has entrusted me with GROWING two ACTUAL human beings. But I am mentally ill. That's uncomfortable to hear, isn't it? I can tell you its pretty fucking uncomfortable to say. Here's the thing: it shouldn't be.
I'll eschew a scathing ass-kicker on stigma, though, to share my recent experiences with America's employer-sponsored health care system and how it manages - or fails to manage - mental health.
Long-time readers - both of them - know that for 15 years I have worked with my doctor to find an anti-depressant that fits reasonably well into my life. This is necessary because, due to a bad hand in the poker game that is genetics, I have neurons in my brain that fire when they shouldn't, and don't fire when they should. My Serotonin doesn't speak Epinephrine, it turns out, or something like that, and pills are frankly the translator. Lexapro, Welbutrin, Welbutrin plus Zoloft - oh dear, dear Zoloft - Cymbalta (scary!). You can imagine that some translators are better than others. And some have accents that some people will understand easily, and others will not be able ignore. Its all very subjective. And all translators, at some point, get old and retire, and you get to search for a one.
Good news - I found a new one! Viibryd, it's called. For long-time users of translators, you'll be happy to know this one A)doesn't make you gain weight and B) doesn't affect your sex drive. (clouds part, organ music, sun rays shine down - for real this is a BIG FUCKING DEAL). My doctor has given me the standard 3-week sample.
You didn't know about samples? Yes, well, for anti-depressants there is almost always a sample, because there's no telling what will work for who. There's no blood test - not even a brain scan - that can predict efficacy. Its literally just blind trial & error. And since side effects are most pronounced while you ween on and ween off of these meds, trial & error is a really long fucking process. Life is cruel.
So, Viibryd. I have to shit roughly 3 times an hour, but I'm told that will pass and experience bears out that this is usually the case. I feel...open to the possibility of improvement. That's huge - it may not sound like much but for real I can come up with a good reason to get out of bed more mornings than not, and that is an amazing improvement over where I was. We'll come back to the meds.
Lest you think I'm one of these soft, 'take a pill to make it all alright' folk, at the same time I sought out a new med I was also seeking out a therapist, and let me tell you - Jesus. If I have to choose between calling the crisis line and navigating a push-button menu for 20 minutes only to learn you have a 10-month wait for appointments - congratulations, I now need the fucking crisis line. What a shit show. I called EVERY SINGLE SHRINK IN YORK COUNTY. Unless you are in the process of driving your car off a cliff, you have two choices: take yourself to the ER for 3-day involuntary psych hold, or swallow your pain - swallow it! - it doesn't matter that it tastes bad, it doesn't matter that you're full. According to how this country manages mental health, you are EITHER a danger to yourself or others this moment OR you are absolutely fine and good to go for at least 10 months. There is no in between. There is no place for gray.
After checking in on a waiting list I'd been on over a year, I got an appointment with a highly recommended psychologist. I wanted a psychiatrist, only because I feel like I've exhausted a lot of options, medication-wise, and wanted some input on meds (psychiatrists can write prescriptions, psychologists can't). Oh well. Beggars, choosers and the like. Psychologist it is.
I finally procure this appointment - which required actual tears on the phone with the poor receptionist, from an office I share with long-suffering co-workers, because embarrassment and risked employment security are JUST PART OF BEING MENTALLY ILL. (Let that sink in, because its important. My mental illness makes me financially insecure in many ways.)
She calls back 30 minutes later - turns out my employer-sponsored health care (which i pay a hefty premium for) doesn't cover therapy until I hit a $750 deductible. Now to be fair - I could get 3 free appointments through a "Wellness Benefit". Here's where I'm going to be a Depression snob, and forgive me - those are great for mentally healthy individuals facing a tough time who could use a bit of help. Really its a great thing and I'm glad it's there for people facing transient challenges. If, however, you've been diagnosed with Moderate Depressive Disorder for over 15 years, you know that 3 appointments with a grad student is a huge waste of your time. I'm sorry - I've read and experienced more about Depression THIS WEEK. So. $150/appointment until my deductible is met. Which is going to hurt. Like, cancel the cable hurt. And here football was one of the few things that brought me joy...
So, I re-do the budget. You can't put a price on your health, right?
In the process I figure I should probably find out the cost of this new, extraordinary med. The Zoloft/Welbutrin cocktail that worked so well for so long cost me about $35/month, and was well worth it. Let's just ring up CVS...
$200/month. Insurance doesn't cover it.
Let's just take a moment to appreciate the fact that I began this process in the first place because I was at the end of my rope.
The moral of the story is that is turns out that you can, in fact, put a price on happiness. On well-being. And that price is $500/month - for two therapy appointments and some pills.
I understand, of course, that things could be worse, and frankly I abhor the argument. I understand that this is not chemo, or insulin, and that its well within the realm of possibility that I would survive without this med or these services. And, if you're the kind of person who wakes up every morning hoping to survive the day, I suppose that would be comforting. I am not. Because I am mentally ill. Do you see how that works? Do you see how it closes in on itself and becomes a cycle? Can you appreciate that I began this process BECAUSE I felt I couldn't take one more fucking step? And the answer is...your credit rating or your well-being. You can buy these meds, and make these appointments, but you'll miss at least a car payment. Do you want to be capable of smiling now and then, or have the ability to buy a house someday? Do you want to provide your kids a childhood free of walking on eggshells in your presence, or do you want to avoid bankruptcy? These are the choices that the mentally ill face in America today, and we're not...anonymous. Its your baby-sitter, your sister, your coworker, your teacher. Hell, it's me.
5 days ago