A Heavy Burden to Bear: When Lack of Access to Affordable and Quality Healthcare Compounds Complex Trauma

With the current focus on mental health issues relating to the Coronavirus Pandemic, I feel this is an opportune time to have an honest and frank discussion regarding access to affordable and quality mental healthcare services in America. Those of us who have been struggling for years living with a mental illness, are all too familiar with the challenges of finding the help that we need to not only reach stability, but maintain it. Often the services and programs to support recovery are difficult to access and some are virtually non-existent or not affordable. Most of us with lived experience have managed to piecemeal our recovery efforts over time to sustain our recovery, but we are also aware that services and programs fall short to meet the needs of many and, as a result, some unfortunately do not ever recover.

One of the main triggers for my depression is the lack of concern for those living among us who are struggling with a mental illness and/or addiction issues that often leads to incarceration, disability, or homelessness. I am particularly sensitive to these issues because of my own life long struggle with mental illness. It is also distressing for me to see those living with addiction issues who experience homelessness or incarceration because I have loved ones who struggle with addiction and I am empathetic towards the issues surrounding the disease.

For the past two years, I have been living in Los Angeles and the level of homelessness here in the city is at epidemic proportions. It is disturbing, to me, to see so many living on the streets in such dismal and dire circumstances. While not all who are homeless struggle with issues of mental illness or addiction, many of them do. As a consumer of mental health services for nearly three decades, I know first hand how difficult treatment can be to access and how, often times, the quality of treatment is poor. Services rarely include the continuity of care that leads to and enables long term recovery. Too many people are slipping through the cracks and it becomes nearly impossible for these individuals to remain in recovery when society lacks the infrastructure needed to support those rebuilding their lives. Most who have never experienced accessing mental health services firsthand are unaware of how deeply fractured the system is and make judgments without having the lived experiences of attempting to do so. As an educated individual who is able to advocate for myself, I have often been appalled by the way I have been mistreated, and even defeated, at times, by the lack of services available that would support and facilitate my recovery.

Many services and programs are often laden with structural and attitudinal barriers that even the most skilled, experienced, and educated individual would have difficulty navigating. My hope in sharing my story is to demonstrate the complex interplay between the individual struggling and the programs and services that are sometimes unavailable or of poor quality. Many times people seeking help are dealing with not only the symptoms of their illness, but also the consequences of struggling for too long in a system that lacks the wrap around services to truly help them. They also may be experiencing shame and frustration from having people in their lives who lack the awareness of how difficult it is to access help, make the false assumption that they are “just not trying hard enough”. Many who do not suffer have the wrong impression that help is easily accessible and they unknowingly invalidate the individual struggling. Using my own struggle, I hope to bring awareness of how one individual over the course of many years might experience several damaging experiences and this can lead, over time, to mistrust and a hesitancy to reach out. I am fortunate to have a good therapist at the moment who validates my complex history which is unfortunately littered with many incidents where I “hit a wall” when attempting to access help. I hope the following resonates with some of those struggling and sheds light on how challenging it can be, at times, to access quality care. The difficulty of accessing quality medical care, the services and programs needed to enable recovery, and the protections meant to prevent disability discrimination can create a challenging and difficult road for an individual who is struggling to recover from a mental illness or addiction. Below, I discuss examples from my own life to help contextualize each of these struggles in hopes to spread awareness and cultivate empathy for those doing their best to access the needed treatment and services to heal.

Lack of access to quality medical care and treatment. This can present itself in a variety of ways. Here are some actual incidents that have occurred to me personally that not only were damaging, but caused a relapse in my symptoms of anxiety and depression. Beginning with the most severe and damaging incident causing a distrust in the system, to the least offensive causing a delay in access to care, the following are my own personal experiences as a an educated individual attempting to access quality care for the disorders I live with: Bipolar 1, PTSD, Somatic OCD, and ADHD.

• Denied access to an inpatient care facility for crisis stabilization: I was once forced to leave inpatient care prematurely after only one day of receiving treatment. I had waited roughly 36 hours in the emergency room department to be assessed by a social worker and was later admitted to the inpatient psychiatric unit. Once admitted, I was able to sleep a few hours. I made the error of requesting to leave after feeling mistreated by one of the staff there. I immediately changed my mind and communicated my wishes to the staff as I knew deep down I needed the help and more than likely needed my medications adjusted. I also was waiting to receive a test that was ordered due to having breathing difficulties from a recent respiratory infection. The doctor there decided to discharge me, even though I was openly requesting help for the suicidal ideation that I was still experiencing. They forced me to leave treatment stating that if I did not leave, I would be ushered out of the inpatient unit by the hospital security. I was discharged with no medication change and the test that was ordered for my breathing difficulty was also not completed. This incident was probably the most damaging experience I have endured during all of my years of treatment for my mental health disorder. It not only placed me at increased vulnerability for a suicide attempt, but the hospital placed my physical health in jeopardy by not completing a test to determine why I was visibly having breathing issues.The incident was traumatizing and has made me not want to ever seek inpatient services again. I also felt powerless to do anything about the incident because I did not feel I would be believed. Other than to write a poor review of my experience on their Facebook page, I have taken no other actions and have moved my life forward.
• Medical providers who have been unwilling to support workplace accommodations. I have had therapists or psychiatric providers who were unwilling to provide documentation to support my request of setting up accommodations in the workplace. This was particularly damaging because the delay caused by having to find a provider that would assist me in this way, lead to employers doubting that I had a disability that required accommodations. This also caused significant stress for me which only exacerbated my symptoms. Some providers are unwilling to assist in letters regarding unemployment claims or accommodations requests. This leaves the individual struggling with no real pathway to gain accommodations in the workplace unless one decides to change providers and this can take a lot of time.
• Inability to afford or being waitlisted for needed healthcare services. I cannot count the amount of treatment opportunities (particularly recommended DBT classes) that were thwarted by lack of insurance or long waitlists. Many times I was willing and waiting for treatment to become available and the waitlist was either too long or it was too costly without my insurance providing payment.
• Certain services that would be helpful are not covered by insurance companies. I was told over and over that residential care would be the most beneficial for me. And yet, my insurance through my workplace did not pay for this type of treatment. Plus, it would have been nearly impossible to get the time off of work required to complete the program. The cost was “out of reach” for me.
• Denied access to needed treatment due to having to rely on Medicaid which often does not cover speciality care. While waiting on Medicare to “kick in” after being approved for disability insurance (SSDI), I was denied multiple needed treatments by Medicaid which caused my condition to worsen and my symptoms were exacerbated as a result. The process of waiting to receive access to quality care for both my physical and mental health for 2 years was a dehumanizing experience where I truly felt invisible and devalued. I was even suffering with a new medical condition that affected my swallowing whereby I had lost nearly 80 pounds in 6 months and I was denied multiple referrals to a gastroenterology specialty clinic. It was a terrifying experience to lose so much weight and not get the help I needed and it actually thwarted my initial plans to attempt working part-time. I was too sick and unable to get the care I needed through Medicaid. With Medicare in place now, I get the care I need and am grateful.

Lack of access to services/programs that facilitate recovery. Many of the program from housing, disability insurance, vocational rehabilitation, etc. are often inaccessible due to long waitlists or other factors. Below are some of my personal experiences trying to access these services and programs.

• Being waitlisted for vocational rehabilitation services. When I lost employment due to being denied accommodations in the workplace, I immediately signed up for vocational rehabilitation services in the state of WA. I was approved for services, but waitlisted for nearly 3 years. By the time my name came up to be served, I had already moved out of the state with a friend in order to prevent homelessness. I consider myself lucky that I have people who have supported me when needed. Being in a state of vulnerability where I could not access the services to help me return to work, has made me more empathetic to those who do not have a “lifeline” and end up homeless.
• The long wait time to be approved for social security disability benefits leaves the disabled more vulnerable to homelessness and loss of needed medical treatment. Waiting for disability insurance (SSDI) to be approved, was yet another dehumanizing experience that included many roadblocks that appear to be “set up” to deter people from gaining benefits. With determination and grit, I was able to get my benefits awarded in a little over a year. However, I know many more who wait 2 and 3 years and lose everything in the process while waiting.
• Programs, like section 8 that helps low income adults afford housing, have long waitlists and are often difficult to access. I have attempted to learn about housing opportunities here in Los Angeles so that I can be independent again and begin working a part-time job. I was told by the Department of Mental Health and another social agency that in order to receive section 8 here in Los Angeles, I would need to be experiencing homelessness. I have placed a few more calls to request about other programs for low income individuals who are dependent on their disability insurance as their only means of income, but they have been very slow to get back to me. I realize I have to be persistent, but again not everyone struggling has my education level or access to the stability I have in housing to make contact in a consistent manner. They might not have access to reliable internet or a phone. Not everyone who is struggling is well enough to voice their needs and remain consistent in pursuing services.

Lack of protection when there is a denial of rights or services. Often when an individual living with a mental illness experiences discrimination in the workplace, a denial of treatment, or another abuse, it is too easy to discredit the individual as often the above can be difficult to “prove”. Many times people who struggle experience poor treatment or other damaging incidents, but they are unaware of their rights or even if they are aware, it is common due to the stigma that surrounds mental illness for a lawyer to decline representation to provide a remedy.

• Workplace disability discrimination is more common than one might think and victims often are unaware of their rights or have difficulty gaining representation. I have experienced multiple incidents of workplace discrimination in the form of denied accommodations and even the refusal to engage in interactive discourse to facilitate the process of getting accommodations set up. This has lead to job loss, loss of housing, loss of health insurance, and ultimately a disruption in continuity of care. The entity where one can file a complaint of discrimination, the EEOC (Equal Employment Opportunity Commission), is often very slow to act. It took a year for them to investigate a claim of discrimination that I reported and I was already in another place of employment when the investigation began. The American with Disabilities Act (ADA) is the civil rights law that protects those living with a disability from discrimination in the workplace, however, it’s language is often not specific enough to provide true consequences for those engaging in discriminatory practices. More often than not, places of employment are able to escape the consequences of discrimination and this leaves the employee extremely vulnerable, having to pick up the pieces and move forward. Many people who experience discrimination in the workplace are fearful to defend themselves as they may need a descent reference or might wish to avoid other negative consequences of doing so.
• There is little protection for those who experience mistreatment from a mental healthcare provider. One can file a grievance and I have, but I have never had anyone follow up with me. Lawyers are very hesitant to get involved because the stigma lends many to believe that those living with a mental illness may not be credible, particularly when in an inpatient setting. Obviously, reaching out to report can be re-traumatizing for the victim in and of itself, especially when the victim is not “believed”.

Many of my examples are more than likely relatable to so many living with a mental illness. And believe it or not, I have many more stories that I could share. These experiences compound upon one another, and, over time, truly “break” a person. It becomes harder to trust the system and more difficult to trust medical providers enough to open up again and risk being vulnerable in order to receive help.

Living through so many tough experiences, I feel compelled to speak out regarding these issues. Many times, people lack the compassion towards those struggling because they only are viewing the one incident that is being shown to them at a particular time. Life is complex and too often I see people minimizing an individual’s struggle because they are simplifying their experience by looking at only one incident. Living with a mental illness often comes with many layers of struggle from living with the stressors of income instability, job and relationship losses, and dealing with the shame that stigma causes for those struggling. All of this is in addition to managing the symptoms of their illness. More often than not, when someone is requesting help, they have been “kicked around” a bit in the system, told “No” a lot, and are truly trying. It is truly hard out there.

This begs the question: “Why do so many not care? Where is our humanity?” I view our world as the interplay between us, the environment, and the systems we create to support a healthy relationship between the two. When we have many homeless living on our streets, we have to ask ourselves, how healthy is our society? Perhaps, those struggling with mental illness are more aware of these issues because some are faced with these risks and this makes them more attuned to the struggle. It is just a thought. My experiences over time have truly cultivated empathy. It hurts to see so many living on the streets. I personally know how hard it is to access the few services that exist to help people and I’m aware that the care is not always of stellar quality. I am acutely aware that had I not had a support system in place, I, too, may be at risk for homelessness.

I also am aware that many who struggle with issues of addiction were raised in families where their parents struggled in similar ways. The system failed to serve them as children and now they are adults mirroring what they have learned. Our society often devalues those who are currently incapable of contributing. And yet, the infrastructure simply isn’t there to help people to contribute. I am educated, persistent, and able to advocate for my needs and it was still impossible, at times, for me to receive the help I needed. As a result, I ended up relapsing and now I even have other physical illnesses, such as fibromyalgia, IBS, and migraines, that I feel are a culmination of living with an illness for so long and never “catching a break”.

I know in my heart that we have enough resources, talent, and creativity to address the problems of mental health issues and addiction that are now both at epidemic proportions. I feel if I want to see change in my community that I have a personal responsibility to act and to voice my concerns. Perhaps, in doing so people will become more aware of the challenges in addressing these issues, as they are complex and multi-layered. Isn’t it time to truly tackle mental healthcare in a creative way that not only changes lives, but changes our community and world? I would wager a guess that most people who do not see the value in serious mental healthcare reform would feel that it is too costly. In reality, the cost of the programs and services created to help families and individuals in need would be more than paid for by the decrease in rates of incarceration, disability insurance, and other medical costs incurred by individuals requiring repeated care due to relapse, etc. Investing in those who are struggling and early intervention/prevention will provide for less dependence overall.

Many times I can hear in people’s tired voices, who indicate that they are depressed, that they don’t know how to put their struggle into words. That is is “too much”. I hope by articulating my struggle I have shaved off a bit of the “iceberg’ so to speak that keeps so many of us immobile. It is too much and we shouldn’t have to work so hard to receive the treatment and services we need to help us truly recover. Society has a responsibility to meet us half way. No one is an island and the more we work collectively to address these systemic issues, the healthier our entire society will be. Our wealth, power, and sense of community is only as strong as our most vulnerable members living within it. How we treat those struggling is the difference between a decaying society and one that is flourishing, truly “rich”, and healthy.

I have hope in humanity. We are resilient and innovative. I hope by sharing my own complicated struggles that some become aware of the different issues impacting many of us who are still paddling at the surface, treading water. Give us a hand, pull us to shore. Be willing to listen. Many of us are willing to share, work, and engage with you. The struggle of so many has been weighing heavy on my heart this year and this is hopefully just the beginning of my own role as an advocate.