The Cost of Effective Mental Health Care

Financial burden is a barrier to health care and mental health care is no exception. This goes for both the uninsured and the insured. As a result of what I later learned was bipolar disorder, I was without health insurance for about four years while I recovered and essentially started my life over. I was able to find affordable mental health care – which I primarily used for medication management – as the therapy sessions were far too short to be effective in my opinion. In fact, I was only consistent with therapy sessions so that I could get medication refills. Perhaps, because I was comparatively more stable than most other consumers at this clinic, my appointments were cut short. Or maybe it was because I consistently kept my appointments, had seemingly more education than the average consumer, and was employed.

While none of these is an indicator of one’s mental health status, I do think that there is a stereotype of mental illness that I didn’t quite fit. The clinic that I went to was for low-income patients who were likely uninsured or underinsured, and most consumers were Black – like me. But, whatever the reason, it seemed as though I got the “in and out” treatment.

Now that I do have health insurance, I find that some of the issues concerning receiving care from a mental health provider haven’t gotten much better. For one, the cost to see a professional is higher since I am no longer on a sliding scale for payment. One could argue that with a better-paying job the difference in payment is negligible; however, if you have a serious mental illness or a mental health issue that needs continued treatment, these costs – co-pays, prescription prices, etc. – add up. For two, finding providers who are available, who specialize in your needs, and who are in your network is a difficult task. Consistent with when I did not have insurance, it seems that now that I do have insurance, finding affordable and effective talk therapy is more so the problem than finding effective medication management. This may be difficult for me personally because the issues I struggle with are not all too common – for instance, experiencing psychosis and the resulting grief, trauma, and loss.

Finding someone culturally aware was also a must for me, especially as a Black woman. I’ve been reading a lot about minority mental health given that July brings awareness to this issue, and some of what I have read is that Black people’s intense emotions are often misinterpreted and misdiagnosed as psychosis or schizophrenia. So, the mood symptoms they present with are largely ignored. This can be the case even for someone like me, who has undeniably experienced psychosis on more than one occasion. A differential diagnosis that I received and had for months before receiving a bipolar diagnosis was brief psychotic disorder. The label makes a difference when it comes to treatment. Not only do I need an antipsychotic but also a mood stabilizer, likely for the rest of my life. It has been my experience that the black therapist who diagnosed me with bipolar in 2017 and the two other black therapists I’ve had (one before the diagnosis and one currently) have been the ones most sympathetic to my illness and the ones who didn’t try to brush it off because I had seemingly made a full recovery. They are the ones who took me the most seriously and whom I didn’t feel wasted my time with the standard assessments and tools that were not designed with me in mind. I don’t have to worry about them talking about themselves and comparing my experience to theirs, or taking phone calls during sessions, or telling me to return to what I was doing before with no game plan.

My current therapist is out-of-network, but she listens, and she strategizes, and she gives me assignments, and she can relate to me. I don’t see her as often as I’d like to because of cost, but to me it’s far more worth my time to have a provider who takes my Black experience into account – even if it is a little atypical. I am not saying that non-Black people cannot be culturally aware – they can. It has just been my experience that having someone who looks like me help me has been more effective in my recovery.

Signed

Lai (Bipolar I)