How Can We Fill in the Gaps Where Mental Health Services Fail?

Our system is far from where it needs to be — but we can help each other while we build a better one

Trigger warning: This article mentions depression, anxiety, and suicide.

You know the hardest thing about mental health struggles? Things like depression, anxiety, and other issues make it really hard — often even impossible — to ask for or seek out help. You’re tired. You’re scared. It takes all your energy just to get out of bed, for god’s sake. And then you’re supposed to search the internet for services that your insurance covers? And then pick up the phone and do the one thing you spend most of your life trying to avoid: talking to someone? About your mental health issues? And asking for help, hoping they are taking new patients?

It’s too hard.

This is what I wish I could say to the powers that be who could do so much better when it comes to mental health care in America: This is too hard.

It’s great that we have so many hotlines available. But everyone who struggles with their mental health knows that when we really need those hotlines…that’s when it’s the hardest to use them.

How do you fix that? How do you make it so that people who need help — whether they are in crisis or just unable to cope with the little details of life and need a boost — can get the help they need? Because a lot of the time, they are not capable of getting it for themselves.

They are not always capable of picking up that phone and calling a hotline when they have a bottle of pills in their hand. Do you know the courage and Herculean strength it involves to do that?

And even those who are not in crisis, but still need help are often incapable of getting it. As mentioned previously, getting out of bed, getting dressed, or even eating cereal in their pajamas might have taken all the energy they had that day. There’s nothing left for researching insurance requirements, calling counselors, and arranging for interviews to try to find a good fit. Honestly, it’s almost funny to think that that’s what’s required if a person needs help with their depression or anxiety: the one thing they really just can’t do.

And I know all this for sure because I’m one of these people.

As someone with mental health issues, I find myself constantly frustrated with the state of mental health care in this country. In my own experience, I’ve found it hard to find good help, the help I have found often lacked compassion or kindness, and, perhaps worst of all, I’ve found help to be mostly financially inaccessible.

When my parents were in the thick of their acrimonious divorce, which was near the end of my own relationship, and the pressure and pain of both situations became so overwhelming that I started to think of ending my life, I knew it was time to seek out help, but I quickly found that without insurance, I couldn’t access therapy, which is what I wanted to try, first. I needed to talk to someone, after all. I needed guidance and help sorting out my feelings more than anything.

Without that option, I knew the only other solution was medication. So I paid for one doctor’s visit, out of pocket, and asked for an antidepressant, which the doctor gave me without question or recommending a follow-up with a counselor.

During the first week of taking that medication, I found myself both emotionally (and sexually) numb and yet simultaneously manic. It was a very scary experience and I called the doctor to talk to her about it and see if there was a way to adjust the dosage or perhaps try another medication.

“Mania and numbness are not known side effects,” she said dispassionately. “Your depression and anxiety are playing tricks on you. You aren’t really feeling that way. You just think you are. Stop indulging in your thoughts and continue on as I instructed you.”

I hung up the phone and cried.

Just over a year later, when my boyfriend had left me for a younger woman a few months after I’d stopped taking that medication, I tipped fully over from suicidal ideation to needing to make it happen. I felt like a useless piece of garbage and was ready to make a reality out of that.

Somehow, something inside me dredged up the strength to start calling local counselors to ask if they were taking new patients. I don’t know what I thought I would accomplish — my job at a local school had just ended and I hadn’t found a new one yet, which meant I had no income and no insurance — but I had hoped by explaining my situation, someone would help me find a resource that I could afford.

I called six counselors, leaving brutally honest messages on their answering machines.

“I really need help,” I said. “I’m struggling with suicidal feelings and I honestly don’t know if I’ll make it through this. I don’t have insurance and I’m between jobs, but I was hoping to find a counselor who can take people on a sliding scale, or at least someone who could recommend help for me that I can afford.”

Only two of them called me back. One left a message, in a chipper voice, “Sorry, I’m not taking new patients at this time, but thanks for calling!” The other said, “I’m sorry you are feeling so badly. I don’t have any resources that could help you. Maybe try the county office? Good luck!”

I didn’t end up getting help at that time in my life when I was regularly sitting down with a bottle of a pills, crying, trying to work up the courage to swallow them all. Somehow, something in me was invested enough in staying alive that I made it through to the other side.

All by myself.

My mom hasn’t been able to sleep in her own bed for over a month now. She has to sleep on the couch or an inflatable mattress in the den because being in her bedroom, for reasons she can’t identify, is making her experience panic attacks.

“I think I’m having stuff come up about the divorce that I haven’t dealt with,” she’s told me. “Or maybe it’s processing the panic and grief I’ve been feeling since the pandemic started, now that I’ve been vaccinated and am feeling a little safer. Or maybe it’s just worry about Alex that I’ve been repressing these past two years.”

I always laugh when she goes through this list. Umm…yeah! Any one of those things might be the very real culprit.

And then I tell her my list of reasons why my anxiety seems to be extra high lately and my depression running at a steady pace like a determined sled dog. Maybe it’s the past year I just spent mostly alone in my house with so little touch I feel both a little dead inside and also dangerously ravenous for someone to hold me for ten hours. Or maybe it’s the sorrow of the kids moving away, leaving six giant holes in my heart. Or maybe it’s my injured shoulder that makes it hard for me to type, shampoo my hair, or even put my clothes on. Or maybe it’s… Well, you get the picture.

My mom called me last night to lean on me, facing another anxious night. She said, “Be proud of how well you’re doing.”

I laughed. I told her I was struggling, too. That between my shoulder and touch starvation and a year of loneliness that has no marked end in the future, I am having a hard time getting my work done each day. It’s hard for me to see where I’m going, what I’m doing. It’s hard for me to visualize the projects I wanted to work on this year and to imagine anything coming of them. Frozen, quarantined pandemic mind has got a strong hold on me. All I can see are more endless months of watching the seasons pass from my living room or my garden.

I can see that my mother needs help. She needs someone to talk to. She doesn’t like to share this aspect of her life with her friends who have their own deep struggles. Just like it’s hard for me to do the same. My friends are literally dealing with their own pandemic depression and anxiety and taking care of their own parents (and children, for the most part). I can’t call them and say, “I’m so lonely right now. Let’s go on a socially distanced walk.”

Just like me, most of the time, they wouldn’t be able to come. They need help, too.

I often wonder how people are faring right now. This has been such a hard year. And while there’s a lot to celebrate, there’s also a long way to go before we see the end of the pandemic.

How many people, I wonder, didn’t have mental health issues before, but do now? How many people have never talked to a therapist and don’t recognize when they need to? How many people don’t know how to identify depression or anxiety because they’ve never really had it before?

And what about those who are going through even bigger issues than someone like me? Like being in a marginalized group that has faced trauma after trauma during 2020 — trauma that far surpasses just the pandemic?

What about people who don’t know who to go to? Who to call? What about those who cannot afford help? Or those who do not have the energy to seek it out?

I wish I could say I had more hope in the way America’s mental health scene was evolving — things are improving but there’s still so much to be done.

In the meantime, we can do our best to help each other out.

When you have a spare minute, check in on your friends. The slightest text or email can help someone who is struggling get through the day. (God knows, I don’t know where I’d be without my loving, generous friends at least one of whom is always knocking on my inbox every day.)

If you see someone posting something particularly grim on social media — especially someone in a marginalized group — reach out. It doesn’t matter if you’ve never spoken before now. Again, the gesture could change the trajectory of their life in that moment.

Offer to help a friend (or stranger on social media) find professional help if they need it. Tell your friend that you’d be happy to help them navigate their insurance to find the right providers and even help them make an appointment, if need be. Drop the number for the National Suicide Prevention Line (1–800–273–8255) into a distraught stranger’s DMs with a note of compassion and support, and offer to help them make the call, if they need it.

If you’re the one feeling bad and don’t have anyone to check on you right now, be your own advocate. Tell someone who cares about you that you need help finding resources to get you through your struggles. Do your best to make more calls to your friends (for you own sake) and love yourself enough to be okay with not being okay.

And if you are doing okay, help others by supporting the creation of a better system. Write to your representatives and share stories of the mental health struggles of your loved ones and ask for change. Ask for services that are accessible to everyone, no matter their financial situation.

And give money to organizations like The Loveland Foundation, who are doing the work that needs to be done right now.

“How about you find me a therapist and I find you one,” I joked to my mother during our phone call.

“Somehow, that seems easier, doesn’t it? I have more energy to help you than I have to help myself.”

“Ditto,” I said.

Unfortunately, that’s the trick with mental health issues — and a medical system that’s pretty far behind the times in an industrialized nation: It’s hard to help yourself.

So we have to be ready to help each other.

© Yael Wolfe 2021

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