Mental Health Isn’t Profitable by Chris Walker

NinaIllingworth July 21, 2021November 5, 2022 abolish for profit health care, Alzheimer's Disease, artificial scarcity, austerity, big pharma, CA4, capitalism, capitalism and mental health, capitalism is failing us, Chris Walker, community support, compassion, Covid, crisis of capitalism, dignity, FA1, for profit care is an oxymoron, for profit medical care, for profit mental health care, FotB, Friends of the Blog, health insurance, Huntington's Disease, intersectionality, JA5, Kafkaesque, marginalization and mental health, medical insurance companies, mental health, mutual aid, neofeudalism, neoliberalism, Our Man in Duval, pandemic, personal, personal experience, police kill people with mental health issues, policing and mental health, policing is not the answer, poverty and health care, poverty and mental health, private healthcare, Psychology, racialization of health care, shared burden, solidarity, ST2, support networks, Walker

Editor’s note: well, it’s certainly been a frustrating couple of weeks in my life; which you can read about over on Can’t You Read if that interests you for some reason.

In the meantime, please welcome back everyone’s favorite Wobbly: NIDC collective writer and analyst, Chris Walker. In today’s hard-hitting, viscerally personal article, Chris walks us through his own familial experiences with the American for-profit mental healthcare system.

Join our author as he explores a drop-dead world of Kafkaesque barriers and risks thrust on innocent people, by a for profit industry whose lust for lucre actively gets in the way of obtaining adequate care, even for someone with health insurance. Of course, mutual aid is a solution, but clearly the problem is capitalism.

Mental Health Isn’t Profitable

We’ve learned some very hard lessons about the healthcare industry in the United States since the pandemic, through two fundamental problems: the US is unwilling to interrupt profit to enforce a lockdown, and very willing to address the problem with vaccines to create another profit stream. The rule of law is completely ineffectual next to the real power of medical profit; in fact, making healthcare harder to obtain and ineffectual, through the perceived legitimacy of our laws, is part of how that profit is made. Providing timely, adequate care while also creating private profits from artificial scarcity is a fundamental contradiction that can only be equitably resolved through public ownership of that care.

I can identify some effects of those contradictions with my own family’s experience. For example, it’s a lot of work just to find someone that can write prescriptions and slowly tweak everything to meet my wife’s needs, and treatment is a delicate process of trial and error that requires time and effort on the part of both patient and practitioner. Despite the psychiatric office staff being completely incompetent, constantly getting dosages or specific drugs or timing wrong, my wife had been taking medication long enough to get over initial side effects and see some positive results. This could be the key to unlocking a more fulfilling life for her.

If it weren’t for our insurance, perhaps an incompetent psychiatric office staff wouldn’t be so bad to deal with, but jumping through hoops to get this medication is part of the journey. Without getting too specific, our health insurance provider regularly pushes for one less expensive drug over another whenever they possibly can. My wife has had a history of heart palpitations and being vulnerable to this and other kinds of side effects. She has discussed this with the psychiatrist many times, with an understanding that trying one of those drugs to “see if it works” isn’t worth the risk of permanent heart damage. Naturally, those messages never really make it to our insurer intact, and several attempts to fill prescriptions have been denied coverage, usually at the most inopportune times.

That frustration was combined with a voicemail from the office over a month ago, cancelling my wife’s appointment scheduled three days later, and informing us the psychiatrist is no longer seeing patients. We were given no notice or opportunity to respond, and our prescriptions were filled for thirty more days. The list of referrals they gave us was laughable. Only two accepted adult cases: one the receptionist hadn’t heard of, and the other with several online reviews highly suggesting a history of sexual harassment. After my wife made it clear the psychologist could possibly be in legal trouble, they got involved directly (just enough to evade real trouble, but not enough for my wife to avoid future hassles). While the truth is the pure defense when it comes to libel, I don’t have the stability or the money to combat lawyers with more time and deeper pockets. Believe me, I would love to name all the names and spill all the tea.

The idea of my wife having to wean off of this medication is frightening, frankly. The search for another psychiatrist starts again, already a multiple-month process, just like it was last time. Considering our luck, I fear what comes next. When I step back and assess my situation, I realize that I am in a relatively fortunate situation despite these constant headaches. I am employed, insured, and a homeowner, able to work from home and provide for my family with one income. I can adjust my schedule to work around life’s (or insurance’s) cruel obstacles. That set of circumstances does not represent the majority who have to sell their labor to survive, nor does my ability to avoid systemic racism or intrusion into my gender or sexuality, just by the way I present.

This experience forces me to ask deeper questions. First, why would a psychiatrist medically abandon all their patients? My tendency is to always ask the workers; they’ll tell you what’s going on. Tricia, a licensed mental health counselor in Florida, describes the severe burnout in the field:

"A previous employer expected me to bill 1200 hours a year. An average of 27 cases a week - that's a lot! On top of that, I was expected to maintain a minimum caseload of 60 people at all times. Because I was the only one licensed to see patients with private insurance, when I left, my caseload was at 97 people. Counselors are ingesting the emotional distress of everyone, and if they aren't careful with self care and boundaries, their own mental health declines."

This severe burnout is accelerated when insurance companies micromanage their care. Even in cases where drugs are scientifically proven necessary, insurance requires enough red tape and haggling to effectively reduce what they pay overall. As a result, doctors are quitting in droves, and many doctors are telling young people not to enter the field. Tricia demonstrates this in her field as well:

"Insurance refuses to cover mental health benefits. Low reimbursement rates and closed panels to approve credentials are ways they directly control the supply of care. Big shops have negotiated a better rate, and small shops are forced to reject insurance and accept self-pay only, introducing a classist obstacle to care. Medicaid reimbursement is completely different, but they pay less than insurance does."

Tricia also confirmed my suspicions about my wife’s struggle to get proper care:

"Psychiatrists have similar struggles, and they react to low reimbursement rates with throughput to stay in business, turning into pill farms. There's no time for a comprehensive diagnosis. When my daughter was taken to the ICU and put on a ventilator, I was interrogated by a psychiatry resident focused on sudden change in behavior rather than broad medical history. It was insulting and traumatic. If it wasn't for a cardiologist trained to take the time and go over every systemic problem, my daughter wouldn't have been timely diagnosed with a rare neuro-immune disorder that presents with psychiatric symptoms."

No one had time to take the time, because insurance doesn’t want to pay out.

Volumes have been written about the struggle for proper healthcare in the United States, but begging politicians for less eugenic zeal is not in my personality. I have experience with Huntington’s Disease and how our family used rough forms of mutual aid, but our approach usually placed a life-altering burden on a single caregiver. My grandmother, for example, cared for my grandfather, my mother, and my brother, and all three were not in their right mind to avoid inflicting violence upon her. She did this because she loved us all. Historically, our loved ones got better care from family than any other entity could provide. We had time to take the time, knowing what it could cost to the sanity of the caregiver. My brother-in-law, my cousins, and many other relatives know this cost. I know this cost. And if you know a family member with a neurological disorder, like Alzheimer’s Disease, chances are, you know this cost, too.

Mutual aid found within a family may be familiar, but broader forms are all too unfamiliar. Feeding and caring for others is a revolutionary act in and of itself, and we can organize to take it upon ourselves to care for our community, despite how difficult it is to give free food and care. Remember that solidarity is not charity, as charity implies the power to give and take away, and an unequal access to resources necessary for a dignified life. Solidarity can be a simple act of knowing your community better, instead of adopting a sense of rugged individualism. If my community was more aware of my family’s needs, even in a small rural town, my brother wouldn’t be mistaken as a drunk pedestrian and arrested by the police when he wandered out of the house (this happened multiple times). Escalations and unreasonable responses to mental illness are far too common in our disconnected communities.

The most distinct advantage of community-led care is how the burden and trauma can be shared in humane ways. A more comprehensive vision necessitates pooling resources and demanding more from those in charge, at least in a “survival pending revolution” sense. Considering how intertwined the healthcare industry is with the government, and with employment itself, our demands should be the total abolition of profit from healthcare, at a bare minimum. The deafening silence from those who made money during the pandemic, wealth specifically made from our suffering, deserves our most intense anger. Our communities still need that extracted wealth restored.

We will not be able to meaningfully develop this necessary sense of community solidarity without overcoming many stigmas surrounding mental health. It is not a character flaw to seek medication, therapy, or help; nor is it a virtue to dismiss the need, or to post a hobby or nature scene on Instagram captioned, “This is my antidepressant.” We are all working through massive amounts of trauma. Your first step should be to understand that no one is an island or a self-made individual. Humans are wired to seek and depend upon others. When you embrace that, the next natural step is mutual aid, and the specifics will always come from what you and your neighbor need for a healthy life. After that, you may realize the nature of the work that needs to be done.