Saturday, November 21, 2009

Getting Help When Money is Tight and When It's Not

Moving on from the Hummus debate...

Today's NYTimes has an article called Getting Mental Health Care When Money is Tight.
Leslie Alderman writes:

According to a recent survey by the federal Substance Abuse and Mental Health Services Administration (Samhsa, pronounced SAM-suh) , the leading reason that people with mental health issues don’t seek treatment is cost. They fear the fees.

The article goes on to list websites, support groups, self-help ideas (yes, exercise was in there!), pastoral counselors and an assortment of options for people who want help but are uncomfortable with the cost. The author even suggests:

If you have a good relationship with your primary care physician, you could see him or her. Your doctor may be able to refer you to a local mental health center for therapy, and maybe consider medication to help you out of your immediate funk. Doctors may also know of psychologists who see patients on a sliding fee scale.

Hmmm, sounds like psychiatrists aren't a very generous crew-- there's no mention of the idea that one of those might discount their fees.

In Maryland, there have traditionally been a few options:
1) Community Mental Health Centers have treated uninsured, indigent patients, specifically those with major mental illnesses. These patients are deemed "gray zone" and have been cared for in the clinics....not sure that continues with all the governmental budget cuts. Often these patients end up being eligible for Medicaid, and sometimes SSDI (Social Security Disability) and eventually Medicare.
2) Homeless patients (and homeless is defined pretty loosely, and not limited to 'street' people--) can be seen at Health Care for the Homeless-- they're sliding fee scale allows for
very low fees.
3) The Pro Bono Counseling Project coordinates care for those with limited resources through a network of volunteers in the community. The list includes therapist of every ilk-- but I will say the social worker volunteers greatly outnumbers the psychiatrists.
4) Teaching programs (and this was an option in the NYTimes article) offer treatments of all types--- including psychoanalytic training programs where discounted analysis is available.

Do you know of other resources? By all means, write in!

So my other thought was this. I think health insurance is a good thing, and actually, I hope some reasonable level of health care should be accessible to all, but given that it's not, have we become complacent in a way that's not helpful? The article starts out talking about a person with what may be a major depression and the person is afraid that the cost of treatment will add to the stress:

IMAGINE this situation. You fall into a deep
malaise. Friends say you need help, but you don’t have insurance (or the insurance you do have has very limited mental health benefits), and you worry that extra bills will only add to your malaise. So you do nothing.

The article goes on to describe discount means of getting care, and you know I think these are all reasonable options. But we all know there are people who worry about money with a variety of thresholds-- one could worry that extra bills will add to the stress even if there's money in the bank. And no where does the article suggest that if there is some means of paying for care, that the cost of NOT getting treatment may well exceed the cost of getting care. Maybe the person above has a depressive episode-- maybe he'll go for an evaluation, a few weekly visits, then a year's worth of monthly visits, and get meds from Walmart or free doc samples. Let's pretend he responds well to the first medication, that he gets a lot out of a few therapy sessions, and ...hmm....maybe $600 later he feels a lot better. Let's say he doesn't spend that money and he's miserable. Let's say he loses his job, he loses opportunities...he lives life less fully.

I've watched people who pay $20K year for their child's kindergarten not be willing to go outside their HMO to get appropriate medical care for the same child.

I liked Alderman's article, she offers good suggestions. I guess I just wished that she'd made the suggestion that, if possible, psychiatric treatment might be worth paying for. I know I'm going to get comments from people who really do stretch to pay for their treatment. I'd love to hear from the folks who have a few resources but still elect not to get treatment they might like to have.