Psychological problems come to all castes and classes in our society, and no group, whether rich, poor, educated, or not, handles mental illness well. However, such problems are especially daunting if you are poor.

This is the first of what I hope will be a series of pieces on mental health in the U.S., emphasizing difficulties for poor persons. In my last piece – if I get that far – I’ll discuss some policy concerns and propose a few solutions. First, however, I want to lay out the difficulties that some specific people have faced.  

One of my former students phones me, saying that she is terribly depressed, thinking strongly of suicide. I’m worried; she is not one to make a bad joke about suicide. I ask, and she says yes, she has the means to end her life: a supply of sleeping pills, alcohol, and painkillers are at the ready. Even worse, her mother and her sons are away for the day. Now I’m very worried. She has all the signs of being ready to end her life, except for calling me – a cry for help, certainly. She needs to see someone very quickly, who can hospitalize her if necessary, and give her medication.

A bit of background: my student is a senior, in her last semester of college, living on a small scholarship and welfare. She is divorced (her husband ran off with another woman), with two boys in elementary school.

I talk with her, and get her to agree to let me help her. She is adamant that she will not go to an Emergency Room with or without me. (And she knows what to say if I could get her there: ERs are not looking to hospitalize anyone who comes in with mental health problems, especially if such a person denies she is suicidal and acts perfectly sane – they don’t have the beds available, a topic for another day.)

The county’s community mental health center has a 6 month waiting list. Oh, but she has health insurance that covers mental health problems! Wonderful! Medicare, thanks to welfare, has assigned her family to a local HMO. She has no regular doctor but sees whoever is present at the clinic they go to when they are ill. She doesn’t feel up to making any effort to contact her HMO, however she will let me contact them on her behalf. She agrees to see a psychiatrist within 24 hours if I can make the arrangements.

Surely I can manage this, and keep her from doing anything harmful to herself for a few hours until she can see a physician with psychiatric training. I call her HMO and eventually talk to their intake worker for mental health. I describe my student’s situation, how desperate it is, how she has intentions, a plan, and means to carry out her plans for killing herself. I lay all my professional credentials on the line – psychologist, prof, depression expert, etc. to convince her I know what I see.

I insist that my student must see a psychiatrist within 24 hours – she is suicidal. I’m told there is a 6-week wait, otherwise go to an emergency room. However, the intake worker has a suggestion: “She’s not crazy, is she? Then why don’t you write her a little scrip (prescription) for a few antidepressants to tide her over until she can get an appointment? You know, just something to make her feel good right now? And then she probably won’t even need to come in at all.”

I am appalled! The intake worker doesn’t know that 1) psychologists do not prescribe medication (there are a very few exceptions to this, and my state is not one of them), 2) even though they work faster than therapy, antidepressants are not fast acting, and 3) depression doesn’t “go away” in 6 weeks or so! And 4), the biggie: this person doesn’t recognize classic signs of high suicide risk!

Eventually I talk to the intake worker’s supervisor and I do get a psychiatrist’s appointment for my student for the next morning. My student seems relieved, and we make arrangements for some of us to stay with her in shifts until she sees the psychiatrist.

Story over. What people need is a good mental health advocate, right? No.

When my student arrived for her appointment the next morning, the person she saw was not a psychiatrist. Rather, he introduced himself as a social worker.

This social worker asked her about her symptoms, and then what was going on in her life at the moment. My student had a long list:  welfare agency hounding her to quit school in her final semester and take a job clerking at a store as part of the new welfare-to-work rules; bill collectors hounding her for a debt her ex-husband had run out on; her old car broken completely, her rent-controlled apartment being sold for a tear-down in two months, her son being taunted and picked on at the school he attended. . .

The social worker’s response was sympathetic but brisk. He told my student that it was no wonder she was depressed. Anyone in those circumstances would be depressed – she was just a typical poor person. Therefore, she did not need to see a psychiatrist, and would not be seeing one that day. He suggested that she see her pastor instead, and spend some time praying, because prayer was about the only thing that would help someone in her situation. Having given his advice, my student was dismissed.

And that was mental health assistance via Medicare for one poor person in my fair state.

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