Mental health no laughing matter

I joke. A lot. Mostly at my own expense, but sometimes it’s watching the reaction of a cat I’m sitting who is bound and determined to find the cat purring in my phone (Chicot is a hoot, as are her sisters Lucy and Nora, especially if my phone is purring or a sky raisin has invaded the house).

I will never not miss this boy.

I lost my own cat Luke nearly seven years ago, and while I haven’t gotten to the point where I feel I’m ready to take on another cat or three of my own, it’s been healing for me to take care of other people’s cats. That’s where I am in that particular part of my mental health journey, though I have a long way to go. Still, for now, I’m more than happy to sit Miley, Tomkin, Ollie, Charlie, Dolly Madison, Smokey Joe, Cheeto and whoever else whenever I can.

For one thing, it’s a lot cheaper than the cost of a therapy session, which is something we should remember as Mental Health Awareness Month comes to an end.

My mom used to say I came out of the womb worried, so the idea that I’ve never not had depression is believable for me, no matter how goofy I may be sometimes. Humor is a defense mechanism for me.

I’ve lived with chronic depression and anxiety for most of my life, but have mostly been able to work around it; I was a functional depressive and could focus on tasks without much problem for decades. I didn’t really know any other way, having grown up poor with no priority put on mental health. I wasn’t diagnosed till around 2010, by which time I was no longer quite so functional and found it harder to do simple tasks; I still barreled on through, though, because that was all I knew to do. Medication has helped, though even that took some adjustment, as one of my long-term meds started contributing to anxiety attacks last year.

I wouldn’t be surprised if there are some attention deficit issues wrapped up in there as well, but I haven’t been diagnosed as yet, partially because the cost of therapy is not easily met for a lot of us. I’m still paying off sessions that I had to end months ago because of the out-of-pocket price tag.

The two of us in the middle (oldest and youngest) are the ones who’ve dealt for decades with depression that runs in the family.

Illnesses like depression and anxiety don’t just affect the brain, and they’re not just being sad or fidgety sometimes. They can affect every part of the body, and what works for one person to feel better might have little to no effect for someone else, and in some cases might make matters worse. (My old landlord was constantly recommending exercise as a fix for my depression; she obviously hadn’t dealt with severe depression in her life, and exercise ended up exacerbating my IBS, which was So. Much. Fun.)

More than one in five Americans live with a mental illness each year, according to the National Alliance on Mental Illness (NAMI), and half of those go untreated. For minorities and lower-income people, it’s hard to get past the barriers (economic, racial, gender, social, etc.) to needed care. Medication is easier to pay for with insurance, so therapy, which can provide breakthroughs and a path forward, gets put off or avoided altogether (and online therapy appears to be better suited to those with low-grade severity of symptoms).

Getting doctors to take you seriously can sometimes be difficult. I’m having a hard time at the moment getting a male doctor to understand that not being able to get to sleep is a big problem for me and is affecting my work and physical and mental health. Image by John Deering.

Daniel Dawes, professor and executive director of the Satcher Health Leadership Institute at Morehouse School of Medicine and author of “The Political Determinants of Health,” told Georgia Public Broadcasting in 2022, “Investing in mental health care saves lives and dollars; we have known this for decades, but until now did not fully understand the monumental impacts of neglecting to act. … For the first time, there is tangible evidence demonstrating how decades of systemic health inequities have yielded significantly worse outcomes for racial and ethnic minoritized, marginalized, and under-resourced populations.”

A Morehouse study found that, “before the pandemic, a lack of mental health care equity cost more than 100,000 lives and $278 billion nationwide,” reported GPB. Dr. Shale L. Wong of the University of Colorado, who participated in the study, told GPB, “Right now, we have a choice. We can maintain policies that perpetuate inequity or take new policy actions to reduce it.”

I know of several people just off the top of my head, several of them family or family friends, who might still be here if access to mental health services was better than it is. The only reason I got a quick turnaround on getting therapy late last year was because I had a meltdown during a regular doctor’s appointment and the family medicine residency clinic I use is implementing a more integrated approach to care by including behavioral health in the practice. While the few weeks of therapy helped, more would have been ideal to get me past some really tough spots (it seems especially cruel that it costs so much when financial instability was a contributing factor to my meltdown). But costs have to be prioritized.

The U.S. needs to change its approach to health care in general, but mental health care needs special attention. The “bootstraps” approach helps no one but the insurance industry. Image by Rudzhan Nagiev found on National Institute of Mental Health.

The United States spends more on health care than any other wealthy, developed nation, but with worse outcomes. The Commonwealth Fund found in 2020 that while there appears to be less stigma in the U.S. to getting behavioral/mental health help (I’d wager you might find there is still a lot of stigma in rural areas/states, though), one in six adults in crisis were unable to get or afford that help. The U.S. was found to have the highest suicide rate of 11 high-income countries and one of the highest substance-abuse rates.

The Commonwealth Fund reported: “The United States has one of the highest mental health burdens among high-income countries studied. Structural capacity to meet mental health needs, in terms of workforce numbers and preparedness, is also relatively lower in the U.S. than in other high-income countries. Although the Affordable Care Act strengthened insurance coverage for, and access to, mental health care and substance use disorder treatment, considerable gaps remain.”

There are things we could and should do to make mental health a priority, and other countries have experimented successfully with solutions such as reducing or eliminating cost-sharing for mental health care.

And while there may be less stigma here overall, I still see the lingering effects of it from my youth, when we didn’t talk openly about our mental troubles; mostly, it was only whispered about if brought up at all. Care is out there. It’s the reluctance to admit we need it and finding a way to pay for it that we have to overcome.

I may joke about my sanity sometimes, but access to mental health care is no laughing matter. It shouldn’t be so hard.

These fur babies are wonderful therapy, though they don’t offer advice much beyond “feed me,” “clean the litterbox, peasant,” and “play with me.” Top from left: Dolly Madison, Smokey Joe and Miley. Center from left: Cheeto, Tomkin, Ollie and Chicot. Bottom from left: Lucy, Charlie and Nora. Love ALL of these kittehs! Got a kitty? I probably love it already. Collage made on Fotor.