My client is sitting across the room, decidedly not looking at me. My breath catches in my throat. I notice and try to correct for it, forcing myself to breathe as calmly as I can; while he composes himself, I run through a sort of anxiety checklist that I typically help others with. Relax your stomach, In-Two-Three-Four, don’t hunch over, Hold-Two-Three-Four… that’s it, Out-Two-Three-Four. We’re still good here. Again.
He glances at me before pulling his knees up to his chin on the chair. I set my notepad and pen down on the desk next to me and lean forward. When I ask him what happened, I see that his cheeks are tearstained. After a moment, he tells me he’s angry at himself because he’d been doing so well recently, and as those words leave his mouth- so WELL recently- he loses his composure and starts sobbing.
As he gets through that initial burst of emotion, he tells me about how he hasn’t been taking his depression medication as prescribed because he thought he’d be alright without it this time. Because he should be alright without it, because normal people are alright without it, and this kid just wants to feel normal. Instead, he stands with his heels on the edge of a cliff he’s doing his best to pretend isn’t there.
But this time, pulling himself off his meds without telling anyone coincided with a particularly bitter fight with his ex-girlfriend who still lives in his house for financial reasons.
Caught between a rock and a hard place, his fragile recovery had shattered and his suicidal ideation had come roaring back; he’d reverted to his old habits of cocaine use and cutting his arms up. There was a time that might’ve made him feel better, but not this time. So when that hadn’t worked, he’d started planning to overdose on a concoction of vodka, more coke, and all the Zoloft he hadn’t been taking.
I breathe an enormous sigh of relief, though. Oh thank Christ, I think to myself, and I silently thank the powers that be.
I’m thankful because this time, I was fortunate. He’d come in all smiles and sunshine, joking like he usually does in the beginning of his sessions. This time, for reasons I can’t remember now, I pulled at a thread; some otherwise innocuous thing he’d said in just the wrong way made the hairs stand up on the back of my neck, made me think No, that’s not right, ask about that. This time, I was able to see through the facade of No, really, I’m OK and talk my client into going to the hospital willingly. This time, we avoided catastrophe.
But this time would have gone much differently if my client hadn’t been covered to see me in the first place.
I’ve been a mental health therapist for five years now. I work at a community mental health center; and working “in the community” is a nice way of saying my clients are usually broke. 100% of the clients I see, every single one of them, has Medicaid. The reason most of them are covered to get services at all is because Pennsylvania took the Medicaid expansion back in 2015, which opened up the coverage to people who hadn’t met the requirements before.
If they lose that coverage, most of them will leave. If they have to choose between using their tax rebates or vouchers to see me, or to see their medical doctor, they’re choosing their doctor and I don’t blame them for a second. Most of my clients have chronic medical diagnoses on top of their mental health challenges- I have a surprising amount of motorcycle accident victims, for example- and they know they have to make every dollar stretch as far as it can.
But if too many of them leave, our practice closes down, and there isn’t another mental health practice even remotely near our capacity on the northeast side. All those people who didn’t want to leave our service will have nowhere to go, or would have to go on a wait list for months somewhere else.
This story is one of the good ones I have. It’s a time when we got lucky, when mental health care works like it’s supposed to, and it catches someone before they fall.
“Medicaid is a vital resource for those with mental health challenges.”
We need to preserve the federal funding that allows these good stories to happen, that lets these people get the care they need. Because these people are our people, and they are among the most vulnerable of us, often for no original fault of their own. Therapists like me help teach people how to cease unhelpful habits that keep them in unhealthy patterns; we help people manage their depression, anger, and anxiety enough to get jobs, socialize, and start families. We’re a profession that helps people become happier, healthier, and more productive. And we do it for cheap, but we can’t do it for free. Not at the scale this challenge exists at.
So please, call your Congressman, your Governor, your Senators — tell them that the Republicare cuts are too deep, that they put at risk the most vulnerable among us. Tell them to send the whole damn plan right to the scrap heap, and tell them to start over with a basic pledge to preserve care for the most needy, instead of starting by asking themselves how profitable government can make an insurance company.
And as far as my client — we got a decently happy ending out of this one. He got out of the hospital in a week or so and later transferred to a higher level of care with a program more aimed toward chronic drug use.
I haven’t heard from him since, but I hope I will.