Links are collected at the end of the post.
I really like this picture. It has compositional flaws, but I really like it. October 20, 2012: 10 years ago close enough to the day.
Speaking of days, twice in recent ones I thought I was done with a thing at least for a while after I wrote a long thing about it, and then more things related to the thing presented themselves. Thus it was with global warming, which had briefly shoved aside a thing about private equity and shortages of mental health providers — which was the product of a thing about attempts to address mental health that often obscure some of the things that contribute to a lack of it — and then returned the next day to interrupt, although not terminally, the thing it had displaced.
I thought I was done at least for a while with the shortages and obscurantism but that seems not the case. Over the weekend the Washington Post published a long-ish story1 about the shortages of mental health providers. The reporter ascribes much of the increase in demand to the pandemic, but that’s as deep as she goes. Why was the pandemic so much worse here than elsewhere? What environmental conditions did it create which helped drive the increase in “anxiety, depression and other mood disorders,” and how can those conditions be addressed other than and in addition to dramatically increasing the number of providers?
The Post piece begins with a hospital emergency, and ends with a struggling physician eventually finding an in-network therapist after months of struggle. In between are other individual examples of struggles precipitated by … something, and worsened by the difficulty of finding a therapist, and examples of therapists struggling to keep up with demand.
This summer, Massachusetts General Hospital had a staggering 880 people on its wait list for psychiatric services. The list had grown so large that the hospital issued an unusual plea to its physicians: Stop referring psychiatry patients for non-urgent care.
“Our triage staff is not able to make any progress in this wait list with the current number of incoming referrals,” the Aug. 18 letter to physicians said.
Earlier this week, a new letter went out saying the problem still hasn’t been solved. “Help is on the way but will be slower to arrive than we had hoped,” it said.
…
Steve Schlozman, a child psychiatrist with Dartmouth Health Children’s in Lebanon, N.H., said he is beginning to suggest workarounds to the therapist shortage that would have been unheard of even five years ago. He said he has reached out to clergy, school guidance counselors and even soccer coaches to act as de facto therapists for children and adolescents suffering from depression.“If the kid is really into soccer, we’d make that call and say to the coach: ‘I would love for someone to sit down with this kid once a week (emphasis ours). If you get scared, or worried, make sure to let us know,’ ” Schlozman said. “It’s a lot of weight on the shoulders of a coach, that’s not what they signed up for. Ideally, we’d love to have the kid meet a trained therapist, but there just aren’t enough available.”
…
Linda Siegel, a pediatric critical and palliative care physician in New York City, was spending about $2,500 a month for out-of-network mental health care for her son and herself (emphasis ours). After several years, Siegel could no longer cover the costs and stopped her own therapy.Then, the pandemic happened, her father died, and her depression returned. Siegel said she called or emailed at least 20 providers; they were either not taking new patients or no longer accepted her insurance. She did try two providers, she said, but neither were a good fit.
“It is hard being a physician and being in therapy,” she said. Finally, Siegel found a young, in-network therapist who could help her navigate her high-stress work life and find balance. But after just a few months, her employer changed insurance carriers and that therapist was no longer in-network. Siegal was devastated, but eventually the therapist was able to arrange a status change that allowed her to move back into the network.
Relying on coaches to regularly do mental health triage for vulnerable children seems like a really, really bad idea. Really bad.
$2500 a month!
One of the striking things about the story is whose individual plights it addresses on the patient side. The first one is a public affairs specialist; the next a nurse educator and her young daughter; the final one, the physician. Low-wage essential workers get absolutely no shrift despite the heightened exposure to disease, the lack of paid sick time, the vulnerability to public anger, and the insecurities bred by poverty and underemployment and other endemic policy stresses peculiar to their stations even without attending to Covid-related issues.
The virtue, perhaps inadvertent, in focusing only on professionals struggling to find care is how it illustrates in the negative what the plights of people who don’t have personal resources must be like. The public affairs worker described a nearly year-long struggle, requiring time off work — either paid or affordable — and a dogged, frustrating pursuit to find first a therapist, and then a psychiatrist to prescribe and manage her medications.
The story in whole offers a perfect example of what Danielle Carr describes as reification, the transmogrification of something that has roots in political policy decisions or the lack of them, into a stand-alone problem to be remedied in ways that completely ignore those important driving forces, and may in fact exacerbate them.
You can read what I wrote about this in the past week here2 and here3 if you didn't already. Both are pretty long.
I'm gonna stop now because I'm getting depressed, and I’m not even done.
Ignore that BuzzFeed one. Shocking! Maybe criminal. I don’t know. I did just read that 10 ways to get mental health help thing,4 because I'm an idiot, and it reinvents the failings of other stories to address any fucking thing at all in the way of external stressors and the situations of anybody who doesn’t have a human resources department. No need to quote it.
“Best of The Mamas & The Papas:” when they were good, they were very very good. And of course they’re a time-travel machine for persons of a certain age. Continuing in the old person’s pop music vein: the criminally underappreciated Melanie, “1984 (Live at the Eagle Mountain House),” which is a two-hour album that has lasted long enough to play me out, not that I wasn’t already.
That, comrades, is all I got. Take care, be well.
Not to minimize the mental health provider issue, it's also true that important medical providers (cardiologists, neurologists, etc.) are hard to find as well, even if one has appropriate and acceptable coverage. Basically, the healthcare system is being slammed even in urban settings. Rural, of course, are even worse.
Hello, W.B. I was determined to send you a thank you for last week's shout-out, which I really thrilled to! Well, I was determined to send you a thank-you last week, and there were all these other things I was determined to do last week, like catch up on periodicals, and catch up on books, and learn to argue with more panache, but - well, I'm having one of those awful weeks wherein it is hard to read. My least favorite sort of week. Anyway! One thing to read if you want to learn to argue more skillfully (and you argue quite well, but sometimes it's fun to cite sources) is this book https://thebaffler.com/latest/perversity-futility-jeopardy-denison It's a very short book, and I even have a copy which I would mail to you did we not live in a historical period wherein such exertions are unnecessary. Or you could just attend to Perversity, Jeopardy, and Futility and how they scaffold the arguments of the right. Finally! For music you can have on as background music, try the pianist Brad Mehldau (he does a marvelous cover of Paranoid Android, but that's just for starters) or the band The Bad Plus, who are now in their third edit, this one without a piano but - it still works! Remain in light.