The Need for Alternative Mental Health Care

As a volunteer counselor at APPRISE, an East Liberty agency providing free one-on-one health insurance counseling to individuals, I spend the day advising our clients on their Medicaid or Medicare options, with a team of other counselors.

While most days are pretty routine, others are more unusual than others. One day, one of our clients pulled from her folder what looked like a list of names. She began to explain that she was pregnant, but she wasn’t able to find a doctor who would deliver her baby; the list of names was a petition intended to help her find doctors. Right away, none of this clicked. The client was in her 60s, so there was no way she could be pregnant. We asked if she needed help with anything health-insurance related, but she insisted that we sign her petition. She brought some paperwork with her, and we began to look through it. After a few minutes of digging, we discovered that she had been admitted to a psychiatric hospital in the past. After some more digging, we found out why: she had schizophrenia.

We weren’t entirely sure how to address the situation at that point. So, we pivoted, and obtained help from one of the more experienced counselors. It turns out the client did have a few health insurance issues we were eventually able to help with. But, after the client left, we were still caught up by the whole ordeal. A couple of big questions stood out to me. First, why wasn’t she receiving treatment for her psychiatric disorder? It seemed that she slipped through the cracks somewhere. There had to be a reason she was sitting at APPRISE, a health insurance counseling center, rather than in front of a mental health professional. Another question was how she could consider her health insurance options while her schizophrenic symptoms were still very clearly present?

It’s hard to answer these questions without knowing more about our client’s background. When we asked her about her stay at the psychiatric facility, she told us she didn’t like it and that’s why she was no longer there. This raises a number of concerns. First, it’s widely known that schizophrenia can be an extremely debilitating illness, if not treated. During our visit, she was convinced that she was pregnant. It was so believable, in fact, that I was almost convinced of her pregnancy myself. Who knows how much worse her symptoms could get without treatment, considering how driven she was by her pregnancy delusion? There must be ways to improve treatment so that patients, especially those with serious illnesses, are able to live with it. For instance, studies have shown that culturally aware mental health treatment is very effective. Some patients may view mental illness differently than practitioners, based on their own personal beliefs. Perhaps if psychiatrists, or other mental health professionals, better understood their patient’s view of illness, they’d be able to better treat it.

But, then again, this kind of culturally-sensitive, patient-centered treatment is very difficult to provide in our current healthcare environment. Physicians are expected to see patient after patient after patient in a short amount of time. How are physicians able to build relationships with patients when they’re only able to see them for minutes at a time? Rather than establishing a deep connection with a patient that informs effective treatment, psychiatrists are forced to rely heavily on prescribing medicine so they can see their next patient in a day full of them. Providing more ‘aware’ treatment requires a great shift in patient care; a change that can be very difficult to realize.

On to my other question. How would our client address her health insurance options while her schizophrenic symptoms are still very clearly present? As I mentioned earlier, our health insurance system can be very difficult to navigate. I, myself, have trouble remembering all of the eligibility requirements, policies, and intricate terminology, even though I went through a training course before I became a counselor. For many of our clients, it’s almost like learning a new language. With that said, I can’t even imagine how challenging it would be for someone with a severe mental illness to understand all of their health insurance options. This is where mental health competency is incredibly important. Training physicians, counselors, and others to communicate effectively and sensitively with individuals with a mental illness could go a long way. I certainly would’ve benefited from it. I feel like I would’ve been better able to help our client if I just knew where she was coming from.

Like culturally sensitive treatment, providing mental health competency is by no means easy. It requires a shift in how patient care and effective treatment is viewed and understood. These are things clinicians, counselors, social workers, and other professionals need to think about and consider. It’s up to us to help shape a health care system that maximizes the well-being of all patients, including our client at APPRISE.

Imaz Athar is an intern for The NewPeople.

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