Finding Help in a Broken Mental Health Care System


 Adapted from A Vision For Change: How to Help Someone With Addiction or Mental Illness by Rich Whitman and Melissa Deuter, MD     

      When a mental health or addiction crisis begins to build, people search for help and too often find that there is nowhere to go.

            Start calling mental health professionals, and you’ll find that getting an appointment with a psychiatrist (a medical specialist in behavioral and mental health and addiction) takes months. So you’re left with generalist care and long wait times for specialists. Primary care physicians are the mainstay of mental health and addiction treatment providers, even when they feel that they lack the necessary training and specialized experience to provide safe care. The lack of access to psychiatric services gave life to my clinic, Sigma Mental Health Urgent Care (and other clinics like it around the country) where people can find immediate help. However, the gap in services remains wide. Many families are unable to get the help they need because the outdated model of care takes too long to access and is too difficult to navigate even for those already in the system.

            If you cannot get a mounting crisis under control, you might find yourself in an emergency room, where you’ll get a few tests and perhaps an assessment for a psychiatric hospital unit, but care won’t be started in most cases since ERs only provide treatments that last a few hours or days, and mental health issues span weeks, months, or years. 

            Get in through the door to see a mental health expert, and there are still major barriers. The standard model of healthcare delivery is one of collaboration. A person wants and needs help, seeks help, receives help. That’s how it works. Medical professionals, and probably most especially mental health specialists, are collaborative people. We want to help people with their problems, and leave them in peace to be odd, eccentric, different, or any other way that’s not the cause of a self-identified impairment. We want satisfied customers who get the assistance they are seeking. And we don’t want to force people to accept treatments that they don’t think they need—at least not unless the situation is an emergency.  Typical patients arrive and say, “Can you help me? I don’t feel well.” The health professional then works together with the person to diagnose and treat the problem. It’s a very satisfying transaction for everyone involved.

Because the healthcare system works this way, finding help for a loved one who doesn’t want help, or doesn’t believe any help is necessary, requires greater effort. If you’re a family member or supportive friend, you’ll need to be part of the team when your loved one struggles with denial, not just take them and leave them to handle to appointments without your involvement. Dropping off a sick person who doesn’t want help at a mental health care appointment and leaving without communicating with anyone is a sure route to treatment failure. Although your loved one needs time alone with his therapist or doctor, it is also important that you get a chance to share information about what’s happening at home and why help is needed. Hearing your perspective can help the clinical team get to the root of the problems faster.

            It’s important that you understand that your loved one has a legal right to healthcare privacy. You can’t ask for information. The purpose of your involvement in care is solely to give accurate information, so that the therapist or doctor gets the full picture.

            Treatment can fall apart when families are shut out of the treatment altogether. Rather than finding a way to involve families while also enforcing healthy boundaries to protect privacy, many clinics choose to slam the door to loved ones and cite the HIPPA privacy rules as the reason for doing so.

            HIPPA does not strictly prohibit speaking with family or loved ones. Patients have a legal right to privacy, but nowhere does it state that healthcare professionals are required to refuse to listen, educate, and reassure concerned loved ones. Hurried professionals probably rationalize the use of privacy rules as an excuse to refuse to talk to loved ones of patients.

            If you are a friend or family member who has arranged treatment, or who drives to appointments or pays for care, it’s important to develop your own relationship with the treatment team. Introduce yourself. Ask questions. Understand your role. Build trust with the team that extends in both directions. But don’t expect to be closely involved with treatment. Know that your role is usually to sit in the waiting room, and be a resource if asked.

            Be patient and let the treatment process work. Let go of any need to be in control, and instead just be supportive and present.



Posted on June 10, 2019 .