So I got diagnosed with depression last year. I wasn’t happy about it (I mean, that’s obvious — that was the problem) but I knew it was one of the most common mental illnesses so I expected getting and executing a treatment plan would be frustrating but straightforward. I was extremely wrong.
First, I took a decent amount of time just coming to terms with the fact I might need some help. I had struggled with depression before, although never to the point of actually getting a diagnosis. In 2020, and I suspect I was not alone, I noticed being depressed had become my new normal. Even then however it was not too severe. But I did notice myself becoming less able to complete tasks, and even struggling to reckon with abstract problems. After some digging and talking with my therapist I wondered if I might have ADHD. I raised this concern with my therapist around March.
I have been blessed, privileged, and lucky enough that I have had good health insurance for pretty much my entire life. I’m also a tech worker and get paid decently well. I also was seeing a therapist. Between insurance, having some funds available, and a therapist as a guide, I thought that treatment, whether medication or something else, would begin in weeks or maybe a month at the most.
It took almost a year.
I knew that dealing with mental health was never going to be something easy, but I didn’t expect so many of the challenges that I faced.
Anxiety, depression, and ADHD are sometimes linked and present similarly. So it can take a psychological evaluation to figure out which one, or which combination, is causing symptoms. My therapist referred me to a psychologist to do an evaluation. She came highly recommended and so had a long wait list. That office likes to schedule intake appointments and the full evaluation at the same time, I chose not to do this. This was a mistake on my part and led to a lot of the delay in my process. My concern was this particular psychologist was not in network with any insurance and all appointments had to be paid out of pocket. So I was hesitant to go ahead and book everything before even meeting the doctor. This means it was around July before I even had my brief video call intake appointment.
I finally had my full evaluation in November. The diagnosis was not ADHD or generalized anxiety, it was “severe depression” which apparently some psychologists are now referring to as “anxious depression”. While not the best news to receive, it was nice to have a formal diagnosis from experts who knew how to treat it. Unfortunately neither my therapist nor the psychologist could write me a prescription, which was the next recommended step. At this point I was referred to a consultation separate from both my therapist and the psychologist. The quickest I could get an appointment with the consultation was a month later.
Once the appointment happened was a video call with a nurse practitioner who prescribed me Wellbutrin in less than 20 minutes. According to both my therapist and the psychologist, this was a common approach to depression at the levels I was experiencing it. Even so, it was somewhat concerning as the person from the new consultation did not have access to my previous psychiatric evaluation and was writing a prescription for brain drugs very quickly.
My best advantage through all of this was a supportive group of family and friends. There are doubtless many in my situation who have insurance and resources and yet might be told to “man up” , or that it’s “all in your head” , or “all you need is some fresh air”. Whether stemming from toxic masculinity, or just general ignorance about Mental Health, many face a severe type of challenge in getting what they need that I did not.
Now I will be the first to admit that some of the decisions I made along the process contributed to making it slow. But it’s significant that in all of this I had to be my own advocate. (It’s worth noting here that people with different health concerns or in different demographics from me had to learn this from an extremely early age. Which I have to imagine only exacerbates every issue I’ve outlined here for those groups). All the professionals along the way were very helpful and accommodating. But definitely not coordinated. It took 11 months from asking my therapist to getting treatment. And being my own advocate in scheduling, diagnosis, following up, dealing with bills, dealing with insurance, dealing with insurance incorrectly denying my claim repeatedly and taking about three months to pay out, were the exact kinds of tasks I was struggling with. The things we ask people with mental health issues to do to treat their issues is almost like an obstacle course where the obstacles are specifically targeted at those suffering from mental health issues.
While the increasing mental health strain we are seeing in the general populace goes beyond the scope of this post, I wanted to call out and highlight the amount of difficulty and problems that I faced getting treatment for an extremely common issue. I meant this mainly as a thought-provoking piece. How many people in our lives, whether it’s friends, the barista we see everyday, the single mother, or the FedEx delivery person, would have been tripped up or entirely blocked by these obstacles I was able to (laboriously) climb.
They may not be able to dedicate the mental energy and time to their own health, or not be able to float several thousand dollars out-of-pocket and wait months for their insurance to reimburse them (and still have spent almost $1,000 out-of-pocket). This is in a country where a significant amount of the population cannot afford $400 for an unexpected expense. And this is even if their insurance covers this. For folks with less insurance or no insurance – tens of millions of people, they would have been blocked before they even saw a psychiatrist. And all of this started because my therapist is covered by my insurance. Otherwise he would be several hundred dollars per session and I meet with him fortnightly.
This is unsustainable
When we are seeing a severe uptick in mental health across all ages in our society, when mental health crises are being declared by health organizations we need to be able to address this as a society. Again the causes of the increase in depression are beyond the scope of this post but we must address them. As we begin to address causes we should not ignore those currently suffering from causes from decades past. We must make mental health care accessible to everyone. We must ensure that costs are affordable to everyone. We must ensure more students go into the mental health field, and should ensure that quality mental health care is accessible everywhere in the country, not just metro areas and large towns. We must treat each other and we must treat ourselves.