There is Something Wrong


I got an email yesterday.  A patient needed to cancel their session, and delay therapy indefinitely.  Not because they don’t believe that they are benefiting from therapy.  Not because they don’t need an additional layer of support.  But because this patient, who works and has health insurance, also has an expensive new diagnosis.  They are facing a condition that has costly treatment, and they just had to add an expensive piece of equipment to that treatment (and yes, my grammar police friends, I know that “they” is the wrong pronoun to use for the singular, but it is the only one that totally protects patient identity).  In the email that I received, my patient directly stated “I just can’t afford it . . . there’s no way that I can take care of physical and mental health.”

There’s something so wrong with this that it makes my heart hurt and my stomach ache.  Here is a patient who has overcome the stigma and fear that prevent many people from seeking counseling.  This person is ready, in need of support, and reaching out.  Their therapy could make a huge difference in their adjustment to the learning curve of their new diagnosis.  Therapy could support healthy choices and contribute to additional positive coping.   And yet, despite having insurance, their out of pocket costs are prohibitive.

I know that I have said this before, but today, I feel like I have to say it again.  Mental health is health.  Not an extra.  Not an add-on.  Not a luxury.  As long as we have a system that ignores this, patients like this one will miss out on the services and support that they need and deserve.  Something is wrong.  And we need to talk with our legislators and insurance administrators to get it fixed.

What do you think?  Does this story ring true for you?  Has this been your experience?  What do you think we should do?  Please share stories and concrete action steps in the comments.  Also, feel free to travel over to the Occupy Healthcare site for great action suggestions.


Photo Credit: Photo by GuySie


15 thoughts on “There is Something Wrong

  1. I cannot imagine the pain that patients must endure while combatting a physicial and mental conditions. You are right that is a morally cruel decision for a patient to make between safeguarding their mental or physical health due to cost considerations. Sadly, many states are cutting back on mental health services for their citizens, particularly the frail, poor and elderly—those most in need. There has got to be a better way.

    This morning I searched on Google for news regarding mental health services and found plenty of current stories regarding such cut backs. Iowa is taking a different tack. Right now, depending on where an Iowan lives, a resident receives different services. This has created disparities in care. They have decided to overhaul their system. They asked an essential question in undertaking their cause: “Shouldn’t every Iowan have a right to certain core set of services?” They have chosen to prioritize mental health and that is what we need to do across this country. I am including a link on the newspaper article highlighting their actions:

    1. Carmen,

      Thank you for sharing that link. It inspires some hope for me that there are lawmakers who are willing to invest in the well-being of their constituents instead of their donors.


  2. Ann,
    You’re so right that mental health IS health. Statistics show that people under stress are more likely to encounter a serious illness than those who are relatively trouble free. Even though I sought counseling last year after James died and his family dissolved, there were days I was beside myself with grief and depression. In the end, it was the sure, steady counseling that helped me climb out of my funk. Part of me worries that the stress of this last year may bring about a recurrence of my breast cancer. If not, then I’m not sure anything will.

    If only insurance companies embraced the cause and effect of mental health on physical health.


    1. Brenda,

      We need to continue to gather the voices like yours, “steady counseling helped me,” and pair them with the outcome research that demonstrates the measurable impact of mental health on physical health outcomes. Thank you so much for sharing your story and your thoughts.


  3. Hi Ann,

    I am saddened by your client’s plight and angered about the state of mental health care in this country. I have encountered this problem with more clients than I can count. The one good thing is that there is beginning to be more parity between physical health and mental health benefits. The intolerable part is how unaffordable the co-pays are. Parity is not really enough when somebody has to pay a copayment weekly or biweekly. Co-payments are more reasonable when you are only paying them occasionally for annual check-ups and specialty care.

    You make an excellent point about the benefits of mental health care as an adjunct to treatment for physical conditions. Many years ago Kaiser Permanente did a study and found that health care costs were lower for those who received psychotherapy. Perhaps it would help if researchers pursued this further. Unfortunately, I think all most insurance companies care about is dollars and cents.

    Best wishes to you and your client.


    1. Andrea,

      Actually, that’s the angle that I’m pursuing. A wonderful research librarian friend of mine has found multiple studies that cite the cost-savings when mental health treatment is included in treatment for chronic illness. I’ll be using that when I speak with the insurance company to advocate for my patient.

      Thanks so much for your thoughts.


  4. Hi Ann

    In the UK we have the famous National Health Service which provides free healthcare for everyone. yet it has its limitations. A couple of years ago I was suffering from (another) period of depression and went to see my GP (non specialist doctor) to see what counselling might be available. They were happy to prescribe medication which I refused and informed me that a new conselling service was being set up and that when it was ready (in a couple of weeks) I would be contacted. It turned out to be 4 months before they got in touch. I had gone to the doctor because I wasn’t coping on my own (at the worst part I could do no more than sit all day doing nothing more demanding than reading a book). By the time I was contacted, the worst part was over and I was assessed for the CBT therapy they were offering (so it turned out not to be full counselling after all), and it was determined that I wasn’t ill enough to be offered the treatment, but that I could now self refer at any time I needed their services!

    Ultimately the NHS was not able to help me in the slightest and I have had to pay for my own counselling over this last year which is what I needed and has been a great experience. My budget is tight and I’m going to have to stop at the end of this month.

    I think that so often mental health issues are overlooked or not deemed worthy because they can’t be seen – there is no limb falling off.

    It’s such a shame when the choice as to whether someone can receive treatment or not comes down to finances.

    1. Dear Ruby,

      Thank you so much for your input. I am so happy to hear that your counseling was helpful–and so bummed to hear that it wasn’t an integrated part of your health care. I appreciate your voice–and your persistence in working with my filters!


  5. That is so sad Ann. I can’t imagine dealing with health issues while in therapy–tackling mental health is heady enough. I’ve had a rough week with potential clients calling to inquire, only to be turned away (by me) b/c of insurance issues. It is heartbreaking when someone reaches out but they can’t begin, or sustain treatment due to finances/insurance.

    I vowed in 2012 I would not feel guilty about turning people away…It was hard enough to make the choice to eliminate, or do away with insurance panels b/c of the countless hours spent tracking down claims…as many times as I say, “I’m so sorry, it’s not your issue, it’s your insurance company’s…” it just doesn’t get easier.

    Positive thought to your former client. May they find the mental and physical health they so deserve.

    Mental health is an imperative.

    1. Linda,

      I hear you about the challenges of not being able to help clients because of insurance issues. That just makes me more determined to build my business to the level that I can afford to have a few very low-cost pro bono slots. And I’m hoping that with some insurance advocacy, I may be able to help this client remain a current client–because you said it, “mental health is an imperative.”

      Glad to have your voice here!


  6. Hi Ann –
    I am so angry about insurance practices. But I am pretty worn down. I need to disconnect as it takes alot of my energy. We are both self-employed so I pay $1900 a month for a family of three ppl. My husband had prostate cancer a few years ago, totally curable. But he has been in counseling for the past year or so. He needs the support. the C word is scary. When I worked in a cancer center as a Mindbody Specialist, my services were free, paid for by a grant, . so it was a great service for the patients there.

    1. Kathy,

      I think that we need to advocate as often and as loudly as we can find energy for. It’s hard after a while not to feel worn down–both by our personal struggle and the struggle to be fairly paid for our work. I know that when I did our mental health legislative day last year, the representatives were hungry to hear about mental health issues. The job at the Cancer Center sounds incredible! How great would it be if that was normal?

      Thanks for sharing,

  7. Ann,
    I share your sadness and anger. It boggles the mind that in a country as wealthy as ours good healthcare can be so difficult to obtain. Further, the cost of our work is really small potatoes compared to medical treatment for cancer or heart disease. Yet we all know that our services can be an important part of that treatment. How very sad that your patient had to choose.
    Thanks for your links to sites with information about advocacy. Here in Massachusetts we have pretty good care (the Romney-care you’ve been hearing about), but there is still a substantial percentage of people who are uninsured. And of course, the demand for child therapists like me outpaces supply.
    Thanks for firing us up as well.

    1. Carolyn,

      Thanks for your support. I have to believe that, if we continue to speak up, to be willing to advocate and educate, that eventually the evidence in support of mental health treatment will win out. We just have to find ways to keep ourselves from getting burned out along the way.


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