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I have a vignette to share tonight. I'm only calm enough about this story to type it up now, even though it happened almost a week ago. This is a story about a descent into madness, but not like you think.

A week ago, I found out a friend of mine is suffering from crushing depression. For the purposes of this diary, the friend is "she," but that's a title of convenience, as I'm not going to reveal any identifiable personal facts about this individual including "her" gender.

So, crushing depression. The hopeless, swelling darkness that consumes your life because you feel like every option will lead to suffering, every choice to pain. The sort of depression that utterly destroys lives, often quite literally, because you feel completely alone, abandoned by life.  Just thinking about the pain in my friend's voice, the vacant space where a vibrant person used to lurk... it's difficult to think about it.

As I hung up the phone, I began googling around for options. I'd asked her if she'd mind if I did, just to see if there's anything out there for her. See, she doesn't have insurance. Of course. It's that story again.

And to make matters worse, she's been on the same medication for 15 years without a follow-up doctor's evaluation because she can't afford to go. Every month, she refills her prescription for the same drugs that may or may not be accomplishing anything at all.

So I googled away, marveling absent-mindedly at the sheer volume of resources available just a click of a mouse away.  I found the state mental health department for her state.  I found the local office in her town. I called.

"Hi," I said, "I'm hoping I might be able to find out some information about treatment for depression that I can pass along to a friend of mine. She's hoping to get some help, but she just doesn't know where to start." The person I spoke with seemed taken aback.

"Is she suicidal?" the person asked.

"Well, no," I replied. "I'm not a doctor, so I don't want to try to diagnose her, but I've had experience with depression, and she seems to be on the brink of going somewhere very, very bad."  This went back and forth for about 10 minutes as I tried to establish that this was an individual who needs help while the person I was speaking with didn't seem to understand.

"Well, you could tell her to come on in. It's about a 2 month wait to see a doctor, but she can certainly see a counselor and begin treatment."

"Great!" I said, preparing to take down information that I could pass along. "Ok, what options do you have for people without insurance?"

"She can pay out of her pocket," she replied.

"Ok, do you offer a sliding scale for costs?" I asked.

"Yes, you can ask her to bring in proof of income, and we will adjust based on that." This was starting to sound pretty good.

"She might not have proof of income. She's unemployed."

I heard paper rustling. "That's fine, we can direct her to other options."

"Pardon?" I asked.

"Well, sliding scale is only available for people with proof of insurance. If she doesn't have an income, we can direct her to a church program. They have volunteers who can help."

A church program. The state mental health clinic was directing me to a church program because my friend didn't have income.  I thanked the individual and hung up. My next call was to a nonprofit program focused on mental health issues. I started the call basically the same way, and the person who answered was equally perplexed that I was calling.

"Are there any options for people without an income?" I asked.

"Sure, let me direct you to our clinic in her area." She gave me a number.

It was the number for the state agency I'd just been talking to. The one that told me to send my friend to a church instead of a doctor because she's unemployed.  Then she directed me to a board member for her organization who represents that area. I spoke to her and received the same advice: call the state mental health office and see what they offer.

I don't want to badmouth the churches and their volunteers. I'm sure they're doing what they can to provide care for the most helpless. I don't even want to get into the discussion about the patent injustice of a state agency not offering care to people without an income. That's a topic that has been covered elsewhere.

I want to talk about the process.  My friend has me. I took the initiative to call around to find resources for her. I'm not patting myself on the back. It's something any friend would do, I hope, to help a friend in a dire situation. But what if I hadn't known? What if she'd been - or felt - truly alone? What if she'd had a flash of clarity and decided to try ... only to rush headlong into the bureaucracy of "care"? Would she have persisted, or would she have just given up, sure that this was one more piece of evidence that the world completely, totally, and utterly sucks?

There would have been options if she were a critical case. If she'd been suicidal, there would be options. If she took action to harm herself, there would be options. I'm sure the emergency care is fine.

But why let it reach that point? Is the system so thinly spread that the idea of treating a noncritical case, someone who wants to avoid the great crisis, is a novelty? Are the state-supported doctors really only available to treat people with an income?  

I know there are other options. I am pursuing them. But I'm deeply angry that the system is so impenetrable. And before I give some right-winger ammunition that this is exactly the problem with public systems, it's not just the public system that's like this. I have a week of stories, of banging my head against my desk, that tell me that preventive mental health care, like preventive care in general, is utterly broken in at least one critical respect: it's not set up to handle the people who need help until they are to the point of harming themselves, perhaps permanently.

Reading back through this, it doesn't sound so bad. It's just a few frustrating phone calls. But disguise even the best the care in the world behind a frustrating process that isn't set up for the patients and that care will be useless if the people who need it give up.

Originally posted to socratic on Wed Oct 07, 2009 at 09:05 PM PDT.

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Comment Preferences

  •  Thank you for being there for 'her'. (10+ / 0-)

    People need to look out for each other.  We need community.

    We need each other.

    The business of Nations is never morality. Moral stories live only through people.

    by tecampbell on Wed Oct 07, 2009 at 09:41:28 PM PDT

  •  Try checking with some of the private providers (6+ / 0-)

    in your area. My group does not take insurance due to overgead. We do offer a reasonable sliding scale (25.00 per session) & we have flexibility to go lower if need be :)

  •  Depression. (4+ / 0-)
    Recommended by:
    erratic, FuddGate, A Voice, GenXangster

    I'm no medical doctor, but from my experience, diet really matters. As the IT folks say: garbage in, garbage out. I wouldn't say it's to the point of clinical depression, but I definitely notice that I just feel kind of lousy when I don't eat healthy. I first noticed this when I moved to France some years back - there, I basically stopped eating anything corporate, and I felt a lot better generally: better mood, more energy, and I even seemed to be cognitively sharper. As far as specific culprits, just about any type of fast food, and anything containing corn syrup, makes me groggy and lethargic.

    Indeed, I'd say it's time to seriously consider an outright ban on high-fructose corn syrup. Though that's not in the cards at the moment, I would advise anyone - especially children or pregnant women, or those suffering from depression - to stay as far away from anything containing corn syrup as humanly possible. For one thing, it's recently been found that a substantial percentage of products rich in corn syrup contain mercury.

    Also, I would suggest that depression sufferers not keen on antidepressants as a first option should try to increase the amount of exercise they get. I know I feel much better when I start my day off with 30 minutes of cardio.

    Some might disagree, but I can't accept the notion that all of the chemical crap in the food and water supply isn't slowly poisoning us all. Even if minimizing the intake of this garbage doesn't help with depression, it's a good idea to try to do so for other health reasons. The Pharma cartel always tries to pitch their chemical concoctions as the first, last, and only solution to depression and other ailments, but it seems to me that if we all ate a bit healthier, we'd have many fewer cases thereof.

    Just my two cents...

    Politicians who betray the general welfare of the public should be charged with treason, and prosecuted to the fullest extent of the law.

    by New Deal Dem on Wed Oct 07, 2009 at 10:01:35 PM PDT

    •  Those two cents (4+ / 0-)

      are worth a lot. One of the reasons that mental health issues are not recognized as medical issues and (I will say it if the author can't) one of the reasons that Church counseling is so ineffective is the belief that there is a mind independant of the body.

      As if we could make things better without making them worse.

      by A Voice on Thu Oct 08, 2009 at 02:53:24 AM PDT

      [ Parent ]

      •  Church-based counseling (0+ / 0-)

        as a response to severe depression. I can't believe it.

        Counseling may be enough in some mild cases. But for severe depression, which involved brain chemistry, it's like prescribing a dietary cure alone for diabetes.

    •  Also.... (4+ / 0-)
      Recommended by:
      wonmug, erratic, Native Light, Clio2

      This should work for people who suffer from diabetes. Insulin is over-rated.
      And every other chronic disease that one might have. Diet and exercise are the answer. Not to slam diet/exercise, but don't minimize the disease discussed in this diary.

      "feeling lousy" is no where near severe chronic depression. The kind the author says her friend has.

      So, crushing depression. The hopeless, swelling darkness that consumes your life because you feel like every option will lead to suffering, every choice to pain. The sort of depression that utterly destroys lives, often quite literally, because you feel completely alone, abandoned by life.  Just thinking about the pain in my friend's voice, the vacant space where a vibrant person used to lurk... it's difficult to think about it.

      The kind of depression where if the magic cure was on a table 10 feet away, getting there would be too great a task.

  •  It might not matter if "she" had insurance (7+ / 0-)

    since mental health care sucks hind teat or might not be there at all. It took monumental effort in Ohio to get mental health treated like any other physical dysfunction and even then it only applies to health plans offered through employers with more than 50 employees and with their headquarters in Ohio.
    And the republican legislator who got the bill passed said he understood the problem because his son had a mental illness. The son's employer promptly fired him.

    Health is the first requisite after morality - T. Jefferson

    by OHdog on Wed Oct 07, 2009 at 10:05:54 PM PDT

    •  It's very sad that we still attach a stigma (7+ / 0-)

      to mental illness. Far too many people still see mental illness as indicative of some sort of moral failing or character flaw. In reality, it's not fundamentally different from any other ailment; indeed, it very much seems to be the case that all forms of mental illness have underlying physiological causes. Thus, to treat - and perhaps even to classify - mental illness in a different way than we do physical ailments is cruel, barbaric, and immoral.

      Unfortunately, many people who should know better continue to perpetuate this cruelty, barbarism, and immorality. As for the politicians who cynically or ignorantly refuse to accept mental health reciprocity with regards to public policy, it is my firm belief that history will treat them no better - probably worse, considering the advances in modern science and medicine - than those who perpetrated the Salem Witch Trials or gave us the crackpot doctrines of eugenics and race "science" of the 20th century.

      Politicians who betray the general welfare of the public should be charged with treason, and prosecuted to the fullest extent of the law.

      by New Deal Dem on Wed Oct 07, 2009 at 11:44:07 PM PDT

      [ Parent ]

  •  The problem with depression is that it is so hard (4+ / 0-)

    to see the point in even trying to look for help. I don't see how anyone can be expected to keep trying after all those disappointments.

    Medicare for All. End Age Discrimination.

    by Hens Teeth on Wed Oct 07, 2009 at 11:31:52 PM PDT

  •  It's interesting. (3+ / 0-)
    Recommended by:
    erratic, CherryTheTart, GenXangster

    I don't want to badmouth the churches and their volunteers. I'm sure they're doing what they can to provide care for the most helpless.

    Yet you reject this alternative, without knowing what resources they have, because they're not "the state". Given the opportunity for your friend to talk to an empathetic figure, if only as a stopgap while you seek alternatives, you reject it. Whos agenda is paramount here?

    •  I don't want "the state" (7+ / 0-)

      I want doctors. Professionals. Trained counselors. Based on what the individual from the MHD said, the church volunteers are not doctors or trained counselors, just interested people. I'm sure they could offer support and care in the short term, but they can't write a prescription to replace the old one and they don't have the professional qualifications (based on the information I was given) to offer long-term care.  

      I think you're reading a whole lot into something that's not there.

      Someone is wrong on the Internet! To the Kosmobile!

      by socratic on Thu Oct 08, 2009 at 08:07:27 AM PDT

      [ Parent ]

    •  Yeh well (0+ / 0-)

      what if somebody doesn't care to get a dose of religion with their counseling?

      In fact, what if the religious setting is totally inappropriate because the individual has personal-history issues with religious institutions?

  •  Lovely that the church is there. (4+ / 0-)

    the problem is, they'd likely counsel me that I'd be fine if I were only straight, monogamous, and their particular flavor of Christian. I've been there.

  •  I have a mental illness. (4+ / 0-)

    I live in Pennsylvania. A person with no income goes to a Dept. of Human Services in their neighborhood. They apply for food stamps and Medicaid. Mental Health clinics in hospitals and free standing treat Medicaid clients. Your friend would need to have some proof of income or lack of income. I know it may differ in other states. If your friend has a diagnosed mental illness that prevents her from working, she is entitled to Social Security benefits that include medical care. Here in PA we have the Alliance for the Mentally Ill. They may be able to help.

    I used to be Snow White. And then I drifted. - Mae West

    by CherryTheTart on Thu Oct 08, 2009 at 12:46:20 AM PDT

  •  I'm in utter hell. (5+ / 0-)

    I'm so used to it that I just continue to live and deal with it. I've never had treatment because I don't trust that people will take care of me properly. The stigma behind depression and bipolarism has caused me a lot of pain and humiliation. People who used to be my friends talk about me behind my back and smear my name to people I don't even know. I'm so surrounded by ignorant theists and people who dont know mental illness from a hole in the ground. They make me want to shut myself in the house and I do. Everyday I hide from the world so they wont see me and tell me to snap out of it.

    To listen to my ignorant ass mother put me down for being like this when she was the one who gave it to me (and she displays the symptoms-so did her father and his father) had driven a permanent wedge between us. I'll see her dumbass at her funeral one day when I get "the call". Screw her.

    Until a few months ago, I thought my friend of 18 years understood me until I started coming out as an atheist (which has NOTHING to do with mental state. I've been an atheist all my life in the closet) My last argument with her confirmed it for me that she never believed in my bipolar disorder diagnosis.

    "Do you understand that I AM SICK and I have NO HELP?!?!"

    "Oh, whatever! EVERYBODY's SICK! YOU need to...."

    No. Everybody is not mentally ill. I cut her off. She's a bitch who was never my friend. I'm just someone to gossip about and make her feel better about her ignorant self. She hates me for being smarter. Always has.

    I went to an emergency room a few years ago because I felt suicidal. The people there knew my mother because I look exactly like her and she'd been there years ago.

    They put me in a room with a black woman counselor and she proceeded to talk to me about God and Jesus and HER GODDAMN problems. I could have literally flown over the desk and strangled that bitch. They put me with that woman because I'm black too. I guess all we need is Jesus.

    I asked a black woman welfare worker about getting help for Depression. The ignorant bitch told me I cant get any help just because I'm going through a "thing" right now.

    My peers, other black women (these ones happen to be uneducated and think they know everything), the ones who should be holding my hand, are the ignorant bitches in my life who dont know anything about anything and they are the bitches Im stuck with. This town is so full of stupid people who block people from getting help that I dont trust anyone anymore.

    I dont blame this all on the black community or black women. Inequality eventually trickles down into the cracks of society (me) but in the meantime, they are killing me.

    Thanks for listening. I have the option of trying Medicaid and going to a local clinic (again). I stopped going there because they were testing Abilify and Seroquel on me and I hated both of them. I felt like a new drug guinea pig and I gained 30 pounds on Seraquel. I was turned down by Social Security and I never reapplied because I never wanted it in the first place. I just want to be a human being again.

    Thank you all for listening.

    •  I hear where you're coming from (3+ / 0-)

      Almost everyone I know who has to deal with the MH "care" system feels that level of frustration, and it's depressingly (bad pun) familiar that your friends and family fail to understand. Believe me, it's not just the Black community, that crap is widespread.
      What you mention about public clinics being used for drug testing is another of the dirty little secrets that a lot of people don't know about... so I can understand why you feel a great deal of mistrust welling up whenever you even consider going back there.

      That said, bipolar depression is a killer, it has one of the highest death rates from suicide and reckless accident of any mental health difficulty, so you've got to take care of yourself somehow--because you're worth it.

      If you can find one, try to find a patient self-advocacy group. They can help you find the right words and action to make the system work for you instead of the other way around, and give you the tools to turn anger into determination.

      Oh yeah--reapply for Social Security. Almost everyone gets turned down the first time. But see if you can get advice on how to fill out the paperwork, there is a trick to it. It may open some doors for you and eliminate some financial worries.

      And your words above tell me that you might be thinking of a change of place. It's not always a bad thing actually, sometimes being away from some long-standing triggers can give you some space to start your recovery. But you don't want to jump from the frying pan into the fire, so if that's what's on your mind o some online research into MH services in the places you're thinking of. There are a lot of forums online where you can ask service users directly about their experiences, they can tll you whether that promising web site about a clinic or service is pure BS, covering fo a 2-year waiting list or a nasty staff. For med questions and also some general ones, can I put in a recommend for http://www.crazymeds.us/ ? In fact, you can ask the good people there lots of non-med questions too.

      Which brings me round to meds... for bipolar disorder it's pretty much a given that you need to be on a mood stabiliser (lithium or one of the newer ones) and sometimes additional medications. There is a lot of mismedication out there so it's a scary prospect. If I can recommend a book, it's a couple years old but good: click here. There are even a couple used copies for less than a buck. It's not just about meds but covers a lot of lifestyle issues, etc. and won't put you down.
      Good luck to you, keep your head up!
      PS--I'm not a medical doctor but this is an area I've researched a lot on my professional life.

      Political Compass says: -8.88, -8.67
      "We never sold out cos no one would buy."--J Neo Marvin

      by expatyank on Fri Oct 09, 2009 at 12:50:03 AM PDT

      [ Parent ]

  •  some help. (7+ / 0-)

    The Samaritans (faith affiliated) are a great outfit and will see her low cost or free. Often charitable organizations like Catholic Charities or Salvation Army have good services. Some pastors are just great, whether or not they have training in counseling. Psychologists or social workers in private practice too will see people reasonably, even if they don't advertise it. I'm currently seeing one guy for $3 a session. Your friend probably needs more legwork to help her make a connection.
        I've just spent a harrowing week dealing with some folks with serious depression. Generally I can help people through it, or at least tolerate the pain while they go through it. Sometimes I luck out and get dramatic fast recoveries. To cap off the week, my beloved son, now 40, called to say he's fallen into a pit. Always a pillar of strength, he spent 2 hours on the phone in tears with me. I'm devastated to see my lovely boy suffer so. Thank God he turned to me. He's coming down tomorrow.

  •  I'm glad this was rescued...your friend is lucky. (4+ / 0-)
    Recommended by:
    churchylafemme, ladybug53, erratic, Clio2

    Your friend is lucky because she has you. I wish I had friends that gave a shit about my problems.

  •  I'm sorry to hear about your friend, (4+ / 0-)

    And appreciate your writing a diary about how hard it is to find help. As someone who's been through some dark times, and was not cured by pharmaceuticals, some helpful advice to pass on...

    1-St John's Wort has really helped me not fall into the black holes. It's not a dramatic change, takes a few weeks to kick in, but really helps to smoothen out the lows. I'd suggest buying it for your friend, if you can. It's a lot more affordable than many pharmaceutical solutions.

    2-Exercise really helps. Walking 15 min a day helps.

    3-One thing that's gotten me through a lot of bad times is a pretty simple & stupid idea - I'm committed to waiting it out. If things are so bad, that I'm considering ending them, what does it matter if I end things now, or 10 years from now? What's the rush? My experience has always been that weeks, months, years later, I look back at those dark periods and think to myself, "Wow, you would have missed out on some really interesting experiences."

    Speaking as someone who had friends there for him when he needed them, thanks for being there for your friend, and I wish her well.

    I used to think that the brain was the most wonderful organ in my body. Then I realized who was telling me this. (Emo Philips)

    by erratic on Thu Oct 08, 2009 at 09:11:46 PM PDT

  •  Yes, you're right (3+ / 0-)
    Recommended by:
    ladybug53, Native Light, Ms Citizen

    If you are suffering from any kind of mental illness, with or without insurance, you are in deep, deep trouble.  The more help you need, the more impossible it is to navigate.

    I wouldn't be so quick to dismiss what you call "church services."  Catholic Social Services and Lutheran Social Services have actual trained professionals, psychologists and social workers, and they don't proselytize--at least they didn't to me.  And they are a freakin' Godsend if you need care and can't afford it.  BUT, as far as I know, they don't have psychiatrists.  Still, check them out--they are not just a nice minister chatting about your little problem.

  •  Try NAMI (3+ / 0-)
    Recommended by:
    ladybug53, Native Light, Ms Citizen

    See what you can find through them.

    http://www.nami.org/

    I help run a mental health support forum at http://www.crazyboards.org/  you or she can feel free to stop by there as well.

    I'm all too familiar with this kind of situation but she should have options out there.  You just have to find the right non-profit.  

    State hospitals aren't much good for anyone other than those with chronic bipolar or schizophrenia anyway.  They are more holding facilities for people whose meds haven't kicked in yet than anything else.

    ---
    Fight the stupid! Boycott BREAKING diaries!

    by VelvetElvis on Thu Oct 08, 2009 at 09:47:36 PM PDT

  •  thank you for noticing this (2+ / 0-)
    Recommended by:
    ladybug53, Clio2

    Sometimes the frustration of being sent in circles when you are already depressed and when it is so hard to summon the courage to try to find help is what sends people over the edge. We can only hope that they head to the emergency room, rather than in some more dangerous direction.

    Thank you so much for being a friend to your friend.

    Is she eligible for Medicaid? Could they help?  

  •  I had a friend who went through (1+ / 0-)
    Recommended by:
    ladybug53

    a severe depression in connection with severe personal stress. The worst, she told me, was trying to call the local suicide hot line and repeatedly getting a tape that stated, "No one is available to answer your call. Leave a message...."

    She is okay now, after a year or so on meds. She got a lot of help from family and friends, including me -- had insurance, but it was a struggle finding a psychiatrist who took that insurance plus was accepting new patients. Then still had to wait 2 weeks for an appointment, watching her cry all day and night, alternatively sitting there unresponsive, unable to work or basically, do anything -- you can imagine what that was like for everybody.

  •  An excellent diary. Thanks for spotlighting how (1+ / 0-)
    Recommended by:
    ladybug53

    healthcare in American really works for those without money.

  •  I'm so sorry (1+ / 0-)
    Recommended by:
    ladybug53

    I didn't see this until after it was too late to recommend or tip.

    A few points I'd like to add:

    1. A few frustrating phonecalls is not the issue, the fact that no help is available is the issue.
    1. "Help" for people who are suicidal is comprised of imprisoning them and forcing them to take medication.
    1. "Preventative care" for mental health? WTF is that? Why should I pay my hard earned tax dollars to...

    attack a liberal and the first thing he says is, "You may have a point there." -- Molly Ivans

    by the tmax on Fri Oct 09, 2009 at 10:25:46 AM PDT

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