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.