Mental Health Care is Hard to Come By, Especially If You’re Poor

During the first wave of the pandemic in April 2020, my boyfriend asked, not unkindly, if I’ve ever been diagnosed with anything besides generalized anxiety disorder.

I was relieved that somebody had finally asked about my mental health.

All spring and summer 2020, I kicked the ball of my fritzing brain down the field to some imaginary goal of “things” getting better in the world, or at least more stable. Plainly, that didn’t happen.

And so, like many others, I went back to therapy. Or tried to.

I’m on Medicaid, and while the insurance I receive through the program is accepted by many dentists and primary care physicians, finding a therapist or a psychiatrist who takes it has been, in my experience, impossible.

I used Psychology Today’s search tool and found just three therapists in my area who said they accepted Medicaid. Only one returned my email, but after a detailed intake interview, I never heard from her again.

Over the next eight months, more fruitless attempts to find care for my mental health took a real toll on my time, money, and well being.

I asked for help finding a therapist and a psychiatrist from my in-network primary care physician. A month later, she wrote to say that she knew no psychiatrists who accepted Medicaid, ending the message with a well-intentioned but unhelpful “;-(”.

After combing the Internet, I found five other local psychiatrists who had “Medicaid” listed on their profiles. They never returned my emails or my calls. I cried.

It turns out I’m not alone. Americans are seeking mental health care in record numbers, and many are struggling to find it. Even before the pandemic, NPR reported that 77 percent of U.S. counties faced a severe shortage of psychiatrists. Meanwhile the number of practices accepting Medicaid has declined.

For people like me, our conditions can grow more disruptive and life-threatening with every passing week without care. Studies show that being poor is correlated to higher rates of mental illness. What is perhaps less widely understood is that poverty causes mental illness, too.

Anyone who has tried to get help knows that the process consigns whole days to the dump.

During my search, I was working as a freelance journalist. The time I spent chasing down care was time I couldn’t spend filing stories and earning income to live. For that matter, it was time I could’ve spent calling my mom, cleaning my fridge, applying for a job, running around the block — anything.

Eventually, I found a graduate student therapist for $25 a session. But a proper psychiatric evaluation remains elusive. One place said I’d have to switch my therapy over to them, but I wasn’t ready to do that. Another said I’d have to leave my current primary care physician.

I said no. I didn’t want to disrupt what stable care I had in exchange for the uncertain promise of eventual help.

Medicaid has been good to my body — I got a dermatologist, a primary care physician, a gynecologist, and a gastroenterologist with relative ease — but it has abandoned my brain. I need timely, accessible, affordable care — just like millions of Americans. I want choice, not a fistful of deeply unhelpful options wrestled from the cruel system we make poor people navigate to access health care.

Some days I still can’t believe that more than a year and a half into a pandemic — with its massive layoffs, record unemployment, hundreds of thousands of deaths, and increase in mental illness — this country still ties “good” insurance to your employer.

We deserve so much more. For me, I want to be present in my existence, rather than getting lost in the endless twilight plains of my mind.

Katie Prout is a staff writer at the Chicago Reader. This op-ed was developed by the Economic Hardship Reporting Project, adapted from a longer story at the Chicago Reader.