OPINION
06/16/2018 07:01 am ET

Mental Health Awareness Can’t Be Just For Rich People

For the unemployed and underemployed, a therapy visit can feel like a luxury.
Tharakorn / Getty Images
For the unemployed and underemployed, a therapy visit can feel like a luxury.

The recent deaths of Kate Spade and Anthony Bourdain have sparked discussions about mental illness in America: How can we prevent further tragedies like these? 

So far, proposed solutions include tackling the stigma surrounding depression and increasing gestures of social support. Such discussions are valuable, but they ignore the glaring problem of unequal access to mental health resources.

Our efforts to create a culture that is more open to speaking candidly about suicide may have been inspired by the deaths of two fabulously rich people, but mental health awareness cannot ultimately revolve around wealthy celebrities. Unfortunately, it looks as if we’re already heading in that direction: An image circulating on Instagram earnestly encourages people to “check in on your rich friend.”

When I read this, I balked. My rich friends with depression can pay $700 per week for cutting-edge treatments like ketamine infusions, they can take off work for months at a time to regroup, and they have every possible self-care modality and tool at their disposal, from glitzy beachfront inpatient centers that cost $3,000 per day to equestrian therapy to the best medical professionals that money can buy.

What about the less affluent or those who live in rural areas with shortages of available therapeutic specialists? What about Medicare patients who can’t reap the benefits of certain types of psychiatric medications because they aren’t covered and the out-of-pocket costs are too high? What about all the working-class Americans who can’t afford to take time off from any of their two or three jobs to go to a counseling appointment?

The typical media narrative frames the experience of depression as somehow cutting across all socioeconomic classes.

If we’re serious about preventing suicide, we must prioritize the needs of middle- and low-income people who lack access to quality medical care.

It’s understandable to feel a sense of connection to a famous person and mourn his or her untimely death. Maybe you were a fan of Spade’s colorful, cheery designs or Bourdain’s adventurous persona. Losing anyone too soon is devastating. But most likely, there are ordinary people close to you — co-workers, neighbors, relatives and acquaintances — who also have moments of acute psychological distress yet far fewer opportunities to find meaningful help.

The tenuous social safety net in modern America is especially deficient when it comes to mental health. Free suicide hotlines, which are being touted as a solution all over social media right now, can be a useful resource in an emergency, but they are an inadequate, often flawed substitute for the kind of consistent treatment that depressed people usually need to feel well enough to function. Community clinics that offer sliding-scale services (people pay what they can) are similarly well intentioned but are underfunded, understaffed and generally ill equipped to manage high-risk patients with severe conditions.

For people who are unemployed or underemployed, a therapy visit can feel like a luxury. Although she has schizoaffective bipolar disorder, 35-year-old Bryne* of Eugene, Oregon, cannot afford regular psychiatric care. After she lost her job, she says, “I [had] to focus on my basic needs, just trying to hustle and get by.” Cady*, a writer who lives in California’s expensive Bay Area, is also not in a position to afford treatment. “I struggle with suicidal thoughts on a weekly basis,” she says. “Not being able to access the help I need adds to my feelings of isolation and despair.”

The tenuous social safety net in modern America is especially deficient when it comes to mental health.

To really understand what happens when a country doesn’t bother to fully invest in mental health care for everyone — which means offering comprehensive, long-term treatment options rather than just emergency services — simply behold the sidewalks of any major American city, where people sleep in tents because their schizophrenia, bipolar disorder or substance use disorder has gone untreated for too long. Many of them eventually end up incarcerated or dead.

The typical media narrative frames the experience of depression as somehow cutting across all socioeconomic classes (the lesson we were supposed to take away from Spade’s and Bourdain’s deaths was that even rich and famous people can be ill and unhappy), but this ignores the ways our mental health is directly informed by our material conditions, not only our brain chemistry. It’s misguided to view depression and suicidal impulses as the result of a chemical imbalance that afflicts everyone in more or less the same way. In fact, research demonstrates a clear connection between poverty and mental health and, with respect to depression, suggests causality rather than mere correlation. A person’s economic status (as well as race) dictates lifetime exposure to things like violence, poor nutrition, food insecurity, traumaphysical ailments and stress — all of which can contribute to mental illness.

As President Donald Trump’s Justice Department prepares to challenge the Affordable Care Act (with the goal of eliminating protections for people with pre-existing conditions), being depressed or suicidal is going to get even tougher for the millions of middle- and working-class Americans who depend on subsidized treatment to keep them alive. They may not make it into the news or onto your Twitter feed, but these people will suffer, and some of them will kill themselves. We have a collective responsibility to address this population with the same amount of concern we give to depression’s more privileged, glamorous victims.

*Names have been changed to protect privacy.

If you or someone you know needs help, call 1-800-273-8255 for the National Suicide Prevention Lifeline. You can also text HOME to 741-741 for free, 24-hour support from the Crisis Text Line. Outside the U.S., please visit the International Association for Suicide Prevention for a database of resources.

Sascha Cohen is a writer, health care activist and historian whose work has been published in Time, Vice, Playboy, Smithsonian Magazine, The New York Daily News, The Washington Post, Self and elsewhere. Follow her @SaschaSo70s.

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