Mental Health is a Social Justice Issue
Many people look at the basic needs as social justice issues- water, food, safe housing. You know, the things on the bottom of Maslow's hierarchy of needs you learn about in your Psychology 101 class in college. While I see those as fundamental human rights, I see mental health as a social justice issue and a fundamental human right as well. Let me explain.
As I mentioned in my "Self-Care Sundays" blog, I see people as integrated beings. Our physical health, spiritual health, and mental health interact with one another. If something is wrong with one area, it can impact us in the other areas of our life. I firmly believe that we should be emotionally well. Our mental fitness can inform how we do in other areas of our lives. Our mental wellness can impact our ability to take care of our physical health, spiritual health, our relationships, work responsibilities, and finances. People experiencing severe forms of anxiety, depression, psychosis, and other mental illnesses may find they are not fully functioning in their lives the way they want. For children, this could mean missed days from school and for adults, it could mean missed days from work which could lead to unstable pay and domino into other issues. I have worked with youth with more severe mental health/behavioral health illnesses in several past positions. Some of these youth missed weeks or months in schools due to being in treatment facilities for their mental health. This can impact them academically and socially. Their mental health affected a variety of areas in their lives.
In American society, it is a cultural norm to have the "bootstrap mentality." This is the "pull yourself up" or "just get over it" mentality that tends to leave little space for honesty and vulnerability when facing challenges with any diseases of the mind. People are quick to show empathy for a person who has a physical illness such as cancer, but when a person experiences others scrutinizing and criticizing their situation when they reveal they are suffering from a mental health disorder. However, both these diseases can require treatments that may cause a person to have to take time off of work, and both can be disrupting to a person's life.
Thankfully, I see that stigma for mental health issues is going down. These days social media has encouraged people to share their stories more, prompting others to share their stories. Is there still a degree of stigma and shame within families and society as a whole? Yes, but I think we are on the right track with dismantling the shame around a person saying they need help. The next thing I want to see is more widespread access to therapists who can meet the needs of people who are suffering. The Affordable Care Act helped to produce more access to mental health care. ACA eliminated the caps that commercial insurances used to limit services, and it also helped expand coverage to more people. So with more people having access to health insurance, more could be able to access mental health care. However, there are still some issues when it comes to insurance and mental health therapy. There are many people who have insurance but cannot afford mental health care services.
In my prior practice, there was a young woman I met who was utilizing her EAP (Employee Assistance Plan) benefits from her job. She worked full-time at a large-scale company. I provided her a designated amount of therapy sessions under her EAP benefits at no cost to her. As we got closer to completing her EAP sessions, we discussed continuing through her employer's insurance plan. She ended up having to pause therapy. Unfortunately, this young woman had a high deductible plan and financially could not afford to pay out-of-pocket as she had not met her deductible for the year. Financially she was strapped and she had recently filed for bankruptcy. So while in some situations having a deductible of $5,000+ a year may make sense to someone who only needs to go for an annual physical each year, it may not make sense for someone who needs to see a therapist weekly when therapy sessions can run $125 or more for a 45-minute session. Especially if you find yourself operating on a tight budget.
Now for this particular young woman, she was in a good mental space where I did not feel that I was being unethical allowing her to forego therapy. As a therapist, I have provided some pro-bono sessions for clients in financial constraints when I could see they were not in a healthy spot with their mental wellness. As a social worker, I understand that I did not come to this field to get a cushy, high-paying job. But why should a person have to decide between paying for therapy or paying their rent? Or why should a person have to think about therapy vs. buying food for the month? It's not a fair scenario when your mental wellness is really something you need to function well in your life. Now some therapists can do what I did, and some make a practice of providing pro-bono sessions for a certain number of people. However, therapists have bills too! While we can do some reduced-pay or pro-bono work, it is not feasible to do it across the board. So it is important to look at our systems to ask how we can make sure that everyone gets what they need.
According to NAMI (National Alliance on Mental Illness-www.nami.org), there are 1 in 5 people who have a mental illness. If you walk into a room with 20 people, at least 4 of them have a diagnosable mental health issue. Given the recent stress of the pandemic, I would imagine that it might be a little more than 1 in 5 these days. A person who is mentally well is resilient and can produce in our society. Imagine what it would look like if more people in our society were mentally well! What would it look like if there were more structures in place to support mental wellness? As a researcher, I want to look at programs and interventions that will help reduce that number. Just as important, I want to continue to advocate for support/access for people who are experiencing challenges in their mental wellness. Mental health services should not be reserved for the financially privileged in life. Mental wellness is a human right.