Is the mental health system broken or working the way it’s designed?

Content warning for trauma surrounding the mental healthcare system, obviously.

People often say the mental health system is broken and that’s why so many people are struggling to access care. And then sometimes you hear others respond by stating that the mental health system isn’t “broken” but it is working the way it’s been designed to, and that that design is to keep people oppressed.

So which is it?

I should preface this by saying that I don’t believe in conspiracy theories and that I believe systemic oppression happens because most people don’t think too deeply about the constructs they’ve been raised in so that we continue to propagate toxic culture sort of subconsciously rather than consciously trying to oppress certain groups. Obviously this is a wildly complex issue - as systems are - and I’ve grossly oversimplified it here so that I can move on to the details I need to cover in this post.

The mental health care offered by my primary care clinic is minimal: the “therapy” they offer is a 20 minute appointment (most therapy uses about 45 minute sessions) and 20 minutes is not long enough to be able to dig into the psyche and get some real work done, right? So I avoided it for a long time. Then I learned that my clinic has recently started a new mental health care program which is designed for folx who need a “higher level of care” and I was very excited at the possibility of actually being able to access therapy! And then it took me over a year to finally get assigned a therapist and once we began working together, it became clear that she wasn’t the therapist for me.

This is very normal within therapy - not every therapist is a good fit for every client. In this case, she would only ever discuss coping skills. Y’all. I am good with coping skills. I utilize the absolute fuck out of coping skills. I was very clear with her from our first session that I understand that she probably needs measurable results so I’m fine with briefly acknowledging coping skills, but that I primarily want to really dig deep into the psyche work and try to untangle some of the bullshit, you know? Doing this work has been the key to the healing I’ve done so far in my life; it’s very important work. Despite affirming this early on, she never actually did that work with me. I wasn’t going to rock the boat by asking for a new therapist because I really need to stay connected to mental heath services in order to get my Adderall prescribed. But she noticed that I would clam up every week when she wanted to talk and talk and talk about coping skills and so she suggested I find another therapist and I felt pushed to agree so I did, after confirming I would not be punished by being kicked out of the program.

And yet!

The next time I met with my psychiatrist (for those unfamiliar, a psychiatrist prescribes medications, but doesn’t do “therapy” - it’s licensed counselors or sometimes psychologists who do talk therapy) through the program, she started making noises about how maybe this program wasn’t for me. “Now you’re back at the end of the waiting list,” she told me, “and the waiting list isn’t moving.” (I mean, first of all, why am I at the back of the waiting list if I’ve literally already been waiting for over a year? Why am I being punished because they hired a therapist too uncreative to be able to shift her style to work with me?) She told me that because this program is for a “higher level of care” they don’t have therapists that do the kind of work I’m wanting to do.

What now?

I asked for clarification because to me “higher level of care” sounds like it should definitely include intensive talk therapy. But it turns out that what they mean is “crisis and stabilization care.” The program is supposed to be a six month program (yet it had taken me over a year to be assigned a therapist). I am still confused as to how even crisis and stabilization care would only ever focus on coping skills? Even if most people in the programs need to work on coping skills, what about those of us who need more intermediate or advanced therapy?

And then to add insult to injury when I told my psychiatrist “well I’ve healed myself this much without therapy so I’m sure I’ll be fine without therapy now” she literally had the balls to try to lecture me about how therapy is important for everyone. BITCH WHY DO YOU THINK WE ARE EVEN STARTED HAVING THIS CONVERSATION? FFS.

To complicate things, my insurance won’t allow me to receive mental healthcare outside of the clinic I am a part of. Which means my options are the “higher level of care” or the 20 minute appointments. In other words, I have zero options for the kind of therapy I need.

So now I don’t know if I’ll even be able to access my Adderall if and when I actually am kicked out of this program (that’s a whole other story). Doors are being shut in my face from every direction.

But this is a new program. It was created in the last three years. They designed it this way. The system is working exactly as it was designed. Literally.

Now what I don’t know about this is why it was designed this way. Did they consciously and specifically aim to oppress folx? Maybe I’m a hopeless optimist, but that feels unlikely. Or are they just completely incompetent and were unable to see the gaping holes that people would inevitably fall through? In the end, it doesn’t matter because they did design it this way, it is working the way it was designed, and it is hurting people.

This is just one program, but in the last few years I’ve had a tour of sorts of many low-income mental health programs for adults and teens, and they are all built in similar ways with similar gaping holes.

And the thing about being in the mental health system is that you are inherently unbelievable to most mental health professionals because, you know, you’re crazy. So they won’t listen to you or believe you. They won’t take you seriously. It is infantilizing and rude. But they aren’t even aware that they hold this bias so it’s impossible to talk to them about it.

Taking a step back and looking at a bigger picture, we can see this sort of pipeline to homelessness or perhaps incarceration happen in this way:

• Firstly, we are all born into this society which teaches us to internalize our traumas and gives us few helpful coping skills unless we are lucky enough to find them on our own.

• The capitalism drags us down. Y’all, inflation has been absolutely bonkers this past year, but food stamps has remained the same. Local gas and electric prices are even worse than grocery prices, but no one is doing anything to truly stop the power company from gouging us (and it’s not like there are multiple options for power companies). People have to work two jobs just to barely survive.

• Working too long takes its toll on our bodies and our minds. Cortisol, a hormone, is released when we are stressed and it has very real effects on our physical selves (and never forget the brain is a body part, too).

• We become sick and depressed and seek help, but the help is often unhelpful at best.

• At some point the brain can no longer function and people get sicker. Some may turn to self medicating with substances.

• Social Security is supposed to provide disability payments to those who cannot work, but the process to get onto disability is difficult to impossible. I’ve been trying for three years and have been denied because my doctors wrote things like “she says she’s depressed but she looks clean” so the judge decided I’m able to work and then my lawyer told me I should get a job to prove to them that I can’t work - despite the fact that I HAD a job and had to stop working because I was too disabled.

This is just one way folx become homeless. But once you are in the system, it becomes like quicksand and the more you struggle, the more the suction pulls you down.

I don’t have an answer as to the intentions behind creating a system that doesn’t function. But I also don’t see why we can’t fix it. If mental health care professionals actually took time to listen to their clients about how the system works, I’m willing to bet we could create meaningful change, first in one clinic and then the next and the next. But I’m admittedly feeling jaded and hopeless because so far I’ve just seen mental health professionals acting confused when I try to explain all this to them.

In truth, I think part of the reason my therapist struggled with me is because most of my problems are beyond my control, the trappings of systemic oppressions. In some ways there is literally nothing she could do to help me. But when I talk about my fears of becoming homeless, and a therapist is only willing to talk about coping skills - that’s hurtful and just adds to the trauma I’ve already experienced in this broken-not-broken system.

And I hate it.