By Marty Parrish
When I walked into an urgent care clinic one Sunday morning, I knew I could not afford the office visit, let alone any of the medications that might be prescribed. But I knew I needed help, and I had to try something.
I was suffering from a deep, dark, debilitating episode of depression that left me unable to function or think clearly. I had been experiencing crushing symptoms of major depression since my teen years (although I hadn’t been able to identify what, exactly, was wrong at the time), but this recent episode was particularly alarming.
It had already lasted several months, and I had been actively thinking of suicide as a way out, trying to talk myself out of such a final decision. I was concerned that I might take my own life. So, despite my inability to pay, I sought out care.
Rather than being honest with the care provider that day, I wrote a check that exceeded what I had in my account. In the moment, I felt as though I had no other choice. Fortunately, I was able to earn some money doing odd jobs over the next few days to put into the bank before the check was cashed.
While this felt necessary in the moment, I can’t say that I would recommend this approach to anyone. In fact, I would suggest being honest with providers about your financial situation if you feel comfortable doing so. If you can’t afford to pay for treatment, but you have the courage and the will to go seek help, explaining the situation to a practitioner may work to your benefit. There are those who may help, at least temporarily, to get you through an immediate crisis.
However, as I would come to learn, consistent treatment for a mental health condition requires financial means.
For the 15 years following my trip to the urgent care clinic, I would be on and off different antidepressant medications to find an effective treatment for my mental health conditions. During that time, I started a successful business and, as a result, I was able to pay for my treatment and carry insurance to help cover costs.
However, after selling my business and weathering another episode of major depression just months later, I ended up divorced, broke and homeless. My mental health continued to deteriorate, and I, once again, had no way to pay for my treatment.
The county where I lived at that time did offer low-cost mental health services. But even then, I was expected to pay a minimum charge for services. At that time $10 or $20 was more than I could afford. Even if I could finance a 30-minute therapy visit, I could not afford to pay for any medications because I had no insurance, and I would have to pay full price for medication that cost hundreds of dollars a month for an uninsured person.
So, I suffered.
For the next several years, I managed to survive by living at reduced rent with friends (or no rent at all with family) earning an income working as an independent consultant when I was able. I purchased medication sporadically, whenever I had the extra money. This was not a stable period in my life.
Going on and off anti-depressants, I learned, is not an effect treatment plan; I was never depression-free for more than three to four months at a time because I could not afford to continue taking the medications as prescribed to me. Even when I was able to pay for medication, the financial stress added to my mental health problems because I felt that I would never be free from this barrier.
Eventually, my situation changed. I was able to find a treatment that worked for me, and I could finally afford to stay with it. But I did not reach this point alone; I had the emotional and financial support of a partner.
My wife and I married 12 years ago. She saw beyond my diagnosis and decided to make sure I had all the help I needed to improve my mental health. Insurance that covered mental health issues was available to me through her employer. She took me to the doctor when I didn’t want to go. She picked up my meds and made sure I took them. She learned to check up on me by asking how I “felt,” not what was “wrong” with me today. These word choices were important because we could communicate without me becoming defensive and withdrawing.
She became my advocate in seeking therapies that had shown promise for a more favorable and longer-term treatment outcome. Because of new treatments and good insurance, for a decade now, I have been gainfully employed, able to cover my co-pays and able to work without taking days off and missing work due to mental health issues. Unfortunately, many people with mental illness may not be able to achieve relief and health without this kind of support from a family member or close friend.
Often low cost, or no cost, options are limited (if they exist at all). This must change. Mental health care is necessary for the good of our society. It should be available to all who need it regardless of their financial status.
We have a responsibility to make this happen for people who cannot afford care. Those of us who have been down this road must end the silence and share our stories. Our experience can shed light on the changes we have to make for the future.
Marty Parrish is a PMI Certified Project Management Professional (PMP) and Senior IT Program Project Manager for the nation’s largest non-profit health care system. He holds a M.A. in political science and has worked as a Congressional legislative assistant and on US presidential campaigns. As a business professional, he founded a successful company that he sold to a Fortune 500 enterprise before the age of 40. He openly talks about his struggles with mental health to help end the silence and break the stigma around mental health care. Marty is also a NAMI Provider trainer.
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