Content note: There are mentions of suicide later in this post and also some very US-specific political stuff.
I promise not to turn this blog into an all politics, all US health-care policy all the time site, but this couldn’t be more important or personal to me. I could not in good conscience neglect the platform that this site and this community has given me to speak. Thank you for reading.
Four years back I wrote a post about how people can reach out to their friends who have depression. The advice still stands – center the person, not the condition, be patient and persistent, respect their autonomy, and come from a place of loving and enjoying them (vs. rescuing or “halping”).
But there’s more to be done.
If you’re a person with a mental illness, live through today. Then try again tomorrow. Unplug from being online if you need to. Be nice to yourself. Be as nice to yourself as you would be to a friend. You’re doing great, sweetie.
If you’re a person without a mental illness, keep reading. We need you.
First, there’s some other individual stuff you can do. Rethink the language you use to describe mentally ill people and mental illness. Rethink blaming gun violence on mentally ill people, instead of where it belongs (toxic masculinity, misogyny, white supremacy are good places to start looking). Do what you can to reduce stigma around seeking mental health care, stop talking about dependence on medications as a weakness. Stop asking mentally ill folks when they are going to be better or “normal.” Most of us are not going to be “normal” without lifelong medication and support. Be an advocate for better mental health accommodations and policies in your workplace. Don’t automatically call police or 911 on mentally ill people (or anyone, really) unless your or someone’s life is in observable, imminent danger.
But individual acts of kindness and avoiding common mistakes are not enough. If we’re going to make things better for people with mental illness, we need big, sustained, collective action. So I want to talk about some more things you can do, especially in the United States, especially right now. If your entire social media feed is yelling “YOU ARE NOT ALONE! REACH OUT! GET HELP!,” stop and ask yourself:
With what resources?
If you want your friends and family with mental illness to be able to get the help they need, you need to do some work to make sure that help is available and real. Not just when prominent people end their lives. But now, yesterday, soon, tomorrow, all the time.
That means getting political.
That means talking about and caring about boring stuff like health policy and legislation.
The Patient Protection And Affordable Care Act of 2010 (aka the Affordable Care Act aka Obamacare) had two ironclad principles that revolutionized the way people with mental illness could access health insurance, namely 1) Mental health conditions needed to be covered and treated just like physical health conditions 2) Pre-existing conditions meant that you couldn’t be charged more for or denied health coverage. (Love and kisses also to 100% coverage of reproductive health care and charging men & women the same premiums, and some other cool stuff). This meant that getting therapy or medication for depression or anxiety in the past wouldn’t go down as a black mark on your medical records and make you uninsurable.
If you read the list of essential health benefits at the link and they sound like pretty basic, normal, reasonable things that a health insurance company should do for its customers, awesome! That means that the ACA has successfully reset our expectations. Before the ACA, literally none of that was guaranteed. As a person whose employer does not provide insurance for people in my job category, I have been denied insurance coverage outright. I have been offered plans that cover everything except “preexisting conditions” (aka the things I would actually need care for). I have had insurance plans that did not cover any reproductive health care but also where getting pregnant would automatically void my policy. I paid at least as much as I do now for this lackluster coverage that I was too afraid to use most of the time.
If you are a young person and you didn’t have to deal with any of this before the ACA, maybe you can’t understand how expensive and terrible and stressful it was, how many of us put off going to the doctor for chronic conditions and things that could be quite treatable until they were emergencies or past the point of treatment.
We can definitely argue that the 2010 law didn’t go far enough, that “single payer” would have been better, that the law wasn’t implemented uniformly across every state, that it still gave the insurance companies too much wiggle room to raise premiums – there are many many policy arguments to be had!
And yet, for someone like me who can’t access health insurance through my employer, it definitely was better than what came before. Our ACA insurance paid for Mr. Awkward’s hospitalization for bipolar disorder in 2015. It meant that when he was at his worst and having constant suicidal ideation, we could go to the hospital without worrying that it would bankrupt us and just get him the care that he needed. It is not exaggerating to say that this probably saved his life because his jerkbrain didn’t have the argument that getting help would create a financial burden for us in its bullshit list of lies about why he should probably die. It also paid for my ADHD treatment and testing, which has changed my life. On an ongoing basis, it has meant that consistent access to a therapist and psychiatrist and necessary meds for both of us are routine, predictable, mostly affordable costs. Physical health stuff is better, too, like where I get to breathe because my asthma is actually treated with something other than a rescue inhaler and pretending that it will go away.
I’m one of the lucky ones. I live in a large urban area with many health care providers and resources. I also live in Illinois, one of the states that accepted the federal government’s deal on the ACA (heavily subsidizing health insurance plans for lower income folks in exchange for states expanding Medicaid). If you live in 24 states, the ACA has never been given the chance to work for you the way it was intended, and I believe you if you say that it didn’t function well for you. Some of the plans still really suck or have a really limited list of providers, it’s still expensive, even with the ACA in place it’s still somehow normal for people to have to crowdfund for their medical expenses which is completely embarrassing for us as a nation (For individuals you do what you need to do, you’ll get no shame from me!) And yet, the ACA is a lifeline for me and mine.
The things that suck about it don’t suck by accident. People with power to do better made decisions that led us here, like when insurers fought every single provision and consumer protection during the drafting of the law and are clearly lobbying to roll them back, or when a number of Republican governors and lawmakers decided to refuse federal funds in order to sabotage and tank the law and legislators removed the individual mandate in the tax bill. These officials made it suck on purpose so they could campaign on how much it sucked, and they spread a ton of misinformation in the process. (The complete irony of this is that the ACA was originally a Republican plan, and a version of it was piloted in Massachusetts by none other than Republican governor and 2012 presidential candidate Mitt Romney. But Mitt Romney was white, I guess? Idek, it’s very confusing to me.)
Anyway, one of the biggest stressors to my own mental and physical health are the constant attempts to repeal or weaken the ACA. For example, right now the rule that insurance companies cannot refuse to coverage for pre-existing conditions is under assault. (Beeteedubs “sexual assault” is considered a pre-existing condition by insurance companies. So imagine being raped, seeking medical care, and then having that used to charge you more money for health care or refuse to allow certain things to be cared for at all.) If these protections are removed, it will eventually affect almost every person who buys health insurance. Even those of you who have employer-provided plans could go back to the days where your company health plan applications also came with filling out detailed medical history forms and a list of exclusions that wouldn’t be covered for a certain period of time.
I can’t describe how stressful the news about this is to me every time it comes up, the “ok, what happens if I lose health coverage and the ability to get it,” the constant stress and fear and burden of having to frantically call elected representatives and rally and beg them – not even to make a thing that works pretty- okay-but-not-perfectly work better – but simply “please don’t destroy the only thing that lets life be even halfway functional or possible so insurance companies can make a tiny bit more dollars and you can brag about how you got one over on Obama, ok thanks.”
All this to say, if you care about people in your life with mental illness, you have to know this: If mentally ill people cannot even *buy* insurance that covers our care, we will die. Some of us will die slower than others, but we will die. This is not an exaggeration or a drill.
And the disability activists I know are exhausted. The mentally ill folks I know are stretched to the breaking point. The patchwork of nonprofits and informal resources we depend on is, well, patchy. The constant assault on our access to care exacerbates every anxious and depressed feeling. Even with adequate care, the anxiety that it could all be taken away at any moment if Senator Collins or Murkowski decide to stop playing hardball with votes affects me. Me, in therapy last week: “Sure, I’ll try a new med, but feeling awful is not actually unreasonable given the current circumstances. Maybe I’m not supposed to feel better. Maybe none of us are until we unfuck this.”
So if you want to help us “reach out” there are some further steps you can take:
If you can possibly vote in the 2018 midterms, do it. Resources on registering here. I’m sure my political leanings aren’t a mystery, but I’m not even going to tell you who to vote for – just vote!
If you literally can’t vote, then phone bank. Register people to vote. Drive people. Knock on doors. Show up to candidate forums and town hall meetings if you’re able. Provide childcare for people who can. Kick in some money if you have it. Do something to make voting more possible for another person.
If you don’t feel “inspired” by any given candidate, well, me fucking neither, but who said you needed to feel inspired in order to do the most basic act of civic participation? Voting is not about your feelings and it has real consequences for human lives that are bigger than your feelings. Voting is a collective act, not a personal one. The lesser of two evils is still LESS EVIL.
Idealism and wanting more and better from the political process is a good thing, but, vote for those imperfect candidates that will use power to move the levers even slightly toward the just world you want to see. Protesting is great but what’s even better is voting for the people who might actually pay attention and listen when you protest their bullshit policies later. Vote on behalf of the people who are incarcerated, the people who are undocumented, the people who have lost their voting rights, the people targeted by voter suppression. Vote as a gesture against apathy and cynicism in the face of an authoritarian state. Vote because they are trying to make it harder for certain people to do it (if it didn’t matter, they wouldn’t try so hard to suppress it).
Vote because they don’t expect that you will, they are counting on the fact that you won’t – vote just to fuck with their heads! If you don’t have time to research every single candidate in every race on the ballot, pick the 10 that are most important to you and vote for those people and leave the rest blank. There will be no quiz or public humiliation ritual after the voting if you turn in an incomplete ballot.
Turnout in the USA 2014 midterm elections was just 36.4 % of eligible voters. That is pathetic. Go read about the Irish citizens who crossed the entire world to make this tiny action with huge, amazing consequences for the rights of their fellow citizens. Have a good cry at how very good and brave people can be and how things can actually eventually change if people work hard enough at it. And then get your ass to those polls.
Contact your elected representatives at the local, state, and national levels. Show up at their town halls if you can. Ask them to go on the record about supporting increased access to affordable health care and mental health care. Tell them that they’d better not repeal the ACA and replace it with something that weakens protections for pre-existing conditions. Tell them that mental health care must continue to be covered by health insurers. Tell them that you support full implementation of the ACA act in your state, including Medicaid expansion. Tell them you support funding for mental health clinics, especially in low-income areas. If you support single-payer health care (or as the Goat Lady likes to call it, “nationalization of the health care system”), tell them that too, but also (pretty please?) insist on full implementation of and expansion of the ACA in the meantime.
There are tons of guides on how to contact elected officials, this one seems like a pretty simple rundown , someone made one just for people with social anxiety and hey there’s an app for that. You could spend forever trying to find the perfect way, don’t worry about that so much, just do something. Start somewhere. The calls don’t take long, you don’t have to make eloquent speeches, they are just recording volume and numbers, my daily routine takes about 15 minutes all told.
And listen I HATE TALKING ON THE PHONE and I totally resent having to make this ridiculous set of phone calls every day, like “please stop tearing immigrant kids away from their parents at the US border and putting them in what sounds suspiciously like concentration camps” and “stop trying to make health insurance less available and suck more, thank you” but the reality is that we should have been making these calls and doing this work all along, all the past decade when we thought things were better, we should have pushed harder for the vulnerable people who were never safe, for the wrongs that were never righted. We had a not completely horrendous president for a minute and many of us, including myself, slept on it (check out that 36.4% turnout in the 2014 midterms number again if you doubt me). Maybe some of what we’re living through now could have been stopped if more of us had pushed harder then.
Whatever happened then, this is our task and our penance now, and if you aren’t currently being eaten alive by your brain it would help us out a lot if you decided to lend a hand. We need all of us to stay in the world, we need help to stay here, and we need to work together to push that world to be a little more bearable in our lifetime.
Moderator Note: If you think I’m going to moderate a comment thread about this today, your optimism and faith in me is adorable, I love you very much, but no.