The Brentwood Springs treatment center in southern Indiana does its best to remove the stigma from mental health. The space looks modern, the cafeteria smells like tasty food, and you may hear the sounds of a guitar coming from creative therapy down the hall.
If you walk through the facility, you'll only see subtle reminders that you're in a treatment center: things like the slanted doors and faucets, finger locks, and signs marking restricted areas. Patients, however, often feel the mental health stigma again when they try to get care after leaving.
“It’s really easy to have the help and motivation to try get things done and better yourself while you’re in that fishbowl. Because you’re in a controlled environment where you’re not dealing with external stimuli,” Southern Indiana native Nick King said.
Nick knows this cycle personally. It starts at the emergency room or a treatment center. Then a lack of proper care afterward leads to another crisis. And that returns him to a place like Brentwood Springs.
It’s important to mention here that mental health disorders like chronic depression and addiction are treatable. However, many factors can get in the way. CheaRon Darrett, who handles assessment at Brentwood Springs, says one of those factors is insurance.
“A lot of individual therapists have a choice to accept what insurances they choose. And for example, yesterday I had a patient who needs an individual therapist. We have a sheet of over 30 individual therapists, and only two took her insurance,” Darrett said.
It's easy to think it would make sense for therapists to just take any insurance plan. In reality, paperwork, red tape, and varying reimbursement rates for identical services mean that’s not always true.
“A commercial insurance like a Cigna or Blue Cross—if you charge $180 for an initial assessment, Blue Cross may pay you $125, while Medicaid may pay you $85,” Darrett said.
Other times, insurance may cap the amount of sessions it will pay for, or restrict approved medications.
“Particularly private pay—what we call private pay insurance companies are, for lack of a better word, I guess a little more stringent about the types of services that they will pay for versus Medicaid or Medicare,” said Kevin Willoughby, director of crisis services for Life Skills Inc., a community mental health center in south-central Kentucky.
Often, centers try to work around insurance to provide care. And many intake facilities work to set up a follow-up appointment for a patient within a week of dismissing them. That’s where waitlists to get an appointment complicate things.
“Need for psychiatry around our community is very high. It may be 3-6 months. There are some who are unable to even take new patients at all,” Darrett said.
According to Darrett, that’s why people may end up seeing a regular physician rather than someone trained to take care of their medication or other needs. Some doctors may lean on treatment centers for re-evaluations.
To a patient like Nick, it doesn’t make much sense why getting seen is so hard.
“I don’t think I’ve ever had a waitlist that was shorter than five months. And I really couldn’t tell you why, because I don’t know how that system works, I couldn’t tell you what any good reason for that would be.”
For many, visits can come with a high price tag. If someone lives in an underserved area, it’s going to take a chunk out of their day to get to an appointment. That might make keeping a job hard, and sometimes it can seem as dire as a choice between taking care of mental health or buying food. That's especially true for someone like Nick, who doesn’t have any in-network therapists nearby.
“I’d probably have to spend $2500 or $5000 out of pocket before I’m able to see anybody out of network—still with a $50 copay,” King said.
Without maintenance care, or someone to watch medications, there’s not a lot preventing another crisis. Experts blame different reasons for the system being how it is, but most agree awareness is among the most important ways to fix it.
After all, treatment can improve people’s health. They just need access to it.
This is the first of a two-part series of stories on some of the challenges people face when trying to get mental health services.