Are we facing an imminent global mental health crisis?

BenderBender Citizen
edited July 24 in Mind and Body Wellbeing

In recent years, I thought my poor opinion of the mental health system is due to personal bias since my own experiences with it were overwhelmingly negative. 

And I have another reason to be biased: years ago, something horrible happened to my best friend who tried to find professional help and (just as I did) gave up after repeatedly dealing with people who either didn't help or even made her problems worse (the condescending attitude towards intelligent adults in such situations can be mindblowing). A lot of regular people were just as unhelpful, basically thinking that enough time passed for her "to get over it" and it was her fault she couldn't. After more than a decade of this, she killed herself, something I don't think I'll ever be able to get over myself. 

So I admit I'm angry and frustrated because of this, but given that I understand these are personal anecdotes (in the big picture of things), that it's been a long time since I had anything to do with the system and I also heard from people who had significantly more success, I thought it's reasonable to assume things are getting better. 

This year, I've been trying to help another friend in a very critical situation navigate the system and find help. More than half a year later, the only significant help he's getting still comes from his partner and friends, including books and online resources we all put together for him and our personal efforts to assist and support him with processing the information and making some changes. This was supposed to be a temporary solution to tide him over until he gets access to someone who can help him with more than getting through the day. He can afford to pay privately, and yet the search is still ongoing because all he could find were "counsellors" who give generic, mostly shallow and fairly condescending advice as efficient as putting a bandaid on gangrene, then bill you 100 euros per session. My friend told me he got better-suited suggestions from his partner, myself and my wife than from any of them.

That's not even mentioning incredibly stupid and dangerous advice like "he needs to be put on medication immediately to spare him the pain of therapy" - yes, a mental health professional said this to me, without even seeing or talking to him. As if this kind of medication is a precise science and most people don't have to go through a process of trial and error with it too, sometimes with drastic and dangerous side-effects.

This made me examine more closely the system in my own country (and other European neighbours since we all like to throw stones at the US one). I found that finding a therapist that accepts insurance is a very difficult and lengthy process and you cannot even choose whom you're going to see - it's a lottery, only one with very high personal stakes. Even if you can afford to pay privately, good luck finding someone that at least seems a good fit and managing to get an appointment with them. Some don't take new clients, some have waiting lists longer than a year, some won't even answer their messages anymore and some say they'll call back and never do. These are the people we are supposed to trust in our most vulnerable moments, in situations where getting or not getting help can literally mean the difference between life and death. And the current pandemic seems to have clogged an already defective system to the point of breakdown.

Paradoxically, someone who's so depressed they can barely function in everyday life needs to engage in a long term uphill battle to find help, while they can barely get out of bed in the morning. I wonder what happens to those who have no resources or friends and family to advocate for them and help with the legwork (rhetorical question, I already know exactly what happens).

I look around me and in the news and see how "normal" and trivial severe untreated mental health issues became, from mass murderers going on a spree every other week or so, various forms of terrorism, parents severely abusing or trying to kill their children, people who resort to violence against others for the most trivial reasons (Soho Karen), the woman on the plane who had to be duct-taped to her chair after biting a crew member and trying to open the emergency door mid-flight, the daycare owner who hung a toddler in the basement and ran over two people with her car in the same day and the list is literally endless.

Modern life, the unexpected effects of very fast technological development, the rampant decline of the education system and several other political and social factors seem to have led to a huge surge of severe untreated mental conditions in our population. It's not even a "few people falling through the cracks" situation anymore: running into someone who obviously presents a danger to themselves or others became a rather trivial occurrence and most of these people don't get the help they desperately need even when they're actively trying to. We mostly find out about it when it's too late.

The pandemic was the cherry on top of this festering mess and the news feeding into paranoid attitudes towards strangers, dissenters, non-conformists, neurodiverse, disabled or merely "different" people have exacerbated, normalised and even justify and promote a mix of partisanship, segregation and isolation reflected by a pervasive "us versus them" mentality, suspicion, open discrimination and hate, shunning and even punishing others "preemptively".

Meanwhile, the majority of the population seems to be struggling with various mental issues - some more serious than others - and people are left to fend for themselves or end up being offered expensive, ineffective and often dangerous "help", while bystanders are usually split between throwing stones and treating mental illness like a character flaw and those who go through extravagant mental gymnastics to justify and defend toxic and dangerous behaviours and actions.

TLDR: It seems to me that the mental health care system in the first world is turning into a colossal failure, coming back at us with a vengeance and most people seem oblivious or indifferent to how incredibly dangerous this is and how much it's affecting us both as a society and individuals.

Comments

  • Statest16Statest16 Citizen, Mentor
    Does not seem quite Bad in the US but higher end doctors won't take government insurance often and only take private insurance.So people on lower incomes have 4-6 month wait to get into clinics that take medicaid type insurance and most of the time those type of clinics only offer master level doctors.You often need expensive insurance or pay out of pocket to get an actual Psychiatrist or Psychologist
  • In the UK 'Care in the community' has been a good  idea that has has been seriously wrecked by years of underfunding for mental health services. If you're not acutely symptomatic/danger to yourself or others/ have an addiction/have a criminal record, you get very little help and support. Unless you have family near you advocating for you. I increasingly self neglected after my wife died , but got so used to being like that it didn't register. It took a few months  being where I am now and my stepdaughter and depot nurse commenting - to realise how bad things had been previously.
  • AmityAmity Administrator, Citizen
    I am sorry to read about your friend, to see so many people currently struggling to keep their wellbeing might lead me to feel a powerless in this situation. Its proactive to talk about this instead, fair play. ☺

    It is pot luck when you seek talk therapy, as some of the terms like counsellor are not a protected title, there can be a broad range of qualifications and experiences among the people offering services in this sector.

    While this is changing albeit slowly here in Ireland, the reality is even today in the UK anyone could legitimately advertise themselves as a counsellor.
    However to register as a practitioner with a recognised professional body requires a minimum level of qualifications in both countries, this is how the sector has regulated itself in the absence of state regulations.

    The upcoming cohort of students in Ireland will be at minimum EFQ 6 (https://nfq.qqi.ie/qualifications-frameworks.html) upon graduation and this is a prerequisite for registration with the Irish professional bodies..

    This will be a safeguard for standards, but not a certainty that all graduates will be suitable. For example the privatisation of further and higher education IMO  introduces a conflict of interest, a business needing to stay afloat, or one in seek of profits will make concessions in applicants if it means running a course or not. Yes there will be checks, but legally to refuse a potential student because they meet the criteria, but you feel they are not suitable generally operates outside the protection of the law.

    So then the responsibility lies with the employers to (again within the law) filter out those who may not be suited, however once qualified with a minimum level of experience a talk therapist can set out as self employed, and this is where we could still see some discrepancies in the standard of care and ethical practices.
    All that said, it will be a massive improvement on how the sector operated in the past, with literally no filtration of people who could call themselves a counsellor.
    The recognition of the sector by the state here, by introducing a protected title status, is a massive step forward in acknowledging the importance of mental health.

    Tldr, standards vary in a largely unregulated (by states) sector.

    I feel myself (all of the above aside) that we dont have a fit for purpose mental health sector, we have some safety nets in place to protect the state from legal actions but from my experience this is only for those in the most dire of circumstances.

    A kneejerk reaction for provision of services like the above, does not provide a sector. It would be akin to calling the hospitals accident and emergency dept and related aftercare, our health secotor.

    My experience in the UKs NHS is that it has a mental health sector in a very limited capacity. A waiting list to visit a CBT therapist (the standard scientifically recognised methodology) attached to a primary care service (local doctors) could easily be 6 months. I was in dire straights when I accessed this service, I was fortunate that my situation was recognied by the therapist in the initial assessment and I was given a six week wait till my first appointment, also fortunate was the impact the sertraline/zoloft had on me in that time. When I arrived for my first session, the therapist was off on sick leave (no contact) and ultimately from that point with no follow up, I fell through the cracks.

    So many of these things feel like a box ticking exercise, with the motivation being: protection from legal action.
  • BenderBender Citizen
    Yeah, while the rant about my friend comes out of frustration, the situation made me dig my heels in and mobilise others too, so one way or the other, his situation will get eventually sorted.

    What got me thinking was what about those who have nobody, little resources and no energy and motivation left to persevere for months and months, against all kinds of odds and obstacles that shouldn't be there.

    Because let's be honest: for many people, a free support/suicide line is not going to do much (definitely not in the long run), and neither is an otherwise sympathetic stranger who tells them to exercise, eat better and take vitamins. People who feel on the edge are really past this kind of thing.

    And the current situation just took this mess to the next level - even at home, I started noticing how people - in general - are less polite and patient, more paranoid and generally acting like they're getting too close to the end of their rope. And things are even worse online where people use fewer filters.

    Basically, everybody whom I talked to (from the US, UK, some other European countries) told me the same thing: they usually pay out of pocket and it took them a long time (sometimes years) to find someone who actually helped them.

    And now we're all under a lot of pressure, more and more people start snapping, and from what I know, not one single government actually prepared for this in any (serious) way. 

    A discussion with Tem here started opening my eyes about how bad things really are and I've been thinking about it ever since, while the information I've gathered myself confirmed the gravity of the situation.

    I'm truly concerned about the situation, even more so since none of our governments or our population as a whole seems aware or willing to acknowledge what huge risks we're taking by having such a cavalier attitude about something so serious and potentially dangerous. 

    And it always makes me angry to see problems that can be prevented being swept under the rug, I'm like this at work too.
  • My personal experience with therapists ranges from useless to emotionally and sexually abusive.

    But I can talk about the availability of services for the people with developmental disabilities, including autism. 

    There are some 30,000 people in the state of Florida who are on the program I contract with. There are also about 30,000 people on the wait list. 

    And even those on the program have difficulty getting services because each service has to be deemed medically necessary, and the standards to meet this criteria are getting stricter by the year. 

    I could not get emergency services for an autist child with severe, life-threatening behaviors until the parent tried to commit suicide. 

    I could not get services for someone with swallowing problems unless he first choked and had to go to the hospital emergency room. The fact that he didn't choke because he was closely monitored and assisted while eating did not count. The program wants him to choke and need medical care within the past 12 months. 

    And...shortly after I lost the appeal to get services for the individual above, another client actually did choke and died even with CPR, emergency services and ICU. This would be the second client I have lost to choking. 

    There used to be specialized mental health counseling for clients, but no more. They did away with that. 

    Anyway, I have a lot of mangos to process today, and none of us really needs to hear all the examples. We are primarily preaching to the choir.

    I have no idea how to fix this problem. Here is the US it is primarily the fundamentalist Christians who turn their backs on people in need. It boggles my mind. 

    And people in the US also have gotten more rude and speak out more nasty things to others. But I thought that was a result of the Trump presidency. 


  • BenderBender Citizen
    ^
    Thank you, blaze, both for sharing your experience and that kind of data - I definitely want to hear such stories because they reflect reality, not what we want to believe. As I said, Tem also directed me towards such realities that opened my eyes, and I really appreciate it.

    I can't imagine how you survived so many heart-breaking moments in your career, but I'm really grateful that many of these people had you to advocate for them. All my thoughts here came from a real concern for what happens to those who have no one, and how dangerous not getting help can be to either themselves or others.

    Enjoy the mangoes, I love them in salsa or chutney!
  • Bender said:
    ^
    Thank you, blaze, both for sharing your experience and that kind of data - I definitely want to hear such stories because they reflect reality, not what we want to believe. As I said, Tem also directed me towards such realities that opened my eyes, and I really appreciate it.

    I can't imagine how you survived so many heart-breaking moments in your career, but I'm really grateful that many of these people had you to advocate for them. All my thoughts here came from a real concern for what happens to those who have no one, and how dangerous not getting help can be to either themselves or others.

    Enjoy the mangoes, I love them in salsa or chutney!

    Exactly. Much of the stuff I do for clients is full of bureaucratic snafus and requires the ability to read and write and think in English. I lot of the time I don't know what the paperwork means and I have to call and research. 

    I often wonder...how does anyone get through this with someone like me to clear out the obstacles. 
    Exactly. Much of the stuff I do for clients is full of bureaucratic snafus and requires the ability to read and write and think in English. I lot of the time I don't know what the paperwork means and I have to call and research. 

    I often wonder...how does anyone get through this with someone like me to clear out the obstacles? What about the 20,000 on the wait list? 

    It is not surprising that many people give up.  Florida closed down all the institutions for DD and mentally ill people because "institutions are bad." And now all those people are on the streets. 
  • Statest16Statest16 Citizen, Mentor
    My personal experience with therapists ranges from useless to emotionally and sexually abusive.




    This is scary,how prevalent is sexual assault against patients.I have never met anyone who said a therapist abused them but maybe people don't talk about it?
  • I certainly don't talk about it, statest.

    I didn't find out it was common,  until I had a clearness committee meeting (a Quaker process)  with Friends, and one was a retired psychiatrist and he validated everything that had happened to me, knowing what he had learned over a half century of practice. Interestingly enough, he said that most women believe the sexual interacts were the woman's fault.  Just like I did. 
    And just like so many other women from the me2 movement said. 
  • Statest16Statest16 Citizen, Mentor
    I certainly don't talk about it, statest.

    I didn't find out it was common,  until I had a clearness committee meeting (a Quaker process)  with Friends, and one was a retired psychiatrist and he validated everything that had happened to me, knowing what he had learned over a half century of practice. Interestingly enough, he said that most women believe the sexual interacts were the woman's fault.  Just like I did. 
    And just like so many other women from the me2 movement said. 
    Hopefully they can put these therapists in jail who are doing that.
  • BenderBender Citizen
    Statest16 said:
    My personal experience with therapists ranges from useless to emotionally and sexually abusive.

    This is scary,how prevalent is sexual assault against patients.I have never met anyone who said a therapist abused them but maybe people don't talk about it?
    I've heard some of these stories too, but usually from people who have been institutionalised/committed.

  • magpiemagpie Citizen
    I'm out of words for such abuse. I hope the shrink ended in jail.

    On the original topic: I might be cynical but I think it's nothing new. My first thought was 1950s here, with a plague of alcoholism, but, honestly, what did all the poor people through the history have?
  • verityverity Administrator, Citizen
    edited July 26
    It is a massive betrayal of trust, which is the cornerstone of the profession.

    Unfortunately predators will sometimes stop at nothing to try and pull the wool over peoples' eyes.
  • BenderBender Citizen
    magpie said:
    I'm out of words for such abuse. I hope the shrink ended in jail.

    On the original topic: I might be cynical but I think it's nothing new. My first thought was 1950s here, with a plague of alcoholism, but, honestly, what did all the poor people through the history have?
    You are correct. But I think it's unacceptable that so little changed in 70 years, especially in countries that make big claims they don't allow people to fall through the cracks because they're poor and have a functional welfare system and universal health care funded by my and your taxes.

    I suspect that at least some of this is related to the societal/cultural stigma and shame still attached to mental illness.
  • magpiemagpie Citizen
    Bender said:
    magpie said:
    I'm out of words for such abuse. I hope the shrink ended in jail.

    On the original topic: I might be cynical but I think it's nothing new. My first thought was 1950s here, with a plague of alcoholism, but, honestly, what did all the poor people through the history have?
    You are correct. But I think it's unacceptable that so little changed in 70 years, especially in countries that make big claims they don't allow people to fall through the cracks because they're poor and have a functional welfare system and universal health care funded by my and your taxes.
    1950s - the war was over, an era of universal happiness of Socialism was dawning, brightened by Comrade Stalin 💩
    And this is the most famous painting depicting the atmosphere of post-WWII Poland:


    Bender said:
    I suspect that at least some of this is related to the societal/cultural stigma and shame still attached to mental illness.
    It's changing in my generation, at least here.
  • BenderBender Citizen
    magpie said:
    Bender said:
    magpie said:
    I'm out of words for such abuse. I hope the shrink ended in jail.

    On the original topic: I might be cynical but I think it's nothing new. My first thought was 1950s here, with a plague of alcoholism, but, honestly, what did all the poor people through the history have?
    You are correct. But I think it's unacceptable that so little changed in 70 years, especially in countries that make big claims they don't allow people to fall through the cracks because they're poor and have a functional welfare system and universal health care funded by my and your taxes.
    1950s - the war was over, an era of universal happiness of Socialism was dawning, brightened by Comrade Stalin 💩
    And this is the most famous painting depicting the atmosphere of post-WWII Poland:


    Bender said:
    I suspect that at least some of this is related to the societal/cultural stigma and shame still attached to mental illness.
    It's changing in my generation, at least here.
    Here too, and I want to see these changes reflected more in policy. But I wonder how many people think (as I used to) that our taxes are used efficiently for this, without having had the experience themselves and finding that's not necessarily the case.

    I like Bronislaw Linke, I tend to associate him with Otto Dix, particularly his depictions of the first world war and its effects



  • magpiemagpie Citizen
    edited July 26
    Well, I grew up thinking of taxes in precisely the opposite way - it's still a pleasant surprise to me when I find out they are spent on something useful 😅
  • Statest16Statest16 Citizen, Mentor
    Bender said:

    I've heard some of these stories too, but usually from people who have been institutionalised/committed.

    In inpatient facilities there are always staff patient relationships going on and consent is questionable with all the drugs the patients are on.
  • BenderBender Citizen
    Statest16 said:
    Bender said:

    I've heard some of these stories too, but usually from people who have been institutionalised/committed.

    In inpatient facilities there are always staff patient relationships going on and consent is questionable with all the drugs the patients are on.
    You'd think such relationships shouldn't be allowed by default, regardless of consent, in order to protect everyone involved. Other forms of abuse aren't exactly unheard of either and it should be obvious someone with mental illness and/or drugged to their eyeballs is going to be vulnerable.

    I've never heard of anyone staying in a regular hospital and starting an affair with a staff member that goes beyond maybe flirting and I doubt it's common (outside of a porno).


  • AmityAmity Administrator, Citizen
    Blaze it is a wonder that you have come through the other side of so many challenges.

    I am a bit low on social energy and words at the moment, but I wanted to respond to your post on the sexual abuse by a therapist.
  • HylianHylian Citizen, Mentor
    I've always wondered how long it's going to take for a global MH crisis to happen, if it's not already happening. Sans crappy mental health services, I don't think humans (which are just glorified great apes) are equipped to handle a lot of the things in modern life. Working in an office all day, living in a crowded city/town devoid of nature, and going home with nothing to do but scroll through the internet isn't natural, and I wouldn't expect a chimpanzee or any other animal to be able to happily do that for the rest of their life.
  • magpiemagpie Citizen
    Hylian said:
    I've always wondered how long it's going to take for a global MH crisis to happen, if it's not already happening. Sans crappy mental health services, I don't think humans (which are just glorified great apes) are equipped to handle a lot of the things in modern life. Working in an office all day, living in a crowded city/town devoid of nature, and going home with nothing to do but scroll through the internet isn't natural, and I wouldn't expect a chimpanzee or any other animal to be able to happily do that for the rest of their life.
    I think the humanity has been living in this crisis for the last 10000 years.
    That may be the source of the myths of the Golden Age, Eden etc. - some memory of the pre-crisis life, lost to civilisation.
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