I’ve spent a lot of time lately thinking about the last 5 months of your life. Specifically about how much we talked about how hard it is to get accessible and affordable help when you are struggling with depression and suicidality. I’ve run into this issue the majority of my life. By the time I’d reach a point low enough to realize I had no option but to reach out for help it would be a 12-16 week wait to see someone. I recall one occasion where I was feeling low enough to nearly beg the person on the phone, “Are you SURE there isn’t anything sooner?” Her response was, “Well, are you going to kill yourself TODAY? If so, just take yourself to the emergency room. If not, then you need to wait 12 weeks to see Dr. So-and-So.” Great bedside manner. It made me feel so embarrassed and ashamed of myself and I didn’t try calling anyone else for help for another few months as a result.
Getting the appointment wasn’t always the most difficult part– it was PAYING for it. For a year in the early 2000’s I was seeing a fabulous therapist. I had insurance, but they only: (1) allowed 30 visits per calendar year and (2) only had about four therapists from which I could choose that were in my network. I’d been to two of them already and had a bad experience with them both. When I found a therapist that really treated me with respect and said she could help me she turned out to be out of my network. Since she did not accept my insurance her typical policy was to request payment in full ($160 per visit) the day of the appointment and the patient in turn would submit the visits to their insurance company for the allowed reimbursement amount. However, she was very accommodating of my financial situation and allowed me to pay her $114 up front ($45 out of network copay plus 60% of the remaining balance of $115) and she would submit the remaining $46 to the insurance company to pay. This worked fine for the first few months until she had to have the uncomfortable conversation with me that my insurance company was not responding to her claims– at all. She would fax them 3, 4, even 5 times with no response. Each time she’d call they’d inform her they hadn’t received them and they’d require her to resubmit them. This went on for the rest of the year until I finally had to quit seeing her altogether– she couldn’t afford to keep seeing me and not get paid the full amount upfront. When speaking with my HR representative I was advised that they were aware that the insurance company was regularly not holding up their part of the deal where mental health visits (whether in or out of network) were concerned. I was so exasperated– the financial struggle involved with getting the help I so badly needed only accelerated my feelings of hopelessness.
For a number of recent years, once on successful dosages of a cocktail of anti-depressants I had been able to simply obtain refills of my prescriptions at my annual physical from my general practitioner. However, after you died she became concerned that she did not possess the expertise which she felt was required to play around with the meds to get me to a better place. So, she referred me to a psychiatrist for my future visits. I found one I liked, that was in network, and would require a $75 copay per visit and insurance would cover the rest. I could deal with that! However, after a few months I got a bill for $900 stating my insurance company would not cover a diagnosis of “Recurring Major Depressive Disorder” as it was classified as a “major mental illness” which, of course, they do not cover. My only option was to switch to their self-pay option of $130 per visit– and of course, she would need to see me every 4 weeks in order to continue to refill my prescription. With the cost of my prescriptions I was paying about $190 per month– just for medication maintenance– not including any of the sessions with my psychotherapist.
I also need to tell you that I have an important letter to write to someone in your defense. You didn’t want me to write this letter while you were alive and, quite frankly, it has been in the intended recipient’s favor that I have chosen to wait a few years to cool off after your death before writing it. A few short months before you took your life you confided in me that the one and only time you had ever sought help for your depression (despite several previous suicide attempts) was about 1-1/2 years before your suicide. You contacted the Employee Assistance Help Line offered by your employer. I used the help line at my company years ago which put me in touch with that amazing therapist I saw for a year. It’s a wonderful program and completely free of charge. They refer you to someone who can help, and pay for the first six visits. These therapists are enrolled in the program knowing that the first six visits are free to the patient– they are paid directly by the referral service. I was apalled to find out that the man to whom you were referred was completely unethical in how he handled your situation. After opening up to him and sharing things with him which had never been shared before, his response was, “well, your troubles are pretty complex and will take a lot of time and effort to work them out. The referral service you used only pays me $60 an hour to see you for these sessions but my office rates are actually $170 per visit so I’d recommend that you contact my office directly for any future sessions.” Nice. Way to tell someone who is suicidal that they aren’t worth helping out for a measly 60 bucks an hour. Clearly he did not enter the profession for its altruism! You never did go back to see him and I can’t say that I blame you for it. I’d have done the same. All of these issues I mentioned above were contributing factors in me making all those calls on your behalf to try and find you a good therapist. It’s hard enough to get the runaround and hear the tone of condescension in the voice on the other end of the line when you’re in a good place let alone when you’re mustering up shreds of strength every morning just to get out of bed and attempt to live through one more excruciating day.
Each time I go through these same issues with getting help for myself I feel the pain so much more deeply now as it only reminds me of how trapped you must have felt those last few months before you finally gave up altogether.
If there is anything good to come out of losing you in such a horrific way it will be that I will do my part to see that mental health is given the same consideration as physical health! And there needs to be less “hey, suck-it-up-and-pull-yourself-up-by-your-bootstraps” going around out there. Unless someone has been in the deep depths of true despair, they know not of what they speak.
Wish me luck writing the letter to that small, small man. I’ll let you know how it goes…