The Cost Of Mental Health Care for a Semi-insured 23-year-old

by Jessie Lochrie

In retrospect, I can see that depression first struck me when I was 14: Suddenly, laying in bed doing nothing seemed vastly more appealing than doing any of the things I had loved for years — dance, skiing, even school. My high school Livejournal is filled with my confusion about my unpredictable moods, but I assumed that all teenagers were moody and that everyone felt the same as I did. It wasn’t until I got to college that I realized something might actually be wrong, and it took until I was 20 to get diagnosed as bipolar and put on medication.

I’ve been in various forms of treatment for years now: college counselor; old-school Boston psychiatrist that handed me drugs once a month; confused beach town therapist who had no idea what to do with me; extremely mean suburban therapist; current wonderful resident at a NYC hospital who sees me once a week and functions as both therapist and psychiatrist.While some treatment has been easy to access — namely the college counselor — most required navigating a maze of phone calls, referrals, string-pulling, insurance snafus, and money.

I am very lucky that I am able to access this care at all, and it’s due largely to two factors: I’m still on my parent’s health insurance in New England, and my mom was a nurse before I was born. Both of these factors have made seeing therapists and psychiatrists relatively easy at home in Massachusetts — Mom set me up with the treatments and our insurance paid. For years, I got my prescriptions from the Boston psychiatrist when I was at home, and saw a counselor at school when I was in NYC. This made my treatment essentially free (besides the copay for my meds and doctor), but ineffective. You want your therapy and meds to work in concert, which is hard when their respective providers are states away.

Eventually, the Boston psychiatrist ran out of ideas of what drugs to give me and suggested I seek another opinion, so my mom called up an old nursing school friend who is now head of psychiatry at a major Boston hospital. This person recommended us the extremely mean therapist, who I hated but went to dutifully two times each week while at home last summer, because I was desperate and out of options and just wanted to not feel like I was dying. My insurance covered one weekly visit, and my wonderful, generous parents paid the other $250 per week out of pockets, hoping that some intensive work before I returned to school in New York could help us plan a long-term strategy. It was also because they were worried that years of depression and anxiety had turned their vibrant daughter into a pet rock who lay in bed until 4 p.m. and then was terrified of getting behind the wheel of a car.

My parents’ health insurance covers me only in New England, except for emergencies, which means that if I break a leg in New York City I’m golden, but if I need therapy I’m fucked. It’s better than nothing, and if I get a UTI or bronchitis I just mosey on down to my college health center. Once I graduate in May this will be ripped away from me and I will be peeing into cups for $140 at the urgent care center (America!). All this means I couldn’t see a therapist at school in New York unless I wanted to be shelling out $300 a session, which I certainly did not. Luckily, by some twist of insurance fate, my prescriptions are covered in NYC. When I was studying abroad in France and attempting to refill prescriptions, I went to the pharmacy and had a meltdown in very bad French when I saw that a month’s worth of Wellbutrin was over 300 euro. The government reimburses you all of that, but I was mid-mental breakdown and pretty sure I didn’t have that much in my bank account.

Ultimately, the extremely mean therapist referred me to Mt. Sinai’s outpatient psychiatry clinic, as she had an in with the director. I wish more than anything I had been hooked up with them years ago instead of seeing college counselors, but so it goes. I also hope it comes across here how important and fucked up it is that you need to know people to get affordable and adequate care: After years of seeing college therapists in New York, who often said I needed more help than they could give me, not one mentioned Mt. Sinai or any similar programs in the city. It took my mom calling in a favor with a college roommate who is now a mental health care bigwig to get the recommendation for the therapist who ultimately knew someone at Mt. Sinai. I am incredibly privileged that my mom knew that bigwig and is also amazing at making phone calls and advocating for me, because I sure as hell could never have figured all that out in a haze of depression. And while there’s a lot of talk about mental health care being accessible and affordable for all, that seems like a pretty distant dream from where I’m sitting.

Here’s how the money works: Mt. Sinai’s clinic operates on a sliding scale. Since I am a full-time student, Mt. Sinai counts me as unemployed, and I pay the unemployment rate of $50 per weekly session. This is a full therapy session plus a conversation about my medications, which are currently in the process of being changed. My doctor and I often spend an hour and a half together, despite the fact that she is a super busy resident who also has other psychiatric patients, ER shifts, and pediatric work. She is a blessing from the universe and I kind of want her to adopt me.

The cost of my mental health care over the past six months:

• Therapy: $1,200
• Medication copays: $300
• Subway to therapy: $120
• Sunglasses to hide subway tears coming home from therapy: $10
Total: $1,630, or $271.67 per month

Lifetime therapy and medication costs plus what my parents pay for health insurance are too disturbing to contemplate, but I’m alive, and typing words on a screen right now, and sometimes I go to parties. As far as I’m concerned, every penny has been worth it.

Jessie Lochrie is a Boston-born, Brooklyn-based writer who is probably popping a Zoloft even as you read this.

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