In the wake of Robin Williams' passing, my experience in a mental health clinic has given me a better understanding of what he went through
This week has been an anomaly for all of us. Hearing of Robin Williams death by suicide has rendered most of us speechless. I thought I would tackle the mental illness subject from a witness’s perspective. I managed a mental health clinic from 1989-1994 and met thousands of patients as result. As someone who has had depression on and off for most of my life, that job saved it.
What I learned over those five years was invaluable. I have kept a mental file of everything I learned from psychiatrists, psychologists, marriage and family therapists, child psychologists and addiction specialists. I dealt with many patients about a variety of issues and got to know some quite well.
In those days, insurance companies did not acknowledge any mental health diagnoses and therefore, did not cover mental health treatment or medications. This came after President Reagan cut all federal funding to states for public mental health clinics and hospitals. All public mental health ceased to exist and since then, the rate of homelessness and suicide has risen exponentially to a staggering and numbing rate.
Only the wealthy or patients with the rare insurance policies could obtain treatment. I remember time and time again people just saying after one visit that they could not afford to continue treatment financially. I nearly lost my mind. After five years, I couldn’t take it anymore. Ironically I ended up depressed and on Prozac, the new wonder drug for depression.
It seemed like everyone was leaving the office with pricey prescriptions for Prozac. The pharmaceutical representative would come in and leave so many starter pack samples for the psychiatrists to hand out, and it was never enough. Soon they were adding another prescription for anxiety and then came the need for follow up visits to monitor the patients symptoms. Every patient I interacted with had different side effects and I learned how brain chemistry was different for everyone. I started understanding depression and the balance of all these different brain chemicals. When someone did feel better, it convinced me that for some people, medications really do work.
During my tenure, there were only two suicides. One was a young man who was about 30 years old and homosexual. He was also Catholic and still lived with his mother. He was so nice but so frail. He came in for medication and therapy for many months. Then one morning I came to work and was told that he lied down on his bed and shot himself in the head. A sadness came over me that was profound. This man had a multitude of issues and was really reaching out for help, but there was no way to fix his belief that he was going to hell for being gay.
He felt that if he wasn’t a homosexual, everything else could be dealt with. This was 20 years ago, but even today, homosexuality can still bring so much shame on a person that suicide feels like the only way out of the closet. I remember thinking to myself, “How many other homosexual men and women are this tormented?”
The other person who committed suicide was a clinician of all people. He was a recovering heroin addict and had been clean and sober for many years. He returned to school, received a PH.D. and became a Certified Drug and Alcohol Counselor. He had several years of experience working in addiction recovery centers before he worked for my employer. After about four years, this clinician had started to take the psychiatrists prescription pad to write himself prescriptions and getting them filled several times a day at different pharmacies.
Two years after I had left, I was told that he committed suicide by overdose. I can’t say I was surprised but having known him a long time, it was surreal. Here was someone who was supposed to be the expert and ended up in the same downward spiral that I kept hearing about.
Three years after I left, in 1997, President Clinton enacted the Mental Health Parity Act. To put it simple, insurance companies had to recognize a mental health diagnosis the same as a medical diagnosis. If the policy limit was $1,000,000 for medical, then it was $1,000,000 for mental health as well. I was so relieved. I thought of all the people in that fancy office who got turned away and couldn’t thank President Clinton enough. On a side note, this was huge health care reform that went pretty much unnoticed.
The only glitch was that there were still pre-existing condition clauses so insurance companies didn’t always have to cover it. Still, if they did, medical and mental health were equal. President Bush signed a rider in October of 2008 to the bill requiring insurance companies to include mental health in health insurance policies. This was called the Mental Health and Addiction Parity Act. However, the pre-existing condition glitch was still an obstacle for the mentally ill and drug addicts. The Affordable Care Act finally closed the pre-existing glitch and anyone with health insurance can now seek treatment. It makes the “there is always help” not just a slogan, but the truth.
Why are so many people depressed or in desperate need of mental health is a question that has a million different answers. What has been so confounding is the increasing rate of depression and suicide when all of these different treatments are available. According to the American Foundation of Suicide Prevention, between 1990 and 2000, the suicide rate decreased from 12.5 suicide deaths to 10.4 per 100,000 people in the population. Over the next 10 years, however, the rate has increased, by 2011 the rate stood at 12.3. The AFSP works closely with the Centers for Disease Control or CDC.
I understand that public mental health and free clinics still don’t have funding and that is a whole other story. If a patient calls the typical psychiatrist, the first appointment may be a month away. Same with psychotherapists. There is definitely a need for accessibility and more mental health professionals; from physicians to mental health nurses and technicians (jobs?).
Traditional treatments didn’t work for Robin Williams. Medications didn’t help. Rehab programs didn’t work. I don’t know what else he tried such as holistic or Eastern medicine. I think for some, it is just situational. A doctor can pump someone full of rainbow colored happy pills that alter brain chemistry but that doesn’t change the fact that depression is subjective. I think it’s probably easier to medicate a schizophrenic successfully than it is for someone like Robin Williams and the millions of individuals like him. In fact, I’ve seen it.