On the Gun Crisis
It isn’t as easy as more therapists - there are many of us - or building more mental health hospitals; it’s about enacting an entire cultural overhaul
It’s happened again. Again, children have been murdered en masse. I struggled writing that sentence. Not because it’s so horrendous - which it is - but because it didn’t seem to capture the horror well enough; we’ve so acclimated to the very concept that children are murdered that the sentence doesn’t hit as hard as it should. How fucked up is that?
Each time this happens, there is outcry and promises of change and politicians making statements that seem to suggest the change we’ve been crying for will come if only we vote for the right people.
Each time this happens, I reach to learn more about the murderer and why, how they became a person who murders children. The country rhetoric for a few days is about strengthening gun laws - an idea that never seems to take hold - and more mental health support. As the aforementioned Mental Health Support, please let me enlighten you to how short-sighted that conversation is. You want to take the responsibility for protecting our community from the consequences of un- or under-treated mental illness off of law enforcement and put it on the Mental Health System. This is not wrong. But it isn’t as easy as all that. It isn’t as easy as more therapists - there are many of us - or building more mental health hospitals; it’s about enacting an entire cultural overhaul (and associated investment) to appropriately compensate said Mental Health Support for the gravity of their work.
First: I’m $160,000 in student loan debt for the bachelor’s and master’s degree that allow me to be a therapist. That number was $140k when I graduated originally. Yes, there’s the PSLF program option but that requires me to work in public service. I’m not opposed to public service; it is, in fact, the reason I got into mental health in the first place. But a public service job AT BEST pays $70K/year (and that was after 10 years of experience and working in management). After taxes and health insurance, we’re looking at a take home of $56k/year. While the country’s inflation rate blows up, we’re consistently being priced out of our rental every 2-3 years, and we continue to try to meaningfully contribute to the economy… PSLF asks me to put aside making personal economic progress for 10 years for the CHANCE at forgiving whatever is left of my loans. Not to mention that said public service salary has often made it impossible to make “qualifying payments” on my loans while also feeding my family. So, that’s not a viable option. And doesn’t even consider the ongoing costs of maintaining licensure.
Second: Managed care is a trash fire. For a therapist to be paneled with insurance (which means applying to insurance companies for the *opportunity* to take their insurance) it takes 3-6 months of sustained, bureaucratic navigation which is nye impossible to do correctly the first time. And once a therapist *is* paneled, you’re looking at making $40 - $50/client and having to navigate various insurance rules and requirements for continued coverage. For most therapists operating independently, it’s simply not worth it. Not to mention medicaid clients are NOT ALLOWED to pay out of pocket for a provider. So, many therapists must decide if they care deeply enough and can support the necessary effort to apply for and maintain medicaid paneling in order to provide support to the most marginalized.
Third: Corporate America has infiltrated the Mental Health System and made it an untenable mess. Corporate America seems like such an easy fall-guy for this issue but I cannot perceive another factor which is more responsible. If you are part of the Mental Health System as a worker (therapist, social worker, mental health tech, etc.) and you want to make a living, the likelihood is that you are going to start by working for a mental health company. Mental health companies, in my experience, are some of the least informed or attentive to employee need and retention.
There is a “burn and churn” philosophy which has infected our system and treats mental health workers as interchangeable, ever replaceable cogs in a money-making system. Oh, they’ll tell you they care and that they do the work that they do to provide care, but functionally most are unwilling or uninterested in making the necessary shifts to truly care for their employees. This looks like nonsensical and inflexible application of policy, unmanageable caseloads, unrealistic administrative expectations, and un-empathetic leadership. The number of colleagues and friends who have been told “this is just how it is, if you can’t handle it maybe you shouldn’t be in this field” is criminal. Appropriate and effective mental health care relies on a clinician having the ability to utilize themselves as their most valuable tool. Empathy is not an infinite resource and compassion fatigue is all too real. To have the capacity to continuously provide empathetic, comprehensive, and insightful care, clinicians and employees must also be cared for. When we’re not, when our calls for help and statements of burn out are met with derision or apathy, we burn out. This is when clinicians miss things. This is when clinicians do damage rather than provide for repair.
So, yes, Mental Health is integral to addressing the homicidal crisis our country continues to find ourselves in, but before you decide that the Mental Health System can fix it: evaluate if you or our system are actually doing what is necessary to support what you are asking for. If you’re going to continue to ask human beings to provide the kind of care to hurting human beings that prevents them from gravely harming and/or murdering others, then value us accordingly.