Mental Healthcare Only Exists For People With Privilege

My Privilege Keeps Me Alive

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I had a bipolar episode recently. Like Quentin Coldwater says in “The Magicians,” sometimes my brain breaks. It started slowly: I argued too much with people on Facebook. Then I argued too much with people in real life. A sense of inevitable doom closed in, served with a side of debilitating anxiety. When the pills began to look more useful as an entire bottle than as a dosage, I called my husband and my psychiatrist, begging my way into an appointment that day. Clearly, I needed mental health care.

My husband talked to me, pretending he was between classes. He kept talking until he reached our driveway. He knew I’d fight him if he said he was coming home from his job as a public school teacher, and he wanted to keep me talking to him, not that bottle of pills. What happened afterwards would have been impossible without a significant amount of money and privilege.

Mental Health Care Comes From Privilege

That my husband could even leave work was a sign of privilege. He has some stunning colleagues who know about my mental health issues. They’ve let him leave before: skipping his last free block to meet me at my psychiatrist’s office, only a few blocks from his school, so I could take an earlier appointment, for example. More than once, they’ve told him to leave early when I’ve had a breakdown. They understand that my husband has a wife who needs mental health care.

That’s some serious privilege.

That afternoon, he stayed home with our kids (privilege: he was home from work) while I drove to my psychiatrist’s office. She’s the best in our state; in fact, she used to run our state’s Board of Psychiatry. Since I have several comorbid (read: overlapping) conditions, I need someone with serious experience. But my mental health care doesn’t come cheap. My doctor does not take insurance. I can file for it later, but they don’t cover it. We pay for her out of pocket at over $150 per half hour, my usual appointment length.

That’s $150 I didn’t know I’d need when I woke up in the morning. Add another $10 to pick up new medication. That doesn’t sound like much. But we already spend over $100 (with insurance) on my psychiatric medication every month.

My mental health care privilege kept going. My husband spent several days home from work. He wasn’t penalized for taking those days, but because he’d already used up his sick days, he wasn’t paid. His resulting paycheck looked a lot smaller. We dealt. My mental health care is too important. I couldn’t have stayed home alone, and in a pandemic — none of our friends could have stayed with me.

I had: a husband who could leave work, then take time off; a psychiatrist who could fit me in immediately; money to drop on said psychiatrist; money to drop on my new medication; and someone (my husband) to oversee our kids’ education while I took care of myself. Moreover, my own bosses didn’t penalize me when I needed a week off with no notice whatsoever. My mental health care was the definition of privilege.

I’m Lucky I Have Insurance

The Affordable Care Act, AKA Obamacare, provides for mental health parity, meaning that insurance must offer equal coverage for mental health care, which includes prescriptions. Some of my medication is more expensive than others; the ADHD medication I can’t substitute doesn’t come generically, and it costs us almost fifty dollars a month.

But even having insurance is a privilege in America. According to the Kaiser Family Foundation, the number of uninsured climbed from 2018 to 2019 to 28.9 million, which doesn’t count uninsured elderly. That’s roughly ten percent of Americans. And I’m lucky my insurance offers decent prescription drug coverage. I shudder to think what my mental health care would cost without prescription drug coverage. Most of my meds only have a nine dollar copay.

My Husband Took Time Off Work

There aren’t really statistics available about how many bosses would let their employees leave because their wives had a mental health crisis. But their number isn’t high. My husband works a white collar job, and it’s far more likely that a job like that would give us consideration we need. Moreover, he wasn’t fired for needing time off. They gladly gave it to him.

We were able to weather his paycheck cut. It wasn’t pretty, but we did it. That’s a hell of a lot of money and a hell of a lot of privilege. Half your main breadwinner’s paycheck — or cut your total monthly income by something like 5%. We didn’t plan for that. We couldn’t plan for that. But we managed it. My mental health care is too important not to.

Mental Health Care Is That Important

Without treatment, I’d be dead.

I could try to sugarcoat it, or dance around it, but I have bipolar 2, anxiety, depression, and ADHD. Medscape says that 25-50% of people who have bipolar disorder attempt to die by suicide in their lifetime. 11% of people with bipolar disorder actually do die by suicide. Over a long enough timeline, my disease has a high mortality rate.

Low income, according to one study, was a strong risk factor associated with suicide. And it’s not as simple as “poor people are stressed, so they die by suicide.” The poorer you are, the less likely you are to be insured, to have access to decent mental health care, and to have a support system that can take time off work when it’s needed.

I recovered. I’m fine. I’m working again. But my breakdown would have had a very different ending without my privilege. My privilege gives us not only a cushion to fall back on, but access to good care in the first place.

My privilege keeps me alive. But there are too many people who cannot say the same.