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April 19, 2019

This is What We’re Missing in Our Quest to Lower the Rate of Suicide.

My friend Kristin was in her late twenties when she sat face to face with her therapist of several years one afternoon.  She had built a rapport with her over time and their relationship had become an important one to her, one that she depended on to piece together the myriad of complex thoughts that usually pair with complex people.  She described to me her trust in her therapist and said that she felt safe leveling with her, yet she still hesitated when she told her, “I need to talk about suicide.”  Her voice quickened as she emphasized that she wasn’t planning on killing herself, but that she really needed to talk about her thoughts about suicide and about death in general, thoughts she had been too afraid to bring up for fear of forced treatment she wasn’t interested in; she had experienced several deaths of young people and a close friend had attempted suicide by jumping off a building when she was in college.  Since then, she felt a numbness about death that she observed was unique to her.  She found it odd that when she heard about others’ deaths, she no longer felt grief for any person who had died, rather she felt relief for them, though she did feel grief for those who were left behind to live without their loved one.  She had thoughts about death that infiltrated her mind daily, and she told her therapist that she had contemplated suicide before, that when she was really struggling with depression, suicidal ideation would creep in, but again, she emphasized for fear that her therapist might be planning to have her committed somewhere, that she wasn’t feeling suicidal in that moment, but just needed to talk about it.  In fact, Kristin had needed to talk about this for over ten years, and was just in that moment mustering up the courage to talk about death in the context of suicide.

She told me that in that moment, her therapist who could have received this appeal with obvious concern, instead softened and responded calmly and kindly that of course they could talk about death and Kristin’s thoughts about suicide.  Kristin had a lot to say. 

The truth was that at that point in her life, she didn’t have an active desire for death to take her, yet she was far from feeling a thirst for living, so she frequently wandered along the thin line between a desire for life and a desire for death.  Her therapist was the first person she ever admitted this to.  

A fundamental truth about living is that being a human is hard.  Experiencing discomfort on a daily basis goes along with living inside of these vessels that are our bodies. and that’s no easy feat.  No matter what body you are born into, in your humanity, you are guaranteed the mundane discomforts of unfavorable weather and temperatures, colds and stomach bugs to inevitably more grave discomforts such as injuries or chronic illness.  Challenges will also present themselves regularly in the form of finances, relationships or loneliness, lack of a sense of purpose or mental illness.  Being a human being is hard, and yet, there is a very distinct line drawn in the sand between what is considered copasetic to bring up to a healthcare worker and what must not be mentioned if you don’t wish to find yourself in a situation where you are forced to have a clinical evaluation (that you will have to pay for).

Of course, if somebody is actively planning their suicide, such plans must be intercepted in order to seek help for that individual; none of this is to discredit the importance and selflessness of those who work in such fields.  However, many people live daily with thoughts about suicide for months or even years before they actually plan to carry through with a plan, but there is a hesitancy to seek help for a couple of reasons that in any modern society should not exist, including an inability to afford regular counseling and a fear of what will happen to them if the admit thoughts about suicide.  

Mental healthcare should be free.  Period.  An individual should not be on the brink of suicide before they are able to seek help.  A suffering individual should not need to prioritize between food, shelter, their children’s needs and their own mental health.  Most importantly, we would be a better society if we provided free mental healthcare, or at the very least, free support groups that were as common as Alcoholics Anonymous where anybody would be encouraged to go, to talk, to bond, and guided to seek greater help in the instances where it were needed.

Curious about how much it would cost a person to see a therapist if they have insurance with a high deductible, I recently investigated to find out how much weekly therapy would cost.  I called a few different places and the average price of an appointment came to $120.  Some therapists charged much more than that, but I did find several therapists who came to $120.  My understanding is that if a person is in network with a provider, the price of the service they are seeking may come down slightly, even if they are paying out of pocket towards their deductible, but not necessarily by much.  I concluded that a person seeking mental healthcare would be paying around $360 on the extremely low end per month, to well over $500 per month if they were paying either out of pocket or with their insurance deductible.  Knowing the financial situations of many of my friends with young families, I know it is safe to say that there are many people who cannot afford an extra $500 bill each month.  Furthermore, what if multiple family members need extra medical care?  The only way to foot these bills for some may be to accrue credit card debt and pay interest on top of it.  For individuals who have faced mental health issues for a long time, they may not have great credit and may not have even this option available to them.  I can imagine there are many people who simply choose not to seek mental healthcare, as the stress of figuring out how they might pay for it is simply too much.

Imagine if mental healthcare were available to all who needed it.  Imagine how people would be better friends, better parents, better teachers, and better members of society as a whole.  Indeed, a symptom I see clinically as a practitioner who treats a lot of mental health disorders is that patients fall behind in their lives.  They become embittered and angry.  They begin to shut down.  They do and say things that are hurtful to those around them.  If we are saying for even a moment that one’s mental health struggles do not affect the world at-large, we are fooling ourselves, and not providing free mental health care impacts us all.

My friend Kristin was lucky that day when her therapist invited her to talk about suicide; not everybody who thinks about suicide sometimes has anybody at all in this world who they can confide in to sort out their thoughts.

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