I work on the front lines of a Community Mental Health Agency that has been in operation for the past 50 years. We serve a 5-county area that is located in East Tennessee. Services are provided to consumers regardless of their ability to pay, a practice that is bold in the state of Tennessee. However, typical consumers of mental health care have state-funded TennCare managed by a contracted Behavioral Health Organization. There are some mental health consumers that have Medicare due to having a disability with those having private insurance being the fewest in number we serve. Most of the time, the demand for our services outweigh the availability given limited funding, but we still try to meet our clients’ needs by creatively making due with what we have. This description is standard for most Community Mental Health Agencies in Tennessee. Upon further reflection, though, my response to the rhetorical question “How is everything?” is not “Fine”. The Tennessee management of mental health care is not fine reflected by progressive restrictions on access to care.
The most recent revision in state coverage is a three-tiered co-pay system required to medicate some of the most acute psychiatric symptoms. There is little mention of expanded funding for the infrastructure necessary to assist mental health consumers in accessing their medication; rather cost-shifting to financially strapped Community Mental Health Agencies is the assumption. The perpetual process of rationing state-funded mental health care has left many behind. I wonder if the lives of those reliant on TennCare have been considered beyond being reduced to a budget item. These numbers are actually people of all ages who work to meet their daily needs for housing, food, and clothing. They often fall between the cracks of available services or are too ashamed to ask for help when they need it most. They are people who rise above trauma and still manage to smile despite years of abuse or continued deprivation. Imagine looking through the eyes of these people. A child who has witnessed unspeakable things, an elderly person who faces sickness alone, a man who commits suicide after becoming disabled, and a woman who is paralyzed by fear after being found by her abuser.
Is it too much to ask our policy makers to consider the lives of those with chronic mental illness? Their lives are made so much harder by having to confront systemic barriers to mental health care. Limitations on state-funded care have resulted in agency closures, services geographically out of reach, and restricted eligibility criteria for the services remaining. Systemic barriers have also taken their toll on mental health workers who continuously struggle to meet client needs with fewer and fewer resources. Being expected to do more with less, mental health workers consequentially become enforcers of the system rather than advocates for change. Systemic barriers are legitimized by job requirements to complete new paperwork for meager reimbursement. Workers learn to harden their hearts to the pleas of their clients by focusing on working within a deprived system despite the personal costs of being arbiters of social injustice. Workers fool themselves into believing that they can serve more with less and consider short-cuts in providing care as treatment innovations. Incredible job demands with little glory finally take a toll on veteran providers of mental health care who burnout and retire only to make way for a second brigade of neophytes.
Perhaps this is what Herbert Spencer theorized was the natural evolution of humankind based on the survival of the fittest. Perhaps this is a form of societal tough love used to enforce the “boot straps” mentality of personal responsibility. Perhaps this is a spiritual test used to model the “right” way of living with the promise of joy in the afterlife. Perhaps this is just the American way to rely on ambition and ingenuity to make a life of desolation livable. This is not what I believe is the American dream, though. The dehumanization of any person is not compatible with my American dream. I believe that we are all called to be part of a collective, responsible for acting in compassion to support the growth of humanity as a whole rather than working for the welfare of a few. Crimes against humanity may have been recognized during times of war, but what about crimes against humanity bore by the poor everyday? Will the government ever stop using managed care organizations to leverage people’s pain for financial gain? Meanwhile, I remain on the front-lines as I wait for my next psychotherapy appointment, out of 14 scheduled for the day, to arrive for his 30 minutes of fame.
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