Mental Health Awareness Month – Entry #7

---

IMPORTANT NOTE: I am NOT a mental health professional. I’m just a person who loves you and has been through some things myself. If you need professional help, please start here.

---

Let’s say you’ve done the hard part.

Let’s say you’ve had the honest conversation we talked about last week. You’ve admitted — to yourself and to someone you trust — that you’re not okay. That you need help. That you’re finally ready to reach for it.

Good. That took guts. That took more than most people will ever know.

Now you pick up the phone. You look up a therapist. You call your insurance company to find out what’s covered. You start trying to actually access the mental health care system in America.

And then the system reminds you, in a hundred different ways, that it was never really built for you.

The Reality Nobody Prepares You For

I want to be clear about something before I go any further: there are good people inside the mental health care system. Genuinely dedicated, talented, compassionate people who got into this work because they care and who do real good every single day. This isn’t about them.

This is about the system itself. The structure. The way it’s designed — or more accurately, the way it isn’t.

When I started seriously trying to get help, I ran into walls I didn’t expect. And I was not unprepared. I have resources, I have health insurance, I have the ability to navigate bureaucracy, I have flexibility in my schedule, and I already knew enough about my own struggles to describe them clearly to a provider. I was about as advantaged as a person can be going into this process.

And it was still a mess.

The Waitlist Problem

The first thing you discover is that the therapists who are accepting new patients are often not the ones with the specific expertise you need. And the ones who specialize in exactly what you’re dealing with? Waitlists. Weeks. Sometimes months.

Think about that for a second. You’ve finally gotten to a place where you’re ready to ask for help — which, as we’ve talked about this month, is one of the hardest things a person can do — and the system’s first response is: take a number and come back in six to eight weeks.

For someone in crisis, six to eight weeks isn’t a scheduling inconvenience. It’s an eternity. It can be the difference between getting help and not making it to the appointment.

I’ve watched people I care about hit that wall and give up. Not because they didn’t want help anymore. Because the barrier was high enough, and they were depleted enough, that the effort required to keep pushing felt impossible. They’d spent everything they had just getting to the point of asking, and then the system handed them a form and told them to wait.

That’s not a personal failing. That’s a system failing.

The Insurance Maze

Then there’s insurance. If you’re lucky enough to have it.

Mental health coverage on paper and mental health coverage in practice are two entirely different things. You’ll call to verify your benefits and get told that yes, mental health is covered — and then discover that the list of in-network providers is outdated, or that your deductible means you’re paying full price until you’ve already spent thousands, or that the specific type of therapy that actually works for your specific condition isn’t covered because of how it’s classified.

Or you’ll find a provider you trust, make real progress, and then lose them because they dropped your insurance plan or you changed jobs or the coverage changed at renewal.

The financial piece is where the system loses the most people. Therapy isn’t cheap. Even with insurance, the out-of-pocket costs can be enough to make someone choose between their mental health and their other bills. And the people who most need consistent, sustained mental health care are very often the people least able to afford the gap between what insurance covers and what care actually costs.

I don’t say this to be political. I say it because it’s true and it affects real people in real ways and we don’t talk about it nearly enough when we talk about mental health awareness.

The Misdiagnosis Problem

Here’s one that hit close to home for me personally.

Getting an accurate diagnosis for something like ADHD as an adult is harder than it should be. The presentation is different in adults than in kids. The symptoms overlap with anxiety, depression, and a dozen other things. And if you spent your whole life masking — developing workarounds, pushing through, performing like everything was fine — you may not look like the textbook version of whatever you’re actually dealing with.

I talked to providers who missed things. Who treated symptoms without understanding the underlying cause, which meant the treatment helped a little and then stopped helping, or didn’t help at all, or occasionally made things worse. That’s not a knock on those individuals — it’s a reflection of a system where appointments are too short, caseloads are too heavy, and the complexity of how a human brain actually works doesn’t fit neatly into a 45-minute intake session.

The misdiagnosis problem matters because the wrong diagnosis leads to the wrong treatment. And the wrong treatment, especially when you’re already struggling and already skeptical about whether help is even possible, can be the thing that convinces someone to stop trying.

I’ve seen it happen. It almost happened to me.

The Stigma That Lives Inside the System

You’d think that a system designed to help people with mental health struggles would be free of stigma about mental health struggles. You’d be wrong.

It’s more subtle inside the system than it is outside — nobody’s going to say anything outright. But it’s there. In the way certain diagnoses get treated as character judgments rather than medical realities. In the way asking for certain medications is still treated with suspicion in some settings. In the way people who’ve struggled with addiction are sometimes treated as less deserving of compassionate care. In the way mental health notes in a medical record can follow you and affect how you’re treated for entirely unrelated things.

We’ve built a system to address a stigmatized problem, and then we let that stigma seep into the system itself. The result is that some of the people who most need non-judgmental care can’t find it even when they’re inside the place that’s supposed to provide it.

So What Do You Do?

I’m not going to pretend I have a fix for a broken system. I don’t. These are structural problems that require structural solutions — more providers, better coverage, smarter policy, a cultural shift in how we fund and prioritize mental health care relative to physical health care.

What I can tell you is what helped me navigate an imperfect system without giving up on the process entirely.

Don’t go it alone. Bring someone with you if you can — not just emotionally, but literally. Someone who can help you make calls, push back on denials, research providers, and keep the momentum going on the days when you don’t have the energy to fight the bureaucracy yourself. The system is exhausting to navigate solo, and you don’t have to.

Be persistent in a way that feels unfair. Because it is unfair. You should not have to call four times to get a callback. You should not have to fight your insurance company to get covered for the care your doctor recommends. You should not have to wait two months to see someone when you’re in crisis. All of that is true — and also, sometimes, you have to do it anyway. Not because you deserve the runaround, but because the alternative is not getting the help you need.

Trust your gut about providers. If something feels off — if you leave sessions feeling worse, if you feel judged, if you don’t feel heard — you are allowed to find someone else. A bad fit is not a failure. Keep looking. The right provider makes a difference that’s hard to overstate, and it’s worth the search.

And if the system has failed you before — if you tried and hit walls and walked away — please don’t let that be the permanent verdict on whether you can get help. The system failed you. That’s on the system, not on you.

The Bigger Point

We spend a lot of time in mental health conversations focused on the individual. Are you asking for help? Are you doing the work? Are you taking care of yourself?

All of that matters. I’ve written about all of it this month.

But we also have to be honest about the fact that some people are doing everything right and still getting failed. They’re recognizing their struggles, they’re reaching out, they’re trying to access care — and the system is putting up barriers that have nothing to do with their willingness or their effort.

Your brain isn’t broken. For a lot of people, it just works differently than the world was designed for. That’s not a personal failing. That’s a design problem.

And the system meant to help you navigate that? It’s got some serious design problems of its own.

We should be louder about that. All of us.

–Evan