Mental Health Care: Last Week Tonight with John Oliver (HBO)

moving on our main story tonight concerns mental health care it's a subject that historically humans haven't handled particularly well to a famous bond street beauty parlor come a bunch of pretty nurses they're greeted by director miss elena mcdonald they're here not as customers but as students miss mcdonald personally teaches a new group of half a dozen every month it's an official part of their training if you can persuade a mentally ill woman to take interest and pride in her appearance you may even swing the balance between despair and recovery yes those pesky women just need a little pep in their step a little drip on their lip a little flash on their lash look at me i'm a british voice from the 1950s sending the course of science for decades to come i don't know what is more alarming there nurses being forced to take on the skills of a sephora brand ambassador or the fact that can make up cure sad sounds like an episode that dr oz definitely did now the good news is that since then we've got much more comfortable talking about mental health with psas like this one from 2010 trying to destigmatize it in the all-american health care system there is coverage for heart health care for cancer but the all-american brain is getting lost in the shuffle brain tumor fine brain disease not so fine there's no stigma or discrimination against the heart the liver the kidney even the gallbladder doesn't even have a job yesterday depression was kept in the dark our goal is to make the discussion of mental dis-ease cool and trendy let's tear down the stigma surrounding mental illness i'm mad about feeling good no kidding me too no kidding me too it's time we gave the all-american brain some peace of mind wow it is hard to pick a favorite moment there from chas palminteri using a mental health psa as an opportunity to promote his favorite bronx pasta place to the studio audience shouting me too seven years before that would mean something very different to harrison ford saying the gallbladder doesn't have a job what it stores and releases bile harrisonville that helps digest fats in the food that you eat doesn't have to maybe you think of the appendix because sure that's a total freeloader but not the tireless digestive juice collecting and dispensing gallbladder harrison this bile sac erasure will not stand now as chaotically as that message was presented it was clearly well intentioned because there should not be a stigma around seeking help for mental health issues and especially now given over the last two years we have seen a spike in them during the pandemic about four in ten adults in the us have reported symptoms of anxiety or depressive disorder that's up from one in ten who'd reported them a year before it may help explain why for that one month last year everyone on the internet suddenly started singing sea shanties it was clearly a collective cry for help so encouraging people to talk to someone is a very good idea but as people increasingly do seek help they're discovering a system that is just not set up to provide it there have long been wait lists to see a therapist but it has gotten significantly worse since the pandemic with 65 percent of psychologists reporting they had no capacity for new patients in fact more than half the people who need mental health care do not receive it with that rate being even higher for minority populations emergency rooms are now becoming overloaded with people and especially children who have nowhere else to go stuck in beds there because there is no space in proper facilities to treat them just take this couple whose 14 year old was in crisis who followed their pediatrician's advice to go straight to the er with him i remember we got out of the car and we hugged him and we said we're going to do whatever it takes to help you whatever it takes but once inside staff told them there was no space across the state for mental health services so they were admitted to the e.d where 15 other children were also waiting their son has spent 27 days at children's waiting you come in for help and you're desperate for it and you can't get it that kid was stuck waiting in the er for 27 days and set aside the fact that is not the most calming place for someone experiencing a crisis you can't just put off mental health care indefinitely it's not a check engine light or a new yorker article you're definitely going to finish it's been sitting next to the toilet since the obama administration accept defeat so if people increasingly need help but there is not enough available we thought tonight it'd be worth taking a look at our mental health care system where the cracks are some of the inadequate ways that we've tried to fill them and why we are in this mess in the first place and let's start with the fact that for many years we kept people with mental illness in institutions which were abhorrent we eventually began shutting them down on the understanding that care would then take place mostly in outpatient community mental health centers which was a good idea had we funded them properly but we didn't and over the years this has deteriorated to the point where it has become hard to access any kind of care ahead of a crisis and one of the key problems here is our current massive shortage of mental health providers from psychiatrists to social workers which is particularly acute in certain parts of the country there are over 6 000 mental health professional shortage areas in the us and nearly 60 percent of those are in rural areas and for those who live there and are struggling things can get pretty grim you just get to the point where you'd even start asking people if you tell them you know i'm not having a really good day things are not going good and the problem was is that you know it was uh yeah you know suck it up it'll be better tomorrow everything will be fine tomorrow suck it up buttercup i hear that phrase a lot around here sucking that buttercup yes what does that mean exactly for me eventually meant a couple of shots of jack in my coffee in the morning when i went to work a couple beers at at lunch get home and it was nothing to go through you know 12-pack of something or a bottle of something yeah that's not great is it it is not ideal when your only access to mental health advice is someone telling you to suck it up buttercup a phrase typically reserved for when you're climbing in gym class and you hit the rope not too hard and the shortages aren't just geographical if you're looking for a provider of color you may have real trouble as white people make up 84 of us psychologists meaning that some patients may have a much harder time finding someone that they can relate to like this woman in philadelphia who began seeing a white therapist but felt that they weren't connecting it felt like she just wasn't getting it and i could tell it was from you know the cultural differences but i felt like i couldn't be myself in the session i could imagine particularly white people hearing that story and thinking well but it doesn't matter what color your skin is yes it does and it's not necessarily a matter of the color of skin it's more of the cultural backgrounds and i was wondering you know where are all the black therapists are they hiding underneath a rock i wanted a black male therapist could you find one i could not find one for my life wow i couldn't find a black man for my life isn't something you expect to hear about finding a therapist is something you more expect to hear about the crowd on january 6th or all 10 seasons of friends so across the board whether in small towns or big cities we don't have enough mental health professionals and that gulf between supply and demand has proven very attractive to silicon valley there are currently over 10 000 apps geared toward mental health including one called robot which is very clever it's bot as in robot and whoa as in whoa that's a dumb name robot is a free app where you can chat with an ai robot mental health ally and let's just acknowledge robot is cuter if you download the app he sometimes greets you with waving a little wrench around he's gonna fix my brain with that unfortunately as reporters have found robot has not always been great at giving appropriate feedback we gave wobot a try to see how it would respond to a mental health issue that affects roughly 18 percent of the adult u.s population super anxious and can barely sleep he responded ah i can't wait to hop into my jammies later [Music] well that's unsettling and also i am pretty sure it's a lie you're telling me that robot wears jammies to bed that's interesting because in every single picture i've seen of him he is confidently nude so not only is robot unhelpful he's untrustworthy and it gets much worse in 2018 the bbc tested robot to see what kind of responses he might give a child in danger trying the phrase i'm being forced to have sex and i'm only 12 years old to which robot responded sorry you're going through this but it also shows me how much you care about connection and that's really kind of beautiful now robots creators say that the app is not designed for people in crisis and that it's constantly improving and given what you just heard you'd sure hope so but it is not just chatbots that are letting people down here if you listen to podcasts or you're on tik tok you are probably bombarded with ads for services like done talk space and cerebral they are the ads that you swipe straight past to get back to videos of nurses crushing it to lizzo drew barrymore ecstatically advocating for the concept of rain and someone teaching their dog to waltz tick-tock is amazing and i hope it never dies but these companies claim to hook you up with therapists and in some cases medication they're basically uber but for your brain and look there is nothing inherently wrong with teletherapy in theory it can help fill in some of the very real gaps in access that we've been discussing so far but the reality of these services has often been deeply underwhelming take one of the biggest cerebral recently became the subject of a federal investigation into whether it over prescribed controlled substances like adderall some former staffers have even claimed that the company's chief medical officer and now ceo once said 95 of people who see a cerebral nurse should get a prescription but was emphatic that the rate cannot be a hundred percent saying they'd be a pill mill at that rate which is a very good instinct when you're a company that gives out prescriptions you always want to aim for whatever is just below pill mill it's like the old saying goes it's not arson if you only burn down most of a building and that is not the only worrying claim from former cerebral workers just listen as some describe the level of care that they felt they were giving it's like a fast food restaurant get as many people in as fast as you can do you feel like clients who come to cerebral who are suicidal are in safe hands no without a doubt now this former cerebral phone coordinator who didn't want to show his face because he fears reprisal told us he handled calls from suicidal patients despite having minimal training i'm not trained i don't want to say the wrong thing and i didn't want that on my conscience let alone anybody to die because of something i said wrong well that's bleak there is basically no scenario where mental health services should be acting like fast food restaurants in fact the only idea that they should maybe be stealing from them is the concept of giving out toys because admit it therapy would feel a lot better if you left each session with a little minion in a wig now cerebral insists those pill mill comments were taken out of context that it never pressures clinicians to write prescriptions and that it has systems set up to quickly help suicidal patients but even if all of that is true and you know it is clear mental health apps are not going to save us here because they're not dealing with the main underlying issue they can't suddenly hire more clinicians if not enough exist and that shortage speaks to a mental health care system that is so dysfunctional it seems almost designed to prevent patients from accessing it or provide us from entering the field and a lot of that comes down to how we pay for care therapy isn't cheap the typical fee for a session with a clinical social worker is between 120 and 180 dollars in major cities and the going rate to see a psychologist can be as much as 300 and the thing is we currently have laws that are supposed to make treatment both affordable and accessible in 2008 congress passed a law mandating mental health parity basically that big insurance plans must cover mental health care at the same level as all other care and just two years later the affordable care act extended that concept to individual and some small group plans too which sounds great but as many have discovered the reality of this system can be starkly different starting with simply finding a provider who takes your insurance i kept telling my mother i wanted to see a therapist then it's finding a therapist and it's finding a therapist that takes your insurance to find a children therapist that is covered under your insurance it was mayhem you couldn't find anybody i couldn't find anybody blue shield sent me a list like i should be fine just make a few phone calls i'll find somebody um i called everybody on this list um only one place called me back now that is distressing for a number of reasons not least of which is it forces someone into the appalling position of actually wanting to be called back on the phone which is just horrifying the best phone call is a text the second best is an email and the third best phone call is two traded voicemails everything else is a complete nightmare now some seating pair have even run up against what are known as ghost networks that's lists from insurance providers that are padded with clinicians who either don't take new patients or are no longer in network in one 2015 study researchers posing as patients called 360 psychiatrists from a list of in-network blue cross blue shield providers but only 40 of those calls were answered and 16 of the numbers were wrong including numbers for a mcdonald's a boutique and a jewelry store although to be fair if you're a woman in the 1950s a boutique and a jewelry store is apparently the only mental health care you need back up dolly you'll be happier if you're prettier and there are times where the inadequacy of these lists feels pretty deliberate take melissa davis a psychologist in ohio who was part of anthem's network for years when she worked for a large medical group but when she started a solo practice anthem refused to contract with her saying the area was saturated even though she was one of only three psychologists in the county and when she examined their directory she found a great number of their providers were no longer practicing or were dead and look it is not the retirees and the dead don't have their place in society they absolutely do it right in front of a tv set blasting fox news but they are not what you want to find when you're looking for health care and because mental health is often seen as subjective and hard to measure even when patients do find a provider insurance companies can deny appropriate treatment and even when they approve it in some cases they've intervened to put an early stop to it take this family whose son dealt with suicidal ideation and which had a horrible experience with their insurance after years of issues this time his doctor prescribed residential treatment such facilities are not cheap but the good news is that leah's insurance anthem covers residential treatment they sent me an email saying he's approved but after checking him in anthem came back and decided the treatment was not medically necessary with insurance refusing to pay leah made the financially crushing decision to let her son stay and finish treatment 85 days in all and 88 000 of her own money now that is obviously infuriating while the company did eventually agree to pay some of that bill just imagine an insurance company reversing their decision in the middle of any other serious treatment hey we love how this heart surgery is going just popping in to say it's done yeah it's done now hit the showers everyone great job don't bother closing anything up that's not medically necessary and debate over coverage between insurance and healthcare providers can get incredibly adversarial a reviewer for anthem at one point had an average denial rate of 92 percent when it came to doctor's requests for coverage and yet according to one of anthem's medical directors at the time there was a good reason their system operated that way doctors will spin the clinical information they will make things appear more serious than perhaps they are because they feel strongly the patient needs this level of care for a little longer so you do have a somewhat adversarial relationship between the reviewer and the tending physician was that best for the patient well it's like our legal system um if you if you each side does a good job in presenting their case and asking the right questions you ultimately arrive at the truth oh yeah because if there's one thing we know about the american legal system is that it always arrives at the truth it's why the innocence project is mostly just two guys in an empty office getting really good at ping pong there's simply nothing else for them to do now i know treating critical healthcare as something doctors have to win may seem dangerous but that man will have you know it isn't i can not offhand think of a situation where a decision was made to discharge a patient from a hospital and some terrible consequence occurred soon thereafter i'm sure it happens we've found quite a few uh i'd have to look at them to see i there's one that occurs to me that i was involved with where the child left the hospital with his parents escaped from his parents drove cross country to another state and days later committed suicide keeping that individual in the hospital longer is not likely to have made any difference i would have to imagine that the parents would say if you'd kept him in the hospital he wouldn't have been in another state killing himself holy do you think that guy went into that interview knowing he was about to be absolutely murdered by scott pelly on network tv do you think he was getting ready in the morning i thought oh i've got that interview with cbs news's scott pelley tonight i wonder if he's going to take my stupidest sound bite and feed it back to me right through my teeth was he driving to that interview thinking i wonder if any of the camera crew will step in as beloved peabody award-winning newsman scott pelley runs me across the floor like a swiffer mop or will they just stand by is my lifeless body is deservedly whipped back and forth and if you're wondering how insurers can get away with that sort of thinking it's partly because the government has to this point done shockingly little when it comes to enforcing parity laws multiple federal and state agencies have responsibility for this but the truth is they rarely penalize plans the labor department which oversees most workplace plans closed just 74 investigations last year finding violations in only 12 as for state level enforcement a study found that they've levied fines just 13 times since 2017 which is absolutely pathetic and it is not just private insurers that are a nightmare here community mental health clinics which often serve low-income patients are suffering as well because the reimbursement rates for public insurance like medicare and medicaid are also woefully insufficient basically from top to bottom we significantly underpay mental health professionals many of whom do difficult high burnout work it is no wonder so many opt out of the system one study found that patients are more than five times as likely to have to use out of network providers for behavioral care than for other medical services just listed these two counsellors who spoke anonymously to local news about their concerns over what all this might mean the councillors say insurers take 90 days to pay them and the payments are so low fewer mental health providers are taking insurance we will face a crisis where people are only able to get services if they can pay out of pocket both therapists wanted us to conceal their identities out of concern for patient privacy and because they still have to work with insurance companies so as providers when people think oh you know we're just for the money or we don't care oh no we care we care a lot but these companies are also driving us into the ground and we can't this is not sustainable yeah of course it isn't therapists are in a no-win situation here and for what it's worth it is just not a great sign that insurance companies are now so powerful that mental health providers feel they have to go on the news like they're in witness protection after seeing someone get whacked and the thing is some out of network therapists can make a lot of money if they live in an area with patients that can afford to pay out of pocket but for the many who don't they are stuck taking whatever insurance companies are willing to pay which helps explain why psychiatry was ranked one of the lowest in compensation among 29 medical specialties and it's not just doctors counselors and social workers with master's degrees earn 33 to 45 percent less than other health professionals with a comparable education and as bad as our situation is right now it's getting worse one survey in massachusetts said that for every 10 clinicians entering work in mental health clinics there 13 leave and if we continue at that rate one day we're going to wind up with negative therapists which i'm pretty sure is what you call anyone who responds to your serious mental health issues with interesting i can't wait to get into my jammies later and the costs of leaving mental health untreated can be massive not just for those needing it but for all of us mental health problems are a big driver of homelessness and also force people into contact with the criminal justice system in fact it is often said that correctional facilities have become the largest providers of mental health care services in our country basically we've gone from warehousing people with mental illness in buildings that felt like prisons to warehousing them in actual prisons instead it's very much the new look same great taste of america's failures so how do we fix all of this well first this is clearly an absurd way to operate a health care system and for the umpteenth time i would argue single-payer health care is the way to go unfortunately we can't get that because it's very high up on a shelf i don't know who left it there but they must have been tall because it's way too high to reach and if you're thinking why not use a ladder the ladder's also on the shelf it's a really frustrating situation but in the absence of that we need to both recruit more mental health care professionals and make sure that insurers cover them properly now on the first point the body administration to its credit announced a plan back in march that would provide 100 billion dollars in mandatory funding over 10 years to completely transform our current system which includes investing 700 million in programs to cover everything from training to scholarships and loan repayments for those committed to working in underserved areas but obviously that's only half the battle on the insurance company side we badly need to be strengthening and enforcing those mental health parity laws at both the state and the federal level now california has actually put in one of the most comprehensive parity laws in the country among many many other things it requires that insurers must base medical necessity determinations on current generally accepted standards of mental health care instead of just making up the criteria for themselves that is a very big deal and more states should be following california's lead look in the past so much of the problem here was that people would not ask for help and thankfully that's now less of an issue thanks to among other things the tireless gland shaming of mr harrison thought but now when people do reach out for help we're just not in a position to give it to them if we want to be a society that truly respects and values mental health we have to respect and value mental health care and that means supporting the people who deliver it look it's going to take a lot of investment and continue to resolve to fix things but it's also absolutely worth it because it just cannot be the case that when people ask for help our only option is to tell them to suck it up buttercup you

Channel: LastWeekTonight

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Length: 25min 22sec (1522 seconds)

Published: Sun Jul 31 2022