Mental health treatment “failure” is a subject, which is overlooked by many. I have been approached by acquaintances who have asked some interesting, and at times difficult questions about mental health treatment. I listened to some of their stories, views, and opinions regarding their treatment experiences. They consider me a friend or family member more than a psychologist, so I feel that some of this more candid insight could be helpful.
The statement “you aren’t one of them,” meaning that I am not like the mental health providers with whom the person had interacted, has been said to me frequently at the beginning of one of these discussions. My first thought was that I am not a treating psychologist during these conversations, so I am glad I am not “one of them” to my family and friends. However, there were other considerations when I thought about the “not one of them” statement. I began asking more questions about what “one of them” meant. Mental health treatment providers were then described to me in an adversarial manner. The individuals sharing their stories were essentially impoverished and residing in rural and critically underserved areas of the U.S. In the view of these service-seekers, clinicians were seen as “rich people” who could never understand what life was like for people who had fewer resources. Treatment providers were identified as holding such a high position that they had the ability to “remove all the rights a person has.”
Most of these folks, understandably, did not seek treatment until they were in a state of utter despair. They discussed feeling judged by the clinicians they saw. While my own experience is that treatment providers are non-judgmental, it was concerning that the perception of many of the people in most need, those seeking treatment in crisis in areas where services are marginally available, was the opposite. Many disclosed that they were not truthful with clinicians because they feared what the clinicians’ responses might be. Often times, people seeking psychotropic medications indicated that waiting lists were unbearably long, which in turn contributed to their perceptions that providers did not understand the suffering they experienced. Much of their perception of the mental health service system as adversarial seemed to be rooted in misunderstandings and miscommunication. Mental health treatment for those I spoke with was relegated for those who “hear and see things.”
As a clinician I feel there is sometimes a lack of time to develop a deep understanding of the patient for whom you want to provide care. It may be that in the precious time we have with a patient, our mannerisms, clothing, or signs of status like jewelry communicate the divide–immediately, at first sight. The person presenting for treatment in some areas of the country has been suffering for a long time, possibly left on a waiting list, and then they must face a person they think cannot relate to their suffering (or any suffering). While this may or may not be true, it is an important variable in how supported some rural, low-income service-seekers feel. Those sharing their stories had a lack of education about many facets of mental health treatment, and more importantly, they were afraid to ask questions.
In my opinion, treatment providers could do more to be attuned to the challenges their patients face, and we could listen more closely to those who are telling us we failed to help them.
Rain Smith, MS
WKPIC Doctoral Intern