Hi man, I’m sorry to hear you’re going through that. I’ve been there myself, and I know how impossible clawing your way out of it is.
The thing that helped me the most was regular exercise, even it’s just the immediate top up of endorphins.
Also, as annoying as it, to both hear and practise, meditation helped me a lot. Just sitting on a chair for 10 minutes a day, and focusing on your breath. Normally I spend about half it thinking about what a twat I am - and then remember to focus. Even that, over time, has an effect. Or maybe try these audio ones, which are a bit more bearable. This one is the only one I’ve found that doesn’t prohibitively irritate me. https://youtu.be/pL02HRFk2vo
I heard on a podcast, where I get all my uninformed, unsolicited advice from, that fish oil has been shown to have an impact on it too. Fish oil with a 1000mg of EPA a day. So I do that as well. It’s not going to solve it, but can’t hurt.
I don’t know what the appropriate sign off to encourage someone to go depression-wrestling is - but give that bastard hell!
I respect your humor and would respond with a joke here, but since we’re talking about your mental health, I’m going to put on my elbow patches as a guy who used to cover the insurance industry for about 25 years.
The short version of this is that you are best off paying for mental health care out of pocket and skipping the gauntlet you just ran. Because this isn’t just Kaiser. Pretty much all health insurance plans will do this to you.
Here’s the long version:
After the Sandy Hook shooting, I published a series of articles on how the U.S. health insurers actively discourage the use of their services for mental health care. To them - Kaiser is not unique here - putting you through hell to get substandard care is a feature, not a bug. It is meant to discourage you from getting the care they owe you contractually and for which you have paid.
The reasons for this go deeper than the insurance industry’s general disdain for its policyholders. Historically, health insurance underwriters (who are NOT medical professionals; they’re just bean-counters) conflated mental health care with drug and alcohol rehabilitation services. As a result, they excluded this care from as many policies as possible because rehab has a terrible loss history (owing to the recidivism of addicts in general). This is hurtful ignorance on the part of the insurance industry, but that’s the insurance industry for you.
However, the Mental Health Parity and Addiction Equity Act of 2008 prevented health plans from providing less favorable provisions for mental health care than for other medical issues, like, say, heart disease. Obamacare further amended this in 2010 to extend that protection to individual health plans as well. That included requiring insurers to provide affordable plans even on those policies meant to be so cheap that anyone could afford them.
Insurers responded by crafting policies where either a) the deductible for mental health care was so high that you effectively pay out of pocket for the whole thing anyway, or b) the policies that were gold-standard enough to provide really good coverage for mental health care were themselves so expensive that if you could afford them, then you could afford to pay for mental health care out of pocket. They did this mainly because they’re jerks. Nice people generally don’t excel in the insurance business.
This reality varies by state. 99% of insurance legislation in this country is on the state level - which bugs the hell out of European insurers, BTW. And insurance (health or otherwise) is regulated like a semi-utility. You need the state’s permission to bring a product to market, change its price, or even leave the market. Insurance is NOT a free market product.
Some states are much worse than others when it comes to providing mental health care through insurance (Texas, I’m looking at you). When I did my deep dive on this, I recall that CA was all over the place on this because it had a pretty diverse insurance marketplace and a certain degree of respect for consumers.
But the ultimate result is that health insurers simply do not prioritize mental health care. They do not want you using their services for it. They will not deliver good service to you. They will make you run an exhaustive gauntlet so they you eventually just give up. Which is something somebody with less than 100% mental wellness is highly likely to do. This is not a coincidental effect. This is intentional on the part of insurers.
If you can pay out of pocket, do. There are plenty of therapists out of system. And if you’re paying them directly, you’ll be amazed at how available they become, because it’s as much of a pain for them to get paid by insurance companies as it is for you to be covered by them.
We are not facing a crisis of practitioner availability so much as we are facing a crisis of people seeking services from a system that very much wants them to fuck off. Pay out of pocket, if you can. At the very least, it will remove the stress of navigating a hostile system.
This is a process. And you’re not alone in it. And your health matters.
All this shit is exactly why I haven't gotten a therapist. I have a Discord server I started as an offshoot from another comedy Discord server where a bunch of us were apparently dragging down the mood. It's pretty much a place for us to dump our struggles and talk each other up and post encouraging memes and funny and dark-funny stuff and TBH it hasn't devolved into the doom spiral people predicted.
Writing it out helps too, even if it's just in a notebook. One thing I've thought about but haven't tried is writing out the bad stuff and then going back when things are better and commenting on it with the "stable" perspective. Like leaving notes for yourself next time it happens.
I'm a Lexabro too and it's been good for me. It's propping up Wellbutrin. I've been trying CBD gummies as a booster when things get beyond the meds but I'm not sure it does anything (the THC ones are still illegal in my backwater state - NH). I haven't tried to get a medical marijuana card because none of my docs have seemed open to the concept (I've switched PCPs several times in the last few years solely because of them retiring or leaving the practice after less than a year of being my PCP - I swear it's not my fault).
Exercise does help a ton, especially if you can get outside to do it.
Well, well, well, if it isn't my sign from the universe to never try find a therapist (kidding of course)! For the short-term maybe your extra naps from the lexapro might just perfectly swap out the not-getting-out-of-bed-time whilst not being on meds? Hope you find that random angel in the health care system that'll see your (re)quest all the way to the finish line!
I do totally get it. I'm Schizoaffective, so my entire life has been in the mental health system. Once all the situationally normal people started needing psych meds and therapy too, not that I blame them, it got a bit harder for me. Not as hard as when they began abusing my anti anxiety meds. I prefer tele heath. It's Nevada, if tele health everything, no one can shoot me. Or give me COVID again.
I commend you for being a Lexabro. That's a good med, I've taken it. Any therapist who wants to know the names of my five cats? It would actually illustrate quite a bit about my character and tastes. My therapist is a cynic like me, so we got along pretty well. Nurse practitioners are not bad at all. Had one in college. They can both prescribe meds and do therapy, a big plus. Otherwise it's different people, which makes no sense.
I wish I still had Kaiser, that was when I had a good job. Now I'm on Disability so have Medicare.
I wish you luck, it's a tough road but you have talent and humor on your side. And a smart wife. Listen to her.
1. America was designed to become a mental health crisis.
2. I think, legit, once or twice. But when you're trying to install a new app or the like and they blanket you with 100 pages of text on the spot, nobody reads it. It's diabolically effective.
3. Maybe this coincides with the emergence of support animals?
4. No. The healthcare system is too inefficient and unwieldly. There are no heroes.
5. It's some catch, indeed. I'm not sure even Heller had it in him to document the ongoing mental health crisis, however.
I appreciate your ability to write about this and still find the funny, or at least a way of telling the story that both conveys the effort required to navigate a health insurer's path to mental wellness and your own state of mind and heart. As I read, I thought of my brother who was living in a rural place and encountered not only the hurdles you describe but also physical distance and unreliable internet. No one deserves this. I hope there is a breakthrough for you soon.
I immediately wondered if perhaps you should send a copy of your column to everyone at Kaiser and other local/CA news outlets.
This is almost hilarious if it wasn't sad at the same time. Unfortunately, healthcare is going down the drain in the whole world. I got good insurance, since I retired from an international organisation and it worked well for me up to now, but I did not yet need mental health support, when things may be otherwise. Keep the humor and please write more of the similar stuff.
Oh man, sorry to hear about what you're going through. I don't have any tips, just good vibes.
2: I act like I'm reading them but I'm actually skimming. And if a nurse/doctor/front desk worker asks I say, "oh, I'm a lawyer. gotta read everything, you know it is" in hopes that they'll mistake me for a good lawyer and figure they better not screw me over or I'll bury them in paperwork.
3: I have a somewhat dark theory on this. If they are worried you're going to off yourself, they can say "think about Fluffy, you don't want her to end up in a shelter." Or maybe it's because every company has to scrape are data whether they need it or not.
4: I'd imagine the very wealthy like their healthcare but for normies no. It's just varying degrees of how bad it can be. I had to call my insurance to see if something was covered and actually got a human being who was helpful and pleasant and I felt like I won the lotto. It's sad that what should be the baseline of customer service is considered a win.
5: Never read it. Probably going to get kicked off of substack for not having sufficient literary cred.
I’m so sorry to hear about allllllllllll the situation unnormal here and I really hope you find the secret sauce to feeling your groove again. Thank dog for doggos and great partners. Clearly that’s why they want your pet name: they are secretly building a network of dog therapists, which, let’s face it WOULD save the world! Trouble is, how to get it to the “non specials” and not only available to the Paltrows and that Dune kid (who probably IS part golden retriever!). We’re pulling for you, Michael. 💗
Sorry, I meant to add to the comment. My depression disappeared during the pandemic. I was going stir-crazy after the first Christmas my husband and spent in our bubble. The vaccinations weren’t available yet so masking, and keeping your distance from people were the only options. It was January in Winnipeg, Manitoba which means -25C (-13F). I went for a walk around the block and have been walking outside almost every day since. Generally I spend an hour walking each morning. My depression is pretty well history. On very rare occasions, I might feel morose in the morning but I’m ready to meet the day full throttle after my walk. This is way better than exercising at a gym. Something about walking in the fresh air has made the difference. If someone had told me this 40 years ago, I would have had an easier time managing my life. I recommend you do it for a month, increasing your time spent as you wish. This is as close to a miracle people with our condition are going to experience. The other side effects are positive too. Lowered my cholesterol and blood pressure and lost some excess baggage.
I have been treated for depression since my early 20s and am now 67. Venlafaxine is my anti-depressant but I am taking much less and have dropped my sleeping pills and anti-anxiety medication as my depression has disappeared.
I hope you start to feel some relief soon. The system is really broken. And you’re not imagining it, life is just harder all around these days. You’re not alone.
Hi man, I’m sorry to hear you’re going through that. I’ve been there myself, and I know how impossible clawing your way out of it is.
The thing that helped me the most was regular exercise, even it’s just the immediate top up of endorphins.
Also, as annoying as it, to both hear and practise, meditation helped me a lot. Just sitting on a chair for 10 minutes a day, and focusing on your breath. Normally I spend about half it thinking about what a twat I am - and then remember to focus. Even that, over time, has an effect. Or maybe try these audio ones, which are a bit more bearable. This one is the only one I’ve found that doesn’t prohibitively irritate me. https://youtu.be/pL02HRFk2vo
I heard on a podcast, where I get all my uninformed, unsolicited advice from, that fish oil has been shown to have an impact on it too. Fish oil with a 1000mg of EPA a day. So I do that as well. It’s not going to solve it, but can’t hurt.
I don’t know what the appropriate sign off to encourage someone to go depression-wrestling is - but give that bastard hell!
I respect your humor and would respond with a joke here, but since we’re talking about your mental health, I’m going to put on my elbow patches as a guy who used to cover the insurance industry for about 25 years.
The short version of this is that you are best off paying for mental health care out of pocket and skipping the gauntlet you just ran. Because this isn’t just Kaiser. Pretty much all health insurance plans will do this to you.
Here’s the long version:
After the Sandy Hook shooting, I published a series of articles on how the U.S. health insurers actively discourage the use of their services for mental health care. To them - Kaiser is not unique here - putting you through hell to get substandard care is a feature, not a bug. It is meant to discourage you from getting the care they owe you contractually and for which you have paid.
The reasons for this go deeper than the insurance industry’s general disdain for its policyholders. Historically, health insurance underwriters (who are NOT medical professionals; they’re just bean-counters) conflated mental health care with drug and alcohol rehabilitation services. As a result, they excluded this care from as many policies as possible because rehab has a terrible loss history (owing to the recidivism of addicts in general). This is hurtful ignorance on the part of the insurance industry, but that’s the insurance industry for you.
However, the Mental Health Parity and Addiction Equity Act of 2008 prevented health plans from providing less favorable provisions for mental health care than for other medical issues, like, say, heart disease. Obamacare further amended this in 2010 to extend that protection to individual health plans as well. That included requiring insurers to provide affordable plans even on those policies meant to be so cheap that anyone could afford them.
Insurers responded by crafting policies where either a) the deductible for mental health care was so high that you effectively pay out of pocket for the whole thing anyway, or b) the policies that were gold-standard enough to provide really good coverage for mental health care were themselves so expensive that if you could afford them, then you could afford to pay for mental health care out of pocket. They did this mainly because they’re jerks. Nice people generally don’t excel in the insurance business.
This reality varies by state. 99% of insurance legislation in this country is on the state level - which bugs the hell out of European insurers, BTW. And insurance (health or otherwise) is regulated like a semi-utility. You need the state’s permission to bring a product to market, change its price, or even leave the market. Insurance is NOT a free market product.
Some states are much worse than others when it comes to providing mental health care through insurance (Texas, I’m looking at you). When I did my deep dive on this, I recall that CA was all over the place on this because it had a pretty diverse insurance marketplace and a certain degree of respect for consumers.
But the ultimate result is that health insurers simply do not prioritize mental health care. They do not want you using their services for it. They will not deliver good service to you. They will make you run an exhaustive gauntlet so they you eventually just give up. Which is something somebody with less than 100% mental wellness is highly likely to do. This is not a coincidental effect. This is intentional on the part of insurers.
If you can pay out of pocket, do. There are plenty of therapists out of system. And if you’re paying them directly, you’ll be amazed at how available they become, because it’s as much of a pain for them to get paid by insurance companies as it is for you to be covered by them.
We are not facing a crisis of practitioner availability so much as we are facing a crisis of people seeking services from a system that very much wants them to fuck off. Pay out of pocket, if you can. At the very least, it will remove the stress of navigating a hostile system.
This is a process. And you’re not alone in it. And your health matters.
All this shit is exactly why I haven't gotten a therapist. I have a Discord server I started as an offshoot from another comedy Discord server where a bunch of us were apparently dragging down the mood. It's pretty much a place for us to dump our struggles and talk each other up and post encouraging memes and funny and dark-funny stuff and TBH it hasn't devolved into the doom spiral people predicted.
Writing it out helps too, even if it's just in a notebook. One thing I've thought about but haven't tried is writing out the bad stuff and then going back when things are better and commenting on it with the "stable" perspective. Like leaving notes for yourself next time it happens.
I'm a Lexabro too and it's been good for me. It's propping up Wellbutrin. I've been trying CBD gummies as a booster when things get beyond the meds but I'm not sure it does anything (the THC ones are still illegal in my backwater state - NH). I haven't tried to get a medical marijuana card because none of my docs have seemed open to the concept (I've switched PCPs several times in the last few years solely because of them retiring or leaving the practice after less than a year of being my PCP - I swear it's not my fault).
Exercise does help a ton, especially if you can get outside to do it.
Well, well, well, if it isn't my sign from the universe to never try find a therapist (kidding of course)! For the short-term maybe your extra naps from the lexapro might just perfectly swap out the not-getting-out-of-bed-time whilst not being on meds? Hope you find that random angel in the health care system that'll see your (re)quest all the way to the finish line!
I do totally get it. I'm Schizoaffective, so my entire life has been in the mental health system. Once all the situationally normal people started needing psych meds and therapy too, not that I blame them, it got a bit harder for me. Not as hard as when they began abusing my anti anxiety meds. I prefer tele heath. It's Nevada, if tele health everything, no one can shoot me. Or give me COVID again.
I commend you for being a Lexabro. That's a good med, I've taken it. Any therapist who wants to know the names of my five cats? It would actually illustrate quite a bit about my character and tastes. My therapist is a cynic like me, so we got along pretty well. Nurse practitioners are not bad at all. Had one in college. They can both prescribe meds and do therapy, a big plus. Otherwise it's different people, which makes no sense.
I wish I still had Kaiser, that was when I had a good job. Now I'm on Disability so have Medicare.
I wish you luck, it's a tough road but you have talent and humor on your side. And a smart wife. Listen to her.
He said, “Now, we’re Lexabros.”
OMG!!!! Made me laugh!
This odyssey is like an Abbott and Costello skit. Round and round you go.
Honestly, I never read consent forms. Who does?
Sorry you’re going through this. My wife and I have had our own run-ins with America’s broken health care system. Not fun! Bad, in fact!
1. America was designed to become a mental health crisis.
2. I think, legit, once or twice. But when you're trying to install a new app or the like and they blanket you with 100 pages of text on the spot, nobody reads it. It's diabolically effective.
3. Maybe this coincides with the emergence of support animals?
4. No. The healthcare system is too inefficient and unwieldly. There are no heroes.
5. It's some catch, indeed. I'm not sure even Heller had it in him to document the ongoing mental health crisis, however.
Noticed a lot of the comments provided thoughtful advice and general wishes of well being - which I second. So I'll go ahead and answer your Qs:
1. What mental health crisis? The real shortage is in wizard hats. I'm already thinking about halloween.
2. I thought consent forms were just fancy origami paper they give you to test your patience while waiting.
3. Therapists ask for your pet's name because that's who's actually in charge of your life decisions.
I appreciate your ability to write about this and still find the funny, or at least a way of telling the story that both conveys the effort required to navigate a health insurer's path to mental wellness and your own state of mind and heart. As I read, I thought of my brother who was living in a rural place and encountered not only the hurdles you describe but also physical distance and unreliable internet. No one deserves this. I hope there is a breakthrough for you soon.
I immediately wondered if perhaps you should send a copy of your column to everyone at Kaiser and other local/CA news outlets.
This is almost hilarious if it wasn't sad at the same time. Unfortunately, healthcare is going down the drain in the whole world. I got good insurance, since I retired from an international organisation and it worked well for me up to now, but I did not yet need mental health support, when things may be otherwise. Keep the humor and please write more of the similar stuff.
Oh man, sorry to hear about what you're going through. I don't have any tips, just good vibes.
2: I act like I'm reading them but I'm actually skimming. And if a nurse/doctor/front desk worker asks I say, "oh, I'm a lawyer. gotta read everything, you know it is" in hopes that they'll mistake me for a good lawyer and figure they better not screw me over or I'll bury them in paperwork.
3: I have a somewhat dark theory on this. If they are worried you're going to off yourself, they can say "think about Fluffy, you don't want her to end up in a shelter." Or maybe it's because every company has to scrape are data whether they need it or not.
4: I'd imagine the very wealthy like their healthcare but for normies no. It's just varying degrees of how bad it can be. I had to call my insurance to see if something was covered and actually got a human being who was helpful and pleasant and I felt like I won the lotto. It's sad that what should be the baseline of customer service is considered a win.
5: Never read it. Probably going to get kicked off of substack for not having sufficient literary cred.
I’m so sorry to hear about allllllllllll the situation unnormal here and I really hope you find the secret sauce to feeling your groove again. Thank dog for doggos and great partners. Clearly that’s why they want your pet name: they are secretly building a network of dog therapists, which, let’s face it WOULD save the world! Trouble is, how to get it to the “non specials” and not only available to the Paltrows and that Dune kid (who probably IS part golden retriever!). We’re pulling for you, Michael. 💗
Sorry, I meant to add to the comment. My depression disappeared during the pandemic. I was going stir-crazy after the first Christmas my husband and spent in our bubble. The vaccinations weren’t available yet so masking, and keeping your distance from people were the only options. It was January in Winnipeg, Manitoba which means -25C (-13F). I went for a walk around the block and have been walking outside almost every day since. Generally I spend an hour walking each morning. My depression is pretty well history. On very rare occasions, I might feel morose in the morning but I’m ready to meet the day full throttle after my walk. This is way better than exercising at a gym. Something about walking in the fresh air has made the difference. If someone had told me this 40 years ago, I would have had an easier time managing my life. I recommend you do it for a month, increasing your time spent as you wish. This is as close to a miracle people with our condition are going to experience. The other side effects are positive too. Lowered my cholesterol and blood pressure and lost some excess baggage.
I have been treated for depression since my early 20s and am now 67. Venlafaxine is my anti-depressant but I am taking much less and have dropped my sleeping pills and anti-anxiety medication as my depression has disappeared.
I hope you start to feel some relief soon. The system is really broken. And you’re not imagining it, life is just harder all around these days. You’re not alone.