The Mental Schema of the Unvaccinated

Mental Schema of the Unvaccinated
What makes someone say no to this common sense shot?

I recently got my booster to protect myself from COVID — this marks my third shot in one year. As soon as the vaccination came out, I wanted it — badly. I had all the things that you probably have been suffering from — tired of the masks, tired of staying indoors, tired of regular life being interrupted — in short, pandemic fatigue! I felt grateful that science was so good that within a year, major pharmaceutical companies had come up with vaccination shots that could protect me and others — and would ultimately put the pandemic to rest.

Why then is the pandemic still raging even as people lose interest? Because so many people have chosen to not get vaccinated. Now, what are the reasons? It ranges anywhere from not wanting to be controlled by the government, to not believing in science, to not being told what to do, to straight out denial that a pandemic even exists. Also, people believe they are strong enough to overcome it if they do contract COVID.

My carpet cleaner recently came into my home — no mask and no vaccination on board. When I asked him why — and went on to give him a piece of my mind — he said his body was strong enough to handle it. Based on what? Do any of these people realize they have been vaccinated since they entered public schools? Someone in their family took them to get their shots so they could attend school — otherwise, who knows if they would still be living? People take for granted what their elders did for them — somehow abiding by public health protocols is not for the strong in body.

There is a felt sense among the unvaccinated that they do not want to be told what to do by the government or anyone else. There is a particular mental schema that askews being told what to do by anyone for anything. I knew someone years ago who always stated he hated being told what to do by his parents — he wants to make his own decisions. He made the umbrella statement that no one wants to be told what to do. I know my friend came from a strict upbringing with caretakers who gave him very little room to make any decisions for himself.

When politicians came along and said, “Liberate yourselves and say no to mandatory vaccination” I can imagine that many people who, like my friend, do not like being told what to do, resonated with this message and now are the ones crashing school board meetings, protesting, booing anyone who speaks up about getting vaccinated and more. It’s all a lot of drama that gets going in rebellion to not being told what to do — unfortunately, in this case, not getting vaccinated can lead to death of self and others.

Yet, many people would rather die than be told what to do by anybody. These same people did as they were told at the age of 5 and got their shots to enter kindergarten. It all feels a little insane that people think their own body itself has gotten along without disease on its own.

For me, the little jab took about a second. The side effects were nominal at best. I know I am protected and I am helping protect others in my community. Millions have been vaccinated and the vast vast majority are safe and healthy afterwards. There is no excuse to not be vaccinated at this point. It’s time people got over rebelling against being told what to do and start working with what is not only logical but also absolutely the right thing to do for self and neighbor. We want a right to life — then it is a responsibility we care for.

In this case, it’s a one second jab — three times. No excuses. None.

Pop Up Mental Health Clinics

Pop Up Mental Health Clinic
Pop Up Mental Health Care Clinics

A pop up mental health clinic? Never heard of it? Nor had I until recently when I read an article on how pharmacies are getting into the game of mental health care. Soon, it seems, we will all be able to roll up to our local pharmacy and not only pick up our prescriptions, but see a therapist on site as well.

As a therapist myself I wondered what does this mean for not only me as a provider, but also for the patient. Certainly the pandemic over this past year has taught all of us that access to mental health care is not only necessary for everyone, but also needs to be accessible with few barriers to receiving treatment. In terms of access, rolling up to your pharmacy and having access to a therapist on the spot feels like this need is being met.

However, I have my questions. Therapy is broad with many therapists offering a range of different types of care for many different types of symptoms and upset. From anxiety to depression to severe illness such as schizophrenia, therapists treat people suffering from all of these and much much more. Given this broad range of mental health ailments, most therapists specialize in an area. The specialization comes from study, their experiences, and their interests. When someone is looking for a therapist, they are often trying to find someone who matches what their needs are.

Walking into a pharmacy, I wonder how people will be matched up. Will it run like a crisis line where whomever walks in gets the next available therapist and the meeting is for the therapy hour (45 to 50 minutes) and then the person gets up and walks away and hopefully feels better with no charge or is it going to operate like a low fee clinic, charging a low fee, and patients have a choice of whom they see and have the option of returning and seeing the therapist on a regular basis?

I also wonder will pharmacies tie people to a therapist based on their prescriptions. Let’s say someone is picking up an anti-anxiety medication and the pharmacy staff not only gives the patients their script, but also the names of therapists in their clinic that they encourage you to see alongside taking your medication. The flip side of this is a therapist who sees someone for anxiety and then sends them to an in-house medical doctor who then prescribes anti-anxiety meds that get filled right at the counter. Convenient one-stop mental health help.

Those two points, i.e. that therapists seeing patients in such pop up mental health clinics, actually have the experience to support whom they are seeing in the pharmacy and that this is not just a grab to prescribe more meds to the public, are the places where I feel concern. This article does not disclose the details of these plans, just to say this fad is coming our way.

The article lists out questions that patients should hold in mind when they meet a therapist, but, truth be told, when people want to talk to somebody such questions often go out the window as their distress is so keen, it is difficult to hold in mind who is this therapist and do I feel comfortable with her? It is then on the therapist to hold on to their minds to decide if they can serve a potential patient or not. If a therapist does not think she can, does she have the ability to not take someone on? In community mental health, that choice is often not there for the clinicians, but will it be in corporate America?

Mental health is serious and corporate America is seeing it as its own power play and grab. Ethically one needs to safe guard themselves from a fast food approach to mental health care. Yes, something is better than nothing, but sometimes fast therapy does little to change anything.

As a practicing therapist in Capitol Hill, Seattle, I believe mental health care should be available to all, but in a responsible way. There are low-cost clinics and websites where Clinicians offer their services at a deep sliding scale. Finding this type of therapist for a long-term relationship feels important as the therapist can then track alongside you your progress, setbacks, and provide a containing space that is ongoing and built on trust. I believe in this type of approach for the work we do together.

Yet! I won’t be surprised to walk into a pharmacy next time and see a line of therapists waiting to see you and me.

Mental Health Crisis in America

Mental Health Crisis in America
Mental Health Crisis Brews in America

I read an interesting article the other day in the Washington Post regarding how the current COVID-19 pandemic is pushing America to the brink of a mental health crisis. I cannot even believe it has taken a severe public health crisis like this one for the media to begin to pick up on how difficult it is for Americans to find and receive quality mental health care today.

Sitting from the vantage point of a therapist, I know this to be true for many reasons. While most articles, like the one in the Post above, focus on access to mental health care, there is something else one has to first realize. Access to mental health care starts with clinicians who are in training to work in the field and serve people in need of mental health services.

It is an unfortunate truth and one not often discussed in the media that to do the work of a therapist, or, as the traditional license is called, a Licensed Mental Health Counselor, is a costly and time-consuming journey. One cannot clinically practice one-on-one therapy with individuals without holding a Master’s Degree in counseling, social work, or marriage and family work. This type of degree takes 3-5 years to complete with significant amounts of debt taken on to complete the degree, upwards and over $100,000.

Along this journey, graduate students in training are called to do an internship with a significant number of clinical hours and supervision time spent in order to earn one’s degree. Although a person may have at least 2-3 years of training experience in school, one’s internship is unpaid. People must find paid jobs as they juggle their internship demands.

This is where it strikes me that the mental health system is failing at its core. Community Mental Health Agencies that serve the poor and mentally unwell, a segment of the population that would have very little access to mental health services, are staffed with interns from graduate schools who are seeing these people for free. The core of the mental health services offered to thousands of Americans is valued at an intern level who earn nothing.

From there, graduate students leave school and are permitted their first license. Where I live it is an Associate’s license, which means you have the ability to see patients, but you must be supervised for a set amount of hours as you work toward full licensure, which is additional hours. Often Associate Mental Health Counselors use this period of time to take clinician positions in mental health agencies. Now they are no longer serving for free, but for $17 to $23 per hour. The average case load for a new Clinician is upwards to 100 clients. Then add in the math of $100,000 of student loan debt.

It is from this vantage point that I see our mental health system failing in America. From the start, when people seek to train to become a mental health clinician, no value is given to the skills that they are learning and employing to help people with their mental health needs. From weighting people down with student loan debt, to not providing any value to the intern seeing clients, and then providing a very low income to the new clinician with a caseload that no one can keep up with — not only are the clinicians burned out, but the system is overwrought with little to no support for people who need tremendous care.

What happens after one has completed her Associate’s license requirements and you are now a fully licensed therapist? Unfortunately, most clinicians leave Community Mental Health and set up their own private practice. Even if the clinician charges a reduced fee, it is often three times the amount one was earning at the mental health agencies. It is unfortunate that the very poor and mentally unwell people in America are left to be churned through by clinicians who are in some training phase of their career burning out without proper care, support, or caseload numbers.

Insurance also plays a roll in the inequity of the Mental Health system in America. Are you in network and, if you are, your patients may benefit, but the Clinician will likely make very little money for their services when all is said and done. If you are out of network, then the Clinician works with the patient to determine the fee. A patient may submit a receipt to their insurance company which may provide them with a portion of the fee they have paid. In this way, the patient has to decide what can they afford given the insurance company will only be reimbursing some of the full fee and that is often after deductibles are met.

All of this to say that when we look at the mental health crisis in America, we need to critically think about how we value our clinicians in training as well as how we value the services provided to the mentally unwell, especially those accessing care through the community mental health agencies. It begins with both parties being valued and supported in terms of money and care.

Until this happens, the system is on crumbling crutches which is going to further lead to the black hole of inadequate care, funding, and a lack of people to serve during crisis such as the one we are in currently.