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Boy, am I lucky. I’ve been privy to some of the most elite treatment centers in the country. My family may not be particularly well off, but I happen to live in a geographic area that allows for my placement in the best programs. When I was sent to the emergency room, on three occasions and ranging in severity, I was shipped off to excellent mental hospitals when discharged. As I was watching the highway melt into the cityscape behind the wailing ambulance, tucked into a gurney, I knew I was being sent somewhere safe and helpful. When I discharged, I did so with the knowledge that I’d be matriculating to excellent doctors. How privileged I am, really.
My family has been considering sending me to McLean Hospital’s OCD institute for a while, now. My team and I think it would do wonders for my primary diagnosis, OCD. However, they don’t accept Medicare from out of state, so it’s a no-go. I’m undergoing intense interpersonal treatment for OCD, and other options are being explored. But yes, my options are limited due to my lack of wealth, to some degree.
I’ve also been fortunately, or unfortunately depending on the perspective, offered a peek into what the tippy top percentage point of wealth does when it has access to mental health treatment. Living in a wealthy county, attending a private school for the mentally ill (our district paid for my outplacement), has shown me what I’m getting and what I’m missing. It takes a bit of zooming out, even further, to understand exactly how lucky I am.
It’s often repeated that anyone can become mentally ill. It’s true, anyone can, and I’ve repeated this often on this site. However, I want to unpack the correlation between mental illness and socioeconomic status, because there is a decently meaty relationship and it’s not exactly what you might think.
The image of the white, emo, depressed-for-no-reason teen that is often associated with mentally ill folks is a myth. It’s not that people like that don’t exist, or even that they’re rare. Mental illness simply looks like so much more than that image, and that stereotype does a disservice to the people who actually end up struggling the most, because they don’t have access to help. Given the fact that 75% of mental disorders appear before the age of 24, many if not most mentally ill folks are still under the care of their parents, meaning they simply need to luck out in being born to parents with access to the resources needed to get them help.
Here’s a demonstrated fact. Higher familial wealth in youth is positively correlated with lesser degrees of psychological distress.
A common outcome for the seriously mentally ill is to end up either homeless or in jail. After the movement in the 60’s to deconstruct barbaric mental institutions successfully ran its course, a series of community based projects were proposed. However, nearly half of these projects were never built or completed, and they were far from prioritized. As a result, there is a lacking number of community oriented, accessible, cheap treatment for the mentally ill. Between the 1950’s and today, the number of seriously mentally ill folks in hospital has plummeted from 550,000 to 77,000 in 2012. The War on Drugs only exacerbated the issue. So if you don’t have the money to get into private care, or don’t live in an area with good public care, what is to become of you? Homelessness and jail are usually the answer.
Incarceration is rarely a state in which folks can get adequate mental healthcare. It’s so needed, however; over half of American inmates meet diagnostic criteria for at least one mental illness. Addiction and prior trauma are good indicators. It’s a deeply rooted, systemic inequity problem, one that will take intense and intentional deconstruction to solve. Ideally, there is work that can be done for the mentally ill before they ever have to set foot in a jail or prison.
But what is to be done, to that end? Awareness is a good first step.
The families I’ve come to know in my area are oblivious to the privilege they wield. Around half of the students at my school for the mentally ill are self-paid, meaning their families shell out 60,000+ a year to get them there. As awful as the school was, it kept students out of the streets and in treatment, technically (if we’re splitting hairs). Do they know how lucky they are? It’s a no from me.
This summer, as I was experiencing an utter breakdown, physically and mentally, and mere days before an incident and hospitalization, my mother was on the phone with the mother of a boy who went to the school. The mother and her family are filthy, disgustingly rich, a socioeconomic level that no one needs to be at and one that was vastly underappreciated by the family. They could afford any treatment in the world. Hell, they could afford Hamilton tickets on more occasions than fit on one hand. They go to Turks and Caicos on random weekends, just because they feel like it. And on the phone that day, this woman forgot her place.
After chewing her out for unrelated but absurd reasons, she told my mother to get me into a specific hospital. Gave her recommendations. In her mind, we could afford to shell out hundreds of thousands of dollars for any hospital of our choosing, because couldn’t everyone? In their Westchester County bubble, where every stay-at-home mom is competing for how expensive they can make their identical grey and white upholstery, money was never a consideration. She didn’t give a second thought to the idea that the wait between scholarship paperwork and admission would prove to be too long, for me. She never considered that we wouldn’t have been able to afford any treatment at all if I hadn’t written good scholarship essays, if I hadn’t conjured the wherewithal to do so while in a near psychotic state, if we hadn’t been told of the scholarships in the first place by a doctor who used to work at the hospital. She didn’t consider that many who are mentally ill end up in the justice system, instead. In her world, sweet, sick children go to hotel hospitals to feel better, always.
There’s going to be a time at which I discuss the faux-liberalism of this family, too- the pussy hat wearing, feminism touting, Bernie Sanders hypocrisy of the white and wealthy who pretend to be sheepish about their fortune while wielding it obliviously, harmfully, liberally (so to speak) and often- but I’ll save that for another bit.
They don’t know how lucky they are. The wealthy tend to not. It’s truly a bubble. So awareness of the inequity of the issue will hopefully result in a new generation, in tandem with packages like the Green New Deal, of mental illness aware youth who are ready to lobby on behalf of change because they’ve developed the required awareness of and empathy for the plights of their ill peers.
At the same time, I urge compassion for the mentally ill population who don’t resemble the well scrubbed, sundress wearing, massaged hospital patients of elite families. Yes, this can look like homelessness or incarceration. It’s all the same group of people. Some just managed to be lucky enough to be born into wealth. It isn’t fair, and knowing it isn’t fair is the first step towards changing it.
The ACA and diversion programs, as well as broader criminal justice reform initiatives, seek to change these outcomes on a political level. I doubt anyone of influence is reading what I have to say. So, here is my set of demands for you.
Spend some time thinking of the ways in which you are lucky, the circumstances of your birth that you couldn’t control. Imagine what it would be like to be born into less. Practice empathy towards those who were born with less than you. Be grateful for what you do have, the treatments you’re privy to. Offer to help the less fortunate in any way that you are able. And when you’re writing policy someday, as I hope to do, keep us in mind.