21 August 2009

Final Run-in With State Run Mental Health Services in North Carolina

For those of you who live in more civilised countries, let me first explain that in the US, state run mental health services are only for the uninsured and poor. In my home state, they were disastrously privatised in 2003 with more or less exactly the results one would expect.

I have been lucky that by pitching battle with them I have managed to stay under the care of a single psychiatrist for about a year and a half. He turned out to be a good one, which is more than I can say for some of his colleagues and co-workers. You can read, if you like, about one specific case worker I had who was worse than useless and more generally about the difficulties of engaging with these people. All of my readers in the UK may feel free to laugh at me but I am really looking forward to having access to the NHS next year. However bad it might be, and it doesn't sound idyllic, I have often found myself agog with envy at various descriptions even of being in hospital (they're allowed outside? they are allowed to go to the shops? they have crisis intervention teams? they have the option to see a therapist, even with a long waiting list?)

That short list of my own incredulity should give you some idea of what it's like here. Am I now a potential target for BNP anti-immigrant attacks for expressing an interest in the NHS? Or will they hold off because I'm white and English-speaking? Oh dear. I can't imagine, though, that anyone would wonder at it if they had to deal with the state of things in this country - or maybe I don't need to imagine it, just read the papers and see what the Republicans have been up to lately. It does seem to me that as I grow saner, the world has gone a bit farther off its rocker.

Anyhow, all I need do now is swing by there to pick up a copy of my chart (that will be interesting to see) to take with me and I'll be done! No more worrying that they will drop low need patients such as myself, no more worrying that the agency I'm currently enrolled with will go bankrupt (as happened last December - it took me six weeks and repeated phone calls that I would not have been able to make had I not been more or less well to get into a new one), no more worrying that I'll get a job only to have to pay for all this myself since most health insurance policies in the US don't cover mental health at all, or, if they do, have a lifetime limit that I would get through in about six months, a year at the outside.

I'm not going to miss this part of life in the US.


  1. I always wonder how people with MH problems in the States manage to ever stay on an even keel with all the worry and stress around getting treatment. I certainly hope you'll find it a more calm and stress-free experience over here. Although it has to be said, the UK system does have its moments (like every bureaucracy everywhere, I suppose). But at least lack of money is never one of the worries. :o)

  2. i have been living in NC for a year now and am very disappointed with the mental health care here. And i thought Maine was bad! Though the bigger problem is on a national level and i am happy for you to be going to a better system. It will be interesting and hopefully motivating to read your blog once you're there and to see the comparisons. Best wishes to you!

  3. When I got started with the state mental health services here, the earliest appointment they could offer me from when I called in the second week of March was on the 19th of June! I ended up in the hospital in the interim. I am lucky enough to be articulate and insistent, which has helped (once I finally got in) but I worry for the homeless people and all the ones sitting alone who are clearly not getting adequate help when I see them in the waiting room. I have done all right with it in the end but I do wonder how I would have fared had I been having problems with hallucinations, for instance.
    Aethelread - It will be nice not to have to worry that the NHS will suddenly drop me for not being cost-efficient or because they, through a very ill-advised PPP, are out of money!
    KC - A fellow North Carolinian, how delightful. I've tried complaining to our public officials, Heath Schuler in particular, whose office is in the same building as my mental health agency, and haven't even had the courtesy of the standard form letter in reply! I don't think that Bev Purdue is going to do anything but make matters worse, unfortunately. Best wishes to you, too. It's not an easy system to deal with and try really hard to avoid Broughton! I know, I've been there. There's some sort of legally binding advance plan they can make for you - I can't remember the exact name of it but ask your caseworker - that will minimize your chances of ending up there if you should end up having to go to the hospital in the first place. Patient directive treatment plan? Something like that, anyway, except I think that it has the word 'advance' in it somewhere. I have a copy of mine around here somewhere.
    Goodness, that's not very cheery advice is it?

  4. Advanced Directive - I'm pretty sure that's the name of it. Anyhow, it kicks in if you've been involuntarily committed and requires the hospital staff to try to find a place for you at all the hospitals, which can be in a certain number of miles, 150 I think, you list before sending you to Broughton. I don't know if you're in my part of the state (Western North Carolina) but if you are, or are close enough, Copestone, the fifth floor at Mission Hospitals, is a very excellent choice. Hopefully it'll never be an issue for you but it's probably worth doing just in case.

  5. My college health psychology textbook is American, and I was shocked to find its explanation of the U.S. healthcare system, and that is when I already knew quite a bit about it and its lack of MH services. I'm really glad I don't live there.

  6. Dear Katherine,
    I do not wish to dint your optimism re. the UK mental Health services. Indeed we have a far, far superior system than the US - and, essentially free at the point of need. However, the quality of service varies enormously between regions and where I live, I am aware that they are particularly stretched. For example, the first time I was ill enough to be referred in this city, it took FIVE months waiting to see a psychiatrist. Since by then I had got alot better, mostly off my own bat, she seemed eager to discharge me with little back-up. There are many, many worse stories of people in this area who have been similarly dismissed or neglected. If you are a 'low-need' case, the chances are you will be referred to a GP and the chances of seeing the same doctor more than once in your time are unlikely. I do hope that London offers a superior service but I wouldn't hold my breath. Having said that and since I do the rounds on our local ward twice a week, I shall report that yes, inpatients have a nice terrace garden with a wooden shelter under which they can smoke in the rain. They have taxis that come to take them out on 'leave' from time to time and I even hear that the food is rather good! But let's hope you never have the opportunity to sample it hey!
    As for psychological therapies, ha! I was on a 3 year waiting list for CBT until they diagnosed me with bipolar and I was straightaway struck off -"this won't help you". *sigh* but I suspect they were right!
    Oh, and I've just remembered - you're going to be a student. That probably ups your chances of better treatment ten-fold. I studied at UCL (just round the corner). Student practice was brilliant then.

  7. astridvanwoerkom: I'm glad I won't be living here much longer!

    Kate: Five months is bad, really bad. Hopefully, you're right and I'll have a decent experience with the student practice. And, hopefully, I'll never have the chance to compare inpatient care! Still nice to know it won't be the hellish experience I had here at one hospital (the other was not hellish but one couldn't even see out of the windows at either of them).
    Happily, I haven't had to make any changes to my medication for 11 months and am still doing well on it, so seeing a GP for it won't cause me too much of a problem (let's hope that lasts). Happily or unhappily, I have never done well with therapy of any kind and I reserve a special scorn and contumely for CBT. As I would prefer never to try therapy again, I won't personally be too bothered by a long waiting list. But, on behalf of those who want therapy, I am going to say that obnoxious thing I always say when people in the US say bad things about waiting lists on the NHS: at least there is a waiting list on which to be. Here, you either have the money or you don't and that's the end of the story, even for people with health insurance, which often does not cover MH treatment at all or has ridiculously low lifetime limits (e.g. $4,000/L 2,500, or so). That's not universally the case but is true for 80% or so of the population.
    I quite like the idea of a roof garden.