Comment by jermaustin1 | Hacker News Reader

Comment by jermaustin1 | Hacker News Reader

My wife is a psychotherapist, and I go to therapy, and so does she (on top of paid supervision and support).

It is the sad state of insurance and mental health coverage in the US that is driving users to these apps that have no/little proven benefit. Then the high cost of education has made it practically impossible to provide low/no cost mental health services.

My wife's internship was at a place where she had 8+ sessions per day, they had a dozen or so unpaid interns still in school (usually second year of masters program) providing mental health services for low-income medicaid patients. And that leads to very quick burn out, and doesn't compensate fairly (or at all, actually) while accruing massive amounts of student debt.

There are federal programs that if you make it 10 years in community mental health paying your student loans at a lower rate, your loans are discharged, but it takes a very special person to survive 40+ hours per week of sessions, taking in and holding other people's mental health, and then add another 10+ hours of notes/insurance/treatment plans.

I have family that is quite severly mentally ill.

They are on SSI and Medic[are|aid] (not sure which).

The nice thing about their insurance, is that it covers 100% of their mental health care needs.

I am not aware of any private insurance that even comes close. The most I've seen, is a limited run of social worker appointments. No inpatient, heavy co-pays, etc.

Mental health is not a priority, in the US. We spend a lot more effort and money, ensuring that mentally ill people have access to weapons, than to care.

> They are on SSI and Medic[are|aid] (not sure which).

The mnemonic I heard from Planet Money was "grey hair? Medicare. Underpaid? Medicaid." Although Medicare will also apply to people under 65 with some conditions.

In school we were taught "we care for the elderly, we aid the less fortunate" but that doesn't rhyme :-(

If you look around in the world, you see all these little pockets of bullshit, where those in power and control see the system as a way to screw over and steal from the individual who's just trying to live their life.

It's the mentality that making as much money as possible is the sole reason we exist. Paying interns nothing because "they're in school, learning" is no different than saying you don't want to pay college athletes because "they're supposed to be in school". Nah, you just want free work from people who you've led to believe that the way to grow in their life is to give you that free work.

Pay your workers, whether they're students or not. Stop working for free.

After struggling for years, I finally found someone through Kaiser (my insurance company for those outside of west coast USA), and they were absolutely phenomenal.

By some sort of fortunate occurrence, I started talking to them about 3 weeks before the COVID lockdowns. I don't know how I would have survived if not for him.

Sadly, due to how Kaiser treats their mental health staff, they decided to move on (and leave practicing therapy). Since he was moving on, Kaiser booted me out of their services since I wasn't a case that necessitated emergency treatment (they are right, but I still needed to _talk to someone_).

It's led me down a rabbit hole of trying to find various therapists. Most in this area are at capacity (naturally, everyone needs a therapist right now) or won't accept the third party service Kaiser partners through.

I ended up doing Betterhelp for a bit and that was such a mixed experience. Therapists that are overbooked and just grinding (one told me they have 70 clients a week! Uh, what?!) and the support was just so sub-par.

Specifically due to privacy concerns (and I think it's only a matter of time before these services have some sort of data breach), I registered with a throw away email, truncated my name, and generally just tried to provide very little identifying info.

(I guess they have my credit card details. Oh, well)

1. Apps seem to be a useful tool. They help a lot of people who either won't use or are not helped by traditional therapy. Think of them like workbooks - they're an alternative that may be better for some.

2. There is no country as far as I'm aware that can meet the demand for mental health services, from the most socialized to the most open market. None. Therapists are always full, most people don't want to be therapists, and the demand for them is super high.

I have no idea how to solve this. A lot of therapists also tend to stop being therapists pretty early in their career or radically reduce how many patients they see. Basically it just sucks to be a therapist no matter how much we pay and we can't make it better.

So it's the state of mental health coverage in Germany too. It's bad. Although therapy is paid for by the mandatory health insurance, there are multiple issues: Wait times of months up to three quarters of a year for a place in hospital, similar wait periods for outpatient care. A lot of therapists won't put you on a waitlist anymore. Federal insurance won't issue more permits for therapist so it's a constant fight for already exhausted patients to find someone (not counting in of they get along). On top, there is more and more pressure to keep mental health costs down by limiting time for inpatient care, by limiting (or severely hinder any extension) the amount of hours and so on.

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