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Mental healthcare system in the u.s.

Guest post: A Reflection on the Mental Healthcare System in the U.S. by Nathan Smith

THIS IS a guest post by nathan smith on his experiences with the Mental HealthCare System in the U.S.

Nathan Smith
Nathan Smith from

Have you ever played a game where you weren’t sure of the rules? You make decisions based on context clues, what you know about the game, and what makes the most sense at the moment. But in the back of your mind, you’re not sure if it’s the right decision. When you lose, you don’t feel too bad; after all, you weren’t exactly set up to win, right? After all, it’s only a game. If it wasn’t, you’d be in trouble.

This is one of the best analogies I can think of to describe the state of mental health care in the United States. In the 10+ years that I’ve been living with anxiety and depression, I’ve gotten to know this game well. You’d think that seeking help for mental health issues would be a piece of cake, right? People need help, and there are people who want to help them. Unfortunately, it’s anything but.

A lot has changed since I first saw a mental health professional for my anxiety, but so much of it remains the same. When I first knew I needed help I went where anyone naturally does these days: to the Internet. It’s not easy finding a doctor, especially as a young adult who doesn’t quite know what to search for. Did I need a therapist? A psychiatrist? A psychologist? Whom did I need to speak with first? Did it even matter? And if someone is doing this search while experiencing symptoms they’re scouring the Internet to get help for…let’s just say it wasn’t as simple as “Google it.” Finding a person who can provide you with the treatment you need felt like a miracle at the time and ten years later, it still does.

It’s easy enough to point out the flaws and issues with the mental health care system, especially when you’ve been an active participant in it for a while. But I think what’s more important than knowing the problems is making sure people get the solutions they need. I learned everything about mental healthcare because it happened to me or someone I knew. I took those lessons and brought them into my next appointment, my next session, and my next conversation with a mental health professional. I made sure to point out my other experiences and that they knew what I was talking about. Because at the end of the day, your mental health is one of the most personal things you possess. Millions of people experience depression, but no one will experience it in the unique way you do. It won’t impact everyone else the way it could impact you. We can’t approach mental health as “one size fits all” because the fact of the matter is, it isn’t. It never has been.

A myth about mental health care that I wish would go away is that there’s an immediate fix. It’s important, life-saving, and vital to reach out for help, but that’s only the first step. There is a domino effect of figuring out the help you need and what that looks like and unfortunately, that takes time.

After finally finding a therapist, I felt relieved. But that relief was misguided because of my misconception about mental health. I thought I’d talk to someone for a few months, figure out “what was wrong with me,” and get back to life. Let me tell you…I was wrong about that! 

After talking with someone, I learned I might need medication. Once I learned that, I needed to find a psychiatrist (not a psychologist) who could prescribe the medication. Then, I needed to make sure I met with both the therapist and the psychiatrist regularly. Oh, and I also needed the right type of insurance that would allow me to continue seeing these people. That’s a lot of different bits of information, and each aspect of it is different depending on the person. Are you starting to see how the game is played?

Mental Health in the U.S.

After a few years of trying to figure things out, I learned what I needed to manage my anxiety and depression: talk therapy and medication. Even once I figured that out, it still took a few years to find the right medication and a therapist I could see consistently. It took time and a lot of patience, but I eventually had a treatment plan that worked for me. 

I still have a treatment plan that works for me – I’ve weaned off medication, but still, meet with a therapist – but the experience with the mental health care system in building that plan will always stick with me. At its best moments, my interactions with the system felt like a game of guess-and-check, trying to see if the right prescription would finally do the trick. But I also learned from my experience that the healthcare system still approaches mental health issues as if they are an illness that needs to be cured as soon as possible. While I wish that were true, that’s not the case for tens of millions of people in the United States. Once more mental health professionals (and their patients) can understand this difference, the more we can have frank conversations about how to improve the system. 

Mental Health in the U.S.

I have lived with anxiety and depression, and navigated the mental health care system, for more than a decade now. l have my ups and downs and it’s extremely difficult at times, but I’m more positive about my overall situation. And that’s because I’ve learned how to navigate this system and make it work for me. But we do deserve better, every one of us, and that starts by addressing the problems. Nothing will change if we can’t have these open and honest conversations, and I’m cautiously optimistic that we will see more of them in the future.

“Nathan is a mental health blogger and activist based in Washington, D.C. in the United States. He runs My Brain’s Not Broken, a blog about his experiences living with anxiety and depression that promotes mental health and wellness. You can also follow the blog on Facebook and Instagram.”