DETROIT—A recent article in Crain’s Detroit Business outlined the grim future of mental health care in Michigan—as instances of mental illnesses and mental health concerns increase, staffing has not kept pace. In fact, in several places, staffing has decreased. The mental health care industry is two-thirds women, many of which “left the workforce in 2020 to handle child care during the pandemic when school closures were most common.”
Michael Garrett, CEO of CNS Healthcare, a Michigan-based non-profit behavioral health clinic, said that the “organization is seeing fewer and fewer applicants, despite an increase in advertising for open positions as well as higher wages,” adding, “I’m not sure where all the workers have gone.”
The crisis of mental health care is coming to light, and even Michigan Gov. Gretchen Whitmer has proposed to “repay up to $200,000 in student loan debt for those working in the nonprofit mental health sector.” The proposed loan-forgiveness is the centerpiece of her plan to “expand access” to mental health care and attract those who left to come back.
However, the question of whether this is actually enough to bring people back remains.
Robert Sheehan, executive director of the Community Mental Health Association of Michigan, said “the result of large [caseloads] is mental health care workers taking on double shifts and organizations reducing the length of treatment to move more people through the system.”
The concern over workload is of a doubling effect: “There is a wait list, so they are shortening treatments for people they normally wouldn’t,” Sheehan added. “This is not only putting a strain on practitioners but clients as well.”
It’s not just that health care professionals are burning out but that patients are not getting the same effect from psychological services and treatments.
Garrett also makes the argument that “the ultimate solution” requires more than just loan repayment. An increase in mental health “so patients can access more mental health services without breaking the bank” is also needed—more access implying better treatment. However, this skips over a couple of required components.
“Access” may be one of the missing pieces, but when we speak of “access,” it’s often without addressing what Garrett only alludes to as also being needed: affordability and availability. On top of this, we have the problem of the “stigmatization” of mental illnesses, addiction, suicide, asking for help, etc.
Part of the problem in addressing the crisis in this way—in terms of “access”—is that it reduces the solution to a passive dimension. By this, I mean to say that should the workforce be saturated with mental health care professions, we will go right back to our “normal” commands of the mentally “unhealthy” other: “seek help,” “ask,” etc. After shifting the “work to be done” back to the “unhealthy,” the problem remains half open and is only a return “things as they were.” In other words, this is exactly how we keep ending up here.
But these are not issues to be addressed separately either. In fact, these two factors—only creating more “access” and tackling “stigma”—are one and the same, and both are part of the same ideology that continues to distance people from mental care (or, in discourse, “mental illness” from “mental health”).
Only focusing on access and not availability or affordability plays into the idea that, in order for us to be healthy, we must have the time and money to spend on “self-care.” Likewise, addressing stigma as the boundary for why people don’t seek treatment not only ignores the same money and time requirements, but also posits it in terms of personal responsibility. This creates a superego-like gap where any and all “free time” not spent on “bettering” one’s health is a personal failure.
This ideological game has direct correlations to social reproduction and labor as well. Not only have “alternative” markets to healthcare exploded—such as the “wellness” industry—to offer “cheaper” or more natural means to “feeling good,” but all these options demand more of us than is available.
Slavoj Žižek is rightfully suspicious of the “wellness” and “self-care” path that mental health has taken in recent years, stating it allows for people “to fully participate in the capitalist dynamic while retaining the appearance of mental sanity.” It should come as no surprise that demands for more participation from the labor force is what we are seeing today. What’s more is that our social value is overdetermined by our “marketable” value in the job market as well.
This is all to say that we as individuals are constantly confronted with more demands on our time—in order to be healthy, in order to save the economy. Not to mention the strain such demands put on the current workforce and labor-in-reserve when headlines about death rates outpacing birth rates abound. When we consider all this along with the demand on mental health professionals in non-profit clinics like CNS, it seems that burnout is coming for all of us at both ends of the candle.
Although Garrett is right to point out “[a] healthy person is of sound mind and body,” and that “[y]ou can’t have one without the other,” what is missing is that in order to be healthy, we need clean water and air, housing security, better public transportation, healthier foods, actual care (not just accessible care), etc.—to say nothing of the mental and physical toll that systemic racism, misogyny, and economic exploitation take on us.
In short, we all either need to take the individual approach and move to “safer,” less polluted, quieter areas, and get better jobs; or, we’re left with tackling this in the social—the political realm.
“There are a lot of different stressors going on in the world, from the pandemic to economic anxiety,” said Garrett. “This isolation and loneliness is the perfect storm on our mental health system.” Garrett is absolutely right, but these “stressors” (read as, antagonisms) have existed and been growing since well before the pandemic.
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