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“Reach out,” they say. “Get help,” they say. “Go to therapy,” they say. They, of course, are seemingly every friend, celebrity, and politician offering well-meaning platitudes after the suicides of culinary force of nature Anthony Bourdain and iconic designer Kate Spade last week.
It is comforting to believe that all that stands between a beloved friend or family member and suicide is an active cry for help. Unfortunately, that banal chestnut too often doesn’t match the available treatment options for a vast number of Americans, especially when the Narcissist in Chief’s budget slashes funding for the National Institute of Mental Health by more than 30 percent in 2019.
In New York City, where major depressive disorder is the single greatest source of disability, according to a 2015 report by the mayor’s office, who exactly are we telling our friends and neighbors to reach out to? The report found that poverty, race and ethnicity, sexuality and gender identity, age, where a person lives, and whether or not they’ve been bullied all increase the likelihood that a New Yorker may experience mental health challenges or suicidal ideation — and yet those same factors make it harder to access treatment.
“At any given time over half a million adult New Yorkers are estimated to have depression, yet less than 40 percent report receiving care for it,” the 2015 report states. Eight percent of New York City public high school students report attempting suicide, a percentage that “doubles if a student has been bullied on school grounds, which 18 percent of students experience.” LGBTQ youth are twice as likely to attempt suicide, while elder citizens and Latina adolescents are both at elevated risk as well.
As a media critic, my journalism has almost never included personal memoir. But in light of the implicit shaming underneath all that stock advice to “reach out,” I want to share a story about how few resources are available for mental healthcare in our city, and why judging someone for “not getting help” is not just rude but dangerous.
Ever since I was a teenager, I’ve considered myself lucky that I have never experienced suicidal ideation, beyond fleeting dark thoughts as a child and adolescent while living in an emotionally abusive home. But because of that upbringing, I’ve dealt with a kind of low-grade depression my whole life, an undercurrent that is always right under the surface, always, and which I work really hard to push through every day. (A coping strategy reflected in the Ani DiFranco lyric “Maybe you can keep me from ever being happy, but you’re not going to stop me from having fun,” which has resonated with me since 1997.) Most of the time I’ve been able to remain functional, but at times the depression has become much more acute.
In my mid twenties in the early 2000s, in the midst of a deep depression during which I stopped having the desire to see friends, take showers, or even write (the most alarming “tell”), I finally overcame my resistance and tried to find a therapist I could afford on a low-income activist writer’s budget. At the time, I was working completely unfunded as the founder and director of a small nonprofit feminist media justice group I was working to build, and I could not afford health insurance; I could barely afford rent and food. As I researched my options, nothing was affordable except for students in training, or group therapy, which — though often extremely useful — I determined wouldn’t be helpful for my specific challenges.
Activating my local network, I finally found one supposedly feminist therapist who I was told offered sliding-scale payment options. I called and asked the therapist if she was taking clients. She said she was. I told her I was living one bare step above poverty and did not have any savings or health insurance, but that I was suffering from a deep depression and I had finally accepted that I needed help. I asked what her rates were at the lowest end of the scale. I can’t remember if she said $75 or $100 per hour; I do remember the burning feeling of internalized shame rising up in my throat as I regretfully explained that I couldn’t afford that rate. Did she have any other options, or could she suggest other therapists with a lower scale? She replied, in a derisive tone I will never forget: “If you are unwilling to pay that little for therapy, you are not dedicated to improving your mental health.”
I hung up the phone and sobbed. I felt even more defeated, demoralized, and depressed than I had been before I reached out, and I quit the search for therapy right at that moment. It wasn’t just that I felt shamed; it was that my research had led me to a brick wall. It seemed as if there was no point in trying to seek additional resources.
Now, many of us are familiar with the phrase “depression is a liar,” so perhaps if I had been in a better state of mental health I would have left her a scathing Yelp review and initiated another search, or returned to my network for additional recommendations. But the whole reason I was reaching out was that I wasn’t in that healthier state of mind, and so I fully believed there were no therapeutic options available for me.
It took a lot longer for me to get out of that period of depression than it should have, in part because of that therapist insisting that I was “choosing to not prioritize my mental health” just because I was unable to afford her fees. I’m in a much better place now (my low-grade depression is less of an urgent battle and more of an endurance race these days), and thankfully I now have the option for mental healthcare under my partner’s employment benefits if I find myself in need of help in the future. But I know that if I — a cis-gender white journalist adept at research who, while having no money, has significant social capital and a strong network of connected writers and advocates — was unable to secure adequate mental healthcare, it’s decidedly more of a struggle for New Yorkers with fewer racial and professional privileges.
The outpouring of grief, disbelief, and concern in the wake of beloved public figures’ suicides is certainly normal, as is the instinct to want to encourage those struggling with depression and suicidal ideation to seek lifesaving support. But blanketing social media with hollow statements about “reaching out” (exhibit A: senior White House adviser and first daughter Ivanka Trump) obscures the fact that, too often, the infrastructure for that aid is wholly inadequate. That is especially true under the despair-provoking darkness and myopic cruelty of the Trump administration, whose budget is making an already rickety ladder of support even more unstable, while triggering increased anxiety and depression.
If we truly want to help keep people alive and thriving, we need more than platitudes about calling friends or suicide hotlines in a moment of extreme crisis — we need ongoing, substantive, broad-based investment in mental healthcare. So instead of demanding that depressed people reach out to some random concept of help, how about every single person who isn’t struggling reach out to politicians who can fight for more effective mental healthcare policies and resources, and to philanthropic foundations and individuals who can help fund nonprofits that provide direct support to people who need it most. That’s the kind of outreach we should advocate for if we truly want to save lives.
If you or someone you love is in need of help, call the National Suicide Prevention Hotline at 1-800-273-8255. It is free, operates 24-7, and provides confidential support for people in crisis.
To learn more about the battles for funding of mental health services in the U.S., visit the Mental Health America website.
To contact your congressional representatives about mental health funding, visit Call My Congress.