1 00:00:23,600 --> 00:00:25,800 LAST WEEK TONIGHT WITH JOHN OLIVER 2 00:00:31,399 --> 00:00:34,799 Welcome to "Last Week Tonight"! I'm John Oliver. 3 00:00:34,880 --> 00:00:37,880 Thank you so much for joining us. It has been a busy week. 4 00:00:37,960 --> 00:00:40,600 Russia's war on Ukraine entered its sixth month, 5 00:00:40,679 --> 00:00:42,759 monkeypox continues to spread around the world, 6 00:00:42,840 --> 00:00:45,880 and in D.C., West Virginia's nastiest little coal skank 7 00:00:46,359 --> 00:00:48,920 finally decided to act like a Democrat for once. 8 00:00:49,000 --> 00:00:52,799 We're gonna start tonight in Europe, which has had a dramatic summer. 9 00:00:52,880 --> 00:00:55,000 A massive heat wave has engulfed the continent 10 00:00:55,079 --> 00:00:58,600 and a walrus named Freya has caused absolute chaos. 11 00:00:59,200 --> 00:01:02,320 Far from the Arctic's icy waters, this lone walrus has sank 12 00:01:02,399 --> 00:01:06,359 several small boats and inflatables in Denmark, Scotland, the Netherlands, 13 00:01:06,439 --> 00:01:08,719 and now Norway in her attempt to sunbathe. 14 00:01:08,799 --> 00:01:12,439 The damage from a 700-kilo walrus on your boat can be extensive, 15 00:01:12,519 --> 00:01:16,239 especially when she chooses a vessel that's not walrus worthy. 16 00:01:17,000 --> 00:01:20,879 Unsurprisingly, boat owners aren't excited to share with Freya. 17 00:01:21,760 --> 00:01:23,680 I don't want it on the dock or on my boat. 18 00:01:24,560 --> 00:01:26,040 Just get it away from here. 19 00:01:26,599 --> 00:01:28,040 No! Don't do that! 20 00:01:28,840 --> 00:01:33,439 I love everything about Norway being terrorized by a walrus in vacation mode 21 00:01:33,799 --> 00:01:36,280 sinking boats like they're three pointers. 22 00:01:36,359 --> 00:01:39,879 But also, Freya's not a mosquito you can just swat away, 23 00:01:39,959 --> 00:01:42,719 she's a 1,300-pound water queen and guess what? 24 00:01:43,079 --> 00:01:44,439 She's the captain now. 25 00:01:45,760 --> 00:01:48,120 But boats are not the only thing being upended in Europe. 26 00:01:48,200 --> 00:01:51,239 Multiple countries are now in the process of choosing new leaders, 27 00:01:51,319 --> 00:01:54,280 including the U.K., where Boris Johnson finally stepped down 28 00:01:54,359 --> 00:01:57,159 earlier this month, after succumbing to a series of scandals. 29 00:01:57,480 --> 00:02:00,519 And in doing so, he offered this inspiring farewell. 30 00:02:01,239 --> 00:02:06,519 I want you to know how sad I am to be giving up the best job in the world. 31 00:02:07,400 --> 00:02:08,639 But them's the breaks. 32 00:02:09,120 --> 00:02:11,120 Yeah, them's the breaks! 33 00:02:11,879 --> 00:02:14,800 Sometimes you drive your country off a massive economic cliff for no reason, 34 00:02:14,879 --> 00:02:16,680 then attend a series of alcoholic bashes 35 00:02:16,759 --> 00:02:18,719 in violation of your own government's Covid lockdowns, 36 00:02:18,800 --> 00:02:21,840 then promote a member of your own party accused of sexual misconduct, 37 00:02:21,919 --> 00:02:23,400 later claiming that you didn't know anything about it, 38 00:02:23,479 --> 00:02:25,080 only for it to turn out that that wasn't true, 39 00:02:25,159 --> 00:02:26,199 and for much of your government 40 00:02:26,280 --> 00:02:27,960 to resign rather than continue working for you. 41 00:02:28,039 --> 00:02:29,639 You know… The breaks! 42 00:02:30,639 --> 00:02:31,960 And with Boris standing down, 43 00:02:32,039 --> 00:02:34,360 the next prime minister will be chosen by his party, 44 00:02:34,439 --> 00:02:36,439 which has narrowed the field down to two candidates. 45 00:02:36,520 --> 00:02:39,360 The first is Rishi Sunak, former finance minister. 46 00:02:39,439 --> 00:02:41,280 He has made a play for social conservatives 47 00:02:41,360 --> 00:02:43,960 by attacking "woke nonsense" this week. 48 00:02:44,039 --> 00:02:45,800 But he's also an incredibly wealthy man 49 00:02:45,879 --> 00:02:49,360 who was educated at one of the most exclusive private schools in England, 50 00:02:49,439 --> 00:02:53,039 although it didn't seem to successfully teach him what to do with his arms. 51 00:02:53,719 --> 00:02:56,960 It's great to be at the Channel 4 studios for tonight's debate. 52 00:02:57,319 --> 00:02:58,919 We've got a brilliant message 53 00:02:59,000 --> 00:03:01,360 and I'm pumped to be able to talk more about it this evening. 54 00:03:02,240 --> 00:03:04,759 Thanks also for all your continued support. 55 00:03:04,840 --> 00:03:06,439 All the offers of help, the emails, 56 00:03:06,520 --> 00:03:08,960 and the Tweets are amazing, keep them coming. 57 00:03:09,039 --> 00:03:14,039 What are you doing? What is it about rich people and hand movements? 58 00:03:14,400 --> 00:03:15,680 Sunak looks like he studied 59 00:03:15,759 --> 00:03:18,319 at the Zuckerberg school of passing for a human. 60 00:03:18,759 --> 00:03:20,400 And that's not even a one-off! 61 00:03:20,479 --> 00:03:23,599 He moves his hands like that all the fucking time! 62 00:03:24,280 --> 00:03:27,080 And you want your hands to support and accentuate what you're saying, 63 00:03:27,159 --> 00:03:30,560 not to look like you're in a boxing match with 100 invisible mice. 64 00:03:31,159 --> 00:03:33,680 If you are going to choose to wave your hands around like that, 65 00:03:33,759 --> 00:03:36,639 the very least you can do is put some puppets on them. 66 00:03:37,840 --> 00:03:40,520 Also, for what it's worth, one of Sunak's campaign promises 67 00:03:40,599 --> 00:03:44,240 is that Britain's National Health Service will be safe in his hands, 68 00:03:44,319 --> 00:03:46,800 but given what you have just seen him do with them, 69 00:03:46,879 --> 00:03:48,639 I fucking doubt that's true. 70 00:03:49,479 --> 00:03:51,879 But luckily for Sunak, his rival, Liz Truss, 71 00:03:51,960 --> 00:03:54,199 is somehow even more awkward. 72 00:03:54,280 --> 00:03:56,479 I could show you plenty of examples of this, 73 00:03:56,560 --> 00:04:00,560 or I could show you the eight seconds that really capture her entire spirit. 74 00:04:01,240 --> 00:04:06,120 In December, I'll be in Beijing, opening up new pork markets! 75 00:04:09,360 --> 00:04:11,520 What is happening there? 76 00:04:12,319 --> 00:04:15,439 Somehow Truss comes off as half-kindergarten teacher, 77 00:04:15,520 --> 00:04:17,079 half kindergarten student. 78 00:04:17,959 --> 00:04:21,240 She's giving off the vibe there of a kid who was cast as Who #14 79 00:04:21,319 --> 00:04:24,399 in an elementary school production of Seussical the Musical, 80 00:04:24,480 --> 00:04:27,360 because that is an energy that can only be described as 81 00:04:27,439 --> 00:04:30,519 "I said my thing, my parents saw it, can I go home now?" 82 00:04:31,639 --> 00:04:34,240 Truss has a real knack for making bad decisions, 83 00:04:34,319 --> 00:04:36,279 and then very much sticking to them, 84 00:04:36,360 --> 00:04:40,199 exemplified by the fact that this Tweet paying tribute to Jimmy Savile, 85 00:04:40,279 --> 00:04:42,199 who turned out to be a monstrous pedophile, 86 00:04:42,279 --> 00:04:47,560 has not been deleted 11 years later, nor has this Tweet from a decade ago, 87 00:04:47,639 --> 00:04:50,199 where she seems to be searching for her own name. 88 00:04:51,160 --> 00:04:54,199 And while Truss is campaigning on her ability to get results, 89 00:04:54,279 --> 00:04:57,879 that may be a tough sell, given her party's record in government, 90 00:04:57,959 --> 00:05:01,560 which was brutally exposed in this interview a few years ago. 91 00:05:02,240 --> 00:05:07,800 You had a plan in 2014 to build 200 000 new starter homes. 92 00:05:08,480 --> 00:05:11,079 That was five years ago. How many did you build? 93 00:05:11,160 --> 00:05:14,160 There haven't been as many starter homes as we would have liked. 94 00:05:14,240 --> 00:05:16,680 - How many did you build? - I don't have the exact numbers. 95 00:05:16,759 --> 00:05:19,759 It's easy to remember. It's zero. You built none. 96 00:05:21,600 --> 00:05:24,519 Not great there, Liz. But take a minute to appreciate 97 00:05:24,600 --> 00:05:27,600 the interviewer who made a whole meal out of that gotcha. 98 00:05:28,000 --> 00:05:30,600 His body language, tone, and glasses position 99 00:05:30,680 --> 00:05:34,560 is basically BBC shorthand for, "Hello, I'm about to be a huge bitch". 100 00:05:35,000 --> 00:05:37,480 "Zero, that's easy to remember, right? 101 00:05:37,560 --> 00:05:42,160 You take what you set out to achieve, and then subtract all of it." 102 00:05:44,079 --> 00:05:47,000 So, neither of the options for leader are good here, 103 00:05:47,079 --> 00:05:50,199 and the fact is, whoever wins will be inheriting a poisoned chalice. 104 00:05:50,279 --> 00:05:54,079 Boris Johnson, the man who both of them have spent years enabling, 105 00:05:54,399 --> 00:05:57,439 has broken a lot of shit that they will now have to clean up, 106 00:05:57,519 --> 00:06:01,560 but I guess, in the words of Europe's second most unwanted mammal, 107 00:06:01,639 --> 00:06:02,959 "Them's the breaks." 108 00:06:03,600 --> 00:06:04,639 And now, this! 109 00:06:05,879 --> 00:06:10,759 And Now: People on TV Daydreaming About Winning the Lottery. 110 00:06:11,639 --> 00:06:15,319 Every lottery story from Topeka to national news. We dream. 111 00:06:15,399 --> 00:06:17,800 And then the anchor, we're supposed to say, 112 00:06:17,879 --> 00:06:19,800 "What would you do, Carry, if you win?" 113 00:06:19,879 --> 00:06:23,639 I would share that money with everybody. 114 00:06:23,959 --> 00:06:26,120 The big question is, would you come back to work though? 115 00:06:26,199 --> 00:06:28,319 - No! - Of course, we wouldn't. 116 00:06:28,759 --> 00:06:32,279 - Have you ever won the lottery? - No. I'm still sitting here. 117 00:06:32,360 --> 00:06:34,959 If you win the lottery, you would not show up to work the next day. 118 00:06:35,040 --> 00:06:36,199 You'd never see me again. 119 00:06:36,279 --> 00:06:37,959 You would never see me again. 120 00:06:38,480 --> 00:06:40,160 - You would never see me again. - Never see you again. 121 00:06:40,240 --> 00:06:42,040 You'll never see me again. I'm gone. 122 00:06:42,120 --> 00:06:44,319 I'd be on some remote island you never heard of. 123 00:06:44,399 --> 00:06:45,720 Would you keep working? 124 00:06:47,279 --> 00:06:50,000 I'm gonna change my name. Y'all won't be able to find me. 125 00:06:50,360 --> 00:06:52,879 I love you, Robin. I love you, Bob. I love you, Jen. 126 00:06:52,959 --> 00:06:56,079 - I wouldn't quit my job. - You would not? 127 00:06:56,160 --> 00:06:57,680 No, that's what they always say. 128 00:06:57,759 --> 00:07:00,920 So, I was just joining in on that. Of course, I'd be out of here. 129 00:07:03,600 --> 00:07:07,040 Moving on. Our main story tonight concerns mental health care. 130 00:07:07,120 --> 00:07:10,600 It's a subject that historically humans haven't handled particularly well. 131 00:07:11,199 --> 00:07:14,439 To a famous Bond Street beauty parlor come a bunch of pretty nurses. 132 00:07:14,519 --> 00:07:17,160 They're greeted by director Ms. Eleanor McDonald. 133 00:07:17,240 --> 00:07:19,399 They're here not as customers, but as students. 134 00:07:20,399 --> 00:07:23,839 Ms. McDonald teaches a new group of half a dozen every month. 135 00:07:24,519 --> 00:07:26,079 It's an official part of their training. 136 00:07:26,160 --> 00:07:27,399 If you can persuade 137 00:07:27,480 --> 00:07:29,959 a mentally ill woman to take interest and pride in her appearance, 138 00:07:30,319 --> 00:07:33,480 you may even swing the balance between despair and recovery. 139 00:07:34,000 --> 00:07:37,240 "Yes, those pesky women just need a little pep in their step, 140 00:07:37,319 --> 00:07:40,199 a little drip on their lip, a little flash on their lash. 141 00:07:40,600 --> 00:07:42,920 Look at me! I'm a British voice from the 1950's, 142 00:07:43,000 --> 00:07:45,600 setting the course of science for decades to come." 143 00:07:46,240 --> 00:07:47,839 I don't know what is more alarming there, 144 00:07:47,920 --> 00:07:51,639 nurses being forced to take on the skills of a Sephora brand ambassador 145 00:07:51,720 --> 00:07:53,920 or the fact that "Can Makeup Cure Sad?" 146 00:07:54,000 --> 00:07:57,079 sounds like an episode that Dr. Oz definitely did. 147 00:07:58,160 --> 00:08:00,000 The good news is that since then, 148 00:08:00,079 --> 00:08:02,680 we've got more comfortable talking about mental health, 149 00:08:02,759 --> 00:08:06,120 with PSAs like this one from 2010 trying to destigmatize it. 150 00:08:06,879 --> 00:08:08,879 In the all-American health care system, 151 00:08:08,959 --> 00:08:11,639 there is coverage for heart health, care for cancer. 152 00:08:11,720 --> 00:08:14,639 But the all-American brain is getting lost in the shuffle. 153 00:08:15,079 --> 00:08:18,279 Brain tumor, fine. Brain disease, not so fine. 154 00:08:18,360 --> 00:08:21,360 There's no stigma or discrimination against the heart, 155 00:08:21,439 --> 00:08:23,240 the liver, the kidney, and the gallbladder. 156 00:08:23,879 --> 00:08:25,160 Doesn't even have a job. 157 00:08:25,480 --> 00:08:27,279 Depression was kept in the dark. 158 00:08:27,680 --> 00:08:32,600 Our goal is to make the discussion of mental disease cool and trendy. 159 00:08:32,919 --> 00:08:35,440 Let's tear down the stigma surrounding mental illness. 160 00:08:35,519 --> 00:08:37,080 I'm mad about feeling good. 161 00:08:37,159 --> 00:08:39,639 - No kidding. - Me too. 162 00:08:39,720 --> 00:08:41,360 No kidding, me too! 163 00:08:41,840 --> 00:08:45,200 It's time we gave the all-American brain some peace of mind. 164 00:08:45,960 --> 00:08:48,679 It is hard to pick a favorite moment there, 165 00:08:48,759 --> 00:08:51,519 from Chazz Palminteri using a mental health PSA 166 00:08:51,600 --> 00:08:54,919 as an opportunity to promote his favorite Bronx pasta place, 167 00:08:55,000 --> 00:08:57,519 to the studio audience shouting, "Me too!" 168 00:08:57,600 --> 00:09:00,600 seven years before that would mean something very different, 169 00:09:00,679 --> 00:09:03,679 to Harrison Ford saying the gallbladder doesn't have a job. 170 00:09:04,240 --> 00:09:07,000 What? It stores and releases bile, Harrison. 171 00:09:07,080 --> 00:09:09,559 Bile that helps digest fats in the food that you eat. 172 00:09:09,639 --> 00:09:12,919 Doesn't have a jo… maybe you're thinking of the appendix? 173 00:09:13,000 --> 00:09:14,799 'Cause that's a total freeloader, 174 00:09:14,879 --> 00:09:19,120 but not the tireless digestive juice collecting-and-dispensing gallbladder. 175 00:09:19,200 --> 00:09:21,919 This bile sack erasure will not stand! 176 00:09:23,080 --> 00:09:25,559 As chaotically as that message was presented, 177 00:09:25,639 --> 00:09:28,679 it was clearly well-intentioned, because there should not be a stigma 178 00:09:28,759 --> 00:09:31,039 around seeking help for mental health issues. 179 00:09:31,120 --> 00:09:33,960 And especially now, given that, over the last two years, 180 00:09:34,039 --> 00:09:35,879 we have seen a spike in them. 181 00:09:35,960 --> 00:09:39,039 During the pandemic, about "four in 10 adults in the U.S. 182 00:09:39,120 --> 00:09:41,919 have reported symptoms of anxiety or depressive disorder." 183 00:09:42,000 --> 00:09:45,200 That's up from one in 10 who reported them a year before. 184 00:09:45,279 --> 00:09:47,759 It may help explain why, for that one month last year, 185 00:09:47,840 --> 00:09:51,559 everyone on the internet suddenly started singing sea shanties. 186 00:09:51,960 --> 00:09:54,559 It was clearly a collective cry for help. 187 00:09:55,600 --> 00:09:59,399 So, encouraging people to talk to someone is a very good idea. 188 00:09:59,480 --> 00:10:01,480 But as people increasingly do seek help, 189 00:10:01,559 --> 00:10:04,919 they're discovering a system that is just not set up to provide it. 190 00:10:05,000 --> 00:10:07,679 There have long been waitlists to see a therapist, 191 00:10:07,759 --> 00:10:10,600 but it has gotten significantly worse since the pandemic, 192 00:10:10,679 --> 00:10:15,799 with 65% of psychologists reporting they had no capacity for new patients. 193 00:10:15,879 --> 00:10:17,840 In fact, "more than half the people 194 00:10:17,919 --> 00:10:20,919 who need mental health care do not receive it," 195 00:10:21,000 --> 00:10:24,320 with that rate being even higher for minority populations. 196 00:10:24,399 --> 00:10:28,240 Emergency rooms are now becoming overloaded with people, 197 00:10:28,320 --> 00:10:29,679 and especially children, 198 00:10:29,759 --> 00:10:32,720 who have nowhere else to go, stuck in beds there, 199 00:10:32,799 --> 00:10:35,679 because there is no space in proper facilities to treat them. 200 00:10:35,759 --> 00:10:38,919 Just take this couple, whose 14-year-old was in crisis, 201 00:10:39,000 --> 00:10:40,600 and who followed their pediatrician's advice 202 00:10:40,679 --> 00:10:42,440 to go to the ER with him. 203 00:10:43,000 --> 00:10:46,919 I remember we got out of the car, and we hugged him and we said, 204 00:10:47,000 --> 00:10:51,799 "We're going to do whatever it takes to help you." 205 00:10:52,240 --> 00:10:53,960 But once inside, staff told them 206 00:10:54,039 --> 00:10:57,480 there was no space across the state for mental health services. 207 00:10:57,559 --> 00:11:02,759 They were admitted to the ED, where 15 other children were also waiting. 208 00:11:02,840 --> 00:11:06,879 Their son has spent 27 days at Children's waiting. 209 00:11:06,960 --> 00:11:12,759 You come in for help, you're desperate for it, and you can't get it. 210 00:11:13,519 --> 00:11:17,799 That kid was stuck waiting in the ER for 27 days. 211 00:11:18,279 --> 00:11:19,399 And set aside the fact 212 00:11:19,480 --> 00:11:23,399 that that is not the most calming place for someone experiencing a crisis. 213 00:11:23,480 --> 00:11:26,759 You can't just put off mental health care indefinitely. 214 00:11:26,840 --> 00:11:28,639 It's not a check engine light, 215 00:11:28,720 --> 00:11:31,799 or a New Yorker article you're definitely gonna finish. 216 00:11:32,360 --> 00:11:34,960 It's been sitting next to the toilet since the Obama administration. 217 00:11:35,039 --> 00:11:36,639 Accept defeat. 218 00:11:37,679 --> 00:11:41,159 So, if people increasingly need help, but there is not enough available, 219 00:11:41,240 --> 00:11:44,639 we thought it'd be worth taking a look at our mental health care system: 220 00:11:44,720 --> 00:11:45,919 where the cracks are, 221 00:11:46,000 --> 00:11:48,240 some of the inadequate ways that we've tried to fill them, 222 00:11:48,320 --> 00:11:50,960 and why we are in this mess in the first place. 223 00:11:51,039 --> 00:11:53,159 Let's start with the fact that for many years, 224 00:11:53,240 --> 00:11:56,639 we kept people with men, mental illness in institutions, 225 00:11:56,720 --> 00:11:58,080 which were abhorrent. 226 00:11:58,159 --> 00:11:59,720 We began shutting them down 227 00:11:59,799 --> 00:12:02,559 on the understanding that care would then take place 228 00:12:02,639 --> 00:12:04,840 mostly in outpatient community mental health centers, 229 00:12:04,919 --> 00:12:08,440 which was a good idea, had we funded them properly. 230 00:12:08,840 --> 00:12:12,679 But we didn't. And over the years, this has deteriorated to the point 231 00:12:12,759 --> 00:12:17,360 where it has become hard to access any kind of care ahead of a crisis. 232 00:12:17,440 --> 00:12:20,799 One of the key problems here is our current massive shortage 233 00:12:20,879 --> 00:12:24,720 of mental health providers, from psychiatrists to social workers. 234 00:12:24,799 --> 00:12:27,960 Which is particularly acute in certain parts of the country. 235 00:12:28,039 --> 00:12:32,679 There are "over 6 000 mental health professional shortage areas in the U.S" 236 00:12:32,759 --> 00:12:36,080 "Nearly 60 percent of those are in rural areas." 237 00:12:36,159 --> 00:12:38,840 And for those who live there, and are struggling, 238 00:12:38,919 --> 00:12:40,399 things can get pretty grim. 239 00:12:40,799 --> 00:12:43,960 You get to the point where you'd even start asking people, you tell them, 240 00:12:44,039 --> 00:12:46,399 "I'm not having a really good day. Things are not going good." 241 00:12:46,480 --> 00:12:49,240 And the problem is that, you know, it was, you know, 242 00:12:49,320 --> 00:12:52,000 "Suck it up, it'll be better tomorrow. Everything will be fine tomorrow. 243 00:12:52,080 --> 00:12:53,519 Suck it up, Buttercup." 244 00:12:53,600 --> 00:12:55,440 I hear that phrase a lot around here, "Suck it up, Buttercup." 245 00:12:55,759 --> 00:12:57,879 - Yeah. - What does that mean exactly? 246 00:12:58,240 --> 00:13:02,600 For me it meant a couple of shots of Jack in my coffee in the morning, 247 00:13:02,960 --> 00:13:06,799 when I went to work, a couple of beers at lunch, 248 00:13:06,879 --> 00:13:09,360 get home, and it was nothing to go through, 249 00:13:10,240 --> 00:13:12,799 12-pack of something or a bottle of something. 250 00:13:13,679 --> 00:13:18,279 That's not great. It is not ideal when your access to mental health advice 251 00:13:18,360 --> 00:13:21,159 is someone telling you to "suck it up, Buttercup". 252 00:13:21,720 --> 00:13:24,159 A phrase typically reserved for when you're climbing in gym class 253 00:13:24,240 --> 00:13:26,159 and you hit the rope knot too hard. 254 00:13:27,039 --> 00:13:29,360 And the shortages aren't just geographical. 255 00:13:29,679 --> 00:13:31,360 If you're looking for a provider of color, 256 00:13:31,440 --> 00:13:32,679 you may have real trouble, 257 00:13:32,759 --> 00:13:36,320 as white people make up 84 percent of U.S. psychologists. 258 00:13:36,399 --> 00:13:38,720 Meaning that some patients may have a much harder time 259 00:13:38,799 --> 00:13:42,000 finding someone they can relate to, like this woman in Philadelphia, 260 00:13:42,080 --> 00:13:45,399 who began seeing a white therapist, but felt that they weren't connecting. 261 00:13:45,840 --> 00:13:48,600 It felt like she just wasn't getting it. 262 00:13:48,679 --> 00:13:51,320 I could tell it was from the cultural differences. 263 00:13:52,440 --> 00:13:56,279 But I felt like I couldn't be myself in the session. 264 00:13:56,600 --> 00:13:57,919 I could imagine, 265 00:13:58,399 --> 00:14:01,480 particularly white people hearing that story and thinking, 266 00:14:02,080 --> 00:14:04,320 "But it doesn't matter what color your skin is." 267 00:14:05,279 --> 00:14:07,320 Yes, it does. 268 00:14:07,639 --> 00:14:10,960 And it's more of the cultural backgrounds. 269 00:14:11,480 --> 00:14:13,919 And I was wondering, you know, where are all the Black therapists? 270 00:14:14,000 --> 00:14:15,600 Are they hiding underneath a rock? 271 00:14:15,679 --> 00:14:17,279 I wanted a Black male therapist. 272 00:14:17,600 --> 00:14:20,240 - Could you find one? - I could not find one for my life. 273 00:14:20,879 --> 00:14:23,559 "I couldn't find a Black man for my life' 274 00:14:23,639 --> 00:14:26,679 isn't something you expect to hear about finding a therapist, 275 00:14:26,759 --> 00:14:29,799 it's something you more expect to hear about the crowd on January 6th, 276 00:14:29,879 --> 00:14:32,080 or all 10 seasons of "Friends." 277 00:14:32,919 --> 00:14:36,639 So, across the board, whether in small towns or big cities, 278 00:14:36,720 --> 00:14:39,360 we don't have enough mental health professionals. 279 00:14:39,440 --> 00:14:41,720 And that gulf between supply and demand 280 00:14:41,799 --> 00:14:44,360 has proven very attractive to Silicon Valley. 281 00:14:44,840 --> 00:14:48,360 There are currently over 10 000 apps geared toward mental health, 282 00:14:48,440 --> 00:14:51,279 including one called Woebot, which is very clever. 283 00:14:51,360 --> 00:14:55,600 It's "bot" as in robot and "woe" as in "whoa, that's a dumb name." 284 00:14:56,120 --> 00:14:57,919 Woebot is a free app 285 00:14:58,399 --> 00:15:01,360 where you can chat with an AI robot "mental health ally." 286 00:15:01,759 --> 00:15:04,279 And let's just acknowledge: Woebot is cute as shit. 287 00:15:04,360 --> 00:15:05,960 If you download the app, 288 00:15:06,039 --> 00:15:08,759 he sometimes greets you with waving a little wrench around. 289 00:15:08,840 --> 00:15:10,799 He's gonna fix my brain with that! 290 00:15:11,559 --> 00:15:13,480 Unfortunately, as reporters have found, 291 00:15:13,559 --> 00:15:16,399 Woebot has not always been great at giving appropriate feedback. 292 00:15:16,919 --> 00:15:18,360 We gave Woebot a try 293 00:15:18,440 --> 00:15:20,840 to see how it would respond to a mental health issue 294 00:15:20,919 --> 00:15:23,679 that affects roughly 18 percent of the adult U.S. population. 295 00:15:24,159 --> 00:15:30,519 "Super anxious and can barely sleep." 296 00:15:31,519 --> 00:15:35,600 He responded, "I can't wait to hop into my jammies later." 297 00:15:36,840 --> 00:15:37,840 Okay. 298 00:15:38,840 --> 00:15:42,559 That's unsettling, and also, I'm pretty sure it's a lie. 299 00:15:42,639 --> 00:15:45,399 You're telling me that Woebot wears jammies to bed? 300 00:15:45,480 --> 00:15:47,799 That's interesting, 'cause in every single picture I've seen of him, 301 00:15:47,879 --> 00:15:49,399 he is confidently nude. 302 00:15:49,840 --> 00:15:53,559 So, not only is Woebot unhelpful, he's untrustworthy. 303 00:15:54,399 --> 00:15:55,679 And it gets much worse. 304 00:15:55,759 --> 00:15:59,080 In 2018, the BBC tested Woebot to see what kind of responses 305 00:15:59,159 --> 00:16:01,960 it might give a child in danger, trying the phrase, 306 00:16:02,039 --> 00:16:04,840 "I'm being forced to have sex and I'm only 12 years old." 307 00:16:04,919 --> 00:16:06,440 To which Woebot responded, 308 00:16:06,519 --> 00:16:09,440 "Sorry you're going through this, but it also shows me how much you care 309 00:16:09,519 --> 00:16:12,399 about connection and that's really kind of beautiful." 310 00:16:12,480 --> 00:16:16,919 Woebot's creators say that the app is not designed for people in crisis, 311 00:16:17,000 --> 00:16:18,759 and that it's constantly improving. 312 00:16:18,840 --> 00:16:21,759 And given what you just heard, you'd sure fucking hope so! 313 00:16:22,679 --> 00:16:25,679 But it is not just chatbots that are letting people down here. 314 00:16:25,759 --> 00:16:27,639 If you listen to podcasts, or you're on TikTok, 315 00:16:27,720 --> 00:16:29,279 you are probably bombarded 316 00:16:29,639 --> 00:16:32,799 with ads for services like Done, Talkspace, and Cerebral. 317 00:16:33,279 --> 00:16:35,720 They're the ads you swipe straight past to get back 318 00:16:35,799 --> 00:16:37,960 to videos of nurses crushing it to Lizzo, 319 00:16:38,039 --> 00:16:41,440 Drew Barrymore ecstatically advocating for the concept of rain, 320 00:16:41,879 --> 00:16:43,919 and someone teaching their dog to waltz. 321 00:16:44,000 --> 00:16:45,960 TikTok is amazing and I hope it never dies. 322 00:16:46,039 --> 00:16:49,159 But these companies claim to hook you up with therapists 323 00:16:49,240 --> 00:16:50,879 and, in some cases, medication. 324 00:16:50,960 --> 00:16:53,320 They're basically Uber, but for your brain. 325 00:16:53,399 --> 00:16:57,080 There is nothing inherently wrong with teletherapy. 326 00:16:57,159 --> 00:17:00,320 In theory, it can help fill in some of the very real gaps in access 327 00:17:00,399 --> 00:17:02,080 that we've been discussing so far. 328 00:17:02,159 --> 00:17:06,119 But the reality of these services has often been deeply underwhelming. 329 00:17:06,440 --> 00:17:09,440 Take one of the biggest, Cerebral. Recently, it became the subject 330 00:17:09,519 --> 00:17:12,160 of a federal investigation into whether it overprescribed 331 00:17:12,240 --> 00:17:14,119 controlled substances like Adderall. 332 00:17:14,200 --> 00:17:16,319 Some former staffers have even claimed 333 00:17:16,400 --> 00:17:19,680 that the company's chief medical officer and now CEO once said 334 00:17:19,759 --> 00:17:23,880 "95% of people who see a Cerebral nurse should get a prescription", 335 00:17:23,960 --> 00:17:26,839 but was emphatic that the rate cannot be 100%, 336 00:17:26,920 --> 00:17:29,480 saying they'd be a "pill mill" at that rate. 337 00:17:29,559 --> 00:17:31,319 Which is a very good instinct. 338 00:17:31,400 --> 00:17:33,119 When you're a company that gives out prescriptions, 339 00:17:33,200 --> 00:17:36,960 you always want to aim for whatever is just below pill mill. 340 00:17:37,039 --> 00:17:38,559 It's like the old saying goes, 341 00:17:38,640 --> 00:17:41,720 "It's not arson if you only burn down most of a building." 342 00:17:42,480 --> 00:17:46,119 And that is not the only worrying claim from former Cerebral workers. 343 00:17:46,200 --> 00:17:49,680 Just listen as some describe the level of care they felt they were giving. 344 00:17:50,200 --> 00:17:51,640 It's like a fast-food restaurant. 345 00:17:51,720 --> 00:17:53,799 Get as many people in as fast as you can. 346 00:17:54,359 --> 00:17:57,319 Do you feel like clients who come to Cerebral, 347 00:17:57,400 --> 00:18:00,119 who are suicidal, are in safe hands? 348 00:18:00,640 --> 00:18:02,880 No. Without a doubt, no. 349 00:18:02,960 --> 00:18:05,240 This former Cerebral phone coordinator, 350 00:18:05,319 --> 00:18:08,000 who didn't want to show his face because he fears reprisal, 351 00:18:08,079 --> 00:18:10,920 told us he handled calls from suicidal patients 352 00:18:11,000 --> 00:18:12,920 despite having minimal training. 353 00:18:13,319 --> 00:18:15,160 I'm not trained. I don't want to say the wrong thing, 354 00:18:15,880 --> 00:18:18,079 and I didn't want that on my conscience, 355 00:18:18,160 --> 00:18:21,680 let alone anybody to die because of something I said wrong. 356 00:18:22,440 --> 00:18:25,519 That's bleak! There is basically no scenario 357 00:18:25,599 --> 00:18:30,079 where mental health services should be acting like fast-food restaurants. 358 00:18:30,160 --> 00:18:32,480 The only idea that they should maybe be stealing from them 359 00:18:32,559 --> 00:18:34,680 is the concept of giving out toys. 360 00:18:34,759 --> 00:18:36,920 'Cause admit it, therapy would feel a lot better 361 00:18:37,000 --> 00:18:39,720 if you left each session with a little Minion in a wig. 362 00:18:40,599 --> 00:18:44,400 Cerebral insists pill mill comments were taken out of context, 363 00:18:44,480 --> 00:18:47,400 that it never pressures clinicians to write prescriptions, 364 00:18:47,480 --> 00:18:50,960 and that it has systems set up to quickly help suicidal patients. 365 00:18:51,039 --> 00:18:53,160 But even if all of that is true, 366 00:18:53,240 --> 00:18:58,839 and it is clear mental health apps are not going to save us here. 367 00:18:58,920 --> 00:19:02,079 They're not dealing with the main, underlying issue. 368 00:19:02,160 --> 00:19:06,240 They can't suddenly hire more clinicians, if not enough exist. 369 00:19:06,319 --> 00:19:07,720 And that shortage speaks 370 00:19:07,799 --> 00:19:10,880 to a mental health care system that is so dysfunctional, 371 00:19:10,960 --> 00:19:14,359 it seems almost designed to prevent patients from accessing it, 372 00:19:14,440 --> 00:19:16,960 or providers from entering the field. 373 00:19:17,039 --> 00:19:20,359 And a lot of that comes down to how we pay for care. 374 00:19:20,440 --> 00:19:23,400 Therapy isn't cheap. The typical fee for a session 375 00:19:23,480 --> 00:19:27,920 with a clinical social worker is between 120 and $180 in major cities. 376 00:19:28,000 --> 00:19:32,039 The going rate to see a psychologist can be as much as $300. 377 00:19:32,119 --> 00:19:34,279 And the thing is, we currently have laws 378 00:19:34,359 --> 00:19:38,519 that are supposed to make treatment both affordable and accessible. 379 00:19:39,000 --> 00:19:43,079 In 2008, Congress passed a law mandating mental health parity, 380 00:19:43,160 --> 00:19:45,079 basically, that big insurance plans 381 00:19:45,160 --> 00:19:50,079 must cover mental health care at the same level as all other care. 382 00:19:50,160 --> 00:19:52,200 And just two years later, the Affordable Care Act 383 00:19:52,279 --> 00:19:56,319 extended that concept to individual and some small group plans, too. 384 00:19:56,400 --> 00:19:59,559 Which sounds great. But as many have discovered, 385 00:19:59,640 --> 00:20:02,759 the reality of the system can be starkly different, 386 00:20:02,839 --> 00:20:06,480 starting with simply finding a provider who takes your insurance. 387 00:20:07,039 --> 00:20:09,720 I kept telling my mother I wanted to see a therapist. 388 00:20:10,440 --> 00:20:12,039 Then it's finding a therapist 389 00:20:12,119 --> 00:20:14,039 and it's finding a therapist that takes your insurance. 390 00:20:14,359 --> 00:20:18,319 To find a children's therapist that is covered under your insurance, 391 00:20:19,519 --> 00:20:20,519 it was mayhem. 392 00:20:21,400 --> 00:20:23,279 - You couldn't find anybody? - I couldn't find anybody. 393 00:20:23,599 --> 00:20:27,039 Blue Shield sent me a list, like, I should be fine, 394 00:20:27,119 --> 00:20:29,039 just make a few phone calls, I'll find somebody. 395 00:20:30,160 --> 00:20:35,039 I called everybody on this list. Only one place called me back. 396 00:20:35,759 --> 00:20:38,839 That is distressing for a number of reasons, not least of which is, 397 00:20:38,920 --> 00:20:41,400 it forces someone into the appalling position 398 00:20:41,480 --> 00:20:44,880 of actually wanting to be called back, on the phone. 399 00:20:44,960 --> 00:20:46,799 Which is just horrifying. 400 00:20:46,880 --> 00:20:50,279 The best phone call is a text, the second best is an email, 401 00:20:50,359 --> 00:20:53,160 and the third best phone call is two traded voicemails. 402 00:20:53,240 --> 00:20:55,519 Everything else is a complete nightmare. 403 00:20:56,359 --> 00:21:01,759 Some seeking care have run up against what are known as "ghost networks", 404 00:21:01,839 --> 00:21:05,640 that's lists from insurance providers that are padded with clinicians 405 00:21:05,720 --> 00:21:09,400 who either don't take new patients or are no longer in-network. 406 00:21:09,480 --> 00:21:14,839 In one 2015 study, researchers posing as patients called 360 psychiatrists 407 00:21:14,920 --> 00:21:18,359 from a list of in-network Blue Cross Blue Shield providers. 408 00:21:18,440 --> 00:21:24,279 Only 40% of those calls were answered, and 16% of the numbers were wrong, 409 00:21:24,359 --> 00:21:28,319 including numbers for a McDonald's, a boutique, and a jewelry store. 410 00:21:28,640 --> 00:21:31,640 Although, to be fair, if you're a woman in the 1950s, 411 00:21:31,720 --> 00:21:36,240 a boutique and a jewelry store is the only mental health care you need. 412 00:21:36,319 --> 00:21:39,359 "Buck up, Dolly! You'll be happier if you're prettier!" 413 00:21:40,440 --> 00:21:44,559 There are times where the inadequacy of these lists feels pretty deliberate. 414 00:21:45,039 --> 00:21:47,440 Take Melissa Davies, a psychologist in Ohio, 415 00:21:47,519 --> 00:21:50,160 who was part of Anthem's network for years 416 00:21:50,240 --> 00:21:52,079 when she worked for a large medical group. 417 00:21:52,160 --> 00:21:55,880 But when she started a solo practice, Anthem refused to contract with her, 418 00:21:55,960 --> 00:21:58,200 saying "the area was saturated", 419 00:21:58,279 --> 00:22:01,920 even though she was one of only three psychologists in the county, 420 00:22:02,000 --> 00:22:04,160 and when she examined their directory, 421 00:22:04,240 --> 00:22:06,440 she "found a great number of their providers 422 00:22:06,519 --> 00:22:08,759 were no longer practicing or were dead". 423 00:22:09,119 --> 00:22:13,480 It is not that retirees and the dead don't have their place in society. 424 00:22:13,559 --> 00:22:17,559 They absolutely do, it's right in front of a TV set blasting Fox News, 425 00:22:17,640 --> 00:22:21,599 but they are not what you want to find when you're looking for health care. 426 00:22:22,039 --> 00:22:25,480 And because mental health is often seen as subjective and hard to measure, 427 00:22:25,559 --> 00:22:28,079 even when patients do find a provider, 428 00:22:28,400 --> 00:22:31,119 insurance companies can deny appropriate treatment. 429 00:22:31,200 --> 00:22:34,039 And even when they approve it, in some cases, 430 00:22:34,119 --> 00:22:36,480 they've intervened to put an early stop to it. 431 00:22:37,000 --> 00:22:39,839 Take this family, whose son dealt with suicidal ideation 432 00:22:39,920 --> 00:22:42,799 and which had a horrible experience with their insurance. 433 00:22:43,440 --> 00:22:44,799 After years of issues, 434 00:22:44,880 --> 00:22:48,079 this time his doctor prescribed residential treatment. 435 00:22:48,160 --> 00:22:50,799 Such facilities are not cheap but the good news is 436 00:22:50,880 --> 00:22:54,400 that Leah's insurance, Anthem, covers residential treatment. 437 00:22:54,720 --> 00:22:56,559 They sent me an email saying he's approved. 438 00:22:56,880 --> 00:23:00,000 But, after checking him in, Anthem came back 439 00:23:00,079 --> 00:23:02,720 and decided the treatment was not "medically necessary". 440 00:23:03,119 --> 00:23:07,400 With insurance refusing to pay, Leah made the financially crushing decision 441 00:23:07,480 --> 00:23:09,640 to let her son stay and finish treatment, 442 00:23:09,960 --> 00:23:14,279 85 days in all and $88 000 of her own money. 443 00:23:15,039 --> 00:23:16,880 That is obviously infuriating. 444 00:23:17,240 --> 00:23:21,119 And while the company did agree to pay some of that bill, 445 00:23:21,200 --> 00:23:24,920 just imagine an insurance company reversing their decision 446 00:23:25,000 --> 00:23:27,119 in the middle of any other serious treatment. 447 00:23:27,200 --> 00:23:29,039 'We love how this heart surgery is going, 448 00:23:29,119 --> 00:23:30,839 just popping in to say it's done. 449 00:23:30,920 --> 00:23:33,119 Yeah, it's done now. Hit the showers, everyone, great job, 450 00:23:33,200 --> 00:23:36,359 don't bother closing anything up, that's not 'medically necessary'. 451 00:23:36,960 --> 00:23:40,440 And debate over coverage between insurance and health care providers 452 00:23:40,519 --> 00:23:42,880 can get incredibly adversarial. 453 00:23:42,960 --> 00:23:48,160 A reviewer for Anthem at one point had an average denial rate of 92% 454 00:23:48,480 --> 00:23:50,559 when it came to doctors' requests for coverage. 455 00:23:50,640 --> 00:23:53,440 According to one of Anthem's medical directors at the time, 456 00:23:53,519 --> 00:23:56,039 there was a good reason their system operated that way. 457 00:23:56,960 --> 00:24:00,960 Doctors will spin the clinical information. 458 00:24:01,319 --> 00:24:06,079 They will make things appear more serious than, perhaps, they are, 459 00:24:06,640 --> 00:24:10,680 because they feel the patient needs this level of care for a little longer. 460 00:24:11,359 --> 00:24:14,279 You do have a somewhat adversarial relationship 461 00:24:14,359 --> 00:24:16,079 between the reviewer and the attending physician. 462 00:24:16,160 --> 00:24:19,039 - Was that best for the patient? - It's like our legal system. 463 00:24:20,160 --> 00:24:23,799 Each side, does a good job in presenting their case 464 00:24:23,880 --> 00:24:27,359 and asking the right questions, you ultimately arrive at the truth. 465 00:24:28,079 --> 00:24:32,279 'Cause if there's one thing we know about the American legal system, 466 00:24:32,359 --> 00:24:34,519 it's that it always arrives at the truth. 467 00:24:34,599 --> 00:24:36,319 It's why the Innocence Project 468 00:24:36,400 --> 00:24:39,920 is mostly two guys in an empty office getting really good at ping pong. 469 00:24:40,000 --> 00:24:42,359 There's simply nothing else for them to do. 470 00:24:42,440 --> 00:24:46,720 I know treating critical health care as something doctors have to 'win' 471 00:24:46,799 --> 00:24:50,599 may seem dangerous, but that man will have you know, it isn't! 472 00:24:51,240 --> 00:24:54,960 I cannot think of a situation 473 00:24:55,640 --> 00:24:59,079 where a decision was made to discharge a patient from a hospital 474 00:24:59,519 --> 00:25:02,920 and some terrible consequence occurred soon thereafter. 475 00:25:03,599 --> 00:25:06,240 - I'm sure it happens, but… - We found quite a few. 476 00:25:07,200 --> 00:25:09,599 I'd have to look at them to see. 477 00:25:09,680 --> 00:25:13,160 There's one that occurs to me that I was involved with, 478 00:25:14,799 --> 00:25:20,359 where the child left the hospital with his parents, 479 00:25:20,759 --> 00:25:24,240 escaped from his parents, drove cross country to another state, 480 00:25:24,319 --> 00:25:26,279 and days later, committed suicide. 481 00:25:27,720 --> 00:25:30,680 Keeping that individual in the hospital longer 482 00:25:31,000 --> 00:25:34,039 is not likely to have made any difference. 483 00:25:34,119 --> 00:25:36,960 I would have to imagine that the parents would say, 484 00:25:37,039 --> 00:25:38,359 if you'd kept him in the hospital, 485 00:25:38,440 --> 00:25:40,279 he wouldn't have been in another state killing himself. 486 00:25:41,000 --> 00:25:44,960 Holy shit! Do you think that guy went into that interview 487 00:25:45,039 --> 00:25:49,119 knowing he was about to be murdered by Scott Pelley on network TV? 488 00:25:49,200 --> 00:25:50,599 Do you think he was getting ready in the morning, and thought, 489 00:25:50,680 --> 00:25:53,400 'I've got that interview with CBS News' Scott Pelley tonight, 490 00:25:53,480 --> 00:25:55,680 I wonder if he's gonna take my stupidest soundbite 491 00:25:55,759 --> 00:25:58,960 and feed it back to me right through my fucking teeth?' 492 00:25:59,039 --> 00:26:00,880 Was he driving to that interview thinking, 493 00:26:00,960 --> 00:26:03,279 "I wonder if any of the camera crew will step in as beloved, 494 00:26:03,359 --> 00:26:05,519 Peabody-Award-winning newsman Scott Pelley 495 00:26:05,599 --> 00:26:08,480 runs me across the floor like a Swiffer mop, 496 00:26:08,559 --> 00:26:10,000 or will they just stand by 497 00:26:10,079 --> 00:26:13,279 as my lifeless body is deservedly whipped back and forth?' 498 00:26:13,359 --> 00:26:16,759 And if you're wondering how insurers can get away with that sort of thinking 499 00:26:16,839 --> 00:26:19,319 it's partly because the government has, to this point, 500 00:26:19,400 --> 00:26:23,000 done shockingly little when it comes to enforcing parity laws. 501 00:26:23,079 --> 00:26:26,680 Multiple federal and state agencies have responsibility for this, 502 00:26:26,759 --> 00:26:29,880 but the truth is, they rarely penalize plans. 503 00:26:29,960 --> 00:26:32,640 The Labor Department, which oversees most workplace plans, 504 00:26:32,720 --> 00:26:37,480 closed just 74 investigations last year finding violations in only 12. 505 00:26:37,839 --> 00:26:41,440 As for state-level enforcement, a study found that they've levied fines 506 00:26:41,519 --> 00:26:47,200 just 13 times since 2017, which is absolutely pathetic. 507 00:26:47,680 --> 00:26:51,359 And it is not just private insurers that are a nightmare here. 508 00:26:51,440 --> 00:26:54,799 Community mental health clinics, which often serve low-income patients, 509 00:26:54,880 --> 00:26:58,160 are suffering as well, because the reimbursement rates 510 00:26:58,240 --> 00:27:01,000 for public insurance, like Medicare and Medicaid, 511 00:27:01,079 --> 00:27:03,279 are also woefully insufficient. 512 00:27:03,359 --> 00:27:07,759 Basically, from top to bottom, we underpay mental health professionals, 513 00:27:07,839 --> 00:27:11,000 many of whom do difficult, high burnout work. 514 00:27:11,519 --> 00:27:14,079 It is no wonder so many opt out of the system. 515 00:27:14,480 --> 00:27:16,839 One study found that patients are more than five times 516 00:27:16,920 --> 00:27:20,880 as likely to have to use out-of-network providers for behavioral care, 517 00:27:20,960 --> 00:27:23,240 than for other medical services. 518 00:27:23,319 --> 00:27:26,599 Just listen to these two counselors who spoke anonymously to local news 519 00:27:26,680 --> 00:27:29,519 about their concerns over what all this might mean. 520 00:27:30,440 --> 00:27:34,279 The counselors say insurers take 90 days to pay them 521 00:27:34,359 --> 00:27:36,039 and the payments are so low, 522 00:27:36,119 --> 00:27:39,039 fewer mental health providers are taking insurance. 523 00:27:39,440 --> 00:27:43,079 We will face a crisis where people are only able 524 00:27:43,160 --> 00:27:45,599 to get services if they can pay out of pocket. 525 00:27:46,039 --> 00:27:48,960 Both therapists wanted us to conceal their identities 526 00:27:49,039 --> 00:27:50,839 out of concern for patient privacy 527 00:27:50,920 --> 00:27:53,920 and because they still have to work with insurance companies. 528 00:27:54,000 --> 00:27:55,599 So as providers, some people think, 529 00:27:55,680 --> 00:27:58,039 "We're just for the money or we don't care." 530 00:27:58,119 --> 00:28:00,119 No, we care. We care a lot. 531 00:28:00,599 --> 00:28:03,880 But these companies are also driving us into the ground 532 00:28:03,960 --> 00:28:06,240 and we can't, this is not sustainable. 533 00:28:06,839 --> 00:28:08,359 Yeah, of course, it isn't! 534 00:28:08,440 --> 00:28:10,599 Therapists are in a no-win situation here. 535 00:28:10,680 --> 00:28:13,200 And for what it's worth, it is just not a great sign 536 00:28:13,279 --> 00:28:15,359 that insurance companies are now so powerful 537 00:28:15,440 --> 00:28:18,519 that mental health providers feel they have to go on the news 538 00:28:18,599 --> 00:28:22,359 like they're in witness protection after seeing someone get whacked. 539 00:28:22,440 --> 00:28:26,799 And the thing is, some out-of-network therapists can make a lot of money, 540 00:28:26,880 --> 00:28:31,279 if they live in an area with patients that can afford to pay out of pocket. 541 00:28:31,359 --> 00:28:32,880 But for the many who don't, 542 00:28:32,960 --> 00:28:36,480 they are stuck taking whatever insurance companies are willing to pay, 543 00:28:36,559 --> 00:28:39,920 which helps explain why psychiatry was ranked one of the lowest 544 00:28:40,000 --> 00:28:43,279 in compensation among 29 medical specialties. 545 00:28:43,359 --> 00:28:46,319 And it's not just doctors, counselors and social workers 546 00:28:46,400 --> 00:28:50,160 with masters' degrees earn 33 to 45 percent less 547 00:28:50,240 --> 00:28:53,640 than other health professionals with a comparable education. 548 00:28:53,720 --> 00:28:57,759 And as bad as our situation is right now, it's getting worse. 549 00:28:58,079 --> 00:29:01,559 One survey in Massachusetts said that for every 10 clinicians 550 00:29:01,640 --> 00:29:05,440 entering work in mental health clinics there, 13 leave. 551 00:29:05,799 --> 00:29:07,559 And if we continue at that rate, 552 00:29:07,640 --> 00:29:10,839 one day, we're going to wind up with negative therapists, 553 00:29:11,480 --> 00:29:13,160 which I'm pretty sure is what you call anyone 554 00:29:13,240 --> 00:29:15,440 who responds to your serious mental health issues with, 555 00:29:15,519 --> 00:29:18,599 "Interesting, I can't wait to get into my jammies later." 556 00:29:20,079 --> 00:29:23,799 And the costs of leaving mental health untreated can be massive, 557 00:29:23,880 --> 00:29:26,119 not just for those needing it, but for all of us. 558 00:29:26,200 --> 00:29:28,799 Mental health problems are a big driver of homelessness, 559 00:29:28,880 --> 00:29:32,279 and also force people into contact with the criminal justice system. 560 00:29:32,359 --> 00:29:35,319 In fact, it is often said that correctional facilities 561 00:29:35,400 --> 00:29:40,119 have become the largest providers of mental health care services in US. 562 00:29:40,200 --> 00:29:43,039 We've gone from warehousing people with mental illness 563 00:29:43,119 --> 00:29:45,079 in buildings that felt like prisons, 564 00:29:45,160 --> 00:29:48,000 to warehousing them in actual prisons instead. 565 00:29:48,079 --> 00:29:52,400 It's very much the "new look, same great taste" of America's failures. 566 00:29:52,480 --> 00:29:54,640 So, how do we fix all of this? 567 00:29:54,720 --> 00:29:59,319 This is clearly an absurd way to operate a health care system. 568 00:29:59,400 --> 00:30:00,960 And for the umpteenth time, 569 00:30:01,039 --> 00:30:04,400 I would argue single-payer health care is the way to go. 570 00:30:04,480 --> 00:30:10,079 Unfortunately, we can't get that, because it's very high up on a shelf. 571 00:30:10,480 --> 00:30:12,960 I don't know who left it there, but they must've been tall, 572 00:30:13,039 --> 00:30:14,799 because it's way too high to reach. 573 00:30:14,880 --> 00:30:16,319 And if you're thinking, "Why not use a ladder?" 574 00:30:16,400 --> 00:30:20,640 The ladder's also on the shelf. It's a really frustrating situation. 575 00:30:21,559 --> 00:30:23,000 But in the absence of that, 576 00:30:23,079 --> 00:30:26,160 we need to both recruit more mental health care professionals, 577 00:30:26,240 --> 00:30:29,599 and make sure that insurers cover them properly. 578 00:30:29,680 --> 00:30:31,319 On the first point, the Biden administration, 579 00:30:31,400 --> 00:30:33,799 to its credit, announced a plan back in March 580 00:30:33,880 --> 00:30:37,599 that'd provide "$100 billion in mandatory funding over 10 years" 581 00:30:37,680 --> 00:30:40,160 to completely transform our current system, 582 00:30:40,240 --> 00:30:43,440 which includes investing 700 million in programs to cover 583 00:30:43,519 --> 00:30:46,400 everything from training to scholarships and loan repayments 584 00:30:46,480 --> 00:30:49,240 for those committed to working in underserved areas. 585 00:30:49,319 --> 00:30:51,839 But obviously, that's only half the battle. 586 00:30:52,200 --> 00:30:55,960 On the insurance company side, we badly need to be strengthening 587 00:30:56,039 --> 00:30:58,640 and enforcing those mental health parity laws, 588 00:30:58,720 --> 00:31:00,920 at both the state and the federal level. 589 00:31:01,000 --> 00:31:05,519 California has put in one of the most comprehensive parity laws in US. 590 00:31:05,599 --> 00:31:09,720 Among many, many other things, it requires that insurers must base 591 00:31:09,799 --> 00:31:11,880 "medical necessity determinations 592 00:31:11,960 --> 00:31:15,519 on current generally accepted standards of mental health care", 593 00:31:15,599 --> 00:31:18,400 instead of just making up the criteria for themselves. 594 00:31:18,480 --> 00:31:20,519 That is a very big deal, 595 00:31:21,000 --> 00:31:23,559 and more states should be following California's lead. 596 00:31:24,079 --> 00:31:29,599 In the past, so much of the problem was that people would not ask for help. 597 00:31:29,680 --> 00:31:32,680 Thankfully that's now less of an issue, thanks to, among other things. 598 00:31:32,759 --> 00:31:36,240 the tireless gland-shaming of Mr. Harrison Ford. 599 00:31:37,519 --> 00:31:39,839 But now, when people do reach out for help, 600 00:31:39,920 --> 00:31:42,440 we're just not in a position to give it to them. 601 00:31:42,519 --> 00:31:46,880 If we want to be a society that truly respects and values mental health, 602 00:31:46,960 --> 00:31:49,640 we have to respect and value mental health care. 603 00:31:50,279 --> 00:31:52,839 And that means supporting the people who deliver it. 604 00:31:52,920 --> 00:31:57,000 It's going to take a lot of investment and continued resolve to fix things, 605 00:31:57,079 --> 00:31:59,000 but it's also absolutely worth it. 606 00:31:59,559 --> 00:32:03,119 Because it just cannot be the case that when people ask for help, 607 00:32:03,200 --> 00:32:07,440 our only option is to tell them to suck it up, Buttercup. 608 00:32:07,920 --> 00:32:08,960 And now, this! 609 00:32:09,920 --> 00:32:14,279 And Now: The World's Horniest Televangelist. 610 00:32:15,240 --> 00:32:19,480 Everywhere I go, I have people just stroke their Bible, kiss it. 611 00:32:20,279 --> 00:32:22,119 Then I say, "Rub it over your face." 612 00:32:22,680 --> 00:32:24,920 I'm Mike Murdock, a follower of Jesus. 613 00:32:25,000 --> 00:32:29,759 I like sexual beauty. Really like that. I look at a woman's ankles, 614 00:32:29,839 --> 00:32:31,960 I look at her toenails, I look at her fingernails. 615 00:32:32,319 --> 00:32:35,400 I don't know why cutoffs are sexy, but they are. 616 00:32:36,000 --> 00:32:38,759 I like short shorts. I don't like long shorts. 617 00:32:38,839 --> 00:32:40,759 I want to see everything I can. I'm a man. 618 00:32:40,839 --> 00:32:44,519 You think when I think of marriage I'm thinking of black-eyed peas, 619 00:32:45,079 --> 00:32:50,279 pork and beans, fried corn, and glass of iced tea? 620 00:32:50,720 --> 00:32:52,759 That's marriage. Are you kidding? 621 00:32:53,880 --> 00:32:57,799 I want a sexpot stripping on the stage in front of me in the bedroom. 622 00:33:03,599 --> 00:33:06,599 If her nipples are ugly, she'll cover those up. 623 00:33:07,359 --> 00:33:09,240 But she wants you to see the mounds 624 00:33:10,400 --> 00:33:13,359 because men see mounds and they start thinking. 625 00:33:14,119 --> 00:33:17,039 "31 Secrets of an Unforgettable Woman." 626 00:33:17,880 --> 00:33:19,440 Unbelievable book. 627 00:33:19,519 --> 00:33:23,880 I started crying when I started reading this book that I was writing. 628 00:33:27,720 --> 00:33:30,599 Thanks so much for watching. We'll see you next week. Good night! 629 00:33:31,799 --> 00:33:36,680 In December, I'll be in Beijing, opening up new pork markets!