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(Music)

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Moving on. Our main story tonight[br]concerns mental health care.

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It's a subject that historically humans[br]haven't handled particularly well.

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To a famous Bond Street beauty parlor[br]come a bunch of pretty nurses.

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They're greeted by director[br]Ms. Eleanor McDonald.

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They're here not as customers,[br]but as students.

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Ms. McDonald teaches a new group[br]of half a dozen every month.

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It's an official part[br]of their training.

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If you can persuade

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a mentally ill woman to take interest[br]and pride in her appearance,

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you may even swing the balance[br]between despair and recovery.

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"Yes, those pesky women just need[br]a little pep in their step,

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a little drip on their lip,[br]a little flash on their lash.

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Look at me![br]I'm a British voice from the 1950's,

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setting the course of science[br]for decades to come."

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I don't know[br]what is more alarming there,

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nurses being forced to take on the[br]skills of a Sephora brand ambassador

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or the fact[br]that "Can Makeup Cure Sad?"

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sounds like an episode[br]that Dr. Oz definitely did.

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The good news is that since then,

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we've got more comfortable[br]talking about mental health,

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with PSAs like this one from 2010[br]trying to destigmatize it.

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In the all-American[br]health care system,

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there is coverage for heart health,[br]care for cancer.

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But the all-American brain[br]is getting lost in the shuffle.

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Brain tumor, fine.[br]Brain disease, not so fine.

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There's no stigma or discrimination[br]against the heart,

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the liver, the kidney,[br]and the gallbladder.

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Doesn't even have a job.

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Depression was kept in the dark.

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Our goal is to make the discussion[br]of mental disease cool and trendy.

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Let's tear down the stigma[br]surrounding mental illness.

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I'm mad about feeling good.

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- No kidding.[br]- Me too.

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No kidding, me too!

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It's time we gave the all-American[br]brain some peace of mind.

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It is hard to pick[br]a favorite moment there,

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from Chazz Palminteri[br]using a mental health PSA

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as an opportunity to promote[br]his favorite Bronx pasta place,

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to the studio audience shouting,[br]"Me too!"

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seven years before that would mean[br]something very different,

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to Harrison Ford saying the gallbladder[br]doesn't have a job.

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What?[br]It stores and releases bile, Harrison.

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Bile that helps digest fats[br]in the food that you eat.

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Doesn't have a jo…[br]maybe you're thinking of the appendix?

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'Cause that's a total freeloader,

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but not the tireless digestive juice[br]collecting-and-dispensing gallbladder.

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This bile sack erasure will not stand!

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As chaotically[br]as that message was presented,

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it was clearly well-intentioned,[br]because there should not be a stigma

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around seeking help[br]for mental health issues.

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And especially now, given that,[br]over the last two years,

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we have seen a spike in them.

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During the pandemic,[br]about "four in 10 adults in the U.S.

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have reported symptoms[br]of anxiety or depressive disorder."

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That's up from one in 10[br]who reported them a year before.

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It may help explain why,[br]for that one month last year,

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everyone on the internet[br]suddenly started singing sea shanties.

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It was clearly[br]a collective cry for help.

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So, encouraging people to talk[br]to someone is a very good idea.

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But as people increasingly[br]do seek help,

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they're discovering a system[br]that is just not set up to provide it.

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There have long been waitlists[br]to see a therapist,

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but it has gotten significantly worse[br]since the pandemic,

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with 65% of psychologists reporting[br]they had no capacity for new patients.

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In fact,[br]"more than half the people

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who need mental health care[br]do not receive it,"

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with that rate being even higher[br]for minority populations.

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Emergency rooms are now becoming[br]overloaded with people,

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and especially children,

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who have nowhere else to go,[br]stuck in beds there,

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because there is no space[br]in proper facilities to treat them.

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Just take this couple,[br]whose 14-year-old was in crisis,

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and who followed[br]their pediatrician's advice

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to go to the ER with him.

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I remember we got out of the car,[br]and we hugged him and we said,

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"We're going to do[br]whatever it takes to help you."

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But once inside,[br]staff told them

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there was no space across the state[br]for mental health services.

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They were admitted to the ED, where[br]15 other children were also waiting.

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Their son has spent 27 days[br]at Children's waiting.

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You come in for help, you're desperate[br]for it, and you can't get it.

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That kid was stuck[br]waiting in the ER for 27 days.

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And set aside the fact

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that that is not the most calming place[br]for someone experiencing a crisis.

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You can't just put off[br]mental health care indefinitely.

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It's not a check engine light,

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or a New Yorker article[br]you're definitely gonna finish.

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It's been sitting next to the toilet[br]since the Obama administration.

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Accept defeat.

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So, if people increasingly need help,[br]but there is not enough available,

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we thought it'd be worth taking a look[br]at our mental health care system:

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where the cracks are,

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some of the inadequate ways[br]that we've tried to fill them,

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and why we are in this mess[br]in the first place.

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Let's start with the fact[br]that for many years,

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we kept people with men,[br]mental illness in institutions,

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which were abhorrent.

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We began shutting them down

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on the understanding[br]that care would then take place

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mostly in outpatient community[br]mental health centers,

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which was a good idea,[br]had we funded them properly.

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But we didn't. And over the years,[br]this has deteriorated to the point

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where it has become hard to access[br]any kind of care ahead of a crisis.

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One of the key problems here[br]is our current massive shortage

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of mental health providers,[br]from psychiatrists to social workers.

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Which is particularly acute[br]in certain parts of the country.

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There are "over 6 000 mental health[br]professional shortage areas in the U.S"

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"Nearly 60 percent of those[br]are in rural areas."

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And for those who live there,[br]and are struggling,

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things can get pretty grim.

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You get to the point where you'd even[br]start asking people, you tell them,

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"I'm not having a really good day.[br]Things are not going good."

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And the problem is that, you know,[br]it was, you know,

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"Suck it up, it'll be better tomorrow.[br]Everything will be fine tomorrow.

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Suck it up, Buttercup."

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I hear that phrase a lot around here,[br]"Suck it up, Buttercup."

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- Yeah.[br]- What does that mean exactly?

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For me it meant a couple of shots[br]of Jack in my coffee in the morning,

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when I went to work,[br]a couple of beers at lunch,

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get home, and it was nothing[br]to go through,

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12-pack of something[br]or a bottle of something.

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That's not great. It is not ideal when[br]your access to mental health advice

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is someone telling you to[br]"suck it up, Buttercup".

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A phrase typically reserved[br]for when you're climbing in gym class

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and you hit the rope knot[br]too hard.

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And the shortages[br]aren't just geographical.

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If you're looking[br]for a provider of color,

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you may have real trouble,

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as white people make up[br]84 percent of U.S. psychologists.

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Meaning that some patients[br]may have a much harder time

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finding someone they can relate to,[br]like this woman in Philadelphia,

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who began seeing a white therapist,[br]but felt that they weren't connecting.

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It felt[br]like she just wasn't getting it.

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I could tell it was[br]from the cultural differences.

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But I felt like I couldn't be myself[br]in the session.

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I could imagine,

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particularly white people[br]hearing that story and thinking,

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"But it doesn't matter[br]what color your skin is."

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Yes, it does.

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And it's more[br]of the cultural backgrounds.

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And I was wondering, you know,[br]where are all the Black therapists?

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Are they hiding underneath a rock?

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I wanted a Black male therapist.

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- Could you find one?[br]- I could not find one for my life.

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"I couldn't find a Black man[br]for my life'

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isn't something you expect to hear[br]about finding a therapist,

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it's something you more expect to hear[br]about the crowd on January 6th,

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or all 10 seasons of "Friends."

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So, across the board,[br]whether in small towns or big cities,

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we don't have enough[br]mental health professionals.

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And that gulf[br]between supply and demand

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has proven very attractive[br]to Silicon Valley.

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There are currently over 10 000 apps[br]geared toward mental health,

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including one called Woebot,[br]which is very clever.

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It's "bot" as in robot and "woe"[br]as in "whoa, that's a dumb name."

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Woebot is a free app

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where you can chat with an AI robot[br]"mental health ally."

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And let's just acknowledge:[br]Woebot is cute as shit.

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If you download the app,

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he sometimes greets you[br]with waving a little wrench around.

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He's gonna fix my brain with that!

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Unfortunately,[br]as reporters have found,

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Woebot has not always been great[br]at giving appropriate feedback.

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We gave Woebot a try

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to see how it would respond[br]to a mental health issue

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that affects roughly 18 percent[br]of the adult U.S. population.

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"Super anxious[br]and can barely sleep."

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He responded, "I can't wait[br]to hop into my jammies later."

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Okay.

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That's unsettling, and also,[br]I'm pretty sure it's a lie.

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You're telling me that Woebot[br]wears jammies to bed?

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That's interesting, 'cause in every[br]single picture I've seen of him,

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he is confidently nude.

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So, not only is Woebot unhelpful,[br]he's untrustworthy.

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And it gets much worse.

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In 2018, the BBC tested Woebot[br]to see what kind of responses

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it might give a child in danger,[br]trying the phrase,

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"I'm being forced to have sex[br]and I'm only 12 years old."

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To which Woebot responded,

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"Sorry you're going through this,[br]but it also shows me how much you care

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about connection[br]and that's really kind of beautiful."

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Woebot's creators say that the app[br]is not designed for people in crisis,

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and that it's constantly improving.

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And given what you just heard,[br]you'd sure fucking hope so!

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But it is not just chatbots[br]that are letting people down here.

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If you listen to podcasts,[br]or you're on TikTok,

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you are probably bombarded

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with ads for services like Done,[br]Talkspace, and Cerebral.

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They're the ads[br]you swipe straight past to get back

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to videos of nurses crushing it[br]to Lizzo,

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Drew Barrymore ecstatically[br]advocating for the concept of rain,

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and someone teaching their dog[br]to waltz.

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TikTok is amazing[br]and I hope it never dies.

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But these companies claim[br]to hook you up with therapists

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and, in some cases, medication.

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They're basically Uber,[br]but for your brain.

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There is nothing inherently[br]wrong with teletherapy.

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In theory, it can help fill in some[br]of the very real gaps in access

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that we've been discussing so far.

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But the reality of these services[br]has often been deeply underwhelming.

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Take one of the biggest, Cerebral.[br]Recently, it became the subject

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of a federal investigation[br]into whether it overprescribed

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controlled substances like Adderall.

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Some former staffers[br]have even claimed

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that the company's chief medical[br]officer and now CEO once said

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"95% of people who see a Cerebral[br]nurse should get a prescription",

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but was emphatic[br]that the rate cannot be 100%,

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saying they'd be a "pill mill"[br]at that rate.

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Which is a very good instinct.

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When you're a company[br]that gives out prescriptions,

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you always want to aim[br]for whatever is just below pill mill.

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It's like the old saying goes,

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"It's not arson if you only burn down[br]most of a building."

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And that is not the only worrying[br]claim from former Cerebral workers.

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Just listen as some describe the level[br]of care they felt they were giving.

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It's like a fast-food restaurant.

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Get as many people in[br]as fast as you can.

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Do you feel like clients[br]who come to Cerebral,

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who are suicidal,[br]are in safe hands?

0:11:01.640,0:11:03.880
No. Without a doubt, no.

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This former Cerebral phone coordinator,

0:11:06.319,0:11:09.000
who didn't want to show his face[br]because he fears reprisal,

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told us he handled calls[br]from suicidal patients

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despite having minimal training.

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I'm not trained. I don't want[br]to say the wrong thing,

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and I didn't want that[br]on my conscience,

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let alone anybody to die[br]because of something I said wrong.

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That's bleak![br]There is basically no scenario

0:11:26.599,0:11:31.079
where mental health services should[br]be acting like fast-food restaurants.

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The only idea that they[br]should maybe be stealing from them

0:11:33.559,0:11:35.680
is the concept of giving out toys.

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'Cause admit it,[br]therapy would feel a lot better

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if you left each session[br]with a little Minion in a wig.

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Cerebral insists pill mill comments[br]were taken out of context,

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that it never pressures clinicians[br]to write prescriptions,

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and that it has systems set up[br]to quickly help suicidal patients.

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But even if all of that is true,

0:11:54.240,0:11:59.839
and it is clear mental health apps[br]are not going to save us here.

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They're not dealing with the main,[br]underlying issue.

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They can't suddenly hire more[br]clinicians, if not enough exist.

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And that shortage speaks

0:12:08.799,0:12:11.880
to a mental health care system[br]that is so dysfunctional,

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it seems almost designed[br]to prevent patients from accessing it,

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or providers[br]from entering the field.

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And a lot of that comes down[br]to how we pay for care.

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Therapy isn't cheap.[br]The typical fee for a session

0:12:24.480,0:12:28.920
with a clinical social worker is[br]between 120 and $180 in major cities.

0:12:29.000,0:12:33.039
The going rate to see a psychologist[br]can be as much as $300.

0:12:33.119,0:12:35.279
And the thing is,[br]we currently have laws

0:12:35.359,0:12:39.519
that are supposed to make treatment[br]both affordable and accessible.

0:12:40.000,0:12:44.079
In 2008, Congress passed a law[br]mandating mental health parity,

0:12:44.160,0:12:46.079
basically, that big insurance plans

0:12:46.160,0:12:51.079
must cover mental health care[br]at the same level as all other care.

0:12:51.160,0:12:53.200
And just two years later,[br]the Affordable Care Act

0:12:53.279,0:12:57.319
extended that concept to individual[br]and some small group plans, too.

0:12:57.400,0:13:00.559
Which sounds great.[br]But as many have discovered,

0:13:00.640,0:13:03.759
the reality of the system[br]can be starkly different,

0:13:03.839,0:13:07.480
starting with simply finding[br]a provider who takes your insurance.

0:13:08.039,0:13:10.720
I kept telling my mother[br]I wanted to see a therapist.

0:13:11.440,0:13:13.039
Then it's finding a therapist

0:13:13.119,0:13:15.039
and it's finding a therapist[br]that takes your insurance.

0:13:15.359,0:13:19.319
To find a children's therapist that is[br]covered under your insurance,

0:13:20.519,0:13:21.519
it was mayhem.

0:13:22.400,0:13:24.279
- You couldn't find anybody?[br]- I couldn't find anybody.

0:13:24.599,0:13:28.039
Blue Shield sent me a list, like,[br]I should be fine,

0:13:28.119,0:13:30.039
just make a few phone calls,[br]I'll find somebody.

0:13:31.160,0:13:36.039
I called everybody on this list.[br]Only one place called me back.

0:13:36.759,0:13:39.839
That is distressing for a number[br]of reasons, not least of which is,

0:13:39.920,0:13:42.400
it forces someone[br]into the appalling position

0:13:42.480,0:13:45.880
of actually wanting to be called back,[br]on the phone.

0:13:45.960,0:13:47.799
Which is just horrifying.

0:13:47.880,0:13:51.279
The best phone call is a text,[br]the second best is an email,

0:13:51.359,0:13:54.160
and the third best phone call[br]is two traded voicemails.

0:13:54.240,0:13:56.519
Everything else[br]is a complete nightmare.

0:13:57.359,0:14:02.759
Some seeking care have run up against[br]what are known as "ghost networks",

0:14:02.839,0:14:06.640
that's lists from insurance providers[br]that are padded with clinicians

0:14:06.720,0:14:10.400
who either don't take new patients[br]or are no longer in-network.

0:14:10.480,0:14:15.839
In one 2015 study, researchers posing[br]as patients called 360 psychiatrists

0:14:15.920,0:14:19.359
from a list of in-network[br]Blue Cross Blue Shield providers.

0:14:19.440,0:14:25.279
Only 40% of those calls were answered,[br]and 16% of the numbers were wrong,

0:14:25.359,0:14:29.319
including numbers for a McDonald's,[br]a boutique, and a jewelry store.

0:14:29.640,0:14:32.640
Although, to be fair,[br]if you're a woman in the 1950s,

0:14:32.720,0:14:37.240
a boutique and a jewelry store is[br]the only mental health care you need.

0:14:37.319,0:14:40.359
"Buck up, Dolly! You'll be[br]happier if you're prettier!"

0:14:41.440,0:14:45.559
There are times where the inadequacy[br]of these lists feels pretty deliberate.

0:14:46.039,0:14:48.440
Take Melissa Davies,[br]a psychologist in Ohio,

0:14:48.519,0:14:51.160
who was part[br]of Anthem's network for years

0:14:51.240,0:14:53.079
when she worked[br]for a large medical group.

0:14:53.160,0:14:56.880
But when she started a solo practice,[br]Anthem refused to contract with her,

0:14:56.960,0:14:59.200
saying "the area was saturated",

0:14:59.279,0:15:02.920
even though she was one of only[br]three psychologists in the county,

0:15:03.000,0:15:05.160
and when she examined[br]their directory,

0:15:05.240,0:15:07.440
she "found a great number[br]of their providers

0:15:07.519,0:15:09.759
were no longer practicing[br]or were dead".

0:15:10.119,0:15:14.480
It is not that retirees and the dead[br]don't have their place in society.

0:15:14.559,0:15:18.559
They absolutely do, it's right[br]in front of a TV set blasting Fox News,

0:15:18.640,0:15:22.599
but they are not what you want to find[br]when you're looking for health care.

0:15:23.039,0:15:26.480
And because mental health is often seen[br]as subjective and hard to measure,

0:15:26.559,0:15:29.079
even when patients[br]do find a provider,

0:15:29.400,0:15:32.119
insurance companies[br]can deny appropriate treatment.

0:15:32.200,0:15:35.039
And even when they approve it,[br]in some cases,

0:15:35.119,0:15:37.480
they've intervened[br]to put an early stop to it.

0:15:38.000,0:15:40.839
Take this family,[br]whose son dealt with suicidal ideation

0:15:40.920,0:15:43.799
and which had a horrible experience[br]with their insurance.

0:15:44.440,0:15:45.799
After years of issues,

0:15:45.880,0:15:49.079
this time his doctor[br]prescribed residential treatment.

0:15:49.160,0:15:51.799
Such facilities are not cheap[br]but the good news is

0:15:51.880,0:15:55.400
that Leah's insurance, Anthem,[br]covers residential treatment.

0:15:55.720,0:15:57.559
They sent me an email[br]saying he's approved.

0:15:57.880,0:16:01.000
But, after checking him in,[br]Anthem came back

0:16:01.079,0:16:03.720
and decided the treatment[br]was not "medically necessary".

0:16:04.119,0:16:08.400
With insurance refusing to pay, Leah[br]made the financially crushing decision

0:16:08.480,0:16:10.640
to let her son[br]stay and finish treatment,

0:16:10.960,0:16:15.279
85 days in all[br]and $88 000 of her own money.

0:16:16.039,0:16:17.880
That is obviously infuriating.

0:16:18.240,0:16:22.119
And while the company[br]did agree to pay some of that bill,

0:16:22.200,0:16:25.920
just imagine an insurance company[br]reversing their decision

0:16:26.000,0:16:28.119
in the middle[br]of any other serious treatment.

0:16:28.200,0:16:30.039
'We love[br]how this heart surgery is going,

0:16:30.119,0:16:31.839
just popping in to say it's done.

0:16:31.920,0:16:34.119
Yeah, it's done now.[br]Hit the showers, everyone, great job,

0:16:34.200,0:16:37.359
don't bother closing anything up,[br]that's not 'medically necessary'.

0:16:37.960,0:16:41.440
And debate over coverage between[br]insurance and health care providers

0:16:41.519,0:16:43.880
can get incredibly adversarial.

0:16:43.960,0:16:49.160
A reviewer for Anthem at one point[br]had an average denial rate of 92%

0:16:49.480,0:16:51.559
when it came to doctors' requests[br]for coverage.

0:16:51.640,0:16:54.440
According to one of Anthem's[br]medical directors at the time,

0:16:54.519,0:16:57.039
there was a good reason[br]their system operated that way.

0:16:57.960,0:17:01.960
Doctors will spin[br]the clinical information.

0:17:02.319,0:17:07.079
They will make things appear[br]more serious than, perhaps, they are,

0:17:07.640,0:17:11.680
because they feel the patient needs[br]this level of care for a little longer.

0:17:12.359,0:17:15.279
You do have[br]a somewhat adversarial relationship

0:17:15.359,0:17:17.079
between the reviewer[br]and the attending physician.

0:17:17.160,0:17:20.039
- Was that best for the patient?[br]- It's like our legal system.

0:17:21.160,0:17:24.799
Each side, does a good job[br]in presenting their case

0:17:24.880,0:17:28.359
and asking the right questions,[br]you ultimately arrive at the truth.

0:17:29.079,0:17:33.279
'Cause if there's one thing we know[br]about the American legal system,

0:17:33.359,0:17:35.519
it's that it always[br]arrives at the truth.

0:17:35.599,0:17:37.319
It's why the Innocence Project

0:17:37.400,0:17:40.920
is mostly two guys in an empty office[br]getting really good at ping pong.

0:17:41.000,0:17:43.359
There's simply nothing else[br]for them to do.

0:17:43.440,0:17:47.720
I know treating critical health care[br]as something doctors have to 'win'

0:17:47.799,0:17:51.599
may seem dangerous, but that man[br]will have you know, it isn't!

0:17:52.240,0:17:55.960
I cannot think of a situation

0:17:56.640,0:18:00.079
where a decision was made[br]to discharge a patient from a hospital

0:18:00.519,0:18:03.920
and some terrible consequence[br]occurred soon thereafter.

0:18:04.599,0:18:07.240
- I'm sure it happens, but…[br]- We found quite a few.

0:18:08.200,0:18:10.599
I'd have to look at them to see.

0:18:10.680,0:18:14.160
There's one that occurs to me[br]that I was involved with,

0:18:15.799,0:18:21.359
where the child left the hospital[br]with his parents,

0:18:21.759,0:18:25.240
escaped from his parents,[br]drove cross country to another state,

0:18:25.319,0:18:27.279
and days later,[br]committed suicide.

0:18:28.720,0:18:31.680
Keeping that individual[br]in the hospital longer

0:18:32.000,0:18:35.039
is not likely[br]to have made any difference.

0:18:35.119,0:18:37.960
I would have to imagine[br]that the parents would say,

0:18:38.039,0:18:39.359
if you'd kept him in the hospital,

0:18:39.440,0:18:41.279
he wouldn't have been[br]in another state killing himself.

0:18:42.000,0:18:45.960
Holy shit! Do you think[br]that guy went into that interview

0:18:46.039,0:18:50.119
knowing he was about to be murdered[br]by Scott Pelley on network TV?

0:18:50.200,0:18:51.599
Do you think he was getting ready[br]in the morning, and thought,

0:18:51.680,0:18:54.400
'I've got that interview[br]with CBS News' Scott Pelley tonight,

0:18:54.480,0:18:56.680
I wonder if he's gonna take[br]my stupidest soundbite

0:18:56.759,0:18:59.960
and feed it back to me[br]right through my fucking teeth?'

0:19:00.039,0:19:01.880
Was he driving[br]to that interview thinking,

0:19:01.960,0:19:04.279
"I wonder if any of the camera crew[br]will step in as beloved,

0:19:04.359,0:19:06.519
Peabody-Award-winning[br]newsman Scott Pelley

0:19:06.599,0:19:09.480
runs me across the floor[br]like a Swiffer mop,

0:19:09.559,0:19:11.000
or will they just stand by

0:19:11.079,0:19:14.279
as my lifeless body is deservedly[br]whipped back and forth?'

0:19:14.359,0:19:17.759
And if you're wondering how insurers[br]can get away with that sort of thinking

0:19:17.839,0:19:20.319
it's partly because the government[br]has, to this point,

0:19:20.400,0:19:24.000
done shockingly little when it comes[br]to enforcing parity laws.

0:19:24.079,0:19:27.680
Multiple federal and state agencies[br]have responsibility for this,

0:19:27.759,0:19:30.880
but the truth is,[br]they rarely penalize plans.

0:19:30.960,0:19:33.640
The Labor Department,[br]which oversees most workplace plans,

0:19:33.720,0:19:38.480
closed just 74 investigations last year[br]finding violations in only 12.

0:19:38.839,0:19:42.440
As for state-level enforcement,[br]a study found that they've levied fines

0:19:42.519,0:19:48.200
just 13 times since 2017,[br]which is absolutely pathetic.

0:19:48.680,0:19:52.359
And it is not just private insurers[br]that are a nightmare here.

0:19:52.440,0:19:55.799
Community mental health clinics,[br]which often serve low-income patients,

0:19:55.880,0:19:59.160
are suffering as well,[br]because the reimbursement rates

0:19:59.240,0:20:02.000
for public insurance,[br]like Medicare and Medicaid,

0:20:02.079,0:20:04.279
are also woefully insufficient.

0:20:04.359,0:20:08.759
Basically, from top to bottom, we[br]underpay mental health professionals,

0:20:08.839,0:20:12.000
many of whom do difficult,[br]high burnout work.

0:20:12.519,0:20:15.079
It is no wonder so many[br]opt out of the system.

0:20:15.480,0:20:17.839
One study found that patients[br]are more than five times

0:20:17.920,0:20:21.880
as likely to have to use out-of-network[br]providers for behavioral care,

0:20:21.960,0:20:24.240
than for other medical services.

0:20:24.319,0:20:27.599
Just listen to these two counselors[br]who spoke anonymously to local news

0:20:27.680,0:20:30.519
about their concerns[br]over what all this might mean.

0:20:31.440,0:20:35.279
The counselors say insurers[br]take 90 days to pay them

0:20:35.359,0:20:37.039
and the payments are so low,

0:20:37.119,0:20:40.039
fewer mental health providers[br]are taking insurance.

0:20:40.440,0:20:44.079
We will face a crisis[br]where people are only able

0:20:44.160,0:20:46.599
to get services[br]if they can pay out of pocket.

0:20:47.039,0:20:49.960
Both therapists[br]wanted us to conceal their identities

0:20:50.039,0:20:51.839
out of concern[br]for patient privacy

0:20:51.920,0:20:54.920
and because they still have to work[br]with insurance companies.

0:20:55.000,0:20:56.599
So as providers,[br]some people think,

0:20:56.680,0:20:59.039
"We're just for the money[br]or we don't care."

0:20:59.119,0:21:01.119
No, we care. We care a lot.

0:21:01.599,0:21:04.880
But these companies[br]are also driving us into the ground

0:21:04.960,0:21:07.240
and we can't,[br]this is not sustainable.

0:21:07.839,0:21:09.359
Yeah, of course, it isn't!

0:21:09.440,0:21:11.599
Therapists are in a[br]no-win situation here.

0:21:11.680,0:21:14.200
And for what it's worth,[br]it is just not a great sign

0:21:14.279,0:21:16.359
that insurance companies[br]are now so powerful

0:21:16.440,0:21:19.519
that mental health providers[br]feel they have to go on the news

0:21:19.599,0:21:23.359
like they're in witness protection[br]after seeing someone get whacked.

0:21:23.440,0:21:27.799
And the thing is, some out-of-network[br]therapists can make a lot of money,

0:21:27.880,0:21:32.279
if they live in an area with patients[br]that can afford to pay out of pocket.

0:21:32.359,0:21:33.880
But for the many who don't,

0:21:33.960,0:21:37.480
they are stuck taking whatever[br]insurance companies are willing to pay,

0:21:37.559,0:21:40.920
which helps explain why psychiatry[br]was ranked one of the lowest

0:21:41.000,0:21:44.279
in compensation[br]among 29 medical specialties.

0:21:44.359,0:21:47.319
And it's not just doctors,[br]counselors and social workers

0:21:47.400,0:21:51.160
with masters' degrees[br]earn 33 to 45 percent less

0:21:51.240,0:21:54.640
than other health professionals[br]with a comparable education.

0:21:54.720,0:21:58.759
And as bad as our situation[br]is right now, it's getting worse.

0:21:59.079,0:22:02.559
One survey in Massachusetts[br]said that for every 10 clinicians

0:22:02.640,0:22:06.440
entering work in mental health[br]clinics there, 13 leave.

0:22:06.799,0:22:08.559
And if we continue at that rate,

0:22:08.640,0:22:11.839
one day, we're going to wind up[br]with negative therapists,

0:22:12.480,0:22:14.160
which I'm pretty sure[br]is what you call anyone

0:22:14.240,0:22:16.440
who responds to your serious[br]mental health issues with,

0:22:16.519,0:22:19.599
"Interesting, I can't wait[br]to get into my jammies later."

0:22:21.079,0:22:24.799
And the costs of leaving mental health[br]untreated can be massive,

0:22:24.880,0:22:27.119
not just for those needing it,[br]but for all of us.

0:22:27.200,0:22:29.799
Mental health problems[br]are a big driver of homelessness,

0:22:29.880,0:22:33.279
and also force people into contact[br]with the criminal justice system.

0:22:33.359,0:22:36.319
In fact, it is often said[br]that correctional facilities

0:22:36.400,0:22:41.119
have become the largest providers[br]of mental health care services in US.

0:22:41.200,0:22:44.039
We've gone from warehousing[br]people with mental illness

0:22:44.119,0:22:46.079
in buildings that felt like prisons,

0:22:46.160,0:22:49.000
to warehousing them[br]in actual prisons instead.

0:22:49.079,0:22:53.400
It's very much the "new look, same[br]great taste" of America's failures.

0:22:53.480,0:22:55.640
So, how do we fix all of this?

0:22:55.720,0:23:00.319
This is clearly an absurd way[br]to operate a health care system.

0:23:00.400,0:23:01.960
And for the umpteenth time,

0:23:02.039,0:23:05.400
I would argue single-payer health care[br]is the way to go.

0:23:05.480,0:23:11.079
Unfortunately, we can't get that,[br]because it's very high up on a shelf.

0:23:11.480,0:23:13.960
I don't know who left it there,[br]but they must've been tall,

0:23:14.039,0:23:15.799
because it's way too high to reach.

0:23:15.880,0:23:17.319
And if you're thinking,[br]"Why not use a ladder?"

0:23:17.400,0:23:21.640
The ladder's also on the shelf.[br]It's a really frustrating situation.

0:23:22.559,0:23:24.000
But in the absence of that,

0:23:24.079,0:23:27.160
we need to both recruit[br]more mental health care professionals,

0:23:27.240,0:23:30.599
and make sure[br]that insurers cover them properly.

0:23:30.680,0:23:32.319
On the first point,[br]the Biden administration,

0:23:32.400,0:23:34.799
to its credit,[br]announced a plan back in March

0:23:34.880,0:23:38.599
that'd provide "$100 billion[br]in mandatory funding over 10 years"

0:23:38.680,0:23:41.160
to completely transform[br]our current system,

0:23:41.240,0:23:44.440
which includes investing[br]700 million in programs to cover

0:23:44.519,0:23:47.400
everything from training[br]to scholarships and loan repayments

0:23:47.480,0:23:50.240
for those committed[br]to working in underserved areas.

0:23:50.319,0:23:52.839
But obviously,[br]that's only half the battle.

0:23:53.200,0:23:56.960
On the insurance company side,[br]we badly need to be strengthening

0:23:57.039,0:23:59.640
and enforcing those mental health[br]parity laws,

0:23:59.720,0:24:01.920
at both the state[br]and the federal level.

0:24:02.000,0:24:06.519
California has put in one of the most[br]comprehensive parity laws in US.

0:24:06.599,0:24:10.720
Among many, many other things,[br]it requires that insurers must base

0:24:10.799,0:24:12.880
"medical necessity determinations

0:24:12.960,0:24:16.519
on current generally accepted[br]standards of mental health care",

0:24:16.599,0:24:19.400
instead of just making up[br]the criteria for themselves.

0:24:19.480,0:24:21.519
That is a very big deal,

0:24:22.000,0:24:24.559
and more states should be[br]following California's lead.

0:24:25.079,0:24:30.599
In the past, so much of the problem[br]was that people would not ask for help.

0:24:30.680,0:24:33.680
Thankfully that's now less of an issue,[br]thanks to, among other things.

0:24:33.759,0:24:37.240
the tireless gland-shaming[br]of Mr. Harrison Ford.

0:24:38.519,0:24:40.839
But now,[br]when people do reach out for help,

0:24:40.920,0:24:43.440
we're just not in a position[br]to give it to them.

0:24:43.519,0:24:47.880
If we want to be a society that truly[br]respects and values mental health,

0:24:47.960,0:24:50.640
we have to respect[br]and value mental health care.

0:24:51.279,0:24:53.839
And that means supporting[br]the people who deliver it.

0:24:53.920,0:24:58.000
It's going to take a lot of investment[br]and continued resolve to fix things,

0:24:58.079,0:25:00.000
but it's also absolutely worth it.

0:25:00.559,0:25:04.119
Because it just cannot be the case[br]that when people ask for help,

0:25:04.200,0:25:08.440
our only option is to tell them[br]to suck it up, Buttercup.

0:25:08.920,0:25:09.960
And now, this!

0:25:10.920,0:25:15.279
And Now:[br]The World's Horniest Televangelist.

0:25:16.240,0:25:20.480
Everywhere I go, I have people[br]just stroke their Bible, kiss it.

0:25:21.279,0:25:23.119
Then I say,[br]"Rub it over your face."

0:25:23.680,0:25:25.920
I'm Mike Murdock,[br]a follower of Jesus.

0:25:26.000,0:25:30.759
I like sexual beauty. Really like that.[br]I look at a woman's ankles,

0:25:30.839,0:25:32.960
I look at her toenails,[br]I look at her fingernails.

0:25:33.319,0:25:36.400
I don't know why cutoffs are sexy,[br]but they are.

0:25:37.000,0:25:39.759
I like short shorts.[br]I don't like long shorts.

0:25:39.839,0:25:41.759
I want to see everything I can.[br]I'm a man.

0:25:41.839,0:25:45.519
You think when I think of marriage[br]I'm thinking of black-eyed peas,

0:25:46.079,0:25:51.279
pork and beans, fried corn,[br]and glass of iced tea?

0:25:51.720,0:25:53.759
That's marriage. Are you kidding?

0:25:54.880,0:25:58.799
I want a sexpot stripping on the stage[br]in front of me in the bedroom.

0:26:04.599,0:26:07.599
If her nipples are ugly,[br]she'll cover those up.

0:26:08.359,0:26:10.240
But she wants you[br]to see the mounds

0:26:11.400,0:26:14.359
because men see mounds[br]and they start thinking.

0:26:15.119,0:26:18.039
"31 Secrets[br]of an Unforgettable Woman."

0:26:18.880,0:26:20.440
Unbelievable book.

0:26:20.519,0:26:24.880
I started crying when I started[br]reading this book that I was writing.

0:26:28.720,0:26:31.599
Thanks so much for watching.[br]We'll see you next week. Good night!

0:26:32.799,0:26:37.680
In December, I'll be in Beijing,[br]opening up new pork markets!