WEBVTT 00:00:00.000 --> 00:00:01.920 (Music) 00:00:04.680 --> 00:00:08.120 Moving on. Our main story tonight concerns mental health care. 00:00:08.120 --> 00:00:11.600 It's a subject that historically humans haven't handled particularly well. 00:00:12.199 --> 00:00:15.439 To a famous Bond Street beauty parlor come a bunch of pretty nurses. 00:00:15.519 --> 00:00:18.160 They're greeted by director Ms. Eleanor McDonald. 00:00:18.240 --> 00:00:20.399 They're here not as customers, but as students. 00:00:21.399 --> 00:00:24.839 Ms. McDonald teaches a new group of half a dozen every month. 00:00:25.519 --> 00:00:27.079 It's an official part of their training. 00:00:27.160 --> 00:00:28.399 If you can persuade 00:00:28.480 --> 00:00:30.959 a mentally ill woman to take interest and pride in her appearance, 00:00:31.319 --> 00:00:34.480 you may even swing the balance between despair and recovery. 00:00:35.000 --> 00:00:38.240 "Yes, those pesky women just need a little pep in their step, 00:00:38.319 --> 00:00:41.199 a little drip on their lip, a little flash on their lash. 00:00:41.600 --> 00:00:43.920 Look at me! I'm a British voice from the 1950's, 00:00:44.000 --> 00:00:46.600 setting the course of science for decades to come." 00:00:47.240 --> 00:00:48.839 I don't know what is more alarming there, 00:00:48.920 --> 00:00:52.639 nurses being forced to take on the skills of a Sephora brand ambassador 00:00:52.720 --> 00:00:54.920 or the fact that "Can Makeup Cure Sad?" 00:00:55.000 --> 00:00:58.079 sounds like an episode that Dr. Oz definitely did. 00:00:59.160 --> 00:01:01.000 The good news is that since then, 00:01:01.079 --> 00:01:03.680 we've got more comfortable talking about mental health, 00:01:03.759 --> 00:01:07.120 with PSAs like this one from 2010 trying to destigmatize it. 00:01:07.879 --> 00:01:09.879 In the all-American health care system, 00:01:09.959 --> 00:01:12.639 there is coverage for heart health, care for cancer. 00:01:12.720 --> 00:01:15.639 But the all-American brain is getting lost in the shuffle. 00:01:16.079 --> 00:01:19.279 Brain tumor, fine. Brain disease, not so fine. 00:01:19.360 --> 00:01:22.360 There's no stigma or discrimination against the heart, 00:01:22.439 --> 00:01:24.240 the liver, the kidney, and the gallbladder. 00:01:24.879 --> 00:01:26.160 Doesn't even have a job. 00:01:26.480 --> 00:01:28.279 Depression was kept in the dark. 00:01:28.680 --> 00:01:33.600 Our goal is to make the discussion of mental disease cool and trendy. 00:01:33.919 --> 00:01:36.440 Let's tear down the stigma surrounding mental illness. 00:01:36.519 --> 00:01:38.080 I'm mad about feeling good. 00:01:38.159 --> 00:01:40.639 - No kidding. - Me too. 00:01:40.720 --> 00:01:42.360 No kidding, me too! 00:01:42.840 --> 00:01:46.200 It's time we gave the all-American brain some peace of mind. 00:01:46.960 --> 00:01:49.679 It is hard to pick a favorite moment there, 00:01:49.759 --> 00:01:52.519 from Chazz Palminteri using a mental health PSA 00:01:52.600 --> 00:01:55.919 as an opportunity to promote his favorite Bronx pasta place, 00:01:56.000 --> 00:01:58.519 to the studio audience shouting, "Me too!" 00:01:58.600 --> 00:02:01.600 seven years before that would mean something very different, 00:02:01.679 --> 00:02:04.679 to Harrison Ford saying the gallbladder doesn't have a job. 00:02:05.240 --> 00:02:08.000 What? It stores and releases bile, Harrison. 00:02:08.080 --> 00:02:10.559 Bile that helps digest fats in the food that you eat. 00:02:10.639 --> 00:02:13.919 Doesn't have a jo… maybe you're thinking of the appendix? 00:02:14.000 --> 00:02:15.799 'Cause that's a total freeloader, 00:02:15.879 --> 00:02:20.120 but not the tireless digestive juice collecting-and-dispensing gallbladder. 00:02:20.200 --> 00:02:22.919 This bile sack erasure will not stand! 00:02:24.080 --> 00:02:26.559 As chaotically as that message was presented, 00:02:26.639 --> 00:02:29.679 it was clearly well-intentioned, because there should not be a stigma 00:02:29.759 --> 00:02:32.039 around seeking help for mental health issues. 00:02:32.120 --> 00:02:34.960 And especially now, given that, over the last two years, 00:02:35.039 --> 00:02:36.879 we have seen a spike in them. 00:02:36.960 --> 00:02:40.039 During the pandemic, about "four in 10 adults in the U.S. 00:02:40.120 --> 00:02:42.919 have reported symptoms of anxiety or depressive disorder." 00:02:43.000 --> 00:02:46.200 That's up from one in 10 who reported them a year before. 00:02:46.279 --> 00:02:48.759 It may help explain why, for that one month last year, 00:02:48.840 --> 00:02:52.559 everyone on the internet suddenly started singing sea shanties. 00:02:52.960 --> 00:02:55.559 It was clearly a collective cry for help. 00:02:56.600 --> 00:03:00.399 So, encouraging people to talk to someone is a very good idea. 00:03:00.480 --> 00:03:02.480 But as people increasingly do seek help, 00:03:02.559 --> 00:03:05.919 they're discovering a system that is just not set up to provide it. 00:03:06.000 --> 00:03:08.679 There have long been waitlists to see a therapist, 00:03:08.759 --> 00:03:11.600 but it has gotten significantly worse since the pandemic, 00:03:11.679 --> 00:03:16.799 with 65% of psychologists reporting they had no capacity for new patients. 00:03:16.879 --> 00:03:18.840 In fact, "more than half the people 00:03:18.919 --> 00:03:21.919 who need mental health care do not receive it," 00:03:22.000 --> 00:03:25.320 with that rate being even higher for minority populations. 00:03:25.399 --> 00:03:29.240 Emergency rooms are now becoming overloaded with people, 00:03:29.320 --> 00:03:30.679 and especially children, 00:03:30.759 --> 00:03:33.720 who have nowhere else to go, stuck in beds there, 00:03:33.799 --> 00:03:36.679 because there is no space in proper facilities to treat them. 00:03:36.759 --> 00:03:39.919 Just take this couple, whose 14-year-old was in crisis, 00:03:40.000 --> 00:03:41.600 and who followed their pediatrician's advice 00:03:41.679 --> 00:03:43.440 to go to the ER with him. 00:03:44.000 --> 00:03:47.919 I remember we got out of the car, and we hugged him and we said, 00:03:48.000 --> 00:03:52.799 "We're going to do whatever it takes to help you." 00:03:53.240 --> 00:03:54.960 But once inside, staff told them 00:03:55.039 --> 00:03:58.480 there was no space across the state for mental health services. 00:03:58.559 --> 00:04:03.759 They were admitted to the ED, where 15 other children were also waiting. 00:04:03.840 --> 00:04:07.879 Their son has spent 27 days at Children's waiting. 00:04:07.960 --> 00:04:13.759 You come in for help, you're desperate for it, and you can't get it. 00:04:14.519 --> 00:04:18.799 That kid was stuck waiting in the ER for 27 days. 00:04:19.279 --> 00:04:20.399 And set aside the fact 00:04:20.480 --> 00:04:24.399 that that is not the most calming place for someone experiencing a crisis. 00:04:24.480 --> 00:04:27.759 You can't just put off mental health care indefinitely. 00:04:27.840 --> 00:04:29.639 It's not a check engine light, 00:04:29.720 --> 00:04:32.799 or a New Yorker article you're definitely gonna finish. 00:04:33.360 --> 00:04:35.960 It's been sitting next to the toilet since the Obama administration. 00:04:36.039 --> 00:04:37.639 Accept defeat. 00:04:38.679 --> 00:04:42.159 So, if people increasingly need help, but there is not enough available, 00:04:42.240 --> 00:04:45.639 we thought it'd be worth taking a look at our mental health care system: 00:04:45.720 --> 00:04:46.919 where the cracks are, 00:04:47.000 --> 00:04:49.240 some of the inadequate ways that we've tried to fill them, 00:04:49.320 --> 00:04:51.960 and why we are in this mess in the first place. 00:04:52.039 --> 00:04:54.159 Let's start with the fact that for many years, 00:04:54.240 --> 00:04:57.639 we kept people with men, mental illness in institutions, 00:04:57.720 --> 00:04:59.080 which were abhorrent. 00:04:59.159 --> 00:05:00.720 We began shutting them down 00:05:00.799 --> 00:05:03.559 on the understanding that care would then take place 00:05:03.639 --> 00:05:05.840 mostly in outpatient community mental health centers, 00:05:05.919 --> 00:05:09.440 which was a good idea, had we funded them properly. 00:05:09.840 --> 00:05:13.679 But we didn't. And over the years, this has deteriorated to the point 00:05:13.759 --> 00:05:18.360 where it has become hard to access any kind of care ahead of a crisis. 00:05:18.440 --> 00:05:21.799 One of the key problems here is our current massive shortage 00:05:21.879 --> 00:05:25.720 of mental health providers, from psychiatrists to social workers. 00:05:25.799 --> 00:05:28.960 Which is particularly acute in certain parts of the country. 00:05:29.039 --> 00:05:33.679 There are "over 6 000 mental health professional shortage areas in the U.S" 00:05:33.759 --> 00:05:37.080 "Nearly 60 percent of those are in rural areas." 00:05:37.159 --> 00:05:39.840 And for those who live there, and are struggling, 00:05:39.919 --> 00:05:41.399 things can get pretty grim. 00:05:41.799 --> 00:05:44.960 You get to the point where you'd even start asking people, you tell them, 00:05:45.039 --> 00:05:47.399 "I'm not having a really good day. Things are not going good." 00:05:47.480 --> 00:05:50.240 And the problem is that, you know, it was, you know, 00:05:50.320 --> 00:05:53.000 "Suck it up, it'll be better tomorrow. Everything will be fine tomorrow. 00:05:53.080 --> 00:05:54.519 Suck it up, Buttercup." 00:05:54.600 --> 00:05:56.440 I hear that phrase a lot around here, "Suck it up, Buttercup." 00:05:56.759 --> 00:05:58.879 - Yeah. - What does that mean exactly? 00:05:59.240 --> 00:06:03.600 For me it meant a couple of shots of Jack in my coffee in the morning, 00:06:03.960 --> 00:06:07.799 when I went to work, a couple of beers at lunch, 00:06:07.879 --> 00:06:10.360 get home, and it was nothing to go through, 00:06:11.240 --> 00:06:13.799 12-pack of something or a bottle of something. 00:06:14.679 --> 00:06:19.279 That's not great. It is not ideal when your access to mental health advice 00:06:19.360 --> 00:06:22.159 is someone telling you to "suck it up, Buttercup". 00:06:22.720 --> 00:06:25.159 A phrase typically reserved for when you're climbing in gym class 00:06:25.240 --> 00:06:27.159 and you hit the rope knot too hard. 00:06:28.039 --> 00:06:30.360 And the shortages aren't just geographical. 00:06:30.679 --> 00:06:32.360 If you're looking for a provider of color, 00:06:32.440 --> 00:06:33.679 you may have real trouble, 00:06:33.759 --> 00:06:37.320 as white people make up 84 percent of U.S. psychologists. 00:06:37.399 --> 00:06:39.720 Meaning that some patients may have a much harder time 00:06:39.799 --> 00:06:43.000 finding someone they can relate to, like this woman in Philadelphia, 00:06:43.080 --> 00:06:46.399 who began seeing a white therapist, but felt that they weren't connecting. 00:06:46.840 --> 00:06:49.600 It felt like she just wasn't getting it. 00:06:49.679 --> 00:06:52.320 I could tell it was from the cultural differences. 00:06:53.440 --> 00:06:57.279 But I felt like I couldn't be myself in the session. 00:06:57.600 --> 00:06:58.919 I could imagine, 00:06:59.399 --> 00:07:02.480 particularly white people hearing that story and thinking, 00:07:03.080 --> 00:07:05.320 "But it doesn't matter what color your skin is." 00:07:06.279 --> 00:07:08.320 Yes, it does. 00:07:08.639 --> 00:07:11.960 And it's more of the cultural backgrounds. 00:07:12.480 --> 00:07:14.919 And I was wondering, you know, where are all the Black therapists? 00:07:15.000 --> 00:07:16.600 Are they hiding underneath a rock? 00:07:16.679 --> 00:07:18.279 I wanted a Black male therapist. 00:07:18.600 --> 00:07:21.240 - Could you find one? - I could not find one for my life. 00:07:21.879 --> 00:07:24.559 "I couldn't find a Black man for my life' 00:07:24.639 --> 00:07:27.679 isn't something you expect to hear about finding a therapist, 00:07:27.759 --> 00:07:30.799 it's something you more expect to hear about the crowd on January 6th, 00:07:30.879 --> 00:07:33.080 or all 10 seasons of "Friends." 00:07:33.919 --> 00:07:37.639 So, across the board, whether in small towns or big cities, 00:07:37.720 --> 00:07:40.360 we don't have enough mental health professionals. 00:07:40.440 --> 00:07:42.720 And that gulf between supply and demand 00:07:42.799 --> 00:07:45.360 has proven very attractive to Silicon Valley. 00:07:45.840 --> 00:07:49.360 There are currently over 10 000 apps geared toward mental health, 00:07:49.440 --> 00:07:52.279 including one called Woebot, which is very clever. 00:07:52.360 --> 00:07:56.600 It's "bot" as in robot and "woe" as in "whoa, that's a dumb name." 00:07:57.120 --> 00:07:58.919 Woebot is a free app 00:07:59.399 --> 00:08:02.360 where you can chat with an AI robot "mental health ally." 00:08:02.759 --> 00:08:05.279 And let's just acknowledge: Woebot is cute as shit. 00:08:05.360 --> 00:08:06.960 If you download the app, 00:08:07.039 --> 00:08:09.759 he sometimes greets you with waving a little wrench around. 00:08:09.840 --> 00:08:11.799 He's gonna fix my brain with that! 00:08:12.559 --> 00:08:14.480 Unfortunately, as reporters have found, 00:08:14.559 --> 00:08:17.399 Woebot has not always been great at giving appropriate feedback. 00:08:17.919 --> 00:08:19.360 We gave Woebot a try 00:08:19.440 --> 00:08:21.840 to see how it would respond to a mental health issue 00:08:21.919 --> 00:08:24.679 that affects roughly 18 percent of the adult U.S. population. 00:08:25.159 --> 00:08:31.519 "Super anxious and can barely sleep." 00:08:32.519 --> 00:08:36.600 He responded, "I can't wait to hop into my jammies later." 00:08:37.840 --> 00:08:38.840 Okay. 00:08:39.840 --> 00:08:43.559 That's unsettling, and also, I'm pretty sure it's a lie. 00:08:43.639 --> 00:08:46.399 You're telling me that Woebot wears jammies to bed? 00:08:46.480 --> 00:08:48.799 That's interesting, 'cause in every single picture I've seen of him, 00:08:48.879 --> 00:08:50.399 he is confidently nude. 00:08:50.840 --> 00:08:54.559 So, not only is Woebot unhelpful, he's untrustworthy. 00:08:55.399 --> 00:08:56.679 And it gets much worse. 00:08:56.759 --> 00:09:00.080 In 2018, the BBC tested Woebot to see what kind of responses 00:09:00.159 --> 00:09:02.960 it might give a child in danger, trying the phrase, 00:09:03.039 --> 00:09:05.840 "I'm being forced to have sex and I'm only 12 years old." 00:09:05.919 --> 00:09:07.440 To which Woebot responded, 00:09:07.519 --> 00:09:10.440 "Sorry you're going through this, but it also shows me how much you care 00:09:10.519 --> 00:09:13.399 about connection and that's really kind of beautiful." 00:09:13.480 --> 00:09:17.919 Woebot's creators say that the app is not designed for people in crisis, 00:09:18.000 --> 00:09:19.759 and that it's constantly improving. 00:09:19.840 --> 00:09:22.759 And given what you just heard, you'd sure fucking hope so! 00:09:23.679 --> 00:09:26.679 But it is not just chatbots that are letting people down here. 00:09:26.759 --> 00:09:28.639 If you listen to podcasts, or you're on TikTok, 00:09:28.720 --> 00:09:30.279 you are probably bombarded 00:09:30.639 --> 00:09:33.799 with ads for services like Done, Talkspace, and Cerebral. 00:09:34.279 --> 00:09:36.720 They're the ads you swipe straight past to get back 00:09:36.799 --> 00:09:38.960 to videos of nurses crushing it to Lizzo, 00:09:39.039 --> 00:09:42.440 Drew Barrymore ecstatically advocating for the concept of rain, 00:09:42.879 --> 00:09:44.919 and someone teaching their dog to waltz. 00:09:45.000 --> 00:09:46.960 TikTok is amazing and I hope it never dies. 00:09:47.039 --> 00:09:50.159 But these companies claim to hook you up with therapists 00:09:50.240 --> 00:09:51.879 and, in some cases, medication. 00:09:51.960 --> 00:09:54.320 They're basically Uber, but for your brain. 00:09:54.399 --> 00:09:58.080 There is nothing inherently wrong with teletherapy. 00:09:58.159 --> 00:10:01.320 In theory, it can help fill in some of the very real gaps in access 00:10:01.399 --> 00:10:03.080 that we've been discussing so far. 00:10:03.159 --> 00:10:07.119 But the reality of these services has often been deeply underwhelming. 00:10:07.440 --> 00:10:10.440 Take one of the biggest, Cerebral. Recently, it became the subject 00:10:10.519 --> 00:10:13.160 of a federal investigation into whether it overprescribed 00:10:13.240 --> 00:10:15.119 controlled substances like Adderall. 00:10:15.200 --> 00:10:17.319 Some former staffers have even claimed 00:10:17.400 --> 00:10:20.680 that the company's chief medical officer and now CEO once said 00:10:20.759 --> 00:10:24.880 "95% of people who see a Cerebral nurse should get a prescription", 00:10:24.960 --> 00:10:27.839 but was emphatic that the rate cannot be 100%, 00:10:27.920 --> 00:10:30.480 saying they'd be a "pill mill" at that rate. 00:10:30.559 --> 00:10:32.319 Which is a very good instinct. 00:10:32.400 --> 00:10:34.119 When you're a company that gives out prescriptions, 00:10:34.200 --> 00:10:37.960 you always want to aim for whatever is just below pill mill. 00:10:38.039 --> 00:10:39.559 It's like the old saying goes, 00:10:39.640 --> 00:10:42.720 "It's not arson if you only burn down most of a building." 00:10:43.480 --> 00:10:47.119 And that is not the only worrying claim from former Cerebral workers. 00:10:47.200 --> 00:10:50.680 Just listen as some describe the level of care they felt they were giving. 00:10:51.200 --> 00:10:52.640 It's like a fast-food restaurant. 00:10:52.720 --> 00:10:54.799 Get as many people in as fast as you can. 00:10:55.359 --> 00:10:58.319 Do you feel like clients who come to Cerebral, 00:10:58.400 --> 00:11:01.119 who are suicidal, are in safe hands? 00:11:01.640 --> 00:11:03.880 No. Without a doubt, no. 00:11:03.960 --> 00:11:06.240 This former Cerebral phone coordinator, 00:11:06.319 --> 00:11:09.000 who didn't want to show his face because he fears reprisal, 00:11:09.079 --> 00:11:11.920 told us he handled calls from suicidal patients 00:11:12.000 --> 00:11:13.920 despite having minimal training. 00:11:14.319 --> 00:11:16.160 I'm not trained. I don't want to say the wrong thing, 00:11:16.880 --> 00:11:19.079 and I didn't want that on my conscience, 00:11:19.160 --> 00:11:22.680 let alone anybody to die because of something I said wrong. 00:11:23.440 --> 00:11:26.519 That's bleak! There is basically no scenario 00:11:26.599 --> 00:11:31.079 where mental health services should be acting like fast-food restaurants. 00:11:31.160 --> 00:11:33.480 The only idea that they should maybe be stealing from them 00:11:33.559 --> 00:11:35.680 is the concept of giving out toys. 00:11:35.759 --> 00:11:37.920 'Cause admit it, therapy would feel a lot better 00:11:38.000 --> 00:11:40.720 if you left each session with a little Minion in a wig. 00:11:41.599 --> 00:11:45.400 Cerebral insists pill mill comments were taken out of context, 00:11:45.480 --> 00:11:48.400 that it never pressures clinicians to write prescriptions, 00:11:48.480 --> 00:11:51.960 and that it has systems set up to quickly help suicidal patients. 00:11:52.039 --> 00:11:54.160 But even if all of that is true, 00:11:54.240 --> 00:11:59.839 and it is clear mental health apps are not going to save us here. 00:11:59.920 --> 00:12:03.079 They're not dealing with the main, underlying issue. 00:12:03.160 --> 00:12:07.240 They can't suddenly hire more clinicians, if not enough exist. 00:12:07.319 --> 00:12:08.720 And that shortage speaks 00:12:08.799 --> 00:12:11.880 to a mental health care system that is so dysfunctional, 00:12:11.960 --> 00:12:15.359 it seems almost designed to prevent patients from accessing it, 00:12:15.440 --> 00:12:17.960 or providers from entering the field. 00:12:18.039 --> 00:12:21.359 And a lot of that comes down to how we pay for care. 00:12:21.440 --> 00:12:24.400 Therapy isn't cheap. The typical fee for a session 00:12:24.480 --> 00:12:28.920 with a clinical social worker is between 120 and $180 in major cities. 00:12:29.000 --> 00:12:33.039 The going rate to see a psychologist can be as much as $300. 00:12:33.119 --> 00:12:35.279 And the thing is, we currently have laws 00:12:35.359 --> 00:12:39.519 that are supposed to make treatment both affordable and accessible. 00:12:40.000 --> 00:12:44.079 In 2008, Congress passed a law mandating mental health parity, 00:12:44.160 --> 00:12:46.079 basically, that big insurance plans 00:12:46.160 --> 00:12:51.079 must cover mental health care at the same level as all other care. 00:12:51.160 --> 00:12:53.200 And just two years later, the Affordable Care Act 00:12:53.279 --> 00:12:57.319 extended that concept to individual and some small group plans, too. 00:12:57.400 --> 00:13:00.559 Which sounds great. But as many have discovered, 00:13:00.640 --> 00:13:03.759 the reality of the system can be starkly different, 00:13:03.839 --> 00:13:07.480 starting with simply finding a provider who takes your insurance. 00:13:08.039 --> 00:13:10.720 I kept telling my mother I wanted to see a therapist. 00:13:11.440 --> 00:13:13.039 Then it's finding a therapist 00:13:13.119 --> 00:13:15.039 and it's finding a therapist that takes your insurance. 00:13:15.359 --> 00:13:19.319 To find a children's therapist that is covered under your insurance, 00:13:20.519 --> 00:13:21.519 it was mayhem. 00:13:22.400 --> 00:13:24.279 - You couldn't find anybody? - I couldn't find anybody. 00:13:24.599 --> 00:13:28.039 Blue Shield sent me a list, like, I should be fine, 00:13:28.119 --> 00:13:30.039 just make a few phone calls, I'll find somebody. 00:13:31.160 --> 00:13:36.039 I called everybody on this list. Only one place called me back. 00:13:36.759 --> 00:13:39.839 That is distressing for a number of reasons, not least of which is, 00:13:39.920 --> 00:13:42.400 it forces someone into the appalling position 00:13:42.480 --> 00:13:45.880 of actually wanting to be called back, on the phone. 00:13:45.960 --> 00:13:47.799 Which is just horrifying. 00:13:47.880 --> 00:13:51.279 The best phone call is a text, the second best is an email, 00:13:51.359 --> 00:13:54.160 and the third best phone call is two traded voicemails. 00:13:54.240 --> 00:13:56.519 Everything else is a complete nightmare. 00:13:57.359 --> 00:14:02.759 Some seeking care have run up against what are known as "ghost networks", 00:14:02.839 --> 00:14:06.640 that's lists from insurance providers that are padded with clinicians 00:14:06.720 --> 00:14:10.400 who either don't take new patients or are no longer in-network. 00:14:10.480 --> 00:14:15.839 In one 2015 study, researchers posing as patients called 360 psychiatrists 00:14:15.920 --> 00:14:19.359 from a list of in-network Blue Cross Blue Shield providers. 00:14:19.440 --> 00:14:25.279 Only 40% of those calls were answered, and 16% of the numbers were wrong, 00:14:25.359 --> 00:14:29.319 including numbers for a McDonald's, a boutique, and a jewelry store. 00:14:29.640 --> 00:14:32.640 Although, to be fair, if you're a woman in the 1950s, 00:14:32.720 --> 00:14:37.240 a boutique and a jewelry store is the only mental health care you need. 00:14:37.319 --> 00:14:40.359 "Buck up, Dolly! You'll be happier if you're prettier!" 00:14:41.440 --> 00:14:45.559 There are times where the inadequacy of these lists feels pretty deliberate. 00:14:46.039 --> 00:14:48.440 Take Melissa Davies, a psychologist in Ohio, 00:14:48.519 --> 00:14:51.160 who was part of Anthem's network for years 00:14:51.240 --> 00:14:53.079 when she worked for a large medical group. 00:14:53.160 --> 00:14:56.880 But when she started a solo practice, Anthem refused to contract with her, 00:14:56.960 --> 00:14:59.200 saying "the area was saturated", 00:14:59.279 --> 00:15:02.920 even though she was one of only three psychologists in the county, 00:15:03.000 --> 00:15:05.160 and when she examined their directory, 00:15:05.240 --> 00:15:07.440 she "found a great number of their providers 00:15:07.519 --> 00:15:09.759 were no longer practicing or were dead". 00:15:10.119 --> 00:15:14.480 It is not that retirees and the dead don't have their place in society. 00:15:14.559 --> 00:15:18.559 They absolutely do, it's right in front of a TV set blasting Fox News, 00:15:18.640 --> 00:15:22.599 but they are not what you want to find when you're looking for health care. 00:15:23.039 --> 00:15:26.480 And because mental health is often seen as subjective and hard to measure, 00:15:26.559 --> 00:15:29.079 even when patients do find a provider, 00:15:29.400 --> 00:15:32.119 insurance companies can deny appropriate treatment. 00:15:32.200 --> 00:15:35.039 And even when they approve it, in some cases, 00:15:35.119 --> 00:15:37.480 they've intervened to put an early stop to it. 00:15:38.000 --> 00:15:40.839 Take this family, whose son dealt with suicidal ideation 00:15:40.920 --> 00:15:43.799 and which had a horrible experience with their insurance. 00:15:44.440 --> 00:15:45.799 After years of issues, 00:15:45.880 --> 00:15:49.079 this time his doctor prescribed residential treatment. 00:15:49.160 --> 00:15:51.799 Such facilities are not cheap but the good news is 00:15:51.880 --> 00:15:55.400 that Leah's insurance, Anthem, covers residential treatment. 00:15:55.720 --> 00:15:57.559 They sent me an email saying he's approved. 00:15:57.880 --> 00:16:01.000 But, after checking him in, Anthem came back 00:16:01.079 --> 00:16:03.720 and decided the treatment was not "medically necessary". 00:16:04.119 --> 00:16:08.400 With insurance refusing to pay, Leah made the financially crushing decision 00:16:08.480 --> 00:16:10.640 to let her son stay and finish treatment, 00:16:10.960 --> 00:16:15.279 85 days in all and $88 000 of her own money. 00:16:16.039 --> 00:16:17.880 That is obviously infuriating. 00:16:18.240 --> 00:16:22.119 And while the company did agree to pay some of that bill, 00:16:22.200 --> 00:16:25.920 just imagine an insurance company reversing their decision 00:16:26.000 --> 00:16:28.119 in the middle of any other serious treatment. 00:16:28.200 --> 00:16:30.039 'We love how this heart surgery is going, 00:16:30.119 --> 00:16:31.839 just popping in to say it's done. 00:16:31.920 --> 00:16:34.119 Yeah, it's done now. Hit the showers, everyone, great job, 00:16:34.200 --> 00:16:37.359 don't bother closing anything up, that's not 'medically necessary'. 00:16:37.960 --> 00:16:41.440 And debate over coverage between insurance and health care providers 00:16:41.519 --> 00:16:43.880 can get incredibly adversarial. 00:16:43.960 --> 00:16:49.160 A reviewer for Anthem at one point had an average denial rate of 92% 00:16:49.480 --> 00:16:51.559 when it came to doctors' requests for coverage. 00:16:51.640 --> 00:16:54.440 According to one of Anthem's medical directors at the time, 00:16:54.519 --> 00:16:57.039 there was a good reason their system operated that way. 00:16:57.960 --> 00:17:01.960 Doctors will spin the clinical information. 00:17:02.319 --> 00:17:07.079 They will make things appear more serious than, perhaps, they are, 00:17:07.640 --> 00:17:11.680 because they feel the patient needs this level of care for a little longer. 00:17:12.359 --> 00:17:15.279 You do have a somewhat adversarial relationship 00:17:15.359 --> 00:17:17.079 between the reviewer and the attending physician. 00:17:17.160 --> 00:17:20.039 - Was that best for the patient? - It's like our legal system. 00:17:21.160 --> 00:17:24.799 Each side, does a good job in presenting their case 00:17:24.880 --> 00:17:28.359 and asking the right questions, you ultimately arrive at the truth. 00:17:29.079 --> 00:17:33.279 'Cause if there's one thing we know about the American legal system, 00:17:33.359 --> 00:17:35.519 it's that it always arrives at the truth. 00:17:35.599 --> 00:17:37.319 It's why the Innocence Project 00:17:37.400 --> 00:17:40.920 is mostly two guys in an empty office getting really good at ping pong. 00:17:41.000 --> 00:17:43.359 There's simply nothing else for them to do. 00:17:43.440 --> 00:17:47.720 I know treating critical health care as something doctors have to 'win' 00:17:47.799 --> 00:17:51.599 may seem dangerous, but that man will have you know, it isn't! 00:17:52.240 --> 00:17:55.960 I cannot think of a situation 00:17:56.640 --> 00:18:00.079 where a decision was made to discharge a patient from a hospital 00:18:00.519 --> 00:18:03.920 and some terrible consequence occurred soon thereafter. 00:18:04.599 --> 00:18:07.240 - I'm sure it happens, but… - We found quite a few. 00:18:08.200 --> 00:18:10.599 I'd have to look at them to see. 00:18:10.680 --> 00:18:14.160 There's one that occurs to me that I was involved with, 00:18:15.799 --> 00:18:21.359 where the child left the hospital with his parents, 00:18:21.759 --> 00:18:25.240 escaped from his parents, drove cross country to another state, 00:18:25.319 --> 00:18:27.279 and days later, committed suicide. 00:18:28.720 --> 00:18:31.680 Keeping that individual in the hospital longer 00:18:32.000 --> 00:18:35.039 is not likely to have made any difference. 00:18:35.119 --> 00:18:37.960 I would have to imagine that the parents would say, 00:18:38.039 --> 00:18:39.359 if you'd kept him in the hospital, 00:18:39.440 --> 00:18:41.279 he wouldn't have been in another state killing himself. 00:18:42.000 --> 00:18:45.960 Holy shit! Do you think that guy went into that interview 00:18:46.039 --> 00:18:50.119 knowing he was about to be murdered by Scott Pelley on network TV? 00:18:50.200 --> 00:18:51.599 Do you think he was getting ready in the morning, and thought, 00:18:51.680 --> 00:18:54.400 'I've got that interview with CBS News' Scott Pelley tonight, 00:18:54.480 --> 00:18:56.680 I wonder if he's gonna take my stupidest soundbite 00:18:56.759 --> 00:18:59.960 and feed it back to me right through my fucking teeth?' 00:19:00.039 --> 00:19:01.880 Was he driving to that interview thinking, 00:19:01.960 --> 00:19:04.279 "I wonder if any of the camera crew will step in as beloved, 00:19:04.359 --> 00:19:06.519 Peabody-Award-winning newsman Scott Pelley 00:19:06.599 --> 00:19:09.480 runs me across the floor like a Swiffer mop, 00:19:09.559 --> 00:19:11.000 or will they just stand by 00:19:11.079 --> 00:19:14.279 as my lifeless body is deservedly whipped back and forth?' 00:19:14.359 --> 00:19:17.759 And if you're wondering how insurers can get away with that sort of thinking 00:19:17.839 --> 00:19:20.319 it's partly because the government has, to this point, 00:19:20.400 --> 00:19:24.000 done shockingly little when it comes to enforcing parity laws. 00:19:24.079 --> 00:19:27.680 Multiple federal and state agencies have responsibility for this, 00:19:27.759 --> 00:19:30.880 but the truth is, they rarely penalize plans. 00:19:30.960 --> 00:19:33.640 The Labor Department, which oversees most workplace plans, 00:19:33.720 --> 00:19:38.480 closed just 74 investigations last year finding violations in only 12. 00:19:38.839 --> 00:19:42.440 As for state-level enforcement, a study found that they've levied fines 00:19:42.519 --> 00:19:48.200 just 13 times since 2017, which is absolutely pathetic. 00:19:48.680 --> 00:19:52.359 And it is not just private insurers that are a nightmare here. 00:19:52.440 --> 00:19:55.799 Community mental health clinics, which often serve low-income patients, 00:19:55.880 --> 00:19:59.160 are suffering as well, because the reimbursement rates 00:19:59.240 --> 00:20:02.000 for public insurance, like Medicare and Medicaid, 00:20:02.079 --> 00:20:04.279 are also woefully insufficient. 00:20:04.359 --> 00:20:08.759 Basically, from top to bottom, we underpay mental health professionals, 00:20:08.839 --> 00:20:12.000 many of whom do difficult, high burnout work. 00:20:12.519 --> 00:20:15.079 It is no wonder so many opt out of the system. 00:20:15.480 --> 00:20:17.839 One study found that patients are more than five times 00:20:17.920 --> 00:20:21.880 as likely to have to use out-of-network providers for behavioral care, 00:20:21.960 --> 00:20:24.240 than for other medical services. 00:20:24.319 --> 00:20:27.599 Just listen to these two counselors who spoke anonymously to local news 00:20:27.680 --> 00:20:30.519 about their concerns over what all this might mean. 00:20:31.440 --> 00:20:35.279 The counselors say insurers take 90 days to pay them 00:20:35.359 --> 00:20:37.039 and the payments are so low, 00:20:37.119 --> 00:20:40.039 fewer mental health providers are taking insurance. 00:20:40.440 --> 00:20:44.079 We will face a crisis where people are only able 00:20:44.160 --> 00:20:46.599 to get services if they can pay out of pocket. 00:20:47.039 --> 00:20:49.960 Both therapists wanted us to conceal their identities 00:20:50.039 --> 00:20:51.839 out of concern for patient privacy 00:20:51.920 --> 00:20:54.920 and because they still have to work with insurance companies. 00:20:55.000 --> 00:20:56.599 So as providers, some people think, 00:20:56.680 --> 00:20:59.039 "We're just for the money or we don't care." 00:20:59.119 --> 00:21:01.119 No, we care. We care a lot. 00:21:01.599 --> 00:21:04.880 But these companies are also driving us into the ground 00:21:04.960 --> 00:21:07.240 and we can't, this is not sustainable. 00:21:07.839 --> 00:21:09.359 Yeah, of course, it isn't! 00:21:09.440 --> 00:21:11.599 Therapists are in a no-win situation here. 00:21:11.680 --> 00:21:14.200 And for what it's worth, it is just not a great sign 00:21:14.279 --> 00:21:16.359 that insurance companies are now so powerful 00:21:16.440 --> 00:21:19.519 that mental health providers feel they have to go on the news 00:21:19.599 --> 00:21:23.359 like they're in witness protection after seeing someone get whacked. 00:21:23.440 --> 00:21:27.799 And the thing is, some out-of-network therapists can make a lot of money, 00:21:27.880 --> 00:21:32.279 if they live in an area with patients that can afford to pay out of pocket. 00:21:32.359 --> 00:21:33.880 But for the many who don't, 00:21:33.960 --> 00:21:37.480 they are stuck taking whatever insurance companies are willing to pay, 00:21:37.559 --> 00:21:40.920 which helps explain why psychiatry was ranked one of the lowest 00:21:41.000 --> 00:21:44.279 in compensation among 29 medical specialties. 00:21:44.359 --> 00:21:47.319 And it's not just doctors, counselors and social workers 00:21:47.400 --> 00:21:51.160 with masters' degrees earn 33 to 45 percent less 00:21:51.240 --> 00:21:54.640 than other health professionals with a comparable education. 00:21:54.720 --> 00:21:58.759 And as bad as our situation is right now, it's getting worse. 00:21:59.079 --> 00:22:02.559 One survey in Massachusetts said that for every 10 clinicians 00:22:02.640 --> 00:22:06.440 entering work in mental health clinics there, 13 leave. 00:22:06.799 --> 00:22:08.559 And if we continue at that rate, 00:22:08.640 --> 00:22:11.839 one day, we're going to wind up with negative therapists, 00:22:12.480 --> 00:22:14.160 which I'm pretty sure is what you call anyone 00:22:14.240 --> 00:22:16.440 who responds to your serious mental health issues with, 00:22:16.519 --> 00:22:19.599 "Interesting, I can't wait to get into my jammies later." 00:22:21.079 --> 00:22:24.799 And the costs of leaving mental health untreated can be massive, 00:22:24.880 --> 00:22:27.119 not just for those needing it, but for all of us. 00:22:27.200 --> 00:22:29.799 Mental health problems are a big driver of homelessness, 00:22:29.880 --> 00:22:33.279 and also force people into contact with the criminal justice system. 00:22:33.359 --> 00:22:36.319 In fact, it is often said that correctional facilities 00:22:36.400 --> 00:22:41.119 have become the largest providers of mental health care services in US. 00:22:41.200 --> 00:22:44.039 We've gone from warehousing people with mental illness 00:22:44.119 --> 00:22:46.079 in buildings that felt like prisons, 00:22:46.160 --> 00:22:49.000 to warehousing them in actual prisons instead. 00:22:49.079 --> 00:22:53.400 It's very much the "new look, same great taste" of America's failures. 00:22:53.480 --> 00:22:55.640 So, how do we fix all of this? 00:22:55.720 --> 00:23:00.319 This is clearly an absurd way to operate a health care system. 00:23:00.400 --> 00:23:01.960 And for the umpteenth time, 00:23:02.039 --> 00:23:05.400 I would argue single-payer health care is the way to go. 00:23:05.480 --> 00:23:11.079 Unfortunately, we can't get that, because it's very high up on a shelf. 00:23:11.480 --> 00:23:13.960 I don't know who left it there, but they must've been tall, 00:23:14.039 --> 00:23:15.799 because it's way too high to reach. 00:23:15.880 --> 00:23:17.319 And if you're thinking, "Why not use a ladder?" 00:23:17.400 --> 00:23:21.640 The ladder's also on the shelf. It's a really frustrating situation. 00:23:22.559 --> 00:23:24.000 But in the absence of that, 00:23:24.079 --> 00:23:27.160 we need to both recruit more mental health care professionals, 00:23:27.240 --> 00:23:30.599 and make sure that insurers cover them properly. 00:23:30.680 --> 00:23:32.319 On the first point, the Biden administration, 00:23:32.400 --> 00:23:34.799 to its credit, announced a plan back in March 00:23:34.880 --> 00:23:38.599 that'd provide "$100 billion in mandatory funding over 10 years" 00:23:38.680 --> 00:23:41.160 to completely transform our current system, 00:23:41.240 --> 00:23:44.440 which includes investing 700 million in programs to cover 00:23:44.519 --> 00:23:47.400 everything from training to scholarships and loan repayments 00:23:47.480 --> 00:23:50.240 for those committed to working in underserved areas. 00:23:50.319 --> 00:23:52.839 But obviously, that's only half the battle. 00:23:53.200 --> 00:23:56.960 On the insurance company side, we badly need to be strengthening 00:23:57.039 --> 00:23:59.640 and enforcing those mental health parity laws, 00:23:59.720 --> 00:24:01.920 at both the state and the federal level. 00:24:02.000 --> 00:24:06.519 California has put in one of the most comprehensive parity laws in US. 00:24:06.599 --> 00:24:10.720 Among many, many other things, it requires that insurers must base 00:24:10.799 --> 00:24:12.880 "medical necessity determinations 00:24:12.960 --> 00:24:16.519 on current generally accepted standards of mental health care", 00:24:16.599 --> 00:24:19.400 instead of just making up the criteria for themselves. 00:24:19.480 --> 00:24:21.519 That is a very big deal, 00:24:22.000 --> 00:24:24.559 and more states should be following California's lead. 00:24:25.079 --> 00:24:30.599 In the past, so much of the problem was that people would not ask for help. 00:24:30.680 --> 00:24:33.680 Thankfully that's now less of an issue, thanks to, among other things. 00:24:33.759 --> 00:24:37.240 the tireless gland-shaming of Mr. Harrison Ford. 00:24:38.519 --> 00:24:40.839 But now, when people do reach out for help, 00:24:40.920 --> 00:24:43.440 we're just not in a position to give it to them. 00:24:43.519 --> 00:24:47.880 If we want to be a society that truly respects and values mental health, 00:24:47.960 --> 00:24:50.640 we have to respect and value mental health care. 00:24:51.279 --> 00:24:53.839 And that means supporting the people who deliver it. 00:24:53.920 --> 00:24:58.000 It's going to take a lot of investment and continued resolve to fix things, 00:24:58.079 --> 00:25:00.000 but it's also absolutely worth it. 00:25:00.559 --> 00:25:04.119 Because it just cannot be the case that when people ask for help, 00:25:04.200 --> 00:25:08.440 our only option is to tell them to suck it up, Buttercup. 00:25:08.920 --> 00:25:09.960 And now, this! 00:25:10.920 --> 00:25:15.279 And Now: The World's Horniest Televangelist. 00:25:16.240 --> 00:25:20.480 Everywhere I go, I have people just stroke their Bible, kiss it. 00:25:21.279 --> 00:25:23.119 Then I say, "Rub it over your face." 00:25:23.680 --> 00:25:25.920 I'm Mike Murdock, a follower of Jesus. 00:25:26.000 --> 00:25:30.759 I like sexual beauty. Really like that. I look at a woman's ankles, 00:25:30.839 --> 00:25:32.960 I look at her toenails, I look at her fingernails. 00:25:33.319 --> 00:25:36.400 I don't know why cutoffs are sexy, but they are. 00:25:37.000 --> 00:25:39.759 I like short shorts. I don't like long shorts. 00:25:39.839 --> 00:25:41.759 I want to see everything I can. I'm a man. 00:25:41.839 --> 00:25:45.519 You think when I think of marriage I'm thinking of black-eyed peas, 00:25:46.079 --> 00:25:51.279 pork and beans, fried corn, and glass of iced tea? 00:25:51.720 --> 00:25:53.759 That's marriage. Are you kidding? 00:25:54.880 --> 00:25:58.799 I want a sexpot stripping on the stage in front of me in the bedroom. 00:26:04.599 --> 00:26:07.599 If her nipples are ugly, she'll cover those up. 00:26:08.359 --> 00:26:10.240 But she wants you to see the mounds 00:26:11.400 --> 00:26:14.359 because men see mounds and they start thinking. 00:26:15.119 --> 00:26:18.039 "31 Secrets of an Unforgettable Woman." 00:26:18.880 --> 00:26:20.440 Unbelievable book. 00:26:20.519 --> 00:26:24.880 I started crying when I started reading this book that I was writing. 00:26:28.720 --> 00:26:31.599 Thanks so much for watching. We'll see you next week. Good night! 00:26:32.799 --> 00:26:37.680 In December, I'll be in Beijing, opening up new pork markets!