After TMZ broke the news last week that Spears had checked herself into a mental health facility, the coverage, though extensive, was comparatively muted. The consensus (rightly) seemed to be that Spears, in the face of extreme stress, had done the responsible thing by seeking help. Many other celebrities expressed their support, and voiced to their fans the importance of getting the care you need. Spears, who announced earlier this year that she was taking some time out of the limelight to focus on her family, posted on her Instagram page last week: "We all need to take time for a little 'me' time."
But for the non-rich and famous, seeking help for mental health issues in America is often fraught with complications which make a mockery of well-meant encouragement.
According to new analysis of 300 emergency rooms published this week in JAMA Pediatrics and reported by CNN, the number of children aged 5-18 who arrived with suicidal thoughts and suicide attempts doubled from 580,000 to 1.12 million between 2007 and 2015. The average age of those evaluated was 13, and 43% of the children visiting were aged between 5 and 11. While previously suicidal behavior made up 2% of pediatric emergency room visits, it now accounts for 3.5%.
It's not just kids who are struggling. Last year the Centers for Disease Control and Prevention reported that suicide among adults has risen in nearly every state over the last 20 years, in half by as much as 30%. Depression and prior suicide attempts represent significant risk factors for suicide.
This is an emergency, but too often, the support millions of Americans need is not available. And, as always, the poorest are hardest hit.
After the financial crisis in 2008, states cut mental health spending by billions of dollars. In 2014, a study published in JAMA Psychiatry found that therapists were the least likely medical providers to accept insurance. The percentage that did was "significantly lower" than physicians in other specialties like cardiology or dermatology. Therapy can cost hundreds of dollars per session, and is especially expensive in cities, where rates of depression are higher. Most of the United States faces a severe shortage of practicing child and adolescent psychiatrists, with fewer than 17 providers available per 100,000 children, according to data from the American Academy of Child and Adolescent Psychiatry.
"Even though I'm able to afford sessions out of pocket now, they're extremely expensive when I have to do that and a lot of the places that I need to go to don't accept my insurance," Cori Siren, an entertainer and jewelry maker from Indiana told me. "So, I'm left going to awful facilities that do accept my insurance and something always gets messed up."
Regardless of whether you have medical insurance or not, finding support can be a mission unto itself, and Siren's story echoes others' who struggle to find timely access to appropriate care. This problem, a longstanding issue, has only grown worse over the course of the Trump administration so far.
In 2017, the Trump administration froze a federal database which had helped direct people to services and interventions to treat mental health disorders and substance abuse. The 2019 fiscal year budget requested $68.4 billion for the Department of Health and Human Services -- a 21% decrease from the budget enacted in 2017.
In March, Trump supported a lawsuit challenging the constitutionality of the Affordable Care Act. This is the latest in a series of attacks, with the administration having already given states powers to weaken Obamacare last October. About 30 million people covered would lose their health insurance if the Affordable Care Act was repealed without a replacement plan, according to the Economic Policy Institute. The expansion of Medicaid under Obamacare dramatically increased access to care for conditions such as substance addiction in the most-affected states.
The stress of seeking out evasive health care can have an impact over generations. Watching parents struggle with bills, drown in forms and sink into debt can put children off engaging with an unwelcoming system in their own adulthood, and exacerbate the effects of the original condition. When you have a mental illness, even the most perfunctory daily tasks can feel like mountains to climb, let alone making important phone calls or filling out complex paperwork.
Though mental illness remains stigmatized, and to hugely varying degrees across race and wealth status, the conversation around it has evolved. The media is moving away from some of the derogatory language it used so thoughtlessly even a few years ago. But for those not wealthy enough to check into rehab facilities or access even basic care, the right words are far from enough to tackle a growing and dangerous problem.
While there is undoubtedly value in seeing a beloved celebrity handle mental health issues as judiciously as Britney Spears has in recent weeks, the real lesson we should take is that against all sense and justice, mental health care in America remains for too many (and even more if the Trump administration has its way on healthcare policy) the domain of the privileged. Until that is addressed, for many, urges to seek help will remain a hollow echo.
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