Where it Hurts

where it hurts

Drowning in debt to stave off the mental illness that destroyed her mother

Elena Scotti/FUSION, Shutterstock

Welcome to Where It Hurts, a weeklong series that tells the stories of people in the United States who have gone without health insurance when they needed it most.

Going without has always been the story of health care in the United States. Even with the gains made under the Affordable Care Act, a greater percentage of Americans are uninsured than citizens in most other similarly wealthy countries. We pay more and receive less in return. Things could still get worse.

Recent estimates from the Congressional Budget Office predict that by 2018, the Republicans’ proposed American Health Care Act would increase the number of uninsured people by 14 million. That number will grow to 24 million come 2026. An analysis from the White House puts that increase even higher, at 26 million. That’s nearly the entire population of Texas, the second largest state in the country, losing their coverage all at once.

These are the stories behind those numbers.

Elizabeth is 35 years old. She asked that we not use her full name.

I had always struggled with my mental health, starting around the time I was nine or ten. I would see a doctor and they would diagnose me with depression and give me antidepressants. Still, it wasn’t getting any better. Then, as a sophomore in college, I had what was described to me as psychotic break. I don’t remember a lot of it, and I think it’s for the best that I don’t. I just know that I called my father, and that whatever I said to him was enough for him to come to my apartment and let himself in. If he had shown up 40 minutes later, I probably would have been dead. I was planning on killing myself. I had bought razor blades and was filling up the bathtub.

The weeks after that are a little fuzzy. I missed a bunch of school and finally saw a doctor who diagnosed me with bipolar. It made so much sense to me, and so much sense to the people around me. I had been hearing voices—not voices telling me to do things, but my head was never silent. It’s a lot easier to function when you aren’t fighting your own brain constantly.

I was on my parents’ insurance through all of this. After college, I had COBRA. Then I went to graduate school and law school and had insurance plans through that. Even after graduating law school in 2009, because of the recession, I had my insurance extended for another year. I had always had insurance. I was fortunate.

But it ran out in 2010. I started looking online and I just couldn’t get insured. Even catastrophe insurance—which basically covers nothing—was going to cost over $1,000 every month. I was doing some freelance legal work but was trying to find a full-time job that had benefits—at a firm, at a nonprofit, anywhere. I would have worked at Starbucks.

I remember what it was like to not have medication and treatment, and I don’t want to go back to that.

Thankfully, there was a sliding scale clinic that I went to for about a year. But then I got a part-time job at a law firm that didn’t offer insurance. Eventually I was making enough money that I was no longer eligible for the sliding scale clinic, but also not making enough money to afford insurance on my own.

It got overwhelming. My medications were coming to about $800 a month. And every six to eight weeks I had to go see a psychiatrist. It was too expensive. It got to the point where I was doing just about every other day with my meds, which is a really bad idea. You just should not be doing that.

I was charging everything. I was charging therapy, I was charging medication, I was charging doctor’s visits. I remember getting an eye infection during all of this and the medication—which was $700—was the cost of my rent at the time.

But still, I was very lucky to even have access to credit. That’s a lot of class and race privilege, to be able to have a crazy high balance and pay minimum payments. And that’s more than a lot of people have. But if I would have had to keep going at that pace, I would have had to file for bankruptcy or roll the dice and stop treatment.

I eventually found a full-time job. And my grandmother passed away and left me some money, which allowed me to pay down some of my debts. But it was crazy. Stressful.

People don’t often think of mental illness as being terminal. But people are going to die by their own hand if they don’t have treatment.

My mother had bipolar disorder too, and didn’t get it treated. She died from suicide at 40. I see that as terminal mental illness. I feel like the disease is really what killed her through suicide. And that’s always in the back of my head in terms of treatment. I remember what it was like to not have medication and treatment, and I don’t want to go back to that.

There was a certain level of shame I experienced without insurance. I think there’s a lot of shame already around mental illness. I got sucked into that whole thing about mental health: Why can’t you just fix this on your own? Why pay all of this money to manage it? I didn’t want to tell anybody about my debt. There is just this narrative about financial stability and not having debt, even if it’s for something like medication.

And it’s scary to think we might go back to where health insurance companies don’t have to cover mental health. I worry about myself. I worry about people who are more vulnerable than I am.

People don’t often think of mental illness as being terminal. But people are going to die by their own hand if they don’t have treatment. I’ve seen that in my own life, and I’ve been on that brink myself. I know how your brain chemistry can get you to that place. I can’t go back to that, I won’t survive.