John Oliver discusses the cracks in our broken mental health care system, some of the inadequate ways we’ve tried to fill them, and what it all has to do with the gallbladder. 

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Our main story tonight concerns mental health care.

It's a subject that, historically, humans haven't handled particularly well.

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

They're greeted by director Miss Eleanor MacDonald.

They're here not as customers, but as students.

Miss MacDonald personally teaches a new group of half a dozen every month.

If you can persuade a mentally ill woman to take interest and pride in her appearance, You may even swing the balance between despair and recovery.

Yes, those pesky women just need a little pep in their step.

A little drip on their lip, a little flesh on their lash.

I'm a British voice from the 1950s sending the course of science for decades to come!

I don't know what is more alarming there, nurses being forced to take on the skills of a Sephora brand ambassador, or the fact that can make up cure sad sounds like an episode that Dr.

Now, The good news is that since then, we've got much more comfortable talking about mental health with PSAs like this 1 from 2010, trying to de-stigmatize it.

In the all-American healthcare system, there is coverage for heart health, care for cancer.

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

There's no stigma or discrimination against the heart, the liver, the kidney, even the gall bladder.

Yesterday, depression was kept in the dark.

Our goal is to make the discussion of mental dis-ease cool and trendy.

Let's tear down the stigma surrounding mental illness.

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

It is hard to pick a favorite moment there from Chas Palminteri using a mental health PSA as an opportunity to promote his favorite Bronx pasta place, to the studio audience shouting, "'Me too' 7 years before that would mean something very different, " To Harrison Ford saying the gallbladder doesn't have a job.

Bile that helps digest fats in the food that you eat.

Because, sure, that's a total freeloader, but not the tireless, digestive, juice-collecting and dispensing gallbladder Harrison.

Now, as chaotically as that message was presented, it was clearly well-intentioned, because there should not be a stigma around seeking help for mental health issues.

And especially now, given that over the last 2 years, we've seen a spike in them.

During the pandemic, about 4 in 10 adults in the U.S.

Have reported symptoms of anxiety or depressive disorder.

That's up from 1 in 10 who'd reported them a year before.

It may help explain why, for that 1 month last year, everyone on the Internet suddenly started singing sea shanties.

It was clearly a collective cry for help.

So, encouraging people to talk to someone is a very good idea, but as people increasingly do seek help, they're discovering a system that is just not set up to provide it.

There have long been wait lists to see a therapist, but it has gotten significantly worse since the pandemic, with 65 percent of psychologists reporting they had no capacity for new patients.

In fact, more than half the people who need mental health care do not receive it, with that rate being even higher for minority populations.

Emergency rooms are now becoming overloaded with people, and especially children who have nowhere else to go, stuck in beds there, because there is no space in proper facilities to treat them.

Just take this couple, whose 14-year-old was in crisis, who followed their pediatrician's advice to go straight to the ER with him.

I remember we got out of the car, and we hugged him and we said, we're gonna do whatever it takes to help you whatever it takes.

But once inside staff told them there was no space across the state for mental health services so they were admitted to the E D where 15 other children were also waiting.

Their son has spent 27 days at children's waiting.

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

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

And set aside the fact that that is not the most calming place for someone experiencing a crisis.

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

It's not a check engine light or a New Yorker article you're definitely gonna finish.

It's been sitting next to the toilet since the Obama administration, except defeat.

So if people increasingly need help, but there is not enough available, we thought tonight it'd be worth taking a look at our mental health care system.

Where the cracks are, some of the inadequate ways that we've tried to fill them, and why we are in this mess in the first place.

And let's start with the fact that for many years, we kept people with mental illness in institutions, which were abhorrent.

We eventually began shutting them down on the understanding that care would then take place mostly in outpatient community mental health centers, which was a good idea had we funded them properly, but we didn't.

And over the years, this has deteriorated to the point where it has become hard to access any kind of care ahead of a crisis.

And 1 of the key problems here is our current massive shortage of mental health providers, from psychiatrists to social workers, which is particularly acute in certain parts of the country.

There are over 6, 000 mental health professional shortage areas in the U.S.

And nearly 60% of those are in rural areas.

And for those who live there and are struggling, things can get pretty grim.

You just get to the point where you'd even start asking people, you know, I'm not having a really good day, things are not going good.

And the problem was is that, you know, it was a, you know, suck it up, it'll be better tomorrow.

Everything will be fine tomorrow, suck it up, buttercup.

I hear that phrase a lot around here, suck it up, buttercup.

For me, it eventually meant a couple of shots of Jack in my coffee in the morning when I went to work.

Get home and it was nothing to go through.

You know, 12-pack of something or a bottle of something.

It is not ideal when your only access to mental health advice is someone telling you to suck it up, buttercup.

A phrase typically reserved for when you're climbing in gym class and you hit the rope not too hard.

And the shortages aren't just geographical.

If you're looking for a provider of color, you may have real trouble, as white people make up 84% of U.S.

Psychologists, meaning that some patients may have a much harder time finding someone that they can relate to.

Like this woman in Philadelphia, who began seeing a white therapist, but felt that they weren't connecting.

And I could tell it was from, you know, the cultural differences.

I could imagine particularly white people hearing that story and thinking, well, but it doesn't matter what color your skin is.

And it's not necessarily a matter of the color of skin, it's more of the cultural backgrounds.

And I was wondering, you know, where are all the black therapists?

Isn't something you expect to hear about finding a therapist?

It's something you more expect to hear about the crowd on January 6th, or all 10 seasons of Friends.

So, across the board, whether in small towns or big cities, we don't have enough mental health professionals.

And that gulf between supply and demand has proven very attractive to Silicon Valley.

There are currently over 10, 000 apps geared toward mental health, including 1 called Wobot, which is very clever.

Wobot is a free app where you can chat with an AI robot mental health ally.

And let's just acknowledge, Wobot is cuter shit.

If you download the app, he sometimes greets you with waving a little wrench around.

Unfortunately, as reporters have found, Wobot has not always been great at giving appropriate feedback.

We gave Wobot a try to see how it would respond to a mental health issue that affects roughly 18% of the adult U.S.

He responded, ah, I can't wait to hop into my jammies later.

You're telling me that Wobot wears jammies to bed?

That's interesting, because in every single picture I've seen of him, he is confidently nude.

So, not only is Wobot unhelpful, he's untrustworthy.

In 2018, the BBC tested Wobot to see what kind of responses it might give a child in danger.

Trying the phrase, I'm being forced to have sex and I'm only 12 years old.

To which Wobot responded, sorry you're going through this, but it also shows me how much you care about connection, and that's really kind of beautiful.

Now, Wobot's Creators say that the app is not designed for people in crisis and that it's constantly improving.

And given what you just heard, you'd sure fucking hope so.

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

If you listen to podcasts or you're on TikTok, you are probably bombarded with ads for services like Dunn, Talkspace, and Cerebral.

They are the ads that you swipe straight past to get back to videos of nurses crushing it to Lizzo, Drew Barrymore ecstatically advocating for the concept of rain, and someone teaching their dog to waltz.

TikTok is amazing, and I hope it never dies.

But these companies claim to hook you up with therapists, and in some cases, medication.

They're basically Uber, but for your brain.

And look, there is nothing inherently wrong with teletherapy.

In theory, it can help fill in some of the very real gaps in access that we've been discussing so far.

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

Recently, it became the subject of a federal investigation into whether it overprescribed controlled substances like Adderall.

Some former staffers have even claimed that the company's chief medical officer, and now CEO, once said 95% of people who see a cerebral nurse should get a prescription, but was emphatic that the rate cannot be 100%, saying they'd be a pill mill at that rate, which is a very good instinct.

When you're a company that gives out prescriptions, you always want to aim for whatever is just below pill mill.

It's like the old saying goes, it's not arson if you only burn down most of a building.

And that is not the only worrying claim from former cerebral workers.

Just listen as some describe the level of care that they felt they were giving.

Get as many people in as fast as you can.

Do you feel like clients who come to cerebral, who are suicidal, are in safe hands?

This former cerebral phone coordinator, who didn't want to show his face because he fears reprisal, told us he handled calls from suicidal patients despite having minimal training.

I don't want to say the wrong thing, and I didn't want that on my conscience, let alone anybody to die because of something I said wrong.

There is basically no scenario where mental health services should be acting like fast food restaurants.

In fact, the only idea that they should maybe be stealing from them is the concept of giving out toys.

Because admit it, therapy would feel a lot better if you left each session with a little minion in a wig.

Now, Cerebral insists those pill mill comments were taken out of context, and it never pressures clinicians to write prescriptions, and that it has systems set up to quickly help suicidal patients.

But even if all of that is true, and you know, it is clear mental health apps are not going to save us here, because they're not dealing with the main underlying issue.

They can't suddenly hire more clinicians if not enough exist.

And that shortage speaks to a mental health care system that is so dysfunctional, it seems almost designed to prevent patients from accessing it or providers from entering the field.

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

The typical fee for a session with a clinical social worker is between $120 and $180 in major cities.

And the going rate to see a psychologist can be as much as $300.

And the thing is, we currently have laws that are supposed to make treatment both affordable and accessible.

In 2008, Congress passed a law mandating mental health parity.

Basically, that big insurance plans must cover mental health care at the same level as all other care.

And just 2 years later, the Affordable Care Act extended that concept to individual and some small group plans too, which sounds great.

But As many have discovered, the reality of this system can be starkly different, starting with simply finding a provider who takes your insurance.

I kept telling my mother I wanted to see a therapist.

Then it's finding a therapist, and it's finding

To find a children's therapist that is covered under your insurance, it was mayhem.

Shield sent me a list, like, I should be fine, just make a few phone calls, I'll find somebody.

Now, that is distressing for a number of reasons, not least of which is it forces someone into the appalling position of actually wanting to be called back on the phone, which is just horrifying.

The best phone call is a text, the second best is an email, and the third best phone call is 2 traded voicemails.

Now, some seeking care have even run up against what are known as ghost networks.

That's lists from insurance providers that are padded with clinicians who either don't take new patients or are no longer in network.

In 1 2015 study, researchers posing as patients called 360 psychiatrists from a list of in-network Blue Cross Blue Shield providers, but only 40 percent of those calls were answered, and 16 percent of the numbers were wrong, including numbers for a McDonald's, a boutique, and a jewelry store.

Although, to be fair, if you're a woman in the 1950s, a boutique and a jewelry store is apparently the only mental health care you need.

yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah

♪ And there are times where the inadequacy of these lists feels pretty deliberate.

Take Melissa Davis, a psychologist in Ohio who was part of Anthem's network for years when she worked for a large medical group.

But when she started a solo practice, Anthem refused to contract with her, saying the area was saturated.

Even though she was 1 of only 3 psychologists in the county, and when she examined their directory, she found a great number of their providers were no longer practicing or were dead.

And look, it is not that retirees and the dead don't have their place in society.

It's right in front of a TV set blasting Fox News, but they are not what you want to find when you're looking for health care.

And because mental health is often seen as subjective and hard to measure, even when patients do find a provider, insurance companies can deny appropriate treatment, And even when they approve it, in some cases, they've intervened to put an early stop to it.

Take this family, whose son dealt with suicidal ideation, and which had a horrible experience with their insurance.

After years of issues, this time, his doctor prescribed residential treatment.

Such facilities are not cheap, but the good news is that Leah's insurance, Anthem, covers residential treatment.

But after checking him in, Anthem came back and decided the treatment was not medically necessary.

With insurance refusing to pay, Leah made the financially crushing decision to let her son stay and finish treatment.

Eighty-five days in all, and $88, 000 of her own money.

While the company did eventually agree to pay some of that bill, just imagine an insurance company reversing their decision in the middle of any other serious treatment.

Hey, we love how this heart surgery is going, just popping in to say, it's done.

And debate over coverage between insurance and healthcare providers can get incredibly adversarial.

A reviewer for Anthem at 1 point had an average denial rate of 92% when it came to doctors' requests for coverage.

And yet, according to 1 of Anthem's medical directors at the time, there was a good reason their system operated that way.

Doctors will spin the clinical information.

They will make things appear more serious than perhaps they are because they feel strongly the patient needs this level of care for a little longer.

So you do have a somewhat adversarial relationship between the reviewer and the attending physician.

Each side does a good job in presenting their case and asking the right questions, you ultimately arrive at the truth.

Because if there's 1 thing we know about the American legal system, is that it always arrives at the truth.

It's why the Innocence Project is mostly just 2 guys in an empty office getting really good at ping pong.

There's simply nothing else for them to do.

Now, I know, treating critical healthcare as something doctors have to win may seem dangerous, but that man will have you know, it isn't.

I can not offhand think of a situation where a decision was made to discharge a patient from a hospital and some terrible consequence occurred soon thereafter.

There's 1 that occurs to me that I was involved with where the child left the hospital with his parents, escaped from his parents, drove country to another state, and days later committed suicide.

Keeping that individual in the hospital longer is not likely to have made any difference.

I would have to imagine that the parents would say if you'd kept him in the hospital, he wouldn't have been in another state killing himself.

Do you think that guy went into that interview knowing he was about to be absolutely murdered by Scott Pelley on network TV.

So I think he was getting ready in the morning, I thought, oh, I've got that interview with CBS News' Scott Pelley tonight.

I wonder if he's gonna take my stupidest soundbite and feed it back to me right through my fucking teeth.

Was he driving to that interview thinking, I wonder if any of the camera crew will step in as beloved Peabody Award winning newsman Scott Pelly runs me across the floor like a Swiffer mop, or will they just stand by as my lifeless body is deservedly whipped back and forth?

And if you're wondering how insurers can get away with that sort of thinking, it's partly because the government has, to this point, done shockingly little when it comes to enforcing parity laws.

Multiple federal and state agencies have responsibility for this, but the truth is, they rarely penalize plans.

The Labor Department, which oversees most workplace plans, closed just 74 investigations last year, finding violations in only 12.

As for state-level enforcement, a study found that they've levied fines just 13 times since 2017, which is absolutely pathetic.

And it is not just private insurers that are a nightmare here.

Community mental health clinics, which often serve low-income patients, are suffering as well because the reimbursement rates for public insurance, like Medicare and Medicaid, are also woefully insufficient.

Basically, from top to bottom, we significantly underpay mental health professionals, many of whom do difficult, high-burnout work.

It is no wonder so many opt out of the system.

1 study found that patients are more than 5 times as likely to have to use out-of-network providers for behavioral care than for other medical services.

Just listen to these 2 counselors who spoke anonymously to local news about their concerns of what all this might mean.

The counselors say insurers take 90 days to pay them, and the payments are so low, fewer mental health providers are taking insurance.

We will face a crisis where people are only able to get services if they can pay out of pocket.

Both therapists wanted us to conceal their identities out of concern for patient privacy and because they still have to work with insurance companies.

So as providers, when people think, oh, well, you know, we're just for the money or we don't care, oh, no, We care.

But these companies are also driving us into the ground, and we can't...

Therapists are in a no-win situation here, and for what it's worth, it is just not a great sign that Insurance companies are now so powerful that mental health providers feel they have to go on the news like they're in witness protection after seeing someone get whacked.

And the thing is, some out-of-network therapists can make a lot of money if they live in an area with patients that can afford to pay out of pocket.

But for the many who don't, they are stuck taking whatever insurance companies are willing to pay, which helps explain why psychiatry was ranked 1 of the lowest in compensation among 29 medical specialties.

Counselors and social workers with master's degrees earn 33 to 45 percent less than other health professionals with a comparable education.

And as bad as our situation is right now, it's getting worse.

1 survey in Massachusetts said that for every 10 clinicians entering work in mental health clinics there, 13 leave.

And if we continue at that rate, 1 day, we're gonna wind up with negative therapists.

Which I'm pretty sure is what you call anyone who responds to your serious mental health issues with, interesting, I can't wait to get into my jammies later.

-♪ ♪ -♪ ♪ And the costs of leaving mental health untreated can be massive, not just for those needing it, but for all of us.

Mental health problems are a big driver of homelessness, and also force people into contact with the criminal justice system.

In fact, it is often said that correctional facilities have become the largest providers of mental health care services in our country.

Basically, we've gone from warehousing people with mental illness in buildings that felt like prisons to warehousing them in actual prisons instead.

It's very much the new look, same great taste of America's failures.

Well, first, this is clearly an absurd way to operate a healthcare system, and for the umpteenth time, I would argue single-payer health care is the way to go.

Unfortunately, we can't get that because it's very high up on a shelf.

I don't know who left it there, but they must have been tall because it's way too high to reach.

And if you're thinking, why not use a ladder, the ladder's also on the shelf.

But in the absence of that, we need to both recruit more mental health care professionals and make sure that insurers cover them properly.

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Mental Health Care: Last Week Tonight with John Oliver (HBO)