Increasing access to mental health care is an important step, says a Michigander with borderline personality disorder, but broader cultural changes are needed.
PORT HURON, Mich.—Lisa Meadows is studying psychology. She’s passionate about the mind and its intricacies, and about the system of mental health care in Michigan and, more broadly, America today. This passion comes in part from her own mental health conditions: Meadows has borderline personality disorder (BPD).
The National Alliance on Mental Illness considers BPD to be one of the most misunderstood and stigmatized psychological conditions today. People with BPD experience dramatic mood swings, intense relationships, impulsive tendencies and rapidly shifting self-image.
“There’s actually a profound amount of stigma about this,” Meadows told The ‘Gander. “I’m not any different. I feel things a bit more intensely, I might have a few more things that are a struggle for me, but that doesn’t mean I can’t have fulfilling relationships. The idea that I can’t? It’s extremely harmful.”
Meadows recounted a story of one of her professors, teaching psychology, who had a profoundly negative view of people living with BPD. That professor told the class Meadows was in that she doesn’t and wouldn’t treat someone with BPD, and would sooner treat patients with violent impulses than someone like Meadows. Studies show that the professor was far from alone.
The stigma isn’t limited to professionals as well. Meadows said the father of the person she’s dating was deeply uncomfortable with her diagnosis and the fact that his child was “dating a borderline” at all.
In her experience, Meadows says the stigma comes often from the same situation.
“It’s somebody in their life that has this disorder that they have a negative opinion of and so that means everybody who has this disorder is the same,” she said. “That’s so not the case.”
It’s a struggle for people with BPD to seek care because of this stigma, or to live their lives acknowledging their condition. But increasing access to mental health care is a good start.
Michigan Prioritizes Mental Health
Investments in Michigan’s mental health resources are a sort of righting of the ship, explains the Communities of Mental Health Association of Michigan. Over the past several years, Michigan budgets deprioritized mental health, and in turn eroded what had been one of the nation’s most robust mental health systems. The end result of continued disinvestment, the Association said, was “death by a thousand cuts.”
For the 2021 budget passed in October, the state allocated $20 million for the state’s psychiatric hospitals to improve access to care for Michiganders needing help. Additionally, it allocated $5 million to hire school counselors and $2.5 million to treat post-traumatic stress among the state’s first responders.
Over the summer, Jacob Halpern, who works patient transport at Butterworth Hospital, spoke about the then-looming threat of the coronavirus pandemic and how it impacted health care workers like him.
“Sometimes I wake up and start having panic attacks just knowing I have to work,” Halpern told The ‘Gander. “I actually took a two-week leave for my mental health recently. Most of us are having a rough time sleeping and have for a few months now, which doesn’t help.”
The $2.5 million for treating post-traumatic stress among people like him is imperative, especially because the services provided by Butterworth for its employees was lackluster.
School counselors are especially important as well, said Kalamazoo teacher Holly Bruning. And school counselors are, nationally, in dangerously short supply, according to research by the American Civil Liberties Union.
“There are so many students that come from trauma-induced backgrounds or extreme poverty that learning is not a priority for them nor should it be—these kids are in survival mode,” Bruning said. “I think having multiple social workers and multiple counselors within my building would not only help students find success, it would mean that we can work on survival skills, find safety, start learning, build community.”
As for hospitals and access to care, Meadows said it addresses a major problem with Michigan’s health care system: Mental health care access is very region-dependent. She recounted a time when she was encouraged to seek help at one of those facilities but couldn’t. And she knows other people living with BPD have had the same experience.
“Self-harm, suicidality, is part of our diagnostic criteria, so we’re gonna be in there a lot,” she said. “I’ve unfortunately had to make the decision of ‘I have a job, I have classes, I have all these other things going on in my life, I can’t just leave those.’ They won’t let you. They won’t let you just peace out even if it’s for something like that.”
Her therapist mentioned a partial hospitalization, which was outpatient, as an option but the nearest mental health hospital is Harbor Oaks, more than half an hour from Port Huron. That still would disrupt her daily obligations. But other regions, like Metro Detroit, have more options and more resources available than Port Huron.
Meadows is optimistic about the way Michigan’s budget has prioritized mental health. But, she said, improving the system is about a lot more than injecting money.
The Cultural Change Money Can’t Buy
In her studies, Meadows encountered a particularly perplexing problem faced by people with mental conditions called the Just World Hypothesis. She explained that people want to believe the world is fair. So, when people see someone suffering, those who subscribe to the idea of a just world assume that suffering was caused by the personal failures of the person suffering. The idea being that those with pain deserve their pain.
This philosophy underpins the stigmatization of mental illness that has made mental health care a distant second to physical health care in terms of priorities for both people and governments. Psychology Today explains that this is a faulty way of viewing the problem.
And that deprioritization has caused uncertainty for mental health providers and for patients. The lack of standardization of care means patients can be treated differently based on factors like how they pay. Meadows has done work in the field on conditions other than BPD and had seen those differences in practice.
“They treat you differently, you have different standards and different criteria depending on if you are state funded, if you have insurance or if you’re private pay,” she explained. “You will get different standards depending on how you’re paying. Ideally, we don’t have that. Ideally we have one-size-fits-all and everybody gets the same level of treatment.”
The money the state allocated for access is good, she said, because people’s access to health care is very region-dependent, but there are broader cultural changes needed as well to help improve the standards of care and dispel some of, and hopefully all of, the stigmatization.
Michiganders who are in need of assistance can check the Michigan Department of Health and Human Services guides to local Communities of Mental Health services or low-cost mental health services. Those whose mental health suffers because of the ongoing pandemic can turn to COVID-specific mental health programs offered by the state.