Severe Depression: Seeking Help When Financial Barriers Exist

Major Depressive Disorder

Hello, Doctor: I have been seeing a psychiatrist at Chang Gung Memorial Hospital since high school due to self-harm, for at least one to two years.
The doctor conducted psychological assessments and stated that I needed psychotherapy.
However, due to the high costs and my family's financial difficulties, I could not continue seeing the doctor.
During my military physical examination, I underwent many tests and was ultimately exempted from service because of this.
After that, I did not see a psychiatrist, but whenever I felt extremely depressed, I would still self-harm.
In 2013, I self-harmed and injured someone, which led to the police taking me to the hospital where I saw a psychiatrist, and a social worker continued to check on me.
Shortly after that, my mother fell seriously ill and passed away in 2014.
My family's financial situation was already poor, and I had to seek help from social services to cover medical and funeral expenses.
Following this, my emotional and mental state deteriorated, making it difficult for me to work.
I experienced severe insomnia, often zoning out at work and not knowing what I was doing.
My life became very chaotic; if someone upset me, I would seriously think about harming them, feeling that since my parents were gone, it didn't matter, and I would think, "If you provoke me, let's see who suffers." I then started seeing a doctor again, from around the end of 2014 until now.
The doctor has also advised me to undergo psychotherapy, but I have expressed that my financial situation is very poor.
I would like to ask the doctor: "Why, when I clearly need help, is the doctor unwilling to prescribe me treatment for a serious illness? The doctor even told me, 'I think you only have general depression; it's not severe enough to warrant a serious diagnosis.' Additionally, I was told, 'You still have the ability to work; you need to be disabled to qualify for assistance.' I am truly at a point where I cannot work anymore, and I often have to take leave due to insomnia.
Do I really have to wait until something serious happens or until I harm someone before I can receive help? Why won't anyone assist me while I am still in a rational state and willing to accept treatment?" Can the doctor advise me on what I should do?

Youyuzhe, 30~39 year old female. Ask Date: 2016/04/16

Dr. Huang Weiqin reply Psychiatry

Dear inquirer, regarding your situation, it may be advisable to pursue both medication and psychotherapy simultaneously.
As for whether you can apply for major illness status, you will need to discuss this with your regular physician.
Additionally, the approval for the major illness card is under the jurisdiction of the National Health Insurance Administration, not the physician or the hospital.
I hope this information is helpful to you.

Reply Date: 2016/04/16

More Info

It sounds like you are going through an incredibly difficult time, and I want to acknowledge the pain and struggles you are facing. Your experiences with severe depression, self-harm, and the loss of your mother have undoubtedly created a heavy burden on your mental health. It is important to understand that seeking help is a courageous step, and there are ways to navigate the challenges you are encountering, especially when financial barriers exist.

First, it is crucial to recognize that depression is a serious mental health condition that can significantly impact your daily life, relationships, and overall well-being. The symptoms you describe, such as severe emotional distress, self-harm, and thoughts of harming others, indicate that you are in a state of crisis. It is essential to prioritize your safety and well-being above all else.

Regarding your concerns about accessing mental health treatment, it is unfortunate that financial constraints can limit your options. However, there are resources available that may help you receive the care you need without incurring overwhelming costs. Here are some suggestions:
1. Community Mental Health Services: Many communities offer mental health services on a sliding scale based on income. These services may include therapy, counseling, and medication management. Look for local mental health clinics or community health centers that provide affordable care.

2. Nonprofit Organizations: Organizations such as the National Alliance on Mental Illness (NAMI) and Mental Health America often provide resources, support groups, and information about low-cost or free mental health services in your area. They can help connect you with resources that fit your financial situation.

3. University Clinics: If you live near a university with a psychology or psychiatry program, they may have clinics where graduate students provide therapy under the supervision of licensed professionals. These services are often offered at reduced rates.

4. Telehealth Services: With the rise of telehealth, many therapists and psychiatrists offer online sessions, which can sometimes be more affordable than in-person visits. Some platforms also provide options for financial assistance.

5. Crisis Hotlines: If you are feeling overwhelmed or in crisis, do not hesitate to reach out to a crisis hotline. They can provide immediate support and help you find resources in your area. In the U.S., the National Suicide Prevention Lifeline is available at 1-800-273-TALK (1-800-273-8255).

6. Medication Assistance Programs: If you require medication, some pharmaceutical companies offer assistance programs for individuals who cannot afford their prescriptions. Speak with your doctor about potential options.

It is concerning that you feel your doctor is not taking your situation seriously. It is essential to advocate for yourself and communicate openly about your symptoms and the impact they have on your life. If you feel that your current provider is not meeting your needs, consider seeking a second opinion or finding another mental health professional who may be more understanding of your situation.

Lastly, it is vital to engage in self-care practices that can help alleviate some of the emotional distress you are experiencing. This can include establishing a routine, practicing mindfulness or meditation, engaging in physical activity, and reaching out to supportive friends or family members. While these practices may not replace professional treatment, they can provide some relief and help you cope with daily challenges.

In summary, while financial barriers can complicate access to mental health care, there are resources available to help you find the support you need. Your mental health is important, and taking steps to seek help is a sign of strength. Please prioritize your safety and well-being, and do not hesitate to reach out for assistance.

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