Play / Download Mental Health Care: Last Week Tonight with John Oliver (HBO)
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LastWeekTonight

LastWeekTonight

Published on 1 week ago





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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Slacker Raven Slacker Raven . 6 minutes ago
John Oliver would know, Harrison, he used to run Anatomy Park
Quentin Kinotayo Quentin Kinotayo . 2 hours ago
Without any animosity and as a long-time follower of John Oliver this is the first time I feel the need to comment : at 6:30 John talks about the shortage of providers of color and the difficulty for some people to find "someone they can relate to", because of the "cultural differences". To be honest, I don't understand why the color of skin matters, as the "cultural background" the woman evokes at 7:12. I used to see a therapist and it didn't even occur to me that the cultural background might be an issue. Could someone explain to me what they would refer to ?
Shay Shay . 2 hours ago
I went to a children’s eating disorder recovery inpatient hospital as a 17 ur old. So many little kids had to leave bc their insurance said they were fine but they were still having breakdowns drinking boost instead of eating their meals.
Smiley P Smiley P . 2 hours ago
Great video but SINGER PAYER healthcare IS the fucking solution
Smiley P Smiley P . 2 hours ago
Wow capitalism is failing humanity because the goal is profit and not human welfare??? Who'd have guessed 🙄

Universal healthcare including mental healthcare NOW
medialM0 medialM0 . 3 hours ago
I'd rather buy a VR headset than spend the same on therapy
MrMediumJoe MrMediumJoe . 3 hours ago
The only person that should determine if a treatment is medically necessary is your doctor.
BMKGR BMKGR . 7 hours ago
Public Service Loan Forgiveness is horrible and only “forgives” <10% of applicants, a tiny portion of the loans and not all. Providers are over-worked and under-paid and clients are receiving poor care because of it. Mental health crisis is largely due to poor material conditions (capitalism). Asylums closed so that the marginalized would be pipelined into prisons where the state can profit off of them and their labor. Most people receive mental health care so that they can remain *just functional enough* to keep working, not thriving. Providers can’t get into the field unless they have ability to get higher education and then pay EXORBITANT exam fees, research shows these exams are racially and culturally biased so white people pass at >90% but non-white as low as 57%. BIPOC end up paying ~3x the amount on exams to retake them (over $1k for study material and exam fee, not to mention transportation to and from the limited testing centers)
cnmmd qiuoo cnmmd qiuoo . 9 hours ago
whole other layer of PTSD that they have to work through and delays their care.
Katie Wenta Katie Wenta . 9 hours ago
My insurance company did that to me with a medication that I take for an auto-immune disease (which could kill me if it rages out of control). A med that is $12k per dose and needed once a month. They approved it and then after I had the second dose, they came back and said it wasn’t medically necessary and weren’t going to pay.
Rebecca Birnbaum Rebecca Birnbaum . 9 hours ago
I hate to see how this show degraded from a enteraining, informative yet respectful program, to this condoscending, cheap-laughs bashing-show.
Not You Not You . 9 hours ago
Alfred Hitchcock Presents, Season 1, Episode 36 ("Mink"): "...I felt so sorry for you when you were wearing that cloth thing. No wonder you were mixed up. A good mink does more for a woman than a psychiatrist." A little shopping, a little makeup, voilà.
Mi Ka El Mi Ka El . 10 hours ago
When no one on the outside can help, we probably should look within.
Mi Ka El Mi Ka El . 10 hours ago
::Andrew Tate has entered the chat::
Peachy Kaida Peachy Kaida . 12 hours ago
For years, I was taken off my antidepressants because there was only one child psychiatrist in the whole city (pretty big city too) and they constantly got rid of therapists, canceled appointments and such. It kinda sucks being forced off your medication as a child and then getting progressively suicidal. Been suicidal since 8 years old.
AltruisticWarrior AltruisticWarrior . 12 hours ago
Cerebral was very helpful for getting my mental health therapy and meds including adderall. They didn't prescribe it so flagrantly to me. I had to give them records of autism/adhd diagnosis with prior treatment. They only prescribed 10mg XR and honestly it worked perfect for me in tandem with an antidepressant and therapy. My wife threatened to leave me if I didn't start addressing some of my adhd and depression issues and Cerebral was the perfect fit for so many reasons. Now I'm back to square one. My insurance plan only covers two psychiatrists in Las Vegas and the wait time is several months and the cost is rather high per visit. It was great getting all my mental health needs under one roof where records were shared and well coordinated. My job has me work out of state 3 weeks and off 2 weeks. That makes it incredibly difficult to see a provider on a monthly rotation. Cerebral and others were meeting a big need that was there but due to prohibitive cost, patient schedules or regional constraints, couldn't be met. How nice it was that the doctor "came to you" and sent the meds to your house or nearby pharmacy. Of course it was to be expected that prescriptions for controlled substances were going to increase dramatically but I imagine that was also true for other medications. This is rather unfortunate.
Deth_Bang Deth_Bang . 13 hours ago
Honestly, I use cerebral and it is difficult to set up appointments in my experience. It’s easier going through a physical prescriber and therapist. Cheaper too in some cases
romanvampire romanvampire . 14 hours ago
thearapist that fall under insurances...
uhm...
am I the only here who sees a HUGE conflict of interest here????
The insurance win most, if fewer people get access to one of those terapists!!
and how fucked up is you system if the insurance you happen to have is the most important limitation to witch psychiaters you can try to consult??
Dave Eve Dave Eve . 16 hours ago
Imagine yourself needing to be taken care of and have to be fed and can’t bath yourself… companies that provide these services need help to fund these sorts of services. Thats all I have to say about that.
C Miller G C Miller G . 16 hours ago
I can sadly attest that our so-so mental health care system is getting even worse. My symptoms are quite acute and I've been on 7+ month wait lists (and then dropped!), get residents or nurse practioners rather than docs, with less frequent appts. The local 24hour crisis phone line doesn't even always pick up... instead, you can get a recorded message suggesting to try calling again in 15 minutes. Clinics also fail to make good on referrals. And diagnoses can vary across providers, as can treatments. After decades of inadequate care, I'm about to give up on this system, as poor care can actually be worse than nothing
vikthya vikthya . 17 hours ago
A major issue causing the dearth of mental health professionals (particularly those of color) was only touched on in this video: even if you want to go into the field, the bar to entry can be prohibitive. Many programs that lead to an LCSW/LPC/LMFT are difficult if not impossible to complete while holding down a job. I've seen some schools advise that during the second year students not work at all, especially because to go into this field you have to do your own therapy as well, which can cause burnout before you ever graduate. Then there are the licensure requirements, which go beyond the cost of a license exam (these vary by state and you have to become licensed in specific states). There's several thousand hours of supervision required as well; this means providing mental health care to clients, often at a reduced rate, while also paying your supervising, licensed therapist their fee for overseeing and reviewing your work. Taking on all of this cost (and astronomical school debt) while knowing you may be making 35-45 thousand a year means for many people, it's just not an option. This is a big part of why we have so few mental health providers, and also a big part of why so many of the ones we do have are financially and socially privileged white people.
Deanna Dolan Deanna Dolan . 18 hours ago
I tried Better Help and after 4 sessions the therapist asked me to rate my progress on a scale to determine if I was over my depression. I tried another therapist and she was so out of touch that I struggled to open up. Eventually, I tried a hybrid program (guided and self-guided) that helped me tremendously. They don't take insurance, but they do offer scholarships to those in economic hardship. It isn't a substitute for crisis counselling, but if you're not in imminent danger it may be beneficial. It's the Personal Development School by Thais Gibson. This is not an excuse or endorsement of a broken system, just an option for those who need a resource for help.
Travis Gudenrath Travis Gudenrath . 18 hours ago
As someone who worked in an in-patient SUD corporately-owned private treatment center, it was fairly common for insurance companies to deny payment shortly after agreeing to cover a stay. It was a 30-day all-gender/sex drug and alcohol treatment residential facility and insurance companies would not actually pay for 30 days of treatment up front. The given justification (which is fair) is that a client may not stay for all 30 days (leave AMA, multiple prior treatment episodes meaning client has enough experience/understanding to need less than 30 days, etc) so a mechanism called "reauthorization" was utilized, which I'm sure is common in other forms of treatment.

Essentially, a client would admit and insurance would agree to cover anywhere from 1-7 days (I saw a handful that were as high as 14 days, we'll say 7 for the example), a case manager at the client's insurance company (call them Insurance X) would review the clinical notes written so far by the case managers and therapists at the treatment center and based on those notes, along with whatever else Insurance X had access to, they would decide whether or not to cover additional days. These reauthorization "windows" as we called them could range from the given 1-7 days (again rare handful at 14) and would happen again and again until the client discharged from residential treatment; if they continued on to an Intensive Outpatient Program or other such treatment, the process would continue there.

Makes sense, right? However, there are some key flaws: Insurance X could provide a reason to treatment staff for not covering treatment stating "not deemed clinically necessary" and we could appeal their decision to their own internal panel of undisclosed psychiatrists/counselors/doctors who would overturn the decision or again say "not deemed clinically necessary". They had no obligation to document their decision-making process nor highlight what aspects they deemed disqualified a client for continued clinical necessity, meaning a client's stay in a drug and alcohol treatment facility they entered voluntarily to attempt to begin recovering from the medically-recognized disease of addiction could be cut short at any time. All days up to that point are covered, but at EOB on the day of that decision, nothing more will be covered. Clients coming in from out-of-state, who did not have immediate access to transportation, and many who did not have a home or safe environment to go back to (many clients were also survivors of sex trafficking, domestic violence, and/or came from dangerous environments they could not return to) would have to agree to pay immediately or via a payment plan (or get a scholarship if funds were available) for ANY DAYS AFTER THAT. All-caps not because it is not obvious, but because at that particular facility, out-of-pocket rate was $900 per day so if this call happened on a Friday (as many oddly did) staying through the weekend (including Monday bc one is charged for where they BEGAN the day not ENDED) is immediately $2700 on top of whatever they put down coming into treatment.

"They can do private pay, right?" Yes they could, at an exorbitant mark-up similar to John Oliver's expose (read it in French) on billing in the hospital industry where providers mark-up cost of care to $X.00 when they only want/need 20-40% of $X.00 because Insurance X commonly haggles prices down and refuses to pay the full amount. "What about financial assistance such as payment plans and scholarships?" There are amazing people working their fucking asses off in the Finance and Utilization Review departments of treatment centers fighting against corporate leadership to get these approved and in a lot of cases, they are able to work out an arrangement or pay partial even full cost for some amount of days in treatment for a client via a "scholarship". However, I saw my fair share of clients prematurely discharged against all treatment staff's clinical recommendation (which is tied to our licenses) as the "scholarship limit" had been reached for that month or quarter.

Seems hard but realistic, can't pay for everyone. HOWEVER, people admitting into residential drug and alcohol treatment are not always in a right state of mind (i.e. drunk, high, withdrawing, etc.) and are signing financially binding agreements with the implicit understanding they will receive, at a minimum, 28 days of residential treatment. Almost always, the fact that this is a hoped-for 28 days is not disclosed at the time of admittance in a way the client understands or can be held to a standard for understanding. In addition to this grey area of ethics, another factor to consider is that many people seeking treatment do not have strong financial resources as addiction tends to wreck havoc on an individual's fiscal arena. I personally saw family members take out 2nd mortgages, use college funds, sell property, and enter into debt in order to get a loved one into treatment and let them stay for a 28-to-30 day period.

Lets put the pieces together: Client A admits to Treatment Center M with Insurance X believing they will receive 30-days of treatment and is told on a Friday their insurance is cut off and a discharge plan (which to be fair is created within the first 7 days of treatment so in some cases enough was lined up for where it wasn't a disaster) has to be implemented as soon as possible to save the client from accruing debt at $900 per day. A tough situation, lets make it worse (as per some client's cases I saw): CPS has ordered 30 days of treatment in order to retain any custody and/or visitation of children, court has ordered 30 days of treatment or will consider it a revocation of parole/probation, company EAP and HR stated 30 days of treatment or termination. Are all of these situations workable? Yes, but once they discharge, treatment center case managers cannot work with them on those issues ethically or legally. Ideally, one contacts as many of those extenuating parties as possible prior to the discharge in order to explain and try to help, but I'd like to see anyone here get CPS/Courts/Company HR on the line after 3pm any weekday much less a Friday. Many times, clients were forced to discharge early and try to handle all these factors on their own and by their own word it was from insurance rather than being kicked out for behavior (documentation could be provided but due to ROIs and HIPPA you'd have to give any documents to client and remember Insurance X does it via phone and does not given a written-out reason) or remain in treatment and hope for scholarship or take on debt and/or spend even more resources on a payment plan.


FINAL KICKER

Max Census at Treatment Center M: 55
Average # of Therapists: 6
Average # of Case Managers: 5
Average Time Spent on Intake (w/o BPS): 1 hour
Average Time Spent on Intake (w/ BPS): 2-2.5 hours

Each client has to meet with their at least therapist once per week and their case manager at least once per week. Therapists/Case Managers also facilitated group sessions, which to be billable to Insurance X was a minimum of 3 50-minute groups per day. Individual therapy sessions were supposed to be a minimum of 50 minutes, case management sessions to be a minimum of 30 minutes.

CONCLUSION

Just want people to be informed of reauthorizations and what that looks like behind-the-scenes!
Late Mauve Late Mauve . 18 hours ago
I had to wait over half a year for my first appointment with my therapist. It was frustrating.
Dexter Thomas Dexter Thomas . 19 hours ago
I had a therapist during the early parts of COVID-19 if not before. I only went enough to count on one hand, including a couple phone call sessions and I found out from my insurance that he was billing my insurance for sessions that never happened for several months. I'd love to consider seeing one again but after the ordeal of disputing this, I don't wish to end up in the situation again.
Macxdmg Macxdmg . 20 hours ago
I'm tall, let me get that for you. Just the box, or the ladder also?
loverrlee loverrlee . 22 hours ago
13:25 The same thing happened to me. I was told due to my childhood PTSD or possible BPD that I need a licensed therapist, but that I had to reach out and call a very small list of people who *might* be taking new patients, but even though I called every single one of those numbers on that list, I was not able to find a single therapist in my area taking new patients, and that was BEFORE the pandemic caused the spike in mental health crisis. So now I’ve basically given up trying to get help now. 🥲
Agent Smith Agent Smith . 23 hours ago
😟
karlicat1 karlicat1 . 1 day ago
As an inpatient therapist it is so frustrating trying to get insurance to pay for treatment. We have to beg for seven days of treatment the jump through hoops to get any more time for our clients. We have clients begging to stay because they are not ready but there is nothing we can do at times. We are also over worked for to a shortage of people qualified to do the job. Therapist are as scarce as hens teeth in my area.
Rebellious Moose Rebellious Moose . 1 day ago
This entire episode is relatable— from struggling to find a therapist that's relatable, to struggling to find proper help as a teen, to struggling to find a therapist that my insurance covers or even finding someone taking new patients, to constantly hearing "just be positive" from people who have no idea what it's like dealing with depression/anxiety/PTSD, to the cops sending me to an adult mental hospital as a teen without my mom's consent...

This country is terrible at helping people dealing with mental health problems.
Derek Davis Derek Davis . 1 day ago
This issue is very important to me, this was so sad that I had to watch it in chunks.
Grady Trainor Grady Trainor . 1 day ago
Trying to find a provider for my wife was very difficult, almost no one even answered the phone.
Isabel Berger Isabel Berger . 1 day ago
As someone who studied psychology and is trying to help her mother with a substance abuse problem, this episode could not have come out at a better time. 😬
Celine Celine . 1 day ago
This is the way the reporters SHOULD REPORT. Good on you Scott!
MeloFelo MeloFelo . 1 day ago
I remember when I first went to college I literally was not allowed to talk to my doctor or my therapist for the entire semester despite Telehealth existing because they “weren’t allowed to practice out of state”. It’s such bullshit.
LWIV&V LWIV&V . 1 day ago
My counselor doesn't accept insurance, and I don't blame him. Dealing with my insurer to at least get my out-of-network repayment is a humungous pain in the ass. It's taken me years to learn all the tricks and hoops I need to go through to get my money, and even with that knowledge it take them months to pay out sometimes. And even then, I'm only getting 60% of what they deem "reasonable and customary" for the treatment (which of course is almost always arbitrarily less than what is charged - I asked a phone rep how they make that determination and she literally said, "I have no idea.")

And hell, I'm well aware I'm pretty much the best case scenario of how the system works, because I'm lucky enough to actually afford out-of-network care, and I know how to actually get reimbursed what I'm due with reasonable certainty, even if it takes a while.
Tommy Fanggidae Tommy Fanggidae . 1 day ago
tik tok is amazing? that doesn't sound right..
scott miller scott miller . 1 day ago
Even more pathetic information on this.. i called the national suicide prevention hotline 4 times in February and every time sat on hold over 2.5 hours and never spoke to a person. I tried my states# and multiple "hotline" for neighboring states and none had a person taking calls or a directory to point you in right direction. Sad so sad..
Kaarin _ Kaarin _ . 1 day ago
Yeah. Remember reading my benefits. They basically only cover like six sessions of therapy. My first insurance required a referral to a psychiatrist, who then had to refer you to a therapist for no more than six sessions. Because as we all know, six weeks of therapy will apparently cure anything.
edwin1818181 edwin1818181 . 1 day ago
I was at Aspen dental couple years ago. The person next to me was getting some serious work done. In the middle of the process they stopped and told the guy his insurance wasn't going to cover it. They started asking him what he wanted to do, with a whole bunch of tools in his mouth and barely able to talk. I didn't see how it all played out.
Darren Fonzseau Darren Fonzseau . 1 day ago
Patient in Tulsa Hospital Shooting Was Angry About Pain Care. FUCK YOU YOU KILL OUR MENTAL HEALTH AND COVER FOR Drs who lie to DENY US PAIN and MENTAL HEALTH MEDS. SADISTIC whores will pay for their sadisic ways. https://youtu.be/Wby1CQyNJH8
Idanthyrsus Idanthyrsus . 1 day ago
Lil to racist of an episode
eLLe Booggie eLLe Booggie . 1 day ago
I have Anthem. This entire episode is 100% true.
Carleen Mulloy Carleen Mulloy . 1 day ago
I love you John ❤️
Molpe Games Molpe Games . 1 day ago
So, to summarize, the most important thing is to self-educate about mental health and seek help when it is absolutely necessary and you have enough money. Cool. Not gonna lie, it's very similar here too (Czech Republic), the problem is that we don't have enough people who'd do it and were affordable. Even if the insurance (and we have an excellent health insurance system) pays at least a part of the bill, it's really hard to find a good therapist/psychologist/psychiatrist (I have SO MANY bad experience...)
James G James G . 1 day ago
Free market will take care of evvvvverything, don't worry.... Here it comes - get your bottles ready - it's trickling down - wait for it! Ooo! You missed it! Ooo
R34 Z Tune R34 Z Tune . 1 day ago
9:43 The promotion and praise of TikTok on here genuinely sickens me. I love LWT segments in general but you have to understand that TikTok is run by a Chinese corporation who uses it to spy on the West. Some in the US have even called it a national security threat and there is clear evidence that China repeatedly accessed US TikTok user data. You could do an entire LWT segment on the shady practices of ByteDance and the scandals involving TikTok. It genuinely isn't amazing and it needs to go immediatly. Shocking that you guys haven't already done your research on TikTok before promoting this garbage spying tool of China.
Ube Soft Ube Soft . 1 day ago
Honestly don't trust the people who are on hotlines or even in relatively small town therapy ....
Think about how small town cops are networked into small cities ...
Same with therapy and they have said and done some utterly racist and homophobic things as part of staff in facilities I've been a patient in...
Not to mention it's hard to find gay male therapist who are also people of color ... Or even anyone who isn't a Christian therapist ....
But yeah sometimes the "help" from the mental health systems seems like being manipulated and bullied by the small town you grew up in and having cancer causing pill pushed onto you ...
I think its partly to do that even if de jure the medical fields are meant to be humanitarian and equitable ... De facto it's completely promoted as a viable way to earn lucrative sums of income... It is difficult grueling work but I think that people's intentions to go into the fields aren't always purely humanitarian especially in a country founded on gaining capital as indicative of it's cultural backbone and identity ...











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