When Your Adult Child Breaks Your Heart

Coping with mental illness, substance abuse, and the problems that tear families apart

Addressing Mental Health Treatment Barriers

How obstacles to care create challenges for families seeking help

The path to a healthy relationship with your child, and getting support from loved ones can be even harder. Well-meaning friends and family might tell you to stage an intervention, find a therapist, or commit your child, thinking these strategies will miraculously fix the problem. The United States annually spends $113 billion on mental health treatment, but barriers to treatment—including flaws in the treatment itself—can mean that the people who need mental health care the most may never get it.

Refusing Treatment

An adult child's refusal to get treatment is perhaps the most significant challenge parents of troubled children face. With rare exceptions, treatment won't work on an unwilling participant, and unless your child is a danger to herself or someone else, you won't be able to force her to seek treatment.

Balancing Life and Treatment

Depending upon the treatment your child needs, treatment can quickly become all-consuming. Inpatient treatment completely eliminates the ability to work, care for children, and engage in many hobbies, and intensive outpatient treatment can easily eat up half of a day. Even a few therapy sessions a week can be overwhelming for someone who works a demanding job, lives in a remote location, or who has small children.

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Financial Issues

There's no getting around the fact that mental health care is costly. The Affordable Care Act mandates that insurance providers cover mental health care, but patients may still have to pay out of pocket for their treatment. Some insurance plans only cover limited treatment options, and if a referring provider doesn't think a particular treatment is warranted—even if the literature recommends it—an insurance company may decline to cover it.

Financial issues aren't limited to the actual costs of treatment, though. Many people with mental illnesses or substance abuse problems face severe financial hardships. They may have to choose between paying for the gas to get to therapy or buying food. And if they work hourly jobs or are self-employed, time spent in treatment means time not making money.

Family Support

While you might acknowledge your child's need for treatment, you may encounter conflicts with other family members. It's common for one parent to support treatment while the other feels that the issue can be handled at home. Your spouse may be concerned about the stigma of mental illness and the treatment it entails. Relatives and family friends may judge your child for seeking treatment or become critical of the treatment path your child chooses.

Geographic Barriers

People who live in large metropolitan areas generally have access to a wide menu of services ranging from community support services to intensive inpatient treatment. But those who live in rural or isolated areas may only have access to a single provider. If that provider can't meet your child's needs, she might have to travel half a day or longer—spending precious time and money—to get the treatment she needs. Unless your child is very committed to getting better, she might not want to make such a massive effort.

Finding the Right Treatment

Mental illnesses are real diseases, but most don't have a single test or treatment protocol. Instead, people seeking mental health care may have to try dozens of medicines and a handful of treatment providers before they find something that works. And even then, a treatment may not work as well as your child would like and may cause unpleasant side effects. Other barriers to finding the right treatment include:

• Locating competent providers who are covered by your child's health insurance

• Finding a treatment provider who specializes in your child's specific condition

• Finding a treatment provider whom your child likes and who listens to your child

• Racial, ethnic, and religious barriers. Many community-based organizations continue to push for culturally competent mental health treatment. But if your child is a member of a minority group, finding someone who understands and respects her beliefs can be challenging.

• Ongoing support for patients seeking care. Treatment doesn't end when your child walks out of a therapist's office. Instead, he will likely have to make a wide variety of lifestyle changes, and these can be challenging, particularly if your child doesn't have support from friends and family.

If you're struggling to find treatment for your child, you're not alone. But thousands of parents and their children have successfully found treatment even after years of struggle. Keep trying, and encourage your child to never give up. If you need additional support, consider joining a local support group or contacting the National Alliance on Mental Illness, which offers resources and support to family members of people with mental health conditions.

Joel L. Young, M.D. is the author of When Your Adult Child Breaks Your Heart: Coping With Mental Illness, Substance Abuse, and the Problems that Tear Families Apart.

 

References:

Barclay, L., M.D. (2009, April 6). Financial barriers to children's mental health services should be removed. Medscape. Retrieved from http://www.medscape.com/viewarticle/590648

Carrasco, M. J. (n.d.). Barriers to mental health treatment by people of color. NAMI: National Alliance on Mental Illness. Retrieved from https://www.nami.org/Template.cfm?Section=Cultural_Competence

Kliff, S. (2012, December 17). Seven facts about America's mental health-care system. The Washington Post. Retrieved from http://www.washingtonpost.com/blogs/wonkblog/wp/2012/12/17/seven-...

Mancini, A. D., Moser, L. L., Whitley, R., McHugo, G. J., Bond, G. R., Finnerty, M. T., & Burns, B. J. (2009). Assertive Community Treatment: Facilitators and Barriers to Implementation in Routine Mental Health Settings. Psychiatric Services, 60(2), 189-195. doi: 10.1176/appi.ps.60.2.189

 

Dr. Young is a psychiatrist practicing north of Detroit, specializing in the treatment of adolescent, adult, and geriatric mental illness.

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