Last year Lars and I spent more than ten-thousand dollars out of pocket on medical and mental health care. And that was only a fraction of the cost of our family's care. 2013 was a pretty good year, as far as health care costs go.

We’re incredibly lucky. Lars has managed to stay employed, in spite of significant amounts of work sacrificed to ongoing crises, and his employer offers health insurance. Even better, because we live in Massachusetts, which takes care of its most vulnerable residents more conscientiously than many other states do, Benjy qualifies for medicaid, through a program for children with significant disabilities. As his secondary insurance, MassHealth picks up the tab when our private insurance declines.

For example, thank goodness Ben was on MassHealth that time our private insurer decided it had spent enough on his mental health care, following the three or so hospitalizations it had significantly underfunded (i.e. covering five days out of about thirty!) and rejected the premise that hospitalization was a necessary intervention. Yes. That decision was made without any clinician setting eyes on him, speaking with him, or with us.

"Patient does not require this level of care," their psychiatrist (read: CFO?) announced.

Actually, all of his experienced and knowledgeable clinicians begged to differ. So did we. Did. We. Ever.

So there we were, caught between the Scylla of fear and the Charybdis of angry despair. (Forgive the Homeric reference, Readers. Sometimes, like repressed desire, my inner English professor will erupt without notice.)

And Ben himself was begging to be admitted. How often do you see that? The kid knew he wasn't safe at home or out in the world--although he very much wished to be.

But Private Insurer Just Said No.

Are you shocked yet? You haven't even heard the worst of it. We were OK with "no," because we had MassHealth. We trusted they would come to the rescue. They did--but the thing is, MassHealth cannot kick in until the primary insurer declines in writing.

Private Insurer was begged to do so, by me and by a hospital case manager, once an hour for the next twelve hours.

Private Insurer said yes. But Private Insurer did not practice what it preached. So our poor boy, only twelve years old and feeling he might not make it to thirteen, had to wait another long night. And guess who waited with him? I did it gladly, and with love, but thinking back on that night, I am a little surprised the two of us are still in one piece.

You know? I don't believe that letter ever came. The hospital finally said, "Just bring him in. This is an outrage. We'll figure it out in the end." And true to their word, they did.

McLean Psychiatric Hospital, Belmont MA

If you haven't had much to do with the mental health care system, or even the medical health care system, I am happy for you. Truly, I am. But if so, I'm guessing you are thinking: Screw insurance. Why didn't they just take him in?

Well. This is just an estimate, but I believe Ben's six hospitalizations ALONE have collectively cost somewhere north of a hundred grand. Probably quite a bit north. As in, Santa's Workshop north.

How the hell does a one-income family make THAT happen, without losing house, car, three meals a day, and everything else? If it were just Lars and me, of course. We are not too proud, by a long shot, to live where and as we must. A car would do. So would a shelter. Maybe not a tent, please.

Saskia, too, would probably survive that kind of blow fairly intact--and she and Lars would do the tent thing without comment. It's just me and my fear of murderers, insects, and bears that makes the camping option untenable.

But my God, losing our family anchor would probably finish Ben off. A lose-lose situation if ever there was one.

Forgive the long-windedness, Readers. That was a loquacious way of saying: thank goodness government programs are there for people who really need them. And thank goodness many people don't--although I suppose most of us will eventually.

But here is the dirty little secret of  psychiatric disability: no matter who you are or where you live, eventually it catches up with your wallet. In our case, even with MassHealth absorbing a lot of the blows, we have been slowly bleeding to death for years. Because health care expenses are only a part of the equation.

Mental illness in a family can cost parents and caregivers their jobs. It foils career plans--and plans of every other kind. Sometimes it takes away people’s homes, no matter how hard they fight against insolvency. Trust me, the choice between buying food and paying your housing expenses--or the hospital--is not one you ever want to face. If you have a mentally ill child in your home, there is a greater chance you’ll have to.

Mental health treatment costs a lot of money. So do lost wages and missed opportunities.Take out a calculator and add it all up--the numbers speak for themselves. Of course, no one can put a price tag on fractured self-esteem, stress, fear, and disappointment. If they could, the numbers would soar beyond limit.

Readers, please share your stories of, or thoughts on, the financial impacts of mental illness.

About the Author

Deborah Vlock, Ph.D.

Deborah Vlock is a Boston-based writer of fiction and creative non-fiction. She spent many dark years fighting, with and for her young son, against the pull of suicidality.

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