jAzmyne Casillas, 23, describes her mental health issues as “pretty twisted.” She has been diagnosed with autism, borderline personality disorder, bipolar 2 comorbidity, depression, and anxiety. She also struggles with the formation of long-term memories. “There are cycles where things are going well, but the moment I hit a slump, my life and everything I do just goes down the drain,” she says.
She knows she needs a good therapist and medication: “I’m pretty sure that if I got medication to manage bipolar 2 disorder and generalized anxiety, my life would improve significantly: I wouldn’t have to worry as much or anticipate depression.” I cycle as often and I wouldn’t be so paralyzed by a bunch of adult decisions I have to make.”
Casillas used to receive mental health treatment through the foster care system, but was left on her own after turning 21. She is now a college freshman in Nebraska, she lacks health insurance and cannot afford care. “Finding a good therapist would be expensive, probably around $500 to $600 a month where she lives,” she says, “not including potential prescription drugs.” To cope, she depends on the emotional support of her fiancée: “Help a batchbut most days it’s hard to even get out of bed.”
Casillas is part of a cohort of young people who report higher rates of mental illness than previous generations, but are unable to get the help they need.
According to federal data, between 2008 and 2019, the number of teens ages 12 to 17 who reported having had at least one major depressive episode almost doubledand suicide rates among people aged 10 to 24 increased 47%.
A january study by McKinsey found that Gen Z respondents were twice as likely as older people to report feeling “emotionally distressed” and two to three times more likely to report that they considered or attempted suicide between the end of 2019 and the end of 2020. Respondents also said they couldn’t afford mental health services. , and the study found that Generation Z was the age group least likely to report seeking professional mental health treatment, in part due to its perceived high cost.
“It’s strange,” says Casillas, “you would think that with more people talking about it, the cost would go down, but it seems to have gotten more expensive over time.”
young people who are policyholders are spending more. Although people under the age of 25 represent 36% of the US population, they contributed 42% of all health plan-related spending on mental health and substance abuse treatment in 2020, according to new data from the Employee Benefits Research Institute.
Economist Paul Fronstin, an author of the study, said that while more employers have added mental health coverage to their benefits, costs haven’t always come down. “More employers are switching people’s health plans from low deductible to high deductible [the amount you have to pay before the insurance kicks in]. And that would increase your out-of-pocket spending on mental health,” he told The Guardian.
a recent national survey of americans in therapy by Verywell Mind found that patients spent an average of $178 a month out of pocket on therapy fees alone, in addition to an average of $40 a month for medication. But while Gen Z is more receptive to therapy than previous generations, the survey found that 57% said they might have to give up therapy if its costs rose, and 48% said they were paying for therapy because of help someone else’s finances.
Amy Morin, a licensed social worker and editor-in-chief of Verywell Mind, said increased demand for therapy had been met by a limited supply of therapists.
“A lot of therapists are running out,” he told The Guardian. Another issue is low pay: “As a therapist, I can tell that sometimes insurance company reimbursement rates are so low that therapists can’t pay their bills, so many therapists only accept cash, which creates a scarcity of many people who have insurance.”
That problem is felt acutely in less densely populated areas. “Sometimes insurance companies may have two in-network therapists within a 100-mile radius. Then someone might discover that those two therapists have very long waiting lists because it only takes one or two companies to have a huge list of employees who have the same insurance and are all competing for the same pair of therapists.” Morin said. “Or maybe you prefer someone who specializes in something specific like OCD, but your closest network therapists could be hundreds of miles away.”
A similar dynamic applies to psychiatrists: as of 2014 to study by the Journal of American Medical Association Psychiatry found that almost half of psychiatrists do not accept insurance due to low reimbursement rates. And psychiatrists also have less incentive to care for patients with complex mental illnesses, according to a report from Bloomberg found.
For young people with no money to treat their mental illness, the alternative is more or less DIY. “A lot of Gen Z deal with it by being nihilistic and escaping to social media, which further exacerbates things,” says Casillas. “However, most students and those close to me seem to rely on a supportive network of friends, family and loved ones, while keeping track of their minds and taking mental health days when needed.”
Casillas’s hope is that one day he will be able to get a job with mental health benefits: “I chose to major in secondary education specifically so that I could look for jobs after graduation that had a health services package that included mental health.”
For now, though, there’s not much to do but hang on. “I can’t say I’m really handling it. I’m just trying to move on and hope for the best until I graduate college and hopefully get a job before the next cycle of depression hits.”
