For many young people, college graduation marks the entry into what grown-ups call "the real world." But if you're a new graduate with a mental health condition, the transition can be especially challenging.
Many young people start managing their own health care for the first time when they graduate. And while finding and paying for a psychologist or psychiatrist can be difficult at any age, for young people who don't have steady jobs or stable paychecks, the task can be especially daunting. Perseverance and planning ahead help.
One of my classmates from college, Sarbani Das, says she had to call over 30 mental health providers in New York before she found one with an opening. "And, of course, you think, if no one else has an opening, why does she?"
Das, 23, who suffers from anxiety, says she eventually found a doctor. He doesn't accept insurance, so she has to pay out of her own pocket. Das says she can because she has a job and savings. "If necessary, I probably would have asked my parents," she says. But she didn't even tell her parents that she was seeking help until very recently.
It should be easier, Das says. "It's a bit ridiculous. If you can't find a good doctor, it's basically your life that's going by."
On NPR's Facebook page, we asked young adults and recent grads to share their stories. Many who responded shared Das' sentiments. Some didn't have health insurance and some couldn't find providers covered by their insurance plans. Others were able to find therapists who took insurance, but had to stop going because of high deductibles, or because they couldn't afford the $25 to $80 copays.
Some felt they couldn't take time off from new jobs and internships to regularly see a therapist or psychiatrist, and several said they had trouble finding someone who had experience working with young patients.
To minimize these hassles, "the trick is planning ahead" long before graduation, says Luis Ramirez, the associate director of clinical services at New York University. Counselors at the school often work with students to help them find providers in the community. The school also helps graduating students who plan on moving away from New York find therapists in their new location. "We've helped students find providers in China," he says.
"Sometimes it takes seeing one or two or three different therapists before you find one that fits," he adds. He advises students to screen providers by chatting on the phone. "I really encourage students to not throw in the towel."
But the process takes time and isn't easy, says Darcy Gruttadaro, who directs the Child and Adolescent Action Center at the National Alliance on Mental Illness, an advocacy group. "With any transition in life, that transition provides a certain set of challenges. When you combine that with mental health issues, that can be really challenging."
The Affordable Care Act has made it slightly easier for young people to get mental health care. Young people can stay on their parents' insurance until they're 26, or get low-cost coverage through state or federal exchanges. And federal health law requires insurance companies to provide the same amount of coverage for mental health as they do for medical and surgical treatment.
Still, some people on their parents' insurance may not be ready to talk to their family about their mental health issues. Others may have insurance plans with limited coverage for both physical and mental health issues.
Many therapists are willing to lower their prices, Gruttadaro tells Shots. And patients shouldn't hesitate to ask a therapist if they have a sliding scale for fees. Still, weekly therapy sessions can be unaffordable.
That's what Rebecca Greenlee, 26, discovered four years ago when she left school in Illinois and moved to Austin, Texas. As a college student, Greenlee was able to see a mental health provider through an on-campus service. Finding care off campus was much harder.
She got a temporary job working for the local government, but the position didn't come with any benefits. Taking time off for weekly visits was difficult, too.
Eventually, she went to a public clinic where she had to wait over eight hours for a preliminary appointment. "It was very challenging to get doctors at the public health clinic to even treat me," she says. "Most of the cases that they were seeing there were so severe." Greenlee says she was often overlooked because her condition wasn't as serious. "While I have an acute case of bipolar disorder ... I'm able to function for the most part."
Now Greenlee has a job with health benefits. And she says she's able to take time off for appointments, no questions asked. Even so, there are issues. "The only person I could see was a licensed nurse practitioner," she says. The psychiatrists covered by her insurance had months-long waiting lists.
"It's enough to make people just give up," Greenlee says. Without support from friends, she says she wouldn't have gotten through the transition.
Support from peers can be crucial, especially for those who are having trouble finding care, says Gruttadaro. "Connect with other young people who may be experiencing the same circumstances."