My name is Owen, I'm an artist, a trans man, a dog lover, physically disabled, a gardener, and I'm not OK. This past year has been brutal for a lot of people; fear, grief, financial peril and an uncertain future have shaken us to our core. Add on a scoop of previously existing mental health issues, and you have a recipe for a heck of a rough time.
I've been managing mental illness since I was a teenager, and I have a well-stocked toolbox of coping methods and a great support system. So what happens when that's not enough? Usually when someone's support and coping mechanisms aren't sufficient, they turn to therapy. What happens when that's just not an option? Transportation isn't an issue; I have health insurance, and, because I'm on disability due to my genetic connective tissue disorder, my schedule is flexible. Why can't I get an appointment?
Like a lot of disabled people, I'm dual eligible for Medicare and Medicaid. It sounds like the best of both worlds, but for me, it's been a nightmare. While some people have trouble finding a therapist who accepts Medicaid, I've found it even more difficult to find a therapist who accepts Medicare. Because I'm dual eligible, it's crucial that any therapist I see accepts Medicare, which is insurance for people 65 and older and some people with disabilities. If not, they're off the table for me.
I've been actively looking for a therapist for over a year now, starting around the time my household began self-isolating in March 2020. Sometimes I tell myself I would have found one by now if only I tried harder, called more offices, sent more emails or just settled for someone I didn't feel completely comfortable with. But how hard exactly am I supposed to try? How many offices should I be calling per week, every week of the year? How many email forms should I fill out, and how many weeks (or months) should I wait for a call or an email back? How many lists of providers that supposedly take Medicare do I need to work through, calling each office only to be told that they were listed in error or they're booked through the next eight months? How many times do I have to be rejected before I'm allowed to just give up? Five? Eight? Twelve?
Sometimes I think if I made finding a therapist my full-time job, I'd surely get in with someone eventually. Clearly that's not a reasonable expectation. For one, I've been found incapable of holding a full-time job by the Commonwealth of Pennsylvania due to my disabilities. Even if I could do the work, people with private insurance aren't expected to devote dozens and dozens of hours to finding someone who will see them. Why am I?
I've gotten through the pandemic with the help of my partners and friends, a hefty serving of dissociation and a twice-weekly virtual support group for disabled people. None of us are OK, but we're not-OK together. The last thing that should be expected of a group of people who lack the mental health therapy they need is to provide that therapy to other people, and that's just what we do. It's strengthened my ties to my community and kept me somewhat grounded. But it's not nearly enough, and we deserve better.
While there are a few organizations in Pittsburgh that have many Medicare-accredited providers, a therapist you don't feel comfortable with can be worse than no therapist at all. A faith-based approach doesn't work for me, so that cuts down the list significantly. I need a therapist familiar with neurodevelopmental disabilities in adults, which eliminates a big swath of people.
I need a therapist whose office is ADA-accessible and reasonably near my home — cross off more names. I need a therapist who is LGBTQ-positive, respects my transgender identity and doesn't pathologize my queerness or attribute my mental health problems to the fact that I'm trans.
I need a therapist who gets that my nontraditional relationships make me happy. I need a therapist who understands the concepts of disability justice and disability pride, who won't try to pin my depression on the fact that I'm disabled. It feels like I'm cutting slices out of a pie chart, winnowing down the options until there's just a blank circle.
It's possible that there's an amazing Medicare-accredited therapist out there who specializes in my diagnoses but doesn't know much about the LGBTQ community or has never had a trans client; maybe they've never heard of disability justice but would be happy to learn. That still makes them a bad match for me. I am not a teaching tool. My life is not a learning experience or a curiosity to be studied.
Able-bodied and cisgender people don’t have to explain the basic premises of their identities to their therapist. They won't have the foundations of their identity pathologized or doubted. Trans and disabled people spend so much of our lives justifying our very existence and educating people — doctors, coworkers, family members, strangers — about our identities and needs. We shouldn't also have to educate our therapists.
Mental health care can only work when we can bring the whole of ourselves into that space. I can't leave my transness or my disability at the door because my therapist isn't comfortable or knowledgeable: if I did, I'd be wasting their time and mine.
Allowing more providers to get both Medicare and Medicaid accreditation would be a step in the right direction, but we need more than just access to more mental healthcare providers. We need access to more diverse ones. There's a serious lack of providers of color, queer providers, disabled and neurodivergent providers. We need disabled people, people of color, and queer and trans people on Medicare and Medicaid to stop being forced to leave bits of ourselves at the door just to get some help. We need therapists who are comfortable with the totality of who we are.
These people are out there: I can name half a dozen providers I've either seen before or had recommended to me who are trans-affirming, knowledgeable in the areas I need and have at least a basic grasp on not being ableist. A few take Medicaid, none take Medicare, and all of them have expressed genuine regret that poor and disabled people are shut out of their practices.
Queer, trans and disabled people are statistically more likely to live in poverty than our straight, cisgender, and nondisabled counterparts. Why aren't the mental health providers who serve our communities credentialed to take Medicare and Medicaid?
Why is it so difficult to find care that isn't faith-based and doesn't cater to senior citizens? Why have several therapists told me they'd like to be credentialed, but the government won't let them? Why are our needs low-priority?
According to federal guidelines, some types of therapists, like licensed professional counselors and those who have a master’s of social work, aren’t even eligible to accept Medicare. There are bills in Congress that would change those guidelines to include marriage and family therapists and mental health counselors. But until they pass, those therapists are off-limits to the Medicare population, further limiting our options.
Disabled people are acutely aware of what it is to be an afterthought, to be slotted into spaces we don't quite fit, to live in a world where our existence makes people uncomfortable. Just because we're used to it doesn't mean it's OK. Being the status quo doesn't make it acceptable. Medicare and Medicaid are supposed to give us the care we need. Here, they limit options and rip away our ability to meet our basic needs. It's a specific kind of deprivation of services that is all too common, government-sanctioned neglect of one of its most vulnerable populations. We're here, we see what's happening, and we deserve better.
Owen Taeger is a queer and disability justice activist, enthusiastic outdoorsman and a lifelong Pittsburgher. He can be reached at email@example.com.
Mental health reporting has been made possible with funding by the Staunton Farm Foundation, but news decisions are made independently by PublicSource and not on the basis of donor support.