Robin Williams’s passing has reminded the public how mental health problems manifest themselves in real, consequential ways. Fans, family and friends seemed to be devastated by his loss, not only because we will miss his future great contributions to our society, but because the impending question of whether there was something that we could have done to stop this.
MGH psychiatrist John Herman reminds us of this sentiment in Kevin Cullen’s Boston Globe piece:
When, in my shop, there’s a suicide, everybody feels terrible. There is a universal sense of guilt. Everyone wonders if there is something we could have done or could have done better. Any physician who loses a patient wonders that.
Advancing the public dialogue on the important work to be done to help those who are still suffering is one way we can still help; and it is quite an apt legacy for Williams, who not only gave us the medicine of laughter but also used his remarkable career to often highlight the stories of people affected by depression and suicide (with movies like What Dreams May Come, Good Will Hunting and World’s Greatest Dad, to name a few).
But we need to make sure that this conversation isn’t just talk. We need take action to ensure that those who need mental health care, have access to it. Because something that this Boston Globe article highlighted that we as clinicians have come to know all too well is that “reimbursement rates have dropped even further in the last couple of years.” In turn, many of us have been caught between a rock and a hard place, “financially survive by taking only out-of-pocket patients… [or] leave the business entirely.”
The sad truth is that Williams was one of the lucky ones. He could easily afford out-of-pocket access, and he probably fought and won more of his previous mental health battles because of it.
For the vast majority of people, who have neither the money nor the clout of a Hollywood star, the prospects are even more daunting in a country where insurance companies, not doctors, decide who gets taken care of and who gets substandard care and who gets financially ruined trying to keep a loved one alive.
As clinicians we didn’t need Robin Williams’ passing to remind us what is at stake, but it should inspire us. We have a responsibility to use the tools at our disposal to turn this upswing in awareness into expanded access to mental health care.