For Millennials, Mental Health Is a Catch-22

Young people are more likely to suffer from mental illness and less likely to seek care.

A young adult uses the computer at Thresholds community health center in Chicago. (Photo: Todd Crawford)

Aug 8, 2014· 5 MIN READ
Nicole Pasulka is a writer and reporter who lives in New York City. She has written for Mother Jones, BuzzFeed, The Believer, and the New York Observer.

When 27-year-old Lindsey Bekkelien started therapy, she wasn’t sure what to expect, but she was hopeful. During high school she’d been paralyzed by fear and anxiety. She had trouble making and keeping friends and thought about suicide. Though she knew something was wrong, she didn’t do anything about it until college, when she learned her school offered free counseling.

She figured she’d see the counselor for a few weeks or months. But “here I am seven years later, still doing it,” Bekkelien says.

During that time Bekkelien has been in and out of college—taking breaks whenever her depression gets too serious. If she’s on a hiatus from school, she has to pay for therapy.

One doctor charged $100 per appointment, which meant she could only afford to go once a month. What was worse, the woman wasn’t a good match for Bekkelien and kept insisting that what she needed was more female friends. “I’m introverted and had no interest,” Bekkelien says.

A different therapist might have been a better match. “Since then I’ve learned that there are ways you can look things up, and there are community resources,” she says.

These early experiences seeking care inspired Bekkelien to create Mental Health Consumer, a website where about 2,000 visitors a month come to read lists about mental health myths, advice for healing from trauma, and tips on getting the most out of talk therapy. One therapist she knows even recommends her site to his patients. Bekkelien is careful not to present herself as a professional, but she thinks being just another patient sharing her experience can be “powerful.”

While there are things Bekkelien won’t discuss on the site, she feels obliged to talk publicly about recovering from mental illness. Treatment is “not as mystical as people think,” she says. It’s about “developing a relationship” that can help you navigate life and recovery.

Lindsey Bekkelien.

People between the ages of 18 and 30, often known as millennials, are more likely to be diagnosed with mental illnesses such as depression, schizophrenia, or bipolar disorder and less likely to seek treatment. Three-quarters of all mental health conditions emerge by the age of 24. Across the country, growing wealth disparity, federal mandates to extend insurance coverage for adult sons and daughters under Obamacare, and shifting attitudes about the origin and nature of mental illness have had a significant impact on the ways that young people get and keep care.

Now that children can stay on their parents’ insurance until they’re 26, rather than 23, it “eases some of the burden for some people,” says Victor Schwartz, a psychiatry professor at New York University and the medical director of the Jed Foundation, a nonprofit organization for suicide prevention among college students. But still, the “baseline is not that good,” Schwartz says.

Between October 2013 and April 2014, 28 percent of those signed up for an insurance plan as part of the Affordable Care Act were between the ages of 18 and 34. Of the 48 million who were uninsured in 2012, nineteen million were in that age range, and a recent poll from Harvard’s Institute of Politics found that less than one-third of millennials plan to sign up for health insurance as part of the new law. Though Obamacare mandates that insurance companies cover mental health, therapists who accept insurance may struggle to adapt to the new bureaucracies, and many states are still trying to opt out of the law.

Now that she has a new therapist whom she thinks is amazing, Bekkelien is very focused on her treatment. Because she’s only in school part-time and doesn’t have insurance, her family helps pay for her medication. If it couldn’t, she would ask her boyfriend. “Not being on medication would not be an option,” she says.

At one point, Bekkelien considered applying for disability insurance, but she found the paperwork overwhelming. In 2012, one-third of the 10 million people who received social security disability benefits qualified because of mental disorders.

If you feel comfortable with your doctor or therapist, treatment outcomes are better, as Bekkelien learned. Those able to become advocates for their own care may gain even more long-term benefits.

When Katrina Gay’s son went through what she calls a “major depressive episode,” he had just turned 26 and been dropped from her insurance. He was working part-time, so he didn’t have his own coverage. Gay, who is the national director of communications for the National Alliance on Mental Illness, told him to call her organization’s help line.

It’s possible she could have helped him herself, but Gay believes that up to a certain point, “the more you figure out how to do this on your own, the less fragile you’re going to feel.” Through a lot of sleuthing, her son found a provider with a sliding scale, prescription assistance, and a program to affordably monitor the levels of medication in his blood.

This quest for mental health care was empowering and had a “good outcome,” says Gay. She thinks catching depression early, before it gets to be debilitating, can make a big difference.

“For a kid who has a chronic condition, the time to understand that is not when you’re in the midst of your struggle,” Gay says. “When you’re well, you need to have a crisis plan for yourself so you can activate it when you need it.”

NAMI has a thriving online community for young people dealing with mental illness called OK2TALK, which overflows with photos, GIFs, and poetry. People younger than 30 need a separate space; they’re “very open,” says Gay, and more willing than adults to talk about the bad times while they’re happening.

Teenagers and people in their 20s who have more severe symptoms—those who hear voices, have been hospitalized, or are self-medicating with drugs or alcohol—can be reluctant to join programs with older adults.

Derisha Rouse.

Young adults “go to a group with 45-year-olds, look around, and say, ‘I don’t want to have anything to do with this.’ They feel like it’s contagious, that they’re going to catch what the old people have,” says Marc Fagan, a psychologist and the vice president of clinical operations and youth services at Thresholds, a mental health facility in Chicago.

Fagan is an expert on the transition between youth mental health services and adult care. He runs the Emerge program at Thresholds, which guides 18- to 26-year-olds as they enter the adult mental health care system.

Many in Emerge are on public assistance and struggle with serious mental illness, so providing therapy and medication is key. But it’s just the beginning. Staff members meet with young adults at their homes or at school and help them find jobs, reenroll in school, and manage family relationships. Most of the staff is young, and Fagan says that while the model isn’t that different from the one used to treat adults, young adults sometimes take a bit longer to warm up.

Derisha Rouse is 19 and has been cutting herself since the seventh grade. Rouse, who is on Medicaid and has a therapist through the Chicago Housing Authority, encountered staffers from Thresholds last December while she was hospitalized in the psychiatric ward of Advocate Illinois Masonic Medical Center.

She was anxious when staff from Thresholds showed up. It wasn’t the first time she’d been suicidal, but it was the first time she’d been hospitalized. Last winter, Rouse started to see “vivid images” of white snow with a patch of red, “and my mind was telling me nobody needs you, you’re useless, what are you here for?” During an appointment, she told her therapist she wasn’t going to make it home safely and instead went to the emergency room.

Though she was skeptical about Thresholds, Rouse didn't like to feel alone and appreciated that the program had an art therapist. She liked to channel her feelings through drawing, and while in the hospital she made a picture of a dark cloud overshadowing happiness. “It was pretty intense, but it felt really good once I got it on paper,” she says.

Typically someone with private insurance gets an allotted number of therapy sessions a year. That’s not enough for people with more complex needs. Recent Medicaid expansion in Illinois has made it possible for more low-income people to get comprehensive mental health care, but many still don’t get help early enough and don’t know that they can get Medicaid coverage for mental illness.

Rouse has been able to bounce back. Her hospitalization was the tipping point, “and I broke,” she explains. Now she’s on medication and heading to college in the fall. She thinks that if she’d seen a psychiatrist earlier, it might have prevented things from getting so bad.

Rouse and Bekkelien learned the value of individualized care and early intervention the hard way, but they learned it nonetheless. Rouse wants to study early childhood education and pass on these lessons. Mental illness isn’t who you are, she says. “It’s just a label.”

The article was published in connection with Please Like Me, a comedy about 27-year-old Australian comedian Josh Thomas, his quarter-life crisis, and his eccentric family and friends. Season 2 premieres Friday at 10:30 p.m. ET on Pivot, our sister network.