JAzmine Casillas, 23, describes her mental health issues as “quite difficult”. She has been diagnosed with autism, borderline personality disorder, comorbid with bipolar type 2, depression and anxiety. She also struggles with forming long-term memories. “There are cycles where things are going well, but the moment I get depressed, 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 could get medication to deal with bipolar 2 and generalized anxiety disorder, my life would be greatly improved: I wouldn’t have to worry as much or to expect depression cycles so often and I wouldn’t be so paralyzed by the many adult choices I have to make.
Casillas received mental health treatment through the foster care system, but was left on her own after she turned 21. Now a freshman at Nebraska, she has no health insurance and can’t afford care. “Finding a good therapist would be expensive, probably about $500 to $600 a month where I live,” she says, “not including potential prescriptions.” To cope, she relies on her fiancé for emotional support – “She helps a a lotbut most days it’s hard to even get out of bed.’
Casillas is part of a group 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 at least one major depressive episode nearly doubled, and suicide rates among those ages 10 to 24 fell. increased by 47%.
A January study by McKinsey found that Gen Z respondents were twice as likely as older adults to report feeling “emotionally upset” and two to three times more likely to report considering or attempting to suicide between the end of 2019 and the end of 2020. Respondents also said they could not afford mental health services, and the survey found that Gen Z was the age group least likely to report seeking professional treatment for mental health, in part because of the high perceived cost.
“It’s weird,” says Casillas, “you’d think that with more people talking about it, the costs would go down, but it feels like it just gets more expensive over time.”
Young people who are the insured spend more. Although people under the age of 25 make up 36 percent of the U.S. population, they contributed 42 percent of all health plan spending for mental health and substance abuse treatment in 2020, according to new data from the Institute for Research on employee income.
Economist Paul Fronstein, an author of the study, said that although more employers have added mental health coverage to their benefits, costs have not always decreased. “More employers are shifting people’s health plans from low to high [the amount you have to pay before the insurance kicks in]. And that would increase your out-of-pocket costs for mental health,” he told the Guardian.
A recent national survey of Americans in Therapy by Verywell Mind found that patients spend an average of $178 per month out of pocket on therapy fees alone – in addition to an average of $40 per month on medications. But while Gen Z is more receptive to therapy than older generations, the survey found that 57 percent said they might have to stop therapy if their costs increased, and 48 percent said they could afford therapy because financial help from someone else.
Amy Morin, a licensed social worker and editor-in-chief of Verywell Mind, said the increased demand for therapy has faced a limited number of therapists.
“A lot of therapists burn out,” she told the Guardian. Another issue is low pay: “As a therapist, I can say that sometimes the reimbursement rates from insurance companies are so low that therapists can’t pay their bills, so many therapists only take cash, which creates a shortage for many people , who have insurance.
This problem is acutely felt in less populated areas. “Sometimes insurance companies may have two therapists that are in-network within a 100-mile radius. So someone might find that these two therapists have super long waiting lists because it only takes maybe one or two companies to have a huge list of employees who have the same insurance, and they’re all fighting for the same therapists,” Morin said. “Or maybe you have a preference for someone who specializes in something specific like OCD, but their closest in-network therapists may be hundreds of miles away.”
A similar dynamic applies to psychiatrists: A 2014 study by the Journal of American Medical Association Psychiatry found that nearly half of psychiatrists do not accept insurance because of low reimbursement rates. Psychiatrists also have less incentive to admit patients with complex mental illnesses, a Bloomberg report found.
For young people without money to treat their mental illness, the alternative is more or less DIY. “Many Gen Zs deal with this by being nihilistic and avoiding social media, which makes things even worse,” says Casillas. “However, most students and people close to me seem to rely on a support network of friends, family and loved ones, while keeping an eye on their minds and taking mental health days when needed.”
Casillas’ hope is that she can get a job with mental health benefits one day: “I chose to go to grad school specifically so I could look for a job after graduation that has a health care package that includes mental health.”
For now, though, there’s not much to do but hold on. “I can’t say I’m really coping. I’m just trying to keep going and hope for the best until I graduate college and hopefully get a job before the next cycle of depression hits.