Broken Systems


One of the first things my teachers told me when I entered Grad School was this: “Remember, you are going to work in a broken system.” I had no perspective then on what “broken system” meant, of course, and so the thought was promptly drowned in the resulting deluge of research papers and assigned readings.

Then came the day when I was looking for an internship site. At the place I now work, my interviewer, now my supervisor, told me the same thing: “Remember, we work in a broken system.” Now, the words scared me, because I wasn’t going to work in a broken system soon, I was going to work in a broken system tomorrow. I still wasn’t sure what it meant. I’m still working on it. It’s one of those phrases that lacks form until it is experienced. For the sake of education, though, I’ll try to put it into words.

We, as Americans, live in a society that is governed by certain assumptions. One such assumption is that everything of value can be measured. We also tend to assume the reverse: that only measurable things have value. As a result we have institutions such as insurance agencies, whose job it is to assign values to the trickier subjects in life, such as death, injury, and sickness.

Here’s where it goes awry for us Counselors. The above organizations set out to quantify the disruption of life brought on by serious mental illness. They landed on the idea that a person had to either have been hospitalized by their illness, or have an illness which is by definition disruptive. This is why certain mental illnesses, like Post-Traumatic Stress Disorder, are usually covered by insurance, and things like, say, a personality disorder are rarely covered by insurance. In things like Medicaid, the system is even more bare-bones in what it covers.

It makes sense, from that point of view; Bob is too sick to go to work, money is lost (and Bob can’t afford his insurance payment), society as a whole is weaker for the sickness, and everybody loses. However, loss is not the key determinant of the severity of mental illness. It’s a canary in the coal mine, but it isn’t the killing smoke. In my mind, The severity of mental illness is based on the suffering of each individual person. The problem with that, as any professor will tell you, is that we have yet to successfully define “suffering”. Even if we could, there’s still the idea that a person can still function even if they’re miserable and in need of help. Try selling that to the insurance companies.

The cherry on top? The people that need mental health care the most are those who can afford it the least. The people that fall through the cracks and have to rely on things like Medicaid have to make due with fewer services than people who are actually healthy. Hence, broken system.

I want to leave you with a sense of hope, as I see this may come off as a bit of a hopeless situation. What I will conclude on is this: Any profession is only as good as the character of those within it. I can’t think of any job with kinder, hardier people.