What happens if you're diagnosed with a mental illness?
June 4, 2012 3:04 PM   Subscribe

What are the potential consequences of having an official mental illness diagnosis on your record?

I suspect that I have OCD and/or depression, though I have never been officially diagnosed with either and, of course, I am not a doctor. I have been afraid to go to a therapist/psychologist/health professional about this because I'm worried about what that will mean for me in the future.

I acknowledge that it's probably more important to get help than worry about any potential fallout from being diagnosed. That being said, I'd like to know what I may be in for should I go and be diagnosed. For example, I read somewhere that in certain states, if you have a mental illness diagnosis you can't own weapons. That may or may not be true, but that's what I'd like to know.

How does a diagnosis affect insurance rates, coverage, ability to get life insurance, obtain weapons, etc.? Do I have to begin disclosing this information as a prior condition? Will all doctors (medical and psychologists) have access to this information from now on?

And, at the root of this, is a fear of the stigma associated with mental illness. How do I get over that fear? Is it possible to just deal with this on my own?

Thanks for your advice.
posted by anonymous to Health & Fitness (19 answers total) 6 users marked this as a favorite
It's likely that your location will play a huge role in this!
posted by two lights above the sea at 3:12 PM on June 4, 2012 [1 favorite]

It makes it hard to get health, disability, long term care, or life insurance.

I have done all my therapy out-of-pocket and off record for this reason, and I have explained my concerns to my MDs, who are notorious for extemporaneously adding opinions about people's mental health that have to be later appealed by your insurance agent.
posted by small_ruminant at 3:13 PM on June 4, 2012 [2 favorites]

What with the guns, I figured it was in the US, but yes, other countries will vary.
posted by small_ruminant at 3:13 PM on June 4, 2012

It makes it hard to get health, disability, long term care, or life insurance.

Completely untrue in my experience. I've been to lots of therapy and haven't had any trouble getting any of those things.
posted by sweetkid at 3:16 PM on June 4, 2012 [9 favorites]

I work in an office that sells a lot of the above mentioned insurances and it is a problem over and over. I am not sure why you've had better luck, unless your therapists were unusually discreet and you have a minimum of drugs on your record.

I keep hoping this is a problem that will go away over time, and it's gotten better- at least you can appeal, and often can find a company who will insure you (for a price, of course)- but it's nowhere near great.
posted by small_ruminant at 3:24 PM on June 4, 2012 [2 favorites]

I recently bought long-term disability insurance, and the guy who sold me the policy told me having a history of anything related to mental illness would have seriously pushed up my premiums. He told me that the number one reason given for long-term disability claims is depression, and therefore insurers are wary of a history that includes a mental illness diagnosis, history of anti-depressant medication, or anything like that. He said that when insurers take health histories, for example, they will specifically ask if Bupropion was prescribed for smoking cessation or depression. (I assume they up your rates either way, and just want to know which rationale to use.)

I'm from Canada, and at the risk of being terribly unoriginal I have to say the U.S. healthcare system is the most fucked-up thing I've ever seen. It breaks my heart to see all its bad unintended consequences -- people not getting care they need, or unable to switch jobs, or bankrupted, because it is so hideously poorly designed.
posted by Susan PG at 3:33 PM on June 4, 2012 [5 favorites]

Over a decade ago I had a very bad reaction to a med change in the midst of a rapidly deepening depression.

When I walked to the nearest hospital and spoke with someone in their psych department, it was explained to me that if I could get myself to my healthcare provider's preferred ER (*not* the ER that was less than 100 ft from me), I would be voluntarily admitted. If I could not, I would be 5150'd and would be barred from purchasing a firearm for a period of several years (I forget how many).

Since the symptoms that I was experiencing included extreme impulsivity and a near-overwhelming desire to kill myself, I thought driving myself or taking a cab halfway across town was probably a VERY BAD IDEA and temporarily losing the right to purchase a gun was a small price to pay in order to keep myself and others safe.

The point of this story (aside from the ridiculousness of having a legal hold placed on you because of heath insurance provider bullshit) is to tell you that losing the right to own firearms because you have a psych diagnosis is not a sure thing - you actually have to be a imminent danger to yourself or others for that to happen. However, finding it impossible to get affordable health insurance on your own, that will definitely be a problem. Get your treatment off the books if possible.
posted by echolalia67 at 3:43 PM on June 4, 2012

If you are US based, I'll offer the following single - person experience: 2 months after my hubby was diagnosed with lymphoma our insurance plan was up for renewal and they raised our rates for two previously 100% healthy people to almost 1k per month. (I'm still paying medical bills after 7 years).

I later on applied for individual insurance and was almost given a high rate because I finally went for counseling (no drugs prescribed). I was faced with the unpleasant task of explaining it away as "just" grief counseling.

If I ever have the funds to be able to seek medical care, it will be cash only with no social security number or identifying info revealed. Even with that experience, I do have a $5k per year high-deductible insurance plan that will pay for some of a potential catastrophic event, but that's for when I'm screwed no matter what.

That said, if you need to see a doc. Do it. Just be prepared to either pay cash, pay higher premiums, or hope for a company insurance policy that protects you from the industry.
posted by mightshould at 4:04 PM on June 4, 2012 [3 favorites]

In certain states and locales, they will ask you if you have ever been diagnosed with a mental illness when you apply for a concealed weapons permit.
posted by corb at 5:01 PM on June 4, 2012

corb: "In certain states and locales, they will ask you if you have ever been diagnosed with a mental illness when you apply for a concealed weapons permit."
This is true in Texas -- on the form for concealed carry they ask questions about any mental illness DX. But I know for a fact that they don't check stringently to see if the person has lied about it -- a friend of mine got his concealed carry license and he's got quite a history of mental illness treatment, both past and current, not to mention that others in his family also have similar issues. I'd bet if I had to that insurance companies would look at things more closely than the state of Texas does.
posted by dancestoblue at 5:34 PM on June 4, 2012

I think you hit the nail on the head when you said this is basically just fear of stigma. Seeing yourself as "mentally ill" is scary and upsetting and demoralizing and nobody really wants to do it. It's something I've wrestled with on and off the whole time I've been in treatment.

And for what it's worth — okay, I know, you probably don't want to hear this, but — it's something that a good therapist can help a lot with.

I tend to dream up nightmare scenarios about Terrible Things that will happen to me as a result of my diagnosis, but they never actually come true. Recently I was diagnosed with ADD as well as depression, and so now my worries tend to involve jail time rather than high insurance premiums. ("Oh god, if I ask about raising my Adderall dose, will my doc think I'm some kind of addict? Will he call the cops on me?") But my actual experience has been that nobody's accused me of anything awful, or violated my privacy, or threatened to Put Anything Down On My Permanent Record.

Other than talking about it in therapy, the best solution I've found for this sort of fear of stigma is to know the rules. I've learned about the HIPAA rules on patient privacy and confidentiality, the rules in my state for prescribing Schedule II medications, the laws about involuntary commitment and treatment — everything I could get my hands on. Generally I find there are two benefits to this. (1) the law usually gives you more protection than you might expect, and learning that is reassuring. And (2) even when the law doesn't give you much protection, it's nice just to understand what the situation is and know what to expect.

On the insurance front it matters a lot whether you have group or individual coverage. (Like everyone else I'm assuming you live in the US. If you don't, send a message to one of the moderators and they can put a note up in this thread with your actual location.) With individual coverage, a serious diagnosis can raise your premiums through the roof or get your policy canceled. I have no personal experience with this but by all accounts it sucks hard. If you have group coverage — for instance, if you've signed on to an insurance plan where you work, or through a school you attend — then a mental health diagnosis is unlikely to cause serious problems. You'll keep paying the same rate as all your co-workers or fellow students pay, no matter how heinous your own medical record looks. Once in a blue moon, someone working at a very small company will get fired because their personal medical history is raising the company's insurance bill too much. This is seriously rare — and, as far as I know, illegal — but allegedly it can happen. It has never happened to me or to anyone I know.

One thing to look out for, though, is that you need to make sure you maintain insurance coverage without gaps from now on — for instance, by signing up for a COBRA to extend your benefits if you lose a job that you were getting insurance through. You may not know this (I didn't until it became relevant to my life) but "pre-existing conditions" are only an issue if you have gaps in your insurance coverage. When you sign on with a new insurer, if you have had gaps in your coverage, they can refuse to cover your pre-existing conditions for your first year or two on the plan. (This is to prevent people from going uninsured until they get sick, and then suddenly signing up for insurance and running up a lot of bills.) But if you've had consistent coverage without gaps, US law requires that they give you the same coverage they'd give anyone else, regardless of whether you have "pre-existing conditions" or not.

My understanding is that a mental health diagnosis alone won't prevent you from getting a gun permit or a concealed carry permit in most states. Under Federal law and most states' laws, the crucial question is whether you've ever been declared mentally incompetent or committed involuntarily to a mental institution. Just being diagnosed with depression, or seeking voluntary treatment — even voluntary hospitalization — won't prevent you from getting a gun. This article lists a few states in which even voluntary mental health treatment can prevent you from getting a gun.

For what it's worth, too, getting involuntarily committed is actually fairly difficult. Three times now I've checked myself into mental hospitals because I was intensely depressed and having uncontrollable suicidal thoughts. All three times, they were happy to treat me as a voluntary patient and to let me leave under my own power when I felt better. To get committed involuntarily you have to be really badly out of control or out of touch with reality. The precise rules will depend on what state you're in.

Anyway, that's enough of that. Go to a doctor! Get your shit treated! If you're self-insured, think about paying for it out of pocket to keep your premiums low. If you've got group insurance but you're just too worried about some hypothetic life-ruining stigmatizing consequences, maybe pay for it out of pocket until you can convince yourself to calm down — if that's what it takes to get yourself to a doctor, then you should do it. A mental health diagnosis doesn't feel awesome, but it is so much better than living with an untreated mental illness!
posted by nebulawindphone at 7:59 PM on June 4, 2012 [1 favorite]

Someone I know was in a car accident. She suffered awful whiplash. Her car insurance company requested her full medical records and then later tried to make it out like her past mental health issues (depression after a trauma) were causing her to fake whiplash. Fortunately, she was able to fight this, but it still affected her settlement.
posted by acoutu at 10:48 PM on June 4, 2012

*Her lawyer said she had to release all her medical records or it would look like she was hiding something. Just wanted to explain that, as she'd thought that the "you get to choose who you release this to" was totally within her control. And it was, as long as she didn't want to win her whiplash case.....
posted by acoutu at 10:49 PM on June 4, 2012

How? By paying cash and having a good relationship with your therapist.

During my potential divorce, I requested not to put down anything of a red flag--depression, anxiety, etc. so she put down PMDD (pre menstrual dysphoric disorder). Essentially wicked PMS. I was worried about custody issues down the road with any other diagnosis.

Some have a slide scale fee so you don't get hit with the $150 per session. The most I've paid out of pocket/cash was $75.

I got over the fear feeling that a judge/whomever rather see that I'm seeking help rather than hiding it. But I still get the generalized/non-descript PMDD :) when getting my meds. Prozac has been indicated for such so people can go screw off if they think otherwise. :)
posted by stormpooper at 10:42 AM on June 5, 2012 [2 favorites]

Some have a slide scale fee so you don't get hit with the $150 per session. The most I've paid out of pocket/cash was $75.

There isn't just one rate for a therapist ($150) by the way. Mine is mostly covered by my insurance but the initial rate even is cheaper (without a sliding scale).
posted by sweetkid at 10:53 AM on June 5, 2012

$150 seems high to me, and I live in an expensive area of the US (SF Bay Area). Most of the people I've gone to are $120 and I have talked them down to $80, $100, or $110, depending on what my financial situation was.
posted by small_ruminant at 10:58 AM on June 5, 2012

If you are in the US, here's a chart on gun ownership laws by state. It looks as though generally you would have to be found mentally ill or incompetent by a court or involuntarily committed for mental health treatment before you would be denied gun ownership. Most people getting outpatient treatment for mental health, in other words, would be fine (and even inpatients if they were voluntarily committing themselves).

NAMI has this chart of mental health parity laws by state, which may help you further figure out how mental health treatment will affect your insurance coverage. Many states now have some kind of law requiring that mental health treatments be covered equitably.

All doctors will not automatically have access to information about any given part of your medical record, but since your physical and mental health are connected, it's usually wise to explain all your various conditions and treatments to any doctor you see. (HIPAA is the law that covers the privacy of health records, if you're curious.)

Getting treated for a serious condition that is making you feel like crap will, I think, ultimately make you feel a lot better than you do now, and thus perhaps less upset about the idea that you have a mental illness. I wish you luck!
posted by newrambler at 11:28 AM on June 5, 2012 [2 favorites]

@Small_ruminant $150 is for a lovely 15 min free consult for med refill (fantabulous, no? Ugh). She thinks I'm filing a claim for reimbursement. Seeing that the out of pocket/deductable/out of network reimbursement fee will never be met, I just fork over the cash.

My 1 hour talk therapy sessions were $75 a pop if out of pocket. Under BCBS insurance it was $15 a session.
posted by stormpooper at 12:37 PM on June 5, 2012

I stumbled across this thread many many months later, but just wanted to jump in - I was denied long term disability in part because I had a history of depression - I had taken an antidepressant for 6 months a number of years ago because my doctor thought my high blood pressure was caused by severe anxiety from my job. I was rather young and in shape to have high blood pressure. I didn't want to take it, but she convinced me it would be for the best. And in fairness, it help my anxiety but my blood pressure remained high and has been to this day. I was only on it for 6 months, quit the job and went off it.

Now, I'm applying for disability for something unrelated that prevents me from working, but the insurance company is trying to claim it's depression because I needed counseling when I first was diagnosed. (As my therapist said, who wouldn't feel bad after having a life changing illness?) Even though the past and current issues have nothing to do with each other, and repeated psych evaluations have shown I'm not depressed.

I thought the stigma of mental illness was a thing of the past until it would turn around and bite me in the ass.
posted by [insert clever name here] at 1:46 PM on December 20, 2012

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