To the Editor:

I had a dream last night that the mental health system was perfect.

Everybody that wanted care received it, no one stigmatized it and there were enough diverse and available practitioners to serve each and every community across the country. There was no such thing as physician burnout or suicide, and there were no patients who felt dissatisfied. Money was available from all sources (the government, schools and insurance companies), and patients never had to pay for something they could not afford; insurance companies, meanwhile, still reimbursed for what a provider’s time is actually worth. Parity was not just a vocabulary word, but a truth.

It was one of those dreams where I felt physically happy simply being in it.

The problem was, when my alarm went off to go to work as a psychiatry resident, the smile quickly faded and I realized it was just that, a dream.

I remembered quickly that I chose to enter a profession that is anything but ideally structured to serve those who need it. Countless conversations with friends, family and patients detailing the woes of connecting to a therapist or psychiatrist were etched in my brain. Hours spent arguing with insurance companies to cover a patient’s medication; calling providers looking for post-hospital follow-up appointments with no success; scheduling patients into my lunch breaks and evenings and attempting with frustration and disheartenment to explain these limitations to families and patients heavily weighed on me. Despite the years of training (four years of medical school and then four in psychiatry residency) and my seemingly good intentions, some days I do not want to go to work. Other days, I just want to scream “HOW CAN I DO MY JOB IN THESE CONDITIONS?” while storming out in true Hollywood dramatic fashion. But something stops me.

Perhaps I take one step back towards my chair because I love my job. Or, maybe the promise of helping even one person feel better stops me. Or, better yet, maybe I am a hopeless romantic (or even slightly narcissistic?) and believe that if I choose to stay, I can be an advocate for change. Maybe I am naïve, but I do believe that someday we will fix what is clearly broken.

The issue, however, is that we need to be partners in change, patients with practitioners and not against them. It is true that patients are not satisfied, but neither are we (and as you pointed out, we can have issues with job retention as a result). The list of grievances in your article entitled “CAPS grapples with wait times and serving underrepresented communities” reads like a laundry wish list for mental health practitioners everywhere across the country. The issues you have noticed at Stanford (wait lists, lack of diversity of providers, cost) are really a microcosm of the problems in the mental health system at large. You may not believe me, but we are on your side.

Consider this a call to arms of sorts. Let’s start fighting it together.

-Jessica Gold
Psychiatry Resident, Stanford

Writer’s note: The opinions expressed herein are solely my own as a psychiatry trainee and mental health advocate.