THE WORK AHEAD
RECENT CUTS TO MENTAL HEALTH CARE PUT BOTH INDIVIDUALS AND FAMILIES IN DANGER
BY WENDY MAIMONE
CONTENT WARNING: This article contains discussion of mental health struggles, lack of access to care, and the real consequences these gaps have on individuals and communities.
My clinical experience has been in the realm of mental health, specifically acute mental health. I have worked as an intake clinician screening patients for a partial hospitalization program, as a social work case manager for people receiving inpatient mental health treatment, and as an emergency room social worker providing mental health assessments and substance use assessments. The bulk of the patients I work with have been so impacted by their mental health symptoms that they are no longer able to remain in the community, either functionally or safely. I’ve heard from many patients during our interactions that they are experiencing one of the worst days of their life.
I am always surprised at the number of people who are shocked to learn that a social worker can be Catholic. For me, the core beliefs of both the social work profession and the Catholic faith are very similar: humans’ autonomy and innate dignity, the importance of working together for the common good, services of the underserved, and the endless pursuit of peace.
My Catholic faith serves as the foundation of my social work practice, and it is how I work to support my community. It also serves as my solace when I worry about where we are heading as a community and as a country. As our government scales back programs and resources on which our most vulnerable populations rely, I find myself in a near constant state of fear for my community.
About eight years ago, while working as an intake clinician for a partial hospitalization program, I encountered a woman on Medicaid seeking treatment for her symptoms. Partial hospitalization programs are often a great alternative to inpatient treatment or serve as a transitional treatment after people are discharged from inpatient treatment. The program length depends on a person’s symptoms, but often people can expect to attend for up to 10 days. They come into the hospital for 6 hours a day where they learn coping skills to manage
their symptoms and meet with a psychiatrist for medication management. They then return home at the end of the day.
I distinctly remember this woman, even years later. She had been trying desperately for months to find outpatient treatment, both in the form of therapy and medication. The waiting lists for people with Medicaid were very long, as there wasn’t an abundance of providers. While she was on such a list, her symptoms began to increase. She began struggling to get out of bed to go to work. When she was able to go to work, she struggled to concentrate. She began to neglect her personal hygiene and was experiencing some suicidal ideation. The week prior to our meeting, the thoughts of suicide became a daily occurrence. The increase in suicidal ideation alarmed her, and she began looking for alternatives to outpatient treatment in order to begin treatment right away: hence our interaction.
After completing her assessment and determining that she met the criteria for the program, the next step was getting insurance authorization. However, after reviewing of the information and symptoms, her insurance determined that she did not meet the criteria; her symptoms were not “severe” enough. The insurance company felt that because she was still able to maintain employment and her suicide risk stratification was still considered low, partial hospitalization was not warranted at this time.
I can still remember the sounds of her sobs on the phone and her expressions of hopelessness when I had to tell her that we weren’t able to admit her into our program. At that time, there weren’t many programs in the area that took her insurance. Her only plan of action was to continue to wait for her outpatient appointment, still a month out, and to go to the emergency room should her symptoms and thoughts of suicide increase. Essentially, our health-care system told her that she didn’t qualify for help because things weren’t bad enough. And this was eight years ago, a time when there was considerably more access to mental health care resources for patients with Medicaid and Medicare.
This story sticks with me when I see the cuts in support of people’s basic needs, health care, and mental health treatment. More and more people on Medicaid and Medicare will
experience the same difficulties. The needless suffering that they will have to endure until their symptoms get “bad enough” is enough to take my breath away. Suicidal ideation alone can have severe consequences to a person’s emotional, cognitive, and behavioral health. Left untreated or not properly treated, a person can experience an increase in negative self-perception, social isolation, substance use, and cognitive impairment. They also run the risk of negative effects on their physical health, such as cardiovascular problems, a weakened immune system, and gastrointestinal issues. All because they need help and help isn’t readily available with their insurance. They can do nothing but sit with these thoughts, waiting for help to come in any form. And they suffer until it gets “bad enough.”
This is when being a Catholic gets hard for me as a social worker. We are taught to love others as God loves us, even if that means loving others who are actively harming your community— including those politicians who support and push for these cuts. For me, it’s easy to take a position of entitlement and look down on them as being wrong or even evil, because they don’t see the negative consequences of their actions. They don’t see people showing up in their places of work with lacerations to their wrists or detailed plans of how they are going to end their life. They don’t have to make a safety plan with families and ensure there are no weapons, firearms, or large doses of medication loved ones could potentially use to harm themselves. I can begin to feel utterly helpless, as though I’m fighting an uphill battle, and nothing’s going to change, because no one really cares anymore.
“All I can do is continue to show up and advocate from a position of humility for my patients and my community and pray that those in positions of power make decisions rooted in love and compassion…”
It’s at this moment that I have to let go and trust God. I’m not serving anyone or changing any minds by pointing out what others are doing wrong or looking down on them. All I can do is continue to show up and advocate from a position of humility for my patients and my community, pray that those in positions of power make decisions rooted in love and compassion, and try to find ways to reflect God’s love to others during the darker periods of their life. I hope in doing so that my patients are reminded that they are human beings of worth and value. And I pray that this will be enough as we move forward into the months ahead and the ramifications of these cuts.
Wendy Maimone is a clinical social worker living in East King County, Washington, where she balances her work with the beautiful chaos of raising two kids. She’s a lover of grandma hobbies, chihuahuas, her hedgehog, and finding small pockets of cozy joy in everyday life.
THE COST OF HEALTH CARE
About half of all adults say that it is difficult to afford medical care. Even among those with insurance, about 40% worry about affording their monthly insurance premiums, and 62% worry about affording their deductible before insurance kicks in.1
According to the Federal Reserve, in 2024 28% of adults skipped medical treatment because of the cost.
40% of adults have debt due to medical bills.2
The biggest health care companies and their annual revenue:
• UnitedHealth Group Inc.: $435.16 billion
• CVS Health Corp.: $394.08 billion
• The Cigna Group (CI): $268.22 billion
• Elevance Health (ELV): $194.82 billion
• Centene Corp. (CNC): $155.6 billion3
In 2023, the United States spent about $13,432 per person on health, almost double the average amount in comparable countries, according to the Peterson-KFF Health System Tracker.
In 2021, the United States spent almost 18% of its GDP on health care.
The United States is the only high-income country in the world that does not guarantee health coverage. According to the CDC, in 2025 about 8% of the population was uninsured—about 27.5 million people. This number was the highest (about 25%) for people earning less than 2x the federal poverty level.
1 https://www.kff.org/health-costs/health-policy-101-health-care-costsand-affordability/?entry=table-of-contents-how-do-high-health-costsaffect-affordability-of-care
2 https://www.kff.org
3 Source: Investopedia, https://www.investopedia.com