Prescribing Hope: Addressing Patient Fears About The Trump Administration

It has been just about a week after the presidential election and my psychiatric clients continue to present with anxiety about the future of their healthcare, and well-being, once Trump is inaugurated on January 20, 2017. On average, I see about 50 clients each week. Since the election, over half have discussed the potential consequences of the election results.

The most common question I have received over the last week is whether or not the client will still receive psychiatric care next year. As most of my clients have Medicaid, this is a question that I cannot answer. I can, however, provide hope. I have told them that likely there will be some sort of medical insurance system in which they can participate. I have mentioned that discontinuation of Medicaid for 23,000,000 people is unlikely. I say it will not only be up to President Trump but also congress what (and when) changes will take place. I encourage people to have patience. I remind clients of acceptance skills.

As I work in community mental health, many of my clients struggle with homelessness, obtaining food and clothing, and unemployment. In Abraham Maslow's seminal 1943 paper "A Theory of Human Motivation," he presented the hierarchy of needs that are still referenced in psychiatry 73 years later. Maslow's theory is that basic needs (physiological and safety) must be met before higher needs (belonging/love, self-esteem, and meeting one's potential ) can be attained.

In fact, it has been widely acknowledged that mental health services are more effective if they address the barriers to clients' basic needs. Many successful community mental health centers provide case management that improves client access to food, shelter, and job training. This operates under the assumption that clients may become more empowered to care for themselves if they are knowledgeable about their resources. In addition, once the basic needs of our clients are met, they are able to more easily focus on their psychiatric concerns and stay on psychotropic medications. After all, if you are sleeping on the streets, how do you take many of the medications for schizophrenia which cause sedation without putting you at risk? How can depression be alleviated in someone who does not know how to get their next meal?

If Medicaid is eradicated for the people who received it in the last 8 years, clients will have little to no access to meeting their basic essentials including food and rest (psychological needs) and housing (safety). As health professionals, we must immediately shore up the education of clients about such resources, assuming they would remain available (the need for such services will likely skyrocket with the reversal of the Affordable Care Act). Although controversial, I believe we must continue to work with drug companies for samples and access to discounted/free psychotropic medications. We must also advocate for programs that enable clients to have discounted generic drugs so that older, sometimes equally efficacious medications are options for our clients as well. We, as providers, will be limited with what we can provide to uninsured clients so we must use all the ethical options we have at our fingertips.

"Get a job" is a solution that I hear from some people -- even those closest to me. How does one obtain/maintain a job if they are hallucinating? I couldn't do it -- could you? What about depressed folks who cannot so much as get dressed for the day because it feels like they are walking in mud, not because of a fault of their own but because of a lack of serotonin or norepinephrine or dopamine in their brains? Jobs are not a simple answer for clients who are actively sick or have no access to medications.

Another frequent concern of my clients over the past week is "what will happen to me?" I have clients who believe they will be (or already have been) victims of overt racist/homophobic/anti-religion acts. Many clients feel hated by half of America due simply to the election results -- an effect of the election that has not, to my knowledge, occurred previously. It is imperative that healthcare providers reassure clients that they are welcome in our offices, that it is good to see them, that they (and their health) matter to us, and that there are people in the community who value them.

Most people, including myself, fear the unknown. As this election and presidency is unprecedented, there is indeed a lot that remains undetermined as of yet. We must demonstrate to our clients that we will help them navigate the healthcare policies of the new administration. Health care providers must be educated and ever vigilant about new resources for clients' access to basic needs. We must always promote recovery and wellness and we must advocate for kindness to each other every chance we get, even in unstable times. For that is who we are and what we do.

Mallory Moss Katz is a board-certified, psychiatric/mental health nurse practitioner who provides services in the Denver area to underserved clients. Her interests and expertise include fighting mental health stigma, equal access to care, genocide, and Eurasia. She has been published in the Huffington Post and The Hill, as well as other national and international publications.