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  • Private mental health providers in the US are pretty unsupervised and have a conflict of interest in that they make more money by keeping their patients/clients unwell, which can lead to negligence and abuse. The only thing keeping in line is the possibility of someone informed and insightful enough to report them to the licensing board or pressing a lawsuit.

    For example, if a provider has poor integrity, it is in their best interest to not treat depression, but rather help the patient/client feel good for the moment. What the patient/client experiences is that they feel better when they see their provider, so they become dependent on their provider. This ensures the provider a reliable source of revenue.

    Another issue is that masters level therapists, while capable of providing treatment for simple cases such as a clear depressive episode, are not properly trained to conduct thorough assessments for complex cases, meaning they can misdiagnose quite easily. Complex cases would be better treated by a well-trained psychologist that can conduct thorough psychometric assessments that are quite sophisticated and take lots of time to analyze. These services are costly and the vast majority of insurance policies won't cover them.

    Relevantly, yet another issue is insurance for mental health. Most insurance policies that pay for mental health services pay low, so the care you receive can be substandard since the more effective providers are charging what they're worth in a market economy. One example that comes to mind is Better Help. They pay providers insultingly low, like around $30/hour, while effective providers are charging ~$150/hr out-of-pocket. That means that when someone uses Better Help to obtain care, they're getting the bottom of the barrel therapist.

    Lastly, the majority of family and marriage therapists aren't properly trained in narcissistic emotional abuse. This can mean that therapy would not only be a waste of time, but can make things much worse as they can help the narcissist abuse the victim even further. Narcissistic abuse is quite complicated and requires a relationship therapist that specializes in that to properly assess and help the victim escape.

    Tips: If you have been seeing a therapist for 12 sessions, and you haven't realized any considerable long-term changes, find another therapist. Also, if your therapist doesn't call you out on your bullshit, let's you ramble about tangential matters, or focuses on helping you overcome specific weekly struggles, rather than helping you develop skills and restructure deep cognitive matters to address them yourself, find another therapist. An effective therapist would develop a clear treatment plan with you that aims to meet objectively measurable goals within a certain time frame.

    Note: I am not a therapist. I have just worked in the mental health field and have friends that are therapists.

    • An effective therapist would develop a clear treatment plan with you that aims to meet objectively measurable goals within a certain time frame.

      This is a great point and true for non-therapists as well. A good measure of whether or not someone helping you is providing you value is if you are progressively improving in measurable ways.

      True for doctors, meds, physical therapists, coaches, you name it

      • Part of the problem with this is no clear treatment plan works consistently for everybody. Insanity is as diverse as cancer, and even the DSM is used as a rough guess as to what is going on, based on what mix-and-match set of symptoms.

        Each psych med takes a month to start, get stabilized and see if that's an improvement. If it doesn't work right (typical) then the options are to add another drug (and then more drugs to counter side-effects) and test it as a cocktail, or get the patient off the first drug (usually two weeks to get sober, during which they're symptomatic) and another month to start something new. I went through over a dozen SSRI combinations and for a while had to settle on a cocktail that wasn't terrible and was slightly less bad than going sober.

        Then there's a matter that we often cannot escape the toxic situations we're in, whether we can't move out of a situation with contentious roommates or are working for a company with cruel middle management and scary toilets and stinks of insecticide. I'd think any physician might argue that someone with a lung condition should be moved out of the moldy house they live in, but when it comes to environments that are psychologically unhealthy, we're all expected to just deal.

        And this informs my job in the psychiatric sector which is as a peer councilor. When patients are stressed out and their professionals aren't doing it for them, they come to me, and the first think I ask is are you safe? Most of the time, they are -- as with the rest of the US population -- in precarity, sometimes not even knowing where their next meal is coming from or if they'll have a place to live next week. But scary parents, scary roommates and scary bosses are also super common, and we're not really going to be able to treat or even manage the crazy when people are fearing for their survival.

    • This is very accurate. I worked 5 years in a BH Insurance company. We saw shitty providers all the time, and we were constantly having to play the game of deciding how much we (and our members) could tolerate before cutting the providers out of the network. Cutting too many providers doesn't correct bad actors or replace providers for people who need them and can cause backlogs if other providers aren't available to take on their patients.

      The only thing we were able to do to correct many providers by changing their pay to a value based model, so providers would get paid more for better outcomes (and sometimes only paid when patients improve). It would increase pay a lot over standard rates. But providers fought that big time. They just wanted to do things their way and cash a check of a set amount with little or no oversight.

      Better help is used by providers as a way to supplement their income, and they typically pay a bit less than conventional appointments because of the digital channels. However, Ive heard they have some issues with data security on their platform and their matching system is pretty flawed due to their network being somewhat ephemeral.

      If you do want to seek therapy, remember you have multiple ways to get it covered. Your health insurance probably has some coverage, and your employer (in the US) likely has an EAP program which will have coverage for therapy for at least a few sessions (typically 3-12) sessions. It's worth looking into that before paying out of pocket.

    • One example that comes to mind is Better Help

      During the pandemic, this company was heavily advertised across Twitch. Not surprised they pay shit wages. Wonder if they originally paid 2-3X market rate during the hype, but slowly clawed back the teaser rates in favor of the dog shit rates.

    • I have lifelong major depression, and got myself integrated into the mental health system of San Francisco (one of the better municipal systems available in the States). Since my insurance was government or state, it typically meant that I'd see interns for a year before they graduated and started their own practice. A friend of mine and I would joke that we were trainers in that our life drama was severe enough to convey to our trainees that life shit is real and that sometimes there are real risks (suicide, stalkers, toxic violent parents, etc.) but we personally were not likely to become a danger to ourselves or others short of natural disasters.

      I also got to crush egos because it's not like the movies where the patient has a good cry and then is better. I've done a lot of crying and I'm still depressed as ever (more so as the world is literally burning, which limits my hope for a better future). I can manage my symptoms more or less, but I'm never going to be a happy self-sustaining good little citizen. And curiously, some of them see that as an end goal: You get Will Hunting to have a good cry and he's fixed. Not so much.

      I eventually got lucky, and was able to find one of my old interns and resume with her while she was working on her PHD. I was a case in her thesis and got an ASD diagnosis out of it in my late forties (it's not helpful yet for navigating benefits, but is useful regarding directing my own symptom management). But most of my career as a patient is spending more than half a year getting my therapist familiar with my case and then the remaining months squeezing a bit of process out of it...

      ...Or just goofing off, since I absolutely have personal demons that don't want to be closely scrutinized, so it becomes too tempting to let my therapist get distracted by details that are entertaining to them. (My history in the BDSM and my burgeoning queerness are fun topics, as are my awareness of issues like the climate crisis, the plastic crisis, the police state, the surveillance state, the transnational white power movement and its uprising and takeover -- all of which were still commonly regarded as conspiracy theories / fringe hypotheses when I was in session.) Sometimes, we patients are so terrified of what our closeted shit says about us that we're not ready to open those doors. And sometimes the therapist doesn't want to look either, so we negotiate a diversion we can agree to distract us until later.

      I stopped going to therapy shortly before the COVID-19 epidemic outbreak and lockdown so I get to start all over again in Sacramento. Hopefully, I'll find a permanent therapist (and a good match) early, but I suspect I'll be back to seeing interns again.

    • You nailed it. 💯

    • This is why I hate that "get therapy" has become a common meme. Most therapy is a scam in the US.

  • This pertains to the US:

    A lot of people are unaware of cancelation lists, and a lot of providers don't really advertise that. When I was a casemanager for adults with severe mental illness, I would always ask to have my clients added to the cancelation list, and this would often get them in much sooner.

    Also butted heads with a receptionist last year when my client was literally experiencing congestive heartfailure and she wanted to schedule him like 1.5 months out to see his specialist about having a defibrillator implanted. I said it was unacceptable and said he needed to be added to the emergency openings I know the providers reserve. She got a look on her face and said "But I need to get provider approval for that.." I told her "I think you better talk to the doctor then."

    Specialist eventually came over to scheduling and asked what was going on. The receptionist said what we wanted and asked if she would approve it, with a real dismissing inflection. The specialist said "Oh my god, yeah of course he's approved for the emergency list.."

    Some of these things are just so overlooked/unknown by the general public. And sometimes you've got to be assertive and stick with your guns to be treated fairly and get the attention you deserve. Especially now more than ever. Our healthcare system was bad before, but it's been so strained ever since covid...

    The healthcare system can be a nightmare for average people functioning well. It is so much worse for the population experiencing severe mental illness/with cognitive disability. This barrier for care plays a significant role in the reduced life expectancy in the disadvantaged population I worked with.

    Patients suffering from severe mental disorders, including schizophrenia, major depression and bipolar disorders, have a reduced life expectancy compared to the general population of up to 10–25 years. This mortality gap requires urgent actions from a public health perspective in order to be reduced. Source

    If anyone reading this has family or friends with severe mental illness or trouble with intellectual functioning, you may want to offer some support for doctors appointments. Honestly, everyone would benefit from having another person in their appointments for support and as a second set of ears.

    Anyone reading this with severe mental illness, don't be afraid to reach out for support. If you don't have a social support system, there are services out there to help. Try to find social services in your area to get some help navigating thru all the bullshit. And don't give up hope.

    Always like to share this website with free evidence-based resources that I used all the time with my clients. I personally benefitted from the material as well.

  • Technically not my industry anymore, but: companies that sell human-generated AI training data to other companies most often are selling data that a) isn't 100% human generated or b) was generated by a group of people pretending to belong to a different demographic to save money.

    To give an example, let's say a company wants a training set of 50,000 text utterances of US English for chatbot training. More often than not, this data will be generated using contract workers in a non-US locale who have been told to try and sound as American as possible. The Philippines is a common choice at the moment, where workers are often paid between $1-2 an hour: more than an order of magnitude less what it would generally cost to use real US English speakers.

    In the last year or so, it's also become common to generate all of the utterances using a language model, like ChatGPT. Then, you use the same worker pool to perform a post-edit task (look at what ChatGPT came up with, edit it if it's weird, and then approve it). This reduces the time that the worker needs to spend on the project while also ensuring that each datapoint has "seen a set of eyes".

    Obviously, this makes for bad training data -- for one, workers from the wrong locale will not be generating the locale-specific nuance that is desired by this kind of training data. It's much worse when it's actually generated by ChatGPT, since it ends up being a kind of AI feedback loop. But every company I've worked for in that space has done it, and most of them would not be profitable at all if they actually produced the product as intended. The clients know this -- which is perhaps why it ends up being this strange facade of "yep, US English wink wink" on every project.

  • Restaurants are 100% more disgusting than your own kitchen.

    It really doesn't matter which one unless it's like super high end. And you've almost definitely eaten something that was dropped on the floor.

  • For those in the US: no medical office dealing with insurance has a clue what they're doing. Why can't you ever "shop around" and get a price for your procedure? Because nobody really knows the price until they submit the claim. It's basically impossible for a human to keep track of the policies that change daily across dozens of insurance providers along with the hugely complicated calculations needed to get a price. And that's before they have software try to rearrange your claim to get the most money possible from insurance companies. And good luck figuring any of this out yourself; even if you manage to track down the policy data, it's written completely in medical insurance jargon and might even leave some room for interpretation.

    Basically, even with the insane amount of work medical coders (people who process and interpret medical claims and policies) do to try and stay on top of it all, at the end of the day, you have to just submit the claim to a black hole and hope that it gets accepted. The patient's cost is whatever it spits out.

    Also, dozens of doctors across the US get fired, banned from practice in their state, or have their licenses revoked every month. Some of them are unfortunate, like doctors being forced into retirement due to old age or physical inability to do their job, but many others get in trouble for practicing without a license, sexual harassment/assault, and, of course, prescription drug abuse. This data is all publicly accessible, but being on atrociously designed and maintained government websites, it's nearly impossible to keep track of who's in trouble without paying for third party software to do it for you. If you don't happen to catch it, it's pretty easy for a medical provider to move a few states over and set up shop like nothing happened.

    Edit: Oh yeah, our company was very serious about HIPAA training and treated patient data with extreme caution. Some offices... really didn't. It got to the point where we'd straight up have to reject ticket requests for having identifying information. Our ticketing system was secure on our end, no telling what was going on outside of it.

    As a side note, for the trans people out there, don't accept that you have to be misgendered on your medical records without a bit of a fuss. There's special modifiers that specifically override restrictions on sex-based medical procedures when your reported gender doesn't match their requirements. Unfortunately, whether your provider knows about or uses them is a bit of a toss-up.

    On a brighter note, as stupid as it is that every single diagnosis has to be codified specifically for the insurance industry, there are some funny codes in there.

    Some favorites:

    Now there's a new standard coming into effect, ICD11. The biggest complaint with ICD10 was the overly specific codes they had to keep track of. They did change things so that you didn't have a completely different code for every single type of, say, dolphin injury, but they did add many more animals.

  • Your PC runs firmware written by some companies with really sloppy engineering and security practices. Whenever possible opt for a computer that runs open source firmware (coreboot).

  • That replacement infrastructure being installed in your area was PE stamped decades ago. It is quite possible he/she who did it has died at this point. All the mistakes they made are still in there and getting replicated with each upgrade. If anyone tries to fix anything it will be an uphill battle. Parts are specified that don't exist so without eBay nothing would get shipped.

    The person managing the project is in sales and their degree is probably in English Lit. Sometimes you get lucky and it is a construction worker. Their boss is the mayor's nephew and has the contract because of a rule that stuff used in local area must go through a local company. An example: a replacement part that we sold last month was for 2,200 dollars. The local company charged 11,500 for doing nothing except repackaging the part. A big fuck you to the Arizona tax payer.

    All your infrastructure is using way more electricity than it needs. We can't get anyone to shift over to more efficient systems because that would involve effort on their part. We also can't get them to upgrade the service, instead we just have to find by trial-and-error what parts can deal with under voltage. Code has to be designed to deal with the frequent brownouts because no one wants to pay for a generator. Speaking of code the number of times I am asked to give people a printout of code is much higher than you would expect.

    Global warming is ripping us a new one. Everything is flooding that shouldn't be flooding plus heat is everywhere. Waterproofing and heat upgrades are taking time because the original specs have to be updated. Which can't happen because they don't want to get the PE in to stamp it. Because that would make the project cost more eating into sales.

    In short everything keeping you alive. Your water, garbage/recycling systems, sewage, trains, traffic signals, and roads was designed by better minds who are now dead. Everything now is a mixture of nepotism and short term self-interest trying to blindly copy what didn't even work that well to begin with under new conditions. If you want a job for life go work in infrastructure, if you want to be happy with your life go work in anything else.

    Oh you might be wondering how is it we all haven't died from choleria and rabies infected garbage rats by now. The answer is simple. The very lowest paid people, the operators and maintenance crews, are actually good at what they do. Perfect? Hell no, however they get the job done. Which you wouldn't know given how hard the government is working to cut their pensions and not increase their salaries but there it is.

  • In Germany: Big car manufacturers do have round-table sessions where they share research informations with each other. However, they do not co-ordinate pricing.

    When you feel like car manufacturers release models with similar specs within a short time frame, this could be why.

  • We’re guessing. Everyone claims it’s all based on research and advanced modelling, but we really have no idea and and are bullshitting our way through presentations and press conferences.

    We say whatever we can to keep our shareholders invested and the public buying. I’ll let you guess the industry, but you probably know.

661 comments