come on, dig you know there is a big difference. you only have to look at the sorts of patient seen in community mental health clinics, in the county outpatient clinics or compare inpatients in county/state hospitals with those in university hospitals to see that as a general rule those uninsured on on medicaid/medicare are sicker. also if you have a chronic severe mental illness and are going cash only it is quite likely someone other than yourself is paying for your care which is an indicator of social support. social support is predictor of the course and severity of psychosis and other mental disorders. Further, African Americans are overrepresented in patients with schizophrenia and bipolar I disorder, and their illness likely more severe, and of course these patients are not seen in cash only practices. Finally, the sickest patients can't as you acknowledge be treated in cash only private practice as they need a comprehensive multidisciplinary care package often involving a psychiatric nurse, social worker, therapist, etc etc which most people could not afford cash only and most cash only psychiatrists do not have access to.
and like you said, these patients are likely 'stable', i.e. not all that sick. I was obviously being inflammatory when I said 'nothing meaningful' - it's of course up to the individual to define what gives them purpose, and of course you might do something that helps more people than someone else, but when you are trained to be able to help so many people and then don't help them you have to think 'what am I really doing here?' I don't want to sound too much like a dirty socialist, but by providing off the radar care, pandering the whiny meanderings of bored housewives and or medicating the children of depressed mothers, you are selecting to care for those who are most able to pay, not those who are most in need. Instead of contributing to the provision of mental health services you reduce access to care, deepens the divisions of inequality, and ultimately, exacerbate the situation where you see the kind of psychopathology in the US that you have not seen in western Europe since the beginning of the 20th century.
This mostly holds true for C&A too, it's no surprise psychopathology is much more common and often more severe in the deprived and poorest communities, and if you're parents are going to pay for you to see a shrink when you have your first break you're not going to be as sick as someone who ends up with a longer duration of untreated psychosis and worse prognosis etc.
