Pages

Showing posts with label mental illness. Show all posts
Showing posts with label mental illness. Show all posts

Tuesday, November 19, 2013

No Comfort Food for Mental Illness






This is a heartbreaking story I saw on Slate.  Written by  .  I admire Mr. Lake.  It takes courage to publicly announce that someone in your family is suffering from mental illness.  Will we ever reach the point where we are not ashamed to talk about depression, drug abuse, alcoholism, bipolar disorder, and all the rest?  Stories like this will help, I'm sure.


"When my wife was diagnosed with breast cancer, we ate well. Mary Beth and I had both read the terrifying pathology report of a tumor the size of an olive. The surgical digging for lymph nodes was followed by months of radiation. We ate very well.

Friends drove Mary Beth to her radiation sessions and sometimes to her favorite ice cream shop on the half-hour drive back from the hospital. She always ordered a chocolate malt. Extra thick.

Our family feasted for months on the lovingly prepared dishes brought by friends from work and church and the neighborhood: chicken breasts encrusted with parmesan, covered safely in tin foil; pots of thick soup with hearty bread; bubbling pans of lasagna and macaroni and cheese. There were warm home-baked rolls in tea towel–covered baskets, ham with dark baked pineapple rings, scalloped potatoes, and warm pies overflowing with the syrups of cherries or apples.

Leftovers piled up in the refrigerator, and soon the freezer filled up too, this tsunami of food offerings an edible symbol of our community’s abundant generosity.

Although few said the word breast unless it belonged to a chicken, many friends were familiar with the word cancer and said it often, without flinching. They asked how we were doing, sent notes and cards, passed along things they’d read about treatments and medications, emailed links to good recovery websites and the titles of helpful books, called frequently, placed gentle if tentative hands on shoulders, spoke in low and warm tones, wondered if we had enough food. The phrase we heard most was: “If there’s anything I can do ... ”

In the following months, after Mary Beth had begun speaking in full sentences again and could stay awake for an entire meal, the stored foods in the freezer ran out, and we began cooking on our own again. Our children, Nick and Maggie, sometimes complained jokingly about our daily fare. “Someone should get cancer so we can eat better food,” they’d say. And we actually laughed. 
* * *
Almost a decade later, our daughter, Maggie, was admitted to a psychiatric hospital and diagnosed with bipolar disorder, following years of secret alcohol and drug abuse.

No warm casseroles.

At 19, she was arrested for drug possession, faced a judge, and was placed on a probation program. Before her hearings, we ate soup and grilled cheese in a restaurant near the courthouse, mere booths away from the lawyers, police officers, and court clerks she might later see.

No scalloped potatoes in tinfoil pans.

This question is rarely heard: “How’s your depression these days?” Maggie was disciplined by her college for breaking the drug and alcohol rules. She began an outpatient recovery program. She took a medical leave from school. She was admitted to a psychiatric hospital, diagnosed, released. She began years of counseling, recovery meetings, and intensive outpatient rehabilitation. She lived in a recovery house, relapsed, then spent seven weeks in a drug and alcohol addiction treatment center.

No soup, no homemade loaves of bread.

Maggie progressed well at the treatment center. When the insurance coverage on inpatient treatment ran out for the year, she was transferred to a “partial house” where she and other women slept at night then were returned by van to the facility for full days of recovery sessions, meals, volleyball games, counseling, and horticultural therapy. This daughter who once stayed as far away from my garden as possible lest I catch a whiff of my stolen whiskey on her breath was now planting a garden herself, arranging painted rocks around an angel statue donated by a counselor, carrying buckets of water to nurture impatiens, petunia, delphinium, and geranium.

Friends talk about cancer and other physical maladies more easily than about psychological afflictions. Breasts might draw blushes, but brains are unmentionable. These questions are rarely heard: “How’s your depression these days?” “What improvements do you notice now that you have treatment for your ADD?” “Do you find your manic episodes are less intense now that you are on medication?” “What does depression feel like?” “Is the counseling helpful?” A much smaller circle of friends than those who’d fed us during cancer now asked guarded questions. No one ever showed up at our door with a meal.

We drove nearly five hours round trip each Sunday for our one weekly visiting hour. The sustenance of food, candy, and fiction were forbidden as gifts to patients at the treatment center. Instead, we brought Maggie cigarettes, sketchbooks, colored pencils, and phone cards. Any beef roasts or spaghetti dinners we ate were ones we’d prepared ourselves or bought in a restaurant on the long road to the center.

Then, late one night in June, Maggie and another patient were riding in the treatment center’s van on the way back to their house after a full day of the hard work of addiction recovery. The number of patients in the partial house had diminished from six a few days before, after a scandal involving small bags of ground coffee some smuggled from the house to the center and sold as though it were cocaine to addicts craving real coffee. (The center, like many, served only decaf.) Dozing off and comfortable in the seat behind the driver, Maggie might have been thinking of those coffee dealers who had been returned to the main facility or dismissed. Or maybe she was thinking about the upcoming wedding of her brother, Nick. A light pink bridesmaid’s dress waited in her closet at our house. Her release from the center was scheduled for two days before she and Mary Beth were to fly to Wisconsin for the wedding.

That night, an oncoming speeding car hit the van head-on.

The medics radioed for helicopters, and soon the air over Chester County, Pa., was full of them, four coming from Philadelphia, Coatesville, and Wilmington, one for each patient. The accident site was soon a garish roadside attraction of backboards, neck braces, IV tubes, oxygen tanks, gurneys, strobing lights, the deep thumping of helicopter blades, and the whine of turbines.

A newspaper picture later showed five firefighters, all in full gear, lifting a woman from a van—only her feet and an edge of the backboard visible. The van’s roof, dark and torn and jagged in the picture, had been removed by hydraulic cutters while the huddled victims, Maggie unconscious among them, were carefully covered with blankets. One of her front teeth lay in a puddle of blood on the ground.

When we saw her in the hospital, her face was a swollen mass of stitches, bruises, and torn flesh. Brown dried blood was still caked in her ears. Mary Beth carefully cleaned it with a licked paper towel, as if she were gently wiping Maggie’s face of grape jelly smudges or white donut powder just before Sunday school. At first, Maggie only remembered headlights, but soon she would mention “a cute EMS tech waking me up,” and the muffled chattering of helicopters.

The day she was released from the hospital, Maggie insisted on returning to the rehab center to complete her program, a heroine in a wheelchair among heroin addicts and alcoholics. On the way there, we stopped at a restaurant for lunch,  where Maggie ate mashed potatoes, a little soup, and sucked a mango smoothie through a straw held carefully where her tooth was missing. Back at the center, we rolled her out to see her garden.

While Maggie was in the hospital, cards and letters filled our mailbox at home. For the two weeks that Maggie remained in rehab, and even while she flew to the Midwest, then wore her pink dress at Nick’s wedding and danced triumphantly with her cousins, offers of food crackled from our answering machine and scrolled out on email: “If there’s anything I can do ... ”



Friday, November 08, 2013

Thinking Outside the Box to Curb Gun Violence






This is such an important piece of news, but I doubt that you will see it on the 6 o'clock news in your city.  It's fair to say, I think, that all of the mass shootings that have taken place were committed by people who had previously had some contact with the mental health system.  It's also fair to say that some of them didn't get the treatment they needed because their insurance (if they had any) wouldn't pay for it.  Now that changes and mental illness will be treated no differently than appendicitis.  It's a lengthy article, but well worth your time reading it.


Rules to Require Equal Coverage for Mental Ills
Published: November 8, 2013 NY Times

WASHINGTON — The Obama administration on Friday will complete a generation-long effort to require insurers to cover care for mental health and addiction just like physical illnesses when it issues long-awaited regulations defining parity in benefits and treatment.

The rules, which will apply to almost all forms of insurance, will have far-reaching consequences for many Americans. In the White House, the regulations are also seen as critical to President Obama’s program for curbing gun violence by addressing an issue on which there is bipartisan agreement: Making treatment more available to those with mental illness could reduce killings, including mass murders.

In issuing the regulations, senior officials said, the administration will have acted on all 23 executive actions that the president and Vice President Joseph R. Biden Jr. announced early this year to reduce gun crimes after the Newtown, Conn., school massacre. In planning those actions, the administration anticipated that gun control legislation would fail in Congress as pressure from the gun lobby proved longer-lasting than the national trauma over the killings of first graders and their caretakers last Dec. 14.

“We feel actually like we’ve made a lot of progress on mental health as a result in this year, and this is kind of the big one,” said a senior administration official, one of several who described the outlines of the regulations that Kathleen Sebelius, the secretary of health and human services, will announce at a mental health conference on Friday in Atlanta with the former first lady Rosalynn Carter.

While laws and regulations dating to 1996 took initial steps in requiring insurance parity for medical and mental health, “here we’re doing full parity, and we’ve also taken steps to extend it to the people covered in the Affordable Care Act,” the senior official said. “This is kind of the final word on parity.”

With the announcement, the administration will make some news that is certain to be popular with many Americans at a time when Mr. Obama and Ms. Sebelius have been on the defensive for the bungled introduction of the insurance marketplaces created under the Affordable Care Act.
According to administration officials, the rule would ensure that health plans’ co-payments, deductibles and limits on visits to health care providers are not more restrictive or less generous for mental health benefits than for medical and surgical benefits. Significantly, the regulations would clarify how parity applies to residential treatments and outpatient services, where much of the care for people with addictions or mental illnesses occurs.

Any geographic or facility-type limitations would have to be comparable for medical and mental health benefits. For example, an administration official said, an insurer “can’t say you can only get substance-abuse treatment in state but you can go anywhere for medical/surgical.”

The regulations, which specifically put into effect the 2008 Mental Health Parity and Addiction Equity Act, would affect most Americans with insurance — roughly 85 percent of the population — whether their policies are from employer plans, other group plans, or coverage purchased in the market for individual plans.

The final parity rules do not apply to health plans that manage care for millions of low-income people on Medicaid. However, the administration has previously issued guidance to state health officials saying that such plans should meet the parity requirements of the 2008 law.
The parity law does not apply to Medicare, according to Irvin L. Muszynski, a lawyer at the American Psychiatric Association.

The rules have been awaited since the 2008 law by patient advocate groups. As it happened, the groups’ complaints about regulatory delays were the subject of a Senate hearing on Thursday. Interest picked up further last month as individuals could begin enrolling in the new insurance marketplaces, or exchanges, provided under Mr. Obama’shealth care law.

Under that law,treatment for mental health and substance abuse is among 10 categories of benefits considered essential and thus mandatory in plans marketed in the new exchanges to individuals and small groups. Although many insurers already provide extensive mental health coverage, some have found ways to get around existing rules and to deny payment for treatment, Senator Richard Blumenthal, Democrat of Connecticut, said the five-year delay in issuing a final rule had real-world consequences. “In mental health, uncertainty kills,” he said. “If an individual poses a threat to himself or others, he cannot be told he will get the care he needs as soon as his insurance company decides what ‘parity’ means.”


Insurance companies have raised concerns about the expense involved in paying for the lengthy and intensive courses of treatment that the final regulations address. But experts have said the rules are not expected to significantly add to the cost of coverage because so few patients require these levels of care. 
Mental health services are scarce in many parts of the country, particularly for children, so experts have questioned whether changes in the law will have much impact in practice.

Former Representative Patrick J. Kennedy of Rhode Island, a co-sponsor of the 2008 law, said the rules could particularly help veterans. “No one stands to gain more from true parity than the men and women who have served our country and now need treatment for the invisible wounds they have brought home from Iraq and Afghanistan,” he said.

Administration officials consulted closely with mental health groups. “What we are hearing is very positive,” said Andrew Sperling, a lobbyist at the National Alliance on Mental Illness, based on what he had been told of the final language.

Under the 2008 law, treatment limits — like restrictions on the number of doctor visits or days in a hospital — cannot be more restrictive for mental health benefits than for medical and surgical benefits. But interpretation of the law left much in question.

For example, Mr. Sperling said, policyholders can easily determine whether numerical limits on doctor visits are comparable in their plans for mental and medical health care. But, he said, it is more difficult to challenge “nonquantitative limits” — like some insurers’ requirements that people get their authorization before seeing a psychotherapist.

The provision of the rule that will seek to clarify the amount of transparency required of health plans “is important,” Mr. Sperling said. Patients advocates say they need to be able to see the criteria by which insurers find a particular service to be medically necessary, so policyholders can judge whether standards for mental health treatments are more restrictive.

Carol A. McDaid, the leader of a coalition of patients and providers of mental health and addiction services, said: “This is the beginning, not the end, of our work to make the vision of the law a reality. We have to make sure that the law and the rules are fully enforced.”

Insurers and business trade groups said they did not know enough about the rules to comment.
Dr. Paul Summergrad of Tufts University, president-elect of the American Psychiatric Association, said he hoped the final rules would end “the uniquely discriminatory form of prior authorization and utilization review” applied to emergency care for patients with mental illness.

A person who has a heart attack or pneumonia and goes to a hospital will routinely be admitted, with electronic notice sent to the insurer on the next business day, Dr. Summergrad said. By contrast, he said, if a person who is profoundly depressed and tried to commit suicide goes to a hospital, an emergency room doctor must call a toll-free telephone number, “present the case in voluminous detail and get prior authorization.”

State insurance commissioners will apparently have the primary responsibility for seeing that commercial insurers comply with the parity standards. They already have their hands full, however, enforcing new insurance market rules, and in some states insurance regulators are considered close to the industry.

“We need enforcement,” Mr. Kennedy said in an interview. “The notion of delegating this to the states, which are looking to the federal government for direction, is problematic.”