Posts tagged abuse
Posts tagged abuse
[In the News] Insurers directed to treat mental health issues the same as physical ailments
By Sandhya Somashekhar and Juliet Eilperin, Washington Post Health and Science
The Obama administration issued a final rule Friday requiring insurers to treat mental health and substance-abuse problems the same way they do physical illnesses.
The rule provides long-awaited clarification on a mental health parity law that was enacted with much fanfare five years ago but had not been fully implemented as the federal government wrote and revised the regulations.
It also represents a fulfillment of a promise made by President Obama, who vowed to put the finishing touches on the regulations as part of a broader effort to address the problem of mass shootings, which have thrust mental health issues into the spotlight in recent years.
“For way too long, the health-care system has openly discriminated against Americans with behavioral health problems. In the past, it was legal for insurance companies to treat these disorders differently than medical and surgical needs,” Health and Human Services Secretary Kathleen Sebelius said in announcing the rule Friday.
Because of the 2008 mental health parity law, as well as the 2010 Affordable Care Act, “we are finally closing these gaps in coverage,” she said.
Mental health advocates lauded Friday’s news because they have been eagerly awaiting final regulations since the passage of the Mental Health Parity and Addiction Equity Act in 2008. Championed more than two decades ago by then-Sens. Paul D. Wellstone (D-Minn.) and Pete V. Domenici (R-N.M.), the law was hailed as a milestone for people with mental illness and substance-abuse problems.
The administration issued interim rules in 2010 meant to partially explain the nuances of the law, but it still left ambiguity in a number of areas, including how insurance companies were to cover the kind of intensive treatment that falls in the gray area between emergency inpatient care and a doctor’s office visit.
Friday’s rule clarifies that people are entitled to information about the standards used by health plans to determine what kind of treatment they cover — information that could be valuable if people want to file a complaint alleging that their mental health service was not treated comparably to a medical one.
It also confirms that the gray-area treatments — for example, intensive therapy after a psychotic break that does not require hospitalization — should be covered in a similar fashion as a medical condition, such as the rehabilitation that takes place after a heart attack.
But some mental health advocates said it fell short in at least one respect: It did not indicate that the rules apply to people in private health plans administered through Medicaid, the state-federal program for the poor.
They also noted that five years was a long time to wait for final rules. It was a period in which patients were somewhat reluctant to assert their rights under the law because of the lack of clarity, they said.
Still, they called Friday’s news historic and hailed it as a huge win for people who suffer from behavior problems.
“What a historic day this is, and what a difference it will make to families and individuals who have been discriminated against legally for many, many years,” said Debbie Plotnick, senior director of state policy for Mental Health America, an advocacy group.
By and large, insurance companies have already been abiding by the 2008 law, according to a federal study issued Friday in conjunction with the new rule.
Health plans “have worked to implement these requirements in a manner that is affordable, safe, and effective for patients,” Karen Ignagni, president of industry group America’s Health Insurance Plans, said in a statement Friday. “We appreciate that the final rule enables patients with mental and behavioral health conditions to continue to benefit from the innovative programs and services health plans have pioneered.”
The law applies only to health plans provided by employers with 50 workers or more. The Affordable Care Act, commonly referred to as Obamacare, extended the parity rules to the private health insurance market. The rules do not apply to people in government health insurance programs such as Medicaid or Medicare.
Finalizing the rule had been among the priorities outlined by Obama and Vice President Biden shortly after the attack in December at Sandy Hook Elementary School in Newtown, Conn., where a gunman opened fire, killing 20 first-graders and six school employees before taking his own life.
According to reports, the shooter, Adam Lanza, may have had a history of mental illness. Although studies show that people with mental disorders are more likely to be the victim of a crime than the perpetrator, Newtown and other mass shootings have prompted renewed interest in bolstering the nation’s mental health safety net.
That incident in particular led Obama and Biden to issue a plan to reduce gun violence through 23 proposed executive actions. With Friday’s announcement, all have now been fully or partially implemented.
For more mental health news, Click Here to access the Serious Mental Illness Blog
The creators of the Serious Mental Illness blog invite you to submit your visual art, poetry, or short fiction to Art from the Edge Now!!!
Art from the Edge, a virtual gallery and resource center by the creators of the Serious Mental Illness blog, is a blog dedicated to art created in and about extreme mental states. It is an open and public world wide forum for artists to share their visual and written works and their personal stories with all those interested in the connection between creativity and “edge” states.
[Article of Interest] Raising the Ritalin Generation
By Bronwen Hruska
Excerpt: I remember the moment my son’s teacher told us, “Just a little medication could really turn things around for Will.” We stared at her as if she were speaking Greek.
“Are you talking about Ritalin?” my husband asked.
Will was in third grade, and his school wanted him to settle down in order to focus on math worksheets and geography lessons and social studies. The children were expected to line up quietly and “transition” between classes without goofing around. This posed a challenge — hence the medication.
“We’ve seen it work wonders,” his teacher said. “Will’s teachers are reprimanding him. If his behavior improves, his teachers will start to praise him. He’ll feel better about himself and about school as a whole.”
Will did not bounce off walls. He wasn’t particularly antsy. He didn’t exhibit any behaviors I’d associated with attention deficit or hyperactivity. He was an 8-year-old boy with normal 8-year-old boy energy — at least that’s what I’d deduced from scrutinizing his friends.
“He doesn’t have attention deficit,” I said. “We’re not going to medicate him.”
The teacher looked horrified. “We would never suggest you do that,” she said, despite doing just that in her previous breath. “We aren’t even allowed by law to suggest that. Just get him evaluated.”
And so it began.
If “accelerated” has become the new normal, there’s no choice but to diagnose the kids developing at a normal rate with a disorder. Instead of leveling the playing field for kids who really do suffer from a deficit, we’re ratcheting up the level of competition with performance-enhancing drugs. We’re juicing our kids for school.
We’re also ensuring that down the road, when faced with other challenges that high school, college and adult life are sure to bring, our children will use the coping skills we’ve taught them. They’ll reach for a pill.
[Video of Interest] A Little Insight
Young people from the Voice Collective came together to create this stigma busting animation. The film will be used in schools and online to educate people about hearing voices and to break down barriers between young people.
From the description: Hearing voices that others around you don’t hear is much more common than most people think. This animation was created by a group of 5 young people who hear voices (aged between 13 and 18) in a bid to raise awareness of the experience in schools, and challenge stigma.
As one young person pointed out - when someone comes back to school with a broken arm, everyone crowds around to sign their cast. When someone’s struggling with hearing voices they tend to back off, unsure what to say or do. Why is there a difference?
A soon-to-be-released documentary feature, Kings Park offers an inside look at public mental health care in America by focusing on the story of this now abandoned institution. The journey back begins with Lucy’s sudden decision, on the cusp of her fiftieth birthday, to return to Kings Park for the first time in over thirty years. Determined to face her past and come to terms with her commitment to the state hospital, Lucy’s goals are purely personal when the film begins. She soon learns, however, that in order to fully understand her own story, she needs to somehow learn about the institutional world in which she was once locked away. To this end, Lucy seeks out other former patients, their families, and hospital staff, who share intimate accounts of life at Kings Park. Shot on the overgrown and sprawling grounds of the shuttered hospital, these firsthand accounts of a vanishing world bear witness to the many changes in treatment, policy and attitudes over the past century.
The film culminates with a vision of today. Stories are shared of the often brutally executed “emptying out” of the hospital, and we follow Lucy in her effort to see how mental health care has changed since the hospital’s close. Scenes shot at small mental health care centers, committed to the recovery of their members despite limited resources, let us see the kind of progress that is being made. In contrast, footage shot at the local jail reveals a very different reality – where the penal system has replaced the state hospital as the default “provider” for people with serious mental illness.
By Robert D. Stolorow, Ph.D. for Psychology Today
A young woman who had been repeatedly sexually abused by her father when she was a child began psychotherapy with a young female therapist who consulted with me on the case. Early in the treatment, whenever the patient began to remember and describe the sexual abuse, or to recount analogously invasive experiences in her current life, she would display emotional reactions that consisted of two distinctive parts, both of which seemed entirely bodily. One was a trembling in her arms and upper torso, which sometimes escalated into violent shaking. The other was an intense flushing of her face. On these occasions, the therapist was quite alarmed by her patient’s shaking and was concerned to find some way to calm her.
I had a hunch that the shaking was a bodily manifestation of a traumatized state and that the flushing was a somatic form of the patient’s shame about exposing this state to her therapist, and I suggested to the therapist that she focus her inquiries on the flushing rather than the shaking. As a result of this shift in focus, the patient began to speak about how she believed her therapist viewed her when she was trembling or shaking: surely her therapist must be regarding her with disdain, seeing her as a damaged mess of a human being. As this belief was repeatedly disconfirmed by her therapist’s responding with emotional understanding rather than contempt, both the flushing and the shaking diminished in intensity. The traumatized states actually underwent a process of transformation from being exclusively bodily states into ones in which the bodily sensations came to be united with words. Instead of only shaking, the patient began to speak about her terror of annihilating intrusion.
The one and only time the patient had attempted to speak to her mother about the sexual abuse, her mother shamed her severely, declaring her to be a wicked little girl for making up such lies about her father. Thereafter, the patient did not tell any other human being about her trauma until she revealed it to her therapist, and both the flushing of her face and the restriction of her experience of terror to its nameless bodily component were heir to her mother’s shaming. Only with a shift in her perception of her therapist from one in which her therapist was potentially or secretly shaming to one in which she was accepting and understanding could the patient’s emotional experience of her traumatized states shift from an exclusively bodily form to an experience that could be felt and named as terror. It is in the formation of such somatic-linguistic unities, the bringing of emotional experience into language within a holding context of human understanding, that a sense of being can be born, restored, or consolidated.
Co-Written and Co-Edited by Daniel Mackler and Matthew Morrissey, with Contributions by:
• Patch Adams, M.D., inspiration for Robin Williams film
• Joanne Greenberg, author, I Never Promised You a Rose Garden
• David Oaks, director, MindFreedom International
• Will Hall, co-founder, Freedom Center
• Annie Rogers, Ph.D., professor, author, A Shining Affliction
Family conflict can wreak havoc on people diagnosed with psychiatric disorders. A Way Out of Madness offers guidance in resolving family conflict and taking control of your life. The book, the first in the ISPS-US book series, also includes personal accounts of family healing by people who were themselves psychiatrically diagnosed.
Excerpt from Will Hall’s Essay in the book:
My mother was in therapy and she realized my father’s violent past was taking a terrible toll on our lives together. But she couldn’t see her own role and was helpless to change it, to talk, to break the spell we were all under. To this day I have never had a conversation with my father, mother, or brother about being diagnosed with schizophrenia. Years of trying to speak only led back into my worst mental states. And so at different times in my life I’ve broken contact from them entirely. When I do make plans to visit I hope for a snowstorm to cancel the flight, or some other reason not to go. I live in a kind of exile from my family, and a silent and unbreakable taboo is still in place against who I am. We continue trapped in the codes and dramas of our past.
I spent a year looking for help in the public mental health system before I began, slowly, to look within myself. My freedom and recovery eventually came through trusted friends and support groups, holistic health and acupuncture and nutrition, meditation and spiritual discipline. I stopped taking psychiatric drugs, and I stopped believing in the diagnosis I was given. I’ve gained enough clarity to make a fragile but lasting peace with madness, and live with my wild mind, voices, and altered states of consciousness. I now trust that when the demons come, the angels will soon also have their turn.
Today I work as a mental health advocate and counselor, and I get calls and emails from people searching for an answer different from what they’ve been told by doctors and TV ads. When parents contact me, desperate to help their sons and daughters, I do hold out the possibility of change. I believe these frightened and traumatized fathers and mothers can grow and become a source of freedom for their children. I tell them that families can heal, and that people can recover.
[Blog Post of Interest] The Big Chill: Psychiatric Medications Now Are on Trial For Murder
By Michael Cornwall, Ph.D. on Mad in America
Excerpt: The Canadian judge in the first North American criminal trial to find Prozac the sole cause of a murder ruled – “There is clear medical evidence that the Prozac affected his (defendant’s) behavior and judgment, thereby reducing his moral culpability.” Will those chilling words cause a small tremor in the writing hand of every prescriber of Prozac and other psychiatric medications from now on?
That Prozac verdict which is not going to be appealed by the District Attorney changes everything. The upcoming Utah Supreme Court trial where the court has already ruled that prescribers of psychiatric medications can be held responsible for the actions of their patients, adds to the huge shift in the landscape for anyone who prescribes.
[Article of Interest] Working at the Limits of Human Experience
By Dr. Knafo, who directs this blog, and a professor at Long Island University, faculty and supervisor at NYU’s Postdoctoral Program in Psychoanalysis.
Our entire approach to treating severe and persistent mental disorder in the United States needs to be seriously reevaluated. Sometimes medication is necessary and helpful. But the person is first and foremost a living relational being whose derailment is often rooted in trauma. Unless we take the time to listen to our patients and hear what they are saying, the problems are likely to persist and become chronic.
My experience working with individuals in hospitals, institutional settings, and private practice has convinced me that regression is sometimes a necessary part of the healing process; we sometimes must go back in order to go forward. Like Winnicott, I view regression as a psychic interruption or breach whose underlying purpose is to return the patient to a traumatic episode or constellation of such episodes in which a reactionary, armored self-developed. The defenses formed against such trauma prevent psychological growth and limit the self’s possibilities. The regressive return offers the opportunity for self-repair by working through the original trauma in a safe, holding environment. It is not true that all psychotics are rigid, lack motivation, and fail to develop transference feelings or that they cannot experience conflict or insight.
It is unfortunately eye opening to consider that psychotic patients fare much better in third world countries than in our own, according to Kim Hopper Glynn Harrison, Aleksandra Janca, and Norman Sartorius. The findings of Courtenay Harding’s remarkable longitudinal research show that over half of psychotic patients recover without treatment, a finding that flies in the face of the popular belief that “once a schizophrenic, always a schizophrenic.” I find it rather frustrating to hear professionals comment on a recovered schizophrenic patient by claiming they were surely misdiagnosed because they could not truly be schizophrenic if they recovered. Yale graduate, law professor schizophrenic, and author of The Center Cannot Hold, Elyn Saks wrote that though medication helped her it is psychoanalysis that saved her life.
Being an ex-drug-addict turned neuroscientist brings a unique insight into the physiological and phenomenological realities of addiction.
Excerpt: For 10 years I spun in and out of an addiction to opiates (and other drugs) that led to despair, crime, and the loss of everything I valued most—including my place in graduate school. After many failed attempts, I finally quit taking addictive drugs 30 years ago. I reentered grad school, got my PhD in developmental psychology, and became a professor at the University of Toronto, focusing on emotional and personality development. I studied these topics for 13 years, but I never quite understood my own personality development. I came to believe that my theories needed help from neuroscience, and that’s why I switched to research on the emotional brain—my focus for the past decade.
When I was in the throes of intense psychological addiction, my thoughts were continuously (and unpleasantly) drawn to drug imagery. It would be so great to have some now! How can I get some tonight?! But attraction to something you are just about to get feels marvelous. Dopamine-induced engagement turns into a headlong rush of triumph when the goal is finally accessible.
This perspective on the dual nature of attraction helps make sense of addiction. Unsated attraction can be a kind of torture, and addicts may seek drugs to put an end to that torture, more than for the modicum of pleasure drugs actually bestow.