Posts Tagged ‘Medicaid

19
Sep
13

America’s Mental Health System Drives You Crazy

So we have another shooting, this time at the Naval Shipyard in our nation’s capital.  All reports say the shooter had exhibited clear signs of not only mental illness, but violent tendencies.  He had been arrested for incidents involving suspicious use of a firearm, but neither was his gun taken away, nor did  the police make any connection with his behavior with mental health issues.  We also have the stabbing death of a professor in Seattle by a homeless crazy person who is representative of the type of person that due to lack of mental health facilities, ends up in prison or on our streets.  Our mental health system is ridiculous and encourages very ill people to act out in desperation.  The way the system is set up, you won’t get any real help until it’s too late for the person with mental health problems or for an innocent bystander.

Following is a composite typical scenario that I created from my own experiences as well as the experiences of others in dealing with the nonsensical and unhelpful system as it exists at least in my state.

Jane had an extremely abusive childhood which understandably left her with major depressive disorder and violent anger issues.  Despite this, she was intelligent and driven enough to put herself through school and graduate from university.  On paper, she seems fine.  However, due to her issues, daily life is a constant struggle and her problems are like a pebble in a pond, radiating repercussions to everyone around her and society at large.

Although smart enough to be employed (at least on paper credentials), she could not cope with daily stressors well and didn’t get along with others, alienating friends, family, and coworkers, sabotaging her ability to make a living and provide for herself.  She tried to seek help, being self-aware that she had major problems.

What typically happens is that when you are low income, you see a primary care physician that generally has little to no training in mental health.  You get a fifteen minute appointment and assessment and then out comes the  prescription pad.  Like most doctors today, the physician had drunk the kool-aid of the pharmaceutical industry and prescribed a pill as the cure to all ills.

The influence of the pharmaceutical industry as well as inadequate funding of our health care system and the American consumer way of thinking led to pill popping as a quick and cheap way to sweep mental health problems under the rug.  Too bad that even the “miracle drugs” SSRIs (Prozac being the most famous of the group) aren’t really that effective, with only about 30% of patients responding positively, which is the same rate of efficacy as the sugar pill placebo.

Not to mention that these drugs have a long list of side effects and that not only are they over prescribed, but wrongly prescribed by doctors that didn’t spend enough time with their patients to give an accurate diagnosis.  These pills can do more harm than good.

Some of the side effects of the antidepressants prescribed are extreme weight gain, severe acne, and hair loss.  Seriously!  If I wasn’t depressed before taking pills, I sure as fuck would be when i became 300lbs, bald and with an oozing pizza face!  Some give you a feeling of “electric brain shocks” when getting off meds that are so excruciating that some patients end up being lifelong users, not by choice.  How hypocritical that our pharmaceutical industry can turn us into drug addicts for life, but our government wages a war on drugs that aren’t controlled by big money corporations.

Back to Jane….Pills were dispensed like candy, but no pill can cure the underlying thought and behavioral problems that accompany mental illness.  No therapy was available other than an hour every two to three weeks with a community therapist that is not a psychiatrist and doesn’t have the expertise to treat people who are severely ill.  Even to get this shitty amount of care, Jane was on a waiting list for three months.

When she was working, it was often as a temp, which provides no benefits and the insurance offered was exorbitant, covered nothing, and made no provisions for mental health.  If there was employer insurance, again, it covered nothing but meds.  Besides, bound to a Monday-Friday, 9-5 schedule, she would never have the time or leeway to see anyone anyway.

Jane couldn’t work more than a year at any job without experiencing a severe breakdown.  The best she could do was to work a year on contract, grit her teeth to tough it out and collapse into another major depressive breakdown.  In the months leading up to it, it was clear to see something was wrong.  Unable to sleep at night, constantly tormented with increasingly angry and violent thoughts, her appearance was disheveled, she was hostile and short-tempered, and often blew up at strangers and was surly with those she knew.

During periods of unemployment, she was unable to access any care as even receiving $1200 per month from unemployment disqualified her as too much money to get any government health care.

After years of this cycle, and intermittently seeking help and getting only a prescription that didn’t work, she gave up and tried to just soldier on.  Eventually, her issues caught up to her and she ended up nearly losing everything before she at last qualified with DSHS to get help.

She had a psych evaluation with a real psychiatrist who diagnosed her with Major Depressive Disorder, and Borderline Personality Disorder.  I picked BPD as the example because while it is a severe mental disorder, it isn’t a delusional one, like Schizophrenia, and there is effective treatment with high success  and low relapse rates that exist.  It is also a condition that is not helped by any medications, so the meds prescribed which she had stopped taking after her initial experiences with SSRIs would have done more harm than good to her overall health.

The government assigns you the status of General Assistance-Unemployable, or GAU.  This gives you medical insurance for a short term condition expected to last six months to a year.  It qualifies you for food stamps of about $200 per month.  There is no government housing subsidy, but a charity provides funds for that.  There is no cash subsidy.

Jane found that after being diagnosed and recommended for a specific type of treatment , the GAU insurance disqualified her from accessing that treatment.  All she had available was the inadequate and scanty therapy from a community clinic.

After six months, her case was reviewed and she was assigned to Aged, Blind, Disabled (ABD), which is a condition expected to last a year to death.  So finally with this change, she could get the specific treatment recommended for her.  Despite, this, on attempting to find a doctor, she was repeatedly told there was a several month waiting list again.

In fact, one administrator told her frankly “Look, if you haven’t at least attempted suicide at least a couple of times, you aren’t going to get in.”  Other administrators told her to at least show up at the emergency room several times as suicidal to document those visits as proof of the need for help.  What a waste of time and money for everyone!  Emergency room visits as we all, now help drive up overall health care costs for all.  To actually have people who work in the system to encourage this wastefulness as the only way to establish some severity and urgency to getting care says a lot about how broken our system is.  Not to mention, subtly (or not so much) encouraging suicide to the patient.

Even worse, though help for her condition was accessible, due to ABD giving her Medicare which is federal, this disqualified her from the charity which subsidized housing which is only for Medicaid recipients on a state level.  She now got a cash subsidy of $197 per month instead which isn’t going to pay rent.

Ok, so if you are really mentally ill, you won’t get the medical help that was prescribed for you for six months to a year, but you have housing, food, and no cash.

After that, if you still aren’t well, you can access the specialized mental health care you need, but then have no place to live.  If you work at all, you get no cash subsidy, and you can’t make more than $1040 per month gross without losing insurance.

There is no low income housing.  In my state, they actually shut down the waiting list to sign up to be eligible for housing for three years now due to overwhelming demand.  Most of the severely mentally ill have no friends or family to help them and no where to go.

The only recourse is to apply for Social Security Disability.  Attorneys tell you it’s standard procedure for them to deny your first claim-no one gets it.  Then 80% or more get turned down for the second claim, and still a third time.  The next step is a hearing request that takes typically a year or more to get to trial.  And you’ll still probably get turned down.

Jane isn’t a hopeless case.  She wanted to get into a year long intensive program that had over 75% success rate in rehabilitating patients. and rejoin society as a productive member.  Instead, she is a drain on the public coffers, taking unemployment too long as the only way to be able to provide basic needs while having time to recover in the short term to be able to work sporadically.  Or while receiving insurance, the system leaving no recourse except to be unemployed in order to keep access to care.

Basically, its the government putting the screws to you.  How sick are you?  You have to be willing to be completely destitute and on the streets before you can get the help you need.  I liken it to being sent to prison for a non-violent drug possession.  If you weren’t corrupt when you went in, being in those conditions will make you far worse by the time you’ve endured all that and get out.  Sick, desperate people who are tortured from their mental suffering, with no recourse, no help, no options are more likely to act out.  You trap an animal in a corner and repeatedly poke it with a sharp stick, what do you really expect besides that animal lashing out in violent fury in an attempt to escape?

And my fictional example is a best case scenario of someone who is “high functioning” and not delusional, psychotic, beset with hallucinations,  or drug addictions which are often an attempt to self-medicate.  And someone who is “high functioning” can be pushed by circumstance or bad luck into becoming even more ill.  Our current system is a waste of resources as well as human potential, not to mention the pain and suffering of the afflicted individual.  As I said, pebble in the pond-that person’s pain has repercussions throughout society in their circle, and can expand to encompass many people in their wake.  Multiply that one person’s effect by millions and all people suffer from the effects of untreated mental illness.  Any one of us can have a series of tragedies and ill luck befall us and fall into depression or have an undiagnosed condition triggered by life’s pitfalls.

Who wrote these policies?  I am always amazed and appalled at the lack of common sense in these statutes.  Who’s really crazy?  Did the politicians even read these regulations that they passed?  How does it make sense that we have a two tier system that provides inadequate medical help, or no wherewithal to be able to access medical care without becoming homeless?

The media focuses on gun control, but for me it’s a case of which came first, the chicken of the egg?  Gun violence is a symptom and result of the underlying mental health issues that drives some people in desperation to such acts.  Basically in America, you have to be a danger to yourself or others before you can get any real help.  When you have a policy that leaves the mentally ill with the choices of the rock or the hard spot, it shouldn’t be a surprise that desperate people can do desperate things.  The real surprise is that more people don’t act out violently, and instead just turn inward and needlessly suffer, living lives of quiet desperation or committing suicide out of hopelessness.

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