Quick Thoughts
Today we began our case study on the topic of mental health. The Ted talk discussed 3 irrational beliefs of mental health: remove stigma, we separate mind and body, and people think their mental illness is a death sentence. We defined mental illness as: a mental, behavioral, or emotional disorder resulting in function impairment (National Institute of Health).
We defined mental health as: a state of physical, social, and mental well-being
Dr. Tony Frontier (2013) reminded us that "everything is the way it is because it got that way." This statement reminds me to understand that every people, place, thing, or idea, has a history - a past. The manifestation of this past makes up the present. This reminds me of the learning year, where we dove into the concept of nurture vs. nature. The environment, influences, and encounters one experiences can nurture their development which will affect their behavior and make-up.
Reflection: The topic of mental health is fairly new to me, so this process of exploring illness of the mind is unmarked territory for my personal education. While I have never experienced mental illness in my immediate circle, I am aware of the three irrational beliefs of mental health the Ted talk (Denny Morrison) discussed. One particular point the Morrison made was the idea looking at those with mental health issues through the lens of individual liberty vs. public safety. I have have a difficult time witnessing those who are clearly mentally ill walking the streets like a ticking time bomb. But at what point do I as a citizen intervene? Is it my individual liberty to intervene for the sake of public safety?
These questions prompt me to return to the liberty vs. safety argument. Through a service lens, I belief we as citizens are responsible to look out for the greater good of public safety. For example, if I am walking down the street and see an individual that is clearly mentally ill walking toward a park where children are playing, I would report the incident to the police for the greater good of the children's safety. Bob Rabe (2013), in my mental health group, suggested that this method of reporting the individual to the police could be a "window of opportunity" for the sick individual to possibly receive help. This perspective looks at the greater good of the individual and the children, in this particular scenario.
A few months back while staying at a hotel in Kenosha, I experienced the fear that an individual with mental illness can inflict on society. It was midnight, and I was sitting in the lobby reading a book when a man turned the corner. He smelled terrible, wreaked of alcohol, and decided to sit right next to me. He kept asking me my name, "Hey you, whats your name man?" It became increasingly annoying, to the point that I got up and began walking back to my room. When I turned the corner to go to my room, I thought of all the children that could be walking through the halls by themselves. I thought about the little old lady that may be on holiday at hotel. It was at that moment I became cognizant of the public safety of the residents of the hotel. I went straight to the front desk and reported the individual to the staff. Within minutes the police were there assessing the situation.
In this situation I believe I looked out for the greater good of the public. Additionally, I looked out for the greater good of the alcoholic individual. In reporting this man to the police, I really hoped that he would be arrested, which could possibly lead to his personal reassessment of his alcohol problem (of course when he sobered up). Additionally, I hoped this intervention could lead to the individual to consider therapy or treatment.
Group Thoughts
Acting like judges before acting like scientists
The people that are making the informed decisions have no connection to mental health (this is a generalization).
What is it was turned into brain-illness (reframing concept of mental illness)
There is an unavoidable tension between the urgent need for transformation and the longer-term nature of scientific progress. Thomas R. Insel, M.D. Director, NIMH
Communities dont have the equal access for youth who suffer from mental illness
How to minimize the financial
Group Notes
Schizophrenia, bipolar disorder, depression, post-traumatic stress disorder, eating disorders, autism, and other disorders are serious, often life-threatening, illnesses for which we need reliable diagnostic tests, new treatments, and effective strategies for prevention.
Mental Health America
MHA
Although the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) was enacted over four years ago, a final rule implementing the law has not yet been issued. Without a final rule from the Administration, many individuals seeking care for mental health and addictive disorders have been unable to access the health care services they need.
The Administration has promised a final MHPAEA rule by the end of the year, but they have not clarified if the needed protections will be in the final rule. The Administration needs to hear from patients and providers who have experienced parity violations so that these practices are clearly prohibited in the final rule. Parity violations include plans denying or more strictly managing mental health and addiction treatment services than other services covered by the plan. More information may be found at www.parityispersonal.org.
Send an email describing your parity violation story to both the Departments of Labor and Health and Human Services. We encourage stories to be reported by either patients or providers who are dealing with the parity issue. A sample template is below. Be sure to tell your personal story and attach any relevant documents (if available) such as a denial letter, summary of benefits or other materials provided by the health plan.
To assist you with understanding the common problems with parity that other providers or consumers have registered, see the below examples:
1. Outpatient sessions are being limited by utilization review (also known as medical necessity review) and this is not being done for medical and surgical conditions.
2. Provider reimbursement rates are too low, so the provider has to offer services out-of-network and the patient has to pay a higher out of pocket for their treatment.
3. The insurance company has labeled my treatments as “experimental” and therefore are refusing to pay for those treatments, leaving the patient to pay 100% out of pocket, or go without.
4. The insurance company says that my plan does not cover residential treatment or intensive outpatient care.
5. The insurance company says that my plan does not cover inpatient or residential treatment unless it is provided in an acute care hospital, but most of the treatment providers are non-hospital based facilities.
6. The insurance company says that they do not authorize any inpatient treatment at all for my opioid addiction, and that I must detox on an outpatient basis.
7. I have requested from my insurance company the reason why they have denied my care and they will either not respond to my requests for further information, or they refuse to tell me what they do for medical and surgical care, or they refer me to an enormous website that I cannot discern any information from.
The Parity Implementation Coalition was formed to help ensure that the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA)-- a federal law that protects a group health plan's mental health and/or substance use coverage benefits -- is properly enforced. If you are a patient or provider who has complaints, we would like to hear from you. Depending on the nature of your complaint, we may be able to provide help in resolving your problem or point you to other resources. Your reports will also help us identify potential patterns of critical concern to federal regulators.
We provide online resources with information about:
Questions We Have...
How do we help? When we see someone on the street exhibiting mental health concerns, at what point would you intervene? When does it look like helping someone in cardiac arrest? If someone doesn’t want to be helped, who are we to determine that they, in fact, do need it? How can we help foster identification and offer support earlier (in children)? What is the cost-benefit analysis of the current system? What are the rights of the mentally ill? What are the rights of family and community members (in relation to the mentally ill)?
Where We Can Advocate....
Departments of Labor and Health and Human Services
Wisconsin Office of the Commissioner of Insurance
State legislators
Increase public awareness through letters and articles in prominent newspapers and journals, media
Insurance Companies
Ourselves - through self-awareness and education
Prison system
Who Is Impacted...
If it is a systemic problem, which we believe it is, then all of society is affected. Until it impacts us in some way, we may not be moved to act, but it affects all of society. We are only as strong as our weakest link.
This is connected to the homeless issue and the gun violence issue from last year. This is a root cause to homelessness (and other societal issues).
What the Problem is....
There is an unavoidable tension between the urgent need for transformation and the longer-term nature of scientific progress. Thomas R. Insel, M.D. Director, NIMH
There is a continuum of need...
- Those who have family structure of support and appropriate resources
- Those who have family structure of support but limited resources
- Those who have no family structure of support or resources
Access to insurance, appropriate diagnosis is inconsistent
Appropriate comprehensive medical care is not readily available
Resource allocation and prioritization of the issue
Currently - Reactionary approach; Needed - Proactive approach
Who Has the Power...
Politicians
Employers
Doctors
Those who have the resources
Law enforcement
Insurance Companies
The mentally ill themselves
Who Has Responsibility....
We all have responsibility, but are not necessarily taking that responsibility
How We Can Help...
From NIMH
- Promote Discovery in the Brain and Behavioral Sciences to Fuel Research on the Causes of Mental Disorders
- Chart Mental Illness Trajectories to Determine When, Where, and How to Intervene
- Develop New and Better Interventions that Incorporate the Diverse Needs and Circumstances of People with Mental Illnesses
- Strengthen the Public Health Impact of NIMH-Supported Research
Foster conversations among community organizations addressing mental health to maximize use of resources
Simply listen
Facts:
- Only 12% of people with diagnosable psychiatric disorders receive minimally adequate treatment
- The National Institute of Mental Health estimates there are 3.6 million American adults with severe mental illness that is untreated. Of those, 200,000 are homeless and 319,000 are in jails or prisons.
- Today, 20 times more people with mental illness are incarcerated than in a medical facility.
- Two-thirds of all patients treated at the Milwaukee County psychiatric emergency room are brought in by police. That's roughly 7,200 people a year. One in three returns within 90 days.
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