Get ready for a rant. But first, a few questions to warm you up.
What will it take to improve the state of our country’s mental health care system? When will our elected officials stop being so polarized and shortsighted about the lack of funding, beds, and available care? When will health insurance companies get their hands out of our wallets and take steps to promote mental as well as physical wellness?
I’m not terribly optimistic. Nor was I terribly surprised when a study released this week said more than half of teens with psychiatric disorders go untreated. Also not surprising: Those who do receive treatment get it more often from school counselors, pediatricians, and probation officers instead of mental health specialists.
As a country, we should be ashamed.
Yesterday, a Virginia state senator and former gubernatorial candidate was stabbed multiple times at his home. The culprit: His 24-year-old son, who received an emergency mental health evaluation on Monday but was sent home after authorities could find no psychiatric beds in Western Virginia.
Today, Creigh Deeds is in the hospital in fair condtion. His son, Gus, is dead from a self-inflicted gunshot wound.
My wife and I have a teenage daughter who has been diagnosed ADHD/bipolar, a genetic one-two punch that leaves her vulnerable to irritability, manic highs and deep, deep lows. Throw in a propensity for anxiety — one that manifests itself in physical tics that are often painful spasms — and it is a constant struggle for her to manage her mood.
Bipolar, or “it” as we used to call the disorder, lurks just below the surface, ready to erupt at a moment’s notice. One day you have rapid, pressured speech and feelings of invincibility; by that evening, you might see anger, extreme sadness, or the desire to do absolutely nothing.
In some ways that last description fits many teenagers who don’t have a formal diagnosis and a list of prescriptions a mile long. But what makes “it” so special is that it takes those typical teen urges and impulses and puts them on red alert.
As Kate’s parents, we have tried almost everything medically imaginable to help. Testing, doctors, psychiatrists, therapists, prescriptions. We’ve taken hard-line stances and tried to use kid gloves. What we’ve discovered is that what works one minute won’t necessarily work the next, and that’s exhausting for all involved.
Especially for our daughter.
Sadly, the survey results released Monday were almost predictable. More than 10,000 teens participated in the National Comorbidity Survey Adolescent Supplement, a project led by Duke University professor E. Jane Costello. Of those surveyed, only 45 percent who have a psychiatric disorder received treatment in the last 12 months. Among the providers, mental health specialists ranked behind pediatricians, school counselors, and probation officers.
Not surprisingly, the survey said those more likely to act out — i.e. the ones with ADHD, conduct disorder, or oppositional defiance disorder — were the ones most likely to receive services. Those with phobias and anxiety disorders were least likely to get treatment.
Costello understated it when she said people don’t “take psychiatric conditions as seriously as they should … despite the fact that these conditions are linked to a whole host of other problems.” She blamed that in part on the lack of consistent care and the limited number of qualified mental health professionals who can address the issue.
That’s something we’ve encountered when trying to find help for Kate. She has received the most assistance from caring people at her high school, even though it took us some time and a bunch of red tape to find the right fit. But due to a shortage of child psychiatrists in the area, she’s had only two since she was diagnosed — one an old-school practitioner who didn’t bother to have a computer, the other a doctor we found three years ago.
Neither takes insurance; like all child psychiatrists we’ve spoken with, they prefer to leave that paperwork to the parents.
Our options also are limited if we have to take our daughter to the emergency room for treatment related to her condition. The hospital will not let her stay overnight; if she is stable, she is sent home. If further (read “emergency”) treatment is needed, we have the option of one facility in Maryland, one in Washington, D.C., one near our home in Northern Virginia, and one in Richmond, 90 miles away.
And that is only if they have an available bed at that time.
Once admitted to one of those four facilities, all of which have the warmth of your average jail cell, the patient is kept until they are considered “medically stable” — no longer a threat to self or others. At that point, insurance — if you’re lucky enough to have it — stops paying. The bills, more than $1,000 a day, start adding up if you want to (or are allowed to) keep the patient there for additional treatment. Oh, and psychiatric services — remember the no insurance factor — are a separate bill.
And we wonder why it is so difficult for people to receive treatment for mental health issues in this country?
Fortunately, earlier this month, the Obama administration finally brought some “parity” to the process when it issued rules that require health insurance plans to offer the same coverage for mental health and substance abuse claims as they do for medical and surgical procedures.
Prior to the rules being put into place, most insurance plans would pay 80 percent for medical care and only 50 percent for mental health claims. Now, thanks to those rules, insurance plans must cover the same number of inpatient hospital days for mental and physical illnesses. Insurers also can’t require many of the onerous preauthorizations — a bureaucratic maze in their own right — for mental health care like they did in the past.
The rules are not perfect; Medicaid recipients and the Children’s Health Insurance Program still don’t have mental health parity requirements. But they are a great first step.
And before you jump into the Obamacare debate over this one, note that the law was passed in 2008, as part of a gigantic Wall Street bailout that then-President Bush signed. It has taken five years for the rules to be issued, a shame in and of itself.
There has always been a stigma of shame, along with a stinging level of insensitivity, around people who have mental health issues, especially among our young people. It's only when tragedy occurs — like the mass killing in Newtown, Conn., last year, or the one yesterday in Virginia — that attention seems to be brought to the topic. Ironically, research has shown the mentally ill are more likely to be victims rather than perpetrators.
Bipolar and ADHD do not have symbols, like pink ribbons or the faces of cute children, that we can rally around. Instead, those symbols — the faces of people like our beautiful daughter — remain largely anonymous.
How many more tragedies will it take before we finally wake up?