The Unconventional Conservative

“What people don’t understand is that mental illness affects one out of five families in America. It’s kind of the hidden illness. It’s a silent killer.”

Bernie Block

Many mentally ill people end up homeless due to lack of access to care.

I know that I have been MIA lately, and I apologize to my loyal readers….I didn’t forget about you! I have been dealing with some things at home that I have been trying to get sorted, and I am going to go a little off course and explain those things to you in this post.

My son just turned eleven in October. He had been withdrawing into his room over the summer, which was odd….he used to go for bike rides and play with his friends a lot. Over the summer, he retreated into the world of video games, and didn’t leave his room much. At first I wasn’t too concerned…he does “talk” to people on the Xbox, so he was still being at least a little social. However, it seemed that he continued to isolate himself, and began to have terrible rages and tantrums. Over the last few months, I have watched my child swing from extreme happiness to being suicidal and telling me that he wanted to hurt himself.

He had been diagnosed ADHD when he was seven, and we tried to go the natural route: elimination diets, homeopathy, behavior counseling…none of it had any impact. I have quite a bit of training in psychology and I recognized the symptoms of cycling over the summer, and our family doctor did as well. We were referred to the University of Iowa to be evaluated for bipolar disorder. (Actually, three different doctors gave us this referral.) We made the appointment, which took months, and I watched my child continue to backslide into deep depression and periods of extreme anger and irritability, which are hallmarks of pediatric bipolar disorder.

Our appointment with the University came, and we spent all of about an hour there (after an hour drive.) The assistant took my son back to talk to him, and then asked me to talk to her.  That took about twenty minutes. I discussed the issues that we had been having and she just kind of nodded and wrote things down. She left to get the psychiatrist and we sat in the hallway to wait.

The psychiatrist spoke to us for about ten minutes. He told me that Freddie has ADHD and that he was sleep deprived. (He is not.) He told me that bipolar in children is rare (it is not) and that we should continue to medicate him for ADHD. I was flabbergasted. We were quickly shuttled out and given prescriptions for a stimulant that I wanted to take him off of, because I felt that it was contributing to the irritability.

My son was very upset. He knew that something was going on other than simply ADHD, and he felt that no one wanted to help him.

I want to make a very important point here: my son has Medicaid. His father is court ordered to carry insurance on him and does not, so my husband is not allowed to insure him on the family policy. We have encountered countless issues with Medicaid, and one of those had to deal with getting my son the help that he needs. It is something that we have been fighting for a very long time.

I am treated for ADHD, so I was able to get my son an appointment with my own psychiatrist. Unfortunately, it was months out. In the meantime, our home life was a nightmare…to the point where I was fearful for my youngest son and afraid that my child’s threats of suicide would come to fruition.

When my son saw my psychiatrist, he confirmed what I had believed all along…my son was showing strong indications of pediatric bipolar. He prescribed an anti-psychotic to address some of the scarier symptoms of bipolar that we were experiencing (hallucinations, etc.) I was relieved that we were finally going to get some help.

Medicaid refused to pay for the medication. It took ten days to even get the “denial”, so that entire time, we sat and waited, unmedicated, to find out what was going on. My psychiatrist travels all over the southeastern part of our state and is only at the office here twice a month, so it took many phone calls to track someone down to get a different prescription. In all, it was an additional two weeks before we could get a medication that Medicaid would approve. At the same time, every time a new medication is prescribed or a dosage change made, Medicaid requires a pre-authorization or they won’t approve it. They give only two weeks worth of a medication when it is approved, so we are back to the hassle of tracking down the doctor to make sure that we are not going for periods of time without medication. It’s not as if it’s aspirin; psychiatric medications must be taken on a regular basis.

I am happy to say that we have had medication for over a week now and my son is starting to stabilize. However, we have been going through this nightmare for almost six months, mostly due to the “process” in which Medicaid has put us through to get to this point. (Their first choice for care is the University of Iowa, which explains the trip there initially).

Situations like this really explain why I am against the idea of government run health care. We have already dealt with delays and denials (I also had the same issue when I had Medicaid), and putting the reigns of ALL health care in the hands of the government would make for a horrible situation, especially for those who are mentally ill.

In 2011, the National Alliance on Mental Illness released a report, State Mental Health Cuts: A National Crisis, documenting cuts that have been made to state programs since 2009. You can read that here. There have been significant cuts that have deeply impacted mental health services for children and adults, and homeless shelters are struggling with a surge of people who are untreated and have no way to care for themselves. People with bipolar disorder and those with schizophrenia are particularly vulnerable, as many need help with medication management.

Many of these people have been shifted to Medicaid as their primary source of funding for care, but Medicaid was cut drastically by the Obama administration in 2011. In my state, the Democrats blocked the merge of state funds for mental health services, rather than the GOP.

Contrary to what many believe, it is NOT easy to qualify for Medicaid in many states. While it is a federal program, the states administer the funds and appropriate them as they see fit. Gross income is what is used to determine eligibility; if the gross income is over a certain amount, they will not even consider taking other factors into consideration (such as rent, mortgage, bills, child support paid, etc.) and will deny you outright. We have faced this situation. My husband’s company has an insurance policy that is modest for families (he pays about $50 a week to insure himself and three of our children), but to add me to the policy would double the cost. As he pays child support for the oldest two children, a $400 check becomes $200 at the end of the week. However, according to Medicaid’s eligibility requirements, we make too much. ($800 per month to support 6 people.)

While I would prefer to not rely on state help with medical expenses, the whole situation has become outrageous. We have completely abandoned the doctor/patient relationship, and have let the insurance companies and the federal government take control of our health care. Obamacare will not change this; in fact, it will make it much worse. I do not believe for a second that it will allow people with low incomes more access to health care; I think that more will continue to fall through the cracks and be denied care.

Here are some statistics on the mentally ill in America (source: SAMHSA November report):

One in 5, or 20%, of adults in the U.S. have some kind of mental illness. (That;s 45.6 million people.)

Among people aged 18 to 25, the rate of mental illness was over two times greater than for those aged 50 and older. Women also showed a higher chance of mental illness than men, 23% versus 16%. In 2011, 5% of adults had serious mental illness defined as when severe function impairment results from mental illness.

Only 4 in 10 adults receive treatment.

As many as 8.5 million adults considered committing suicide, as many as 2.4 million made plans to do so and 1.1 million actually followed through on the attempt. People with serious mental health issues had a higher chance of substance dependence or abuse at 23%.

The report also has important findings regarding mental health issues among those aged 12 to 17. According to the report 2.0 million youth aged 12 to 17 (8.2 percent of this population) had experienced a major depressive episode in the past year.(This is indicative of pediatric and adolescent bipolar in a good portion of children on the younger end of the spectrum. My son has experienced more major depressive episodes than mania.)

For people who have severe mental illness, private insurance is pretty much meaningless…many cannot afford it, nor can they manage it. When enacting Medicaid, the federal government specifically excluded payments for patients in state psychiatric hospitals and other “institutions for mental diseases,” or IMDs, in order to support deinstitutionalization and to shift the costs back to the states. States then transferred people out of state hospitals into nursing homes and other facilities to throw the cost back to the government through Medicaid. What that means for those who need treatment is that they are excluded from inpatient care in hospitals….Medicaid will not pay for it.

According to the Treatment Advocacy Center, Medicaid’s denial of coverage results in homelessness, incarceration, victimization and even death for many people who are so ill they cannot care for themselves. Of the 4 million Americans with schizophrenia and manic-depression, approximately 50 percent (2 million) are not being treated. In 1998, the Justice Department estimated that there were about 283,800 mentally ill people locked up in the nation’s jails and prisons. Another 150,000 to 200,000 mentally ill are homeless, and 28 percent get at least some of their meals from garbage cans. More than ten percent will die from suicide. Others will commit acts of violence against family, friends and total strangers.

Obamacare keeps the IMDs intact. In doing so, millions of people will continue to be denied psychiatric treatment that some desperately need. And for those who are truly ill, it may well be a death sentence. The cost is shifted back to the states, and the states will cut mental health services again. Not only that, but the generic medication business will boom…and there are differences. One major Wellbutrin generic was recently recalled because it was completely ineffective.

So, what does that mean for the millions of Americans that are uninsured or underinsured and have severe mental illness? Obamacare will give them coverage; but it will be substandard coverage and likely worse than it is now. For children like my (bipolar) son, Medicaid’s medication and care denials will continue and the burden will shift back to the states, who will cut funds even more. It’s a vicious cycle that Obamacare promises to continue and exacerbate.

Obamacare will not be beneficial for the mentally ill, in any way. In fact, it may well prove to be a very disastrous situation.

“Can you understand? Someone, somewhere, can you understand me a little, love me a little? For all my despair, for all my ideals, for all that – I love life. But it is hard, and I have so much – so very much to learn.”

  Sylvia Plath