Good change

Year after year I can remember my father reminding my mother's doctors that they had only 60 days to get my mother's mind back in the real world and taking her medicine correctly. He would say this because after 60 days the wonderful private psy-ward care was going to all be paid for by his cold, hard cash. The insurance and medicare would only cover for that long no matter what condition the patient was in, so this new legislation is great news for the mentally ill.

Insurance coverage for mental illness is catching up in Texas

Twenty-five years ago, Bob pressed a .45-caliber pistol against his head, straining against the desire to die.

"I felt the cold metal on my temple," he said. "It took every single [bit of] strength I had in my body not to pull the trigger to blow my brains out."

This January, a lifelong struggle with depression resurfaced dramatically. Stressed out and overworked, Bob, who is in his 50s, wanted to hurt himself again. He imagined hanging himself at the front counter at work or by the boss’s office. Bob rediscovered hope at Millwood Hospital in Arlington, receiving outpatient treatment five days a week for a month.

Then, still hurting, he was told his insurance was going to run out Friday.

"Here you’re somewhere where something is helping and you need more of it, and you don’t have enough," said Bob, who works in Tarrant County.

Unlike treatment for cancer or heart disease, some insurance companies cap treatment for mental disorders such as depression, which can be just as deadly. Treatments for other general-health conditions are often unlimited, several experts said.

But that’s changing in Texas.

Since October, insurance companies in Texas have been required to provide as many outpatient visits for mental-health services as they do for physical illnesses, according to the Texas Department of Insurance. Insurers have until June to show that policies and "evidences of coverage," such as forms, are compliant.

The parity ruling applies to companies with at least 51 employees. Small businesses are affected only if they elect to provide mental-health benefits to their employees, Insurance Department officials said.

One state lawmaker wants to go further and has filed a bill to raise the lifetime limits on mental-health services.

And next year, the federal Mental Health Parity and Addiction Equity Act of 2008 will take effect, establishing equal treatment for both mental-illness and substance-abuse conditions.

"It ends the discrimination between treating general health and mental health," said Julio Abreu, senior director of government affairs for Mental Health America. "It says that mental health is fundamental to one’s overall health. It does so by ending arbitrary limits that had not been based on medical treatment."

But some in the insurance industry say Texans will end up paying higher premiums as a result.

"A lot of employers are struggling to pay the premiums that they have right now," said Will Haff, media chairman for the Texas Association of Health Underwriters. "So you’re talking about increases.  . . . That’s not something a lot of them are going to swallow."

The Congressional Budget Office estimated that parity of medical coverage would increase health insurance premiums by an average of 0.4 percent.

Because of absenteeism and other problems, the cost to employers of untreated and mistreated mental illness has been estimated at $113 billion annually, according to Mental Health America.

Costly treatments

Administrators at two local psychiatric hospitals, Millwood in Arlington and Texas Health Springwood hospital in Bedford, said co-payments and deductibles often take patients by surprise.

And even though Texas law had required that patients be provided 60 outpatient mental-health visits a year, some people ran out of benefits and had to pay out of pocket to continue treatment.

"It’s not too frequent, but it does happen," said Ramona Osburn, director of Springwood hospital and Springwood outpatient centers in the Metroplex.

In such cases, patients are informed of the full cost they have to pay.

"We also have an extensive list of resources that we can give the patient," Osburn said. "We help them get into a different program if that’s what they want to do."

Jane Phillips, director of outpatient services at Millwood, also said she’s seen people run out of benefits.

"That certainly does happen where they have just a few visits for the year," she said. "What we’ve seen more and more is that people have really high co-pays or very high deductibles."

Bob, who feared being stigmatized if his full name was used, said he had to pay more than $1,000, including a $500 deductible, just to begin treatment for the first two weeks.

Then his co-pays were about $50 a day, he said. He had to put much of it on his credit card. When he learned he was out of insurance benefits, he realized that "I would be stuck because I have no way to pay for it."

State law requires that co-payments be the same for the treatment of any illness, mental or physical.

As for parity of outpatient visits, Texas law was unclear until last year. It once stated that large companies had to provide at least 60 outpatient visits for serious mental illness.

But the law was recodified in 2003 to require the same coverage for mental and physical illnesses.

Even though the law was on the books, it wasn’t enforced by the Insurance Department, said Doug Danzeiser, a deputy commissioner.

"We were treating it under the prior language," he said.

The Texas attorney general clarified in October that group health plans must "provide the same number of visits for serious mental health" as for physical health.

Rep. Valinda Bolton, D-Austin, said the attorney general’s opinion doesn’t address lifetime benefits. She wants her bill to accomplish that.

"That’s probably the biggest issue," she said. "It doesn’t say, well you know you can have a $2 million [cap] on physical health and a $50,000 cap on mental health. The ruling, to my understanding, does not address that issue."

'An illness like any other’

Bob caught a lucky break. He was given an extension on his insurance benefits so he could continue visits at Millwood for five more days.

Though he said that probably isn’t enough time, he was grateful. His employer said he may have been limited to 30 office visits if he was not diagnosed with a serious mental illness.

"The depression stuff, it gets so bad you don’t want to talk to anybody," he said. "I’m like a bear that gets into my cave. All I want to do is hibernate, sleep."

And he feels guilty about missing so much work because he likes to help others.

"Lately I haven’t been able to help anybody," he said. "I needed to help myself."

Robin Peyson, executive director of the National Alliance on Mental Illness of Texas, said state and national laws have reflected for too long the persisting stigma about mental illness.

"Its roots go back to 200 years to where people thought mental illness was a moral issue or a character issue," she said. "Science and research clearly indicates that it’s a brain disorder. Mental illness is an illness like any other."

What’s covered The Texas attorney general has ruled that serious mental illnesses must be covered with as many outpatient visits as physical illnesses. Serious mental illnesses are defined as:

Bipolar disorders (hypomanic, manic, depressive and mixed)

Depression in childhood and adolescence

Major depressive disorders (single episode or recurrent)

Obsessive-compulsive disorders

Paranoid and other psychotic disorders

Schizoaffective disorders (bipolar or depressive)

Schizophrenia

Don't Forget the Families

This is what my book is all about. Don't forget the families. Let's talk about the children and spouses of the mentally ill. The diagnosed mentally ill patient gets a lot of attention and rightfully so; but having said that, let's take time to take care of the care givers. In my opinion, without the caregivers some mentally ill persons will be on the street. My teachers aide just today told me her sister-in-law is mentally ill and currently living on the street. She said they are just waiting her out for the time that she will be either arrested or taken against her will to a psy-ward and get the medical care she desperately needs. This is the repeated story of many families around this country, sadly. Don't forget the caregivers need help and compassion as well. They are also the victims of any mental illness.

Mental illness hard on families
They often juggle desire to help loved one, fears for their own safety.

Tuesday, February 17, 2009

A thick sheaf of hospital discharge forms and medical records paint a grim picture of a Norcross woman tormented by demons that neither she nor her family were strong enough to exorcise.

Hospital records show that Na Yong Pak, 32, who is accused of setting her mother on fire and killing her, had been involuntarily committed to inpatient psychiatric treatment twice within the past six months. She had also been arrested twice since September for allegedly beating up her mother, 58-year-old Myong Hui Pak.

The tragedy of Hui Pak’s slaying last Tuesday has turned a spotlight on the anguish of thousands of families who are grappling with mental illness. Many feel they have nowhere to turn.

Family members said Yong Pak, who was diagnosed with schizophrenia and depression, set her mother on fire last Tuesday because she thought she was being poisoned. She refused to take the anti-psychotic medication that doctors prescribed when she was released from a state mental health facility Jan. 29, according to her father, Gold Pak.

“She beat her mother all the time,” Gold Pak said Wednesday. “[My wife] was scared of her.”

Experts say that the problems the Pak family faced are not uncommon.

“I’ve talked to parents who have a hard time sleeping because they’re afraid of their loved one in the house,” said Lisa Roberts, president of the National Alliance on Mental Illness chapter in Cobb County. “It’s sad for the person who is ill and the family members who are suffering. They both suffer.”

Families don’t want loved ones jailed or thrown out on the street, even when they are uncooperative or violent, said Sgt. Tracy Lee of the Gwinnett County Sheriff’s Department. Lee is a member of the county Domestic Violence Task Force. Reluctance to see a loved one imprisoned prevents some people from seeking a protective order, because a violation of the order gets the offender jailed, he said.

Getting medical help for mental illness also can be a Catch-22. Gold Pak and his adult son sought permission from a Gwinnett probate judge to have Yong Pak involuntarily committed to a psychiatric hospital in September. She went to Charter Peachford Hospital in Dunwoody for about a week and a half before being released, they said. Yong Pak also was taken to Georgia Regional Hospital in Decatur for a second round of inpatient treatment in December, after Norcross police arrested her on suspicion of battery against her mother. The family said Georgia Regional released her Jan. 29 following a seven-week stay.

Few families can afford long-term inpatient treatment at a private mental health facility. State mental hospitals in many instances are just a stopgap, where the patient is stabilized and then released, said Eric Spencer, executive director of the National Alliance on Mental Illness (NAMI) in Georgia.

Spencer said local NAMI chapters in many Georgia counties can provide resources for families of people suffering from mental illness, but the state also needs to fund more treatment options. Georgia is ranked 45th out of the 50 states on per capita spending on mental health care, Spencer said.

Plenty of people do manage to live normal lives despite having a mental disorder. Ric Hershman, 50, of Lawrenceville is one of them. Hershman was hospitalized a dozen times after he began to suffer from schizo affective disorder at about age 18. At one time, he had paranoid delusions that the world was coming to an end, but now he manages his symptoms effectively with medication and therapy. Hershman now works training volunteers for NAMI.

“People with a mental illness can live productive, constructive lives,” Hershman said. “They’re on a constant road to recovery, but that doesn’t mean that they’re not functional and caring people.”

The important thing is that safety comes first.

“What we usually tell the parents is that you have to protect yourself, first and foremost,” said Spencer. “If you can’t take care of yourself, then you can’t be there to help and protect your loved one.”

Early Death Verification

The psychiatrist who last treated my mother before she died told me that her anti-psychiotic drug she had taken for over 40 years were a direct cause of her early death at the age of 73. She, like I have stated before, lost her ability to walk, control her body functions, and was impaired on her right side due to stroke-like episodes. Her brain had severe atrophy also. So, in my opinion, it is still sad the choices that bipolar persons must make, take very powerful drugs to be able to live in the "real" world or not, that is the question.

Link Between Bipolar Disorder And Risk Of Early Death From Natural Causes

Bipolar disorder appears to increase the risk of early death from medical illnesses, according to a literature review study published as the lead article this week in the journal Psychiatric Services.

The researchers comprehensively reviewed 17 studies involving more than 331,000 patients. Evidence suggested that people with bipolar disorder have a higher mortality from natural causes compared to people in the general population of similar age and gender but without mental illness. The various studies indicated that the risk was from 35 percent to 200 percent higher. The risk is the same for men and women. The most common conditions leading to premature death were heart disease, respiratory diseases, stroke, and endocrine problems such as diabetes.

"The review of data gathered from large population studies suggests that having bipolar disorder is similar to being a smoker in terms of increasing a person's risk of early death," said Dr. Wayne Katon, a University of Washington (UW) professor of psychiatry. He co-authored the study with third-year UW psychiatry resident Babak Roshanaei-Moghaddam. The article is titled, "Premature Mortality from General Medical Illnesses Among Persons with Bipolar Disorder: A Review." Katon is a noted researcher on the interplay between life-shortening medical conditions and mood disorders.

People with bipolar disorder tend to have manic phases and depressed phases in their lives. During mania, they might be too wound up to sleep, their thoughts might race, and they might have boundless energy. During depression, they might feel painfully sad, hopeless, and immobilized.

In the past, the higher premature death rate among people with bipolar disorder was attributed to a higher rate of suicide and accidents. More recently, Katon said, researchers are finding that, while rates of suicides and accidents are indeed greater among those with bipolar disorder compared to the general population, they only partly account for the higher premature death rate. Emerging evidence, Katon said, shows that the majority of early deaths among people with bipolar disorder come from medical conditions.

As psychiatric conditions such as bipolar disorder become more treatable, Katon said, "We're saving people from this illness and losing them to other medical illnesses."

The possible reasons for this higher risk of premature death are manifold. Many factors could be contributing to poor physical health among people with bipolar disorder, according to the published report. These include unhealthy diet, binge eating, lack of exercise, smoking, substance abuse, social deprivation, living alone, homelessness, lack of access to health services, biased attitudes of health professionals towards people with psychiatric illnesses, failure among psychiatrists to address their patient's medical problems, or delaying medical care because of the overriding need for psychiatric treatment.

Biological abnormalities associated with bipolar illness might also be shortening lives, Katon noted. The illness can stress the immune system and the hypothalamic-pituitary axis, a system that controls many body processes. Bipolar disorders also heighten the activity of the sympathetic nervous system, which sets off the fight-or-flight response to stress.

Katon also noted that some new antipsychotic medications used to successfully treat bipolar disorders are safer and more comfortable for the patient in some ways than previous medications, but can cause weight gain leading to obesity and other metabolic changes that predispose people to Type 2 diabetes. Some mood stabilizers, Katon added, also are associated with weight gain and metabolic disorders.

Katon mentioned new attempts to try to reduce premature death in people with bipolar disorder. These include providing psychiatrists and other mental health professionals with guidelines and training in monitoring their patients' basic physical health and teaching them how to advise their patients about smoking cessation, exercise and other preventive measures.

"Changes are also occurring in medical schools to teach new physicians in all specialties how to recognize psychiatric illnesses and to understand the serious health risks associated with mental illness," Katon said.

Increasingly, community mental health centers are adding primary-care physicians and nurse practitioners to the staff to see patients for medical conditions, he said. Medical specialty centers are also adding mental health professionals to diagnose and treat the depression, anxiety and other psychic distress that often accompany serious illnesses.

"Psychiatrists are now on the staff of a growing number of medical specialty clinics, such as centers for diabetes, heart disease and cancer, and at primary-care centers, such as family medicine practices," Katon said. "Mental health professionals are working side-by-side with providers who treat medical illnesses. New approaches to health care and wellness programs are being tested at a number of places to find effective models for preventing premature deaths associated with bipolar disorder and other mental illnesses."

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Article adapted by Medical News Today from original press release.