Category Archives: Psychology & Psychiatry

When rehab might help an addict, but insurance won’t cover it – WITF-Fm

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Federal law requires insurance firms to cover treatment for addiction as they do treatment for other diseases. But some families say many drug users aren’t getting the inpatient care they need.

Cris and Valerie Fiore hold one of their favorite pictures of their sons Anthony (with the dark hair) and Nick. Anthony died from a heroin overdose in May 2014 at the age of 24. Cris Fiore’s eulogy described his son’s death as a shock, but “not a surprise.” Anthony had been addicted to heroin for years.

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Achieving mental health parity: Slow going even in ‘pace car’ state

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Flag_of_CaliforniaBy Jenny Gold
KHN

After the state of California fined her employer $4 million in 2013 for violating the legal rights of mental health patients, Oakland psychologist Melinda Ginne expected her job — and her patients’ lives — to get better.

Instead, she said, things got worse.

Within months, Ginne, a whistleblower in the 2013 case, was back to writing her supervisors at Kaiser Permanente about what she considered unconscionable delays in care.

Patients who were debilitated or dying from physical diseases for which they were receiving regular medical treatment had to wait months for psychological help, she said.

Some patients, she said, might not live long enough to make the next available appointment.

Psychologist Melinda Ginne, 65, at her house in Oakland, California on Tuesday, May 26, 2015 (Photo by Heidi de Marco/KHN).

Psychologist Melinda Ginne, 65, at her house in Oakland, California on Tuesday, May 26, 2015 (Photo by Heidi de Marco/KHN).

“I can’t tell a family whose elderly mother is declining that I can’t provide treatment until 2014,” she wrote to her managers at the Kaiser Medical Center in Oakland in September 2013. In February, two years after assessing the second largest fine in its history, the California Department of Managed Health Care stepped in again, finding that Kaiser Foundation Health Plan had improved somewhat but still was short-changing patients on mental health care. The state is considering another fine against the health maintenance organization, which is not affiliated with Kaiser Health News.

“Every time the DMHC has an edict, Kaiser Permanente has a way around it,” said Ginne, who retired in September 2014. Continue reading

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Insurers must cover residential mental-health care – Kriedler

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Washington MapFrom the Office of the Insurance Commissioner

Washington State Insurance Commissioner Mike Kreidler has clarified to insurance companies in Washington that mental-health services must now be offered in parity with medical services.

The commissioner updated rules on mental-health parity in 2014 and asked insurers to review previous mental-health claims that had been denied under a blanket exclusion. He asked insurers to rectify those denials.

The need for clarification arose after a consumer filed a complaint with Office of the Insurance Commissioner after being denied for residential mental-health treatment. The individual said this violated federal laws regarding mental-health parity. Continue reading

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Screen pregnant women, new moms for depression – panel

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Blue Pregnant BellyBy Michelle Andrews
KHN

One in seven women experience depression during pregnancy or the first year after giving birth, yet many may not realize it or report their concerns to clinicians.

new proposal by the U.S. Preventive Services Task Force could help change that. It recommends that all women who are pregnant or within a year of giving birth be screened for perinatal depression, as it’s called.

The screening proposal is included as part of a broader recommendation to screen all adults for depression that the task force released this week for public comment.

One in seven women experience depression during pregnancy or the first year after giving birth.

The task force proposal would update the current guidelines, adopted in 2009, which recommend depression screening in all adults if clinicians are available to address depression care.

In the 2009 document, the task force didn’t review depression in pregnant and postpartum women and made no screening recommendation for them. Continue reading

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Sometimes a little more Minecraft may be quite all right

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By Sarah Jane Tribble, WCPN

It’s family vacation time, and I’ve taken the kids back to where I grew up — a small plot of land off a dirt road in Kansas.

For my city kids, this is supposed to be heaven. There are freshly laid chicken eggs to gather, new kittens to play with and miles of pasture to explore.

But we’re not outside.

minecraft-tribble-570

At a Minecraft camp in Shaker Heights, Ohio, kids trade secrets about making their virtual worlds come to life. (Photo by Sarah Jane Tribble/WCPN)

I’m sitting in my childhood bedroom watching my 7-year-old son and his 11-year-old-cousin stare at a screen. The older kid is teaching the younger the secrets of one of the most popular games on Earth: Minecraft.

“You can’t mine ores unless you have a pickax,” explains my nephew to my son. “You need a wooden pickax to get stone, and you need a stone pickax to get iron, and you need an iron pickax to get gold,” and so on.

Minecraft is the megapopular video game that ranges from simple to complicated. But the basics are that players enter a world that looks sort of like Legos on a screen and build anything they want. Think houses, mountains and farms. Continue reading

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Calming dementia patients without powerful drugs

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By Rachel Dornhelm, KQED

Diane Schoenfeld comes every Friday to the Chaparral House nursing home in Berkeley, Calif. to spend time with her aunt, Lillie Manger.

“Hi Aunt Lill!” she says, squatting down next to her aunt’s wheelchair, meeting her at eye level.

Manger is 97. She has straight white hair pulled back in a neat bun today. It’s tied with a green scarf, a stylish reminder of the dancer she used to be.

Diane Schoenfeld, left, shows a family photo to her 97-year-old aunt, Lillie Manger. (Photo by Rachel Dornhelm/KQED)

Diane Schoenfeld, left, shows a family photo to her 97-year-old aunt, Lillie Manger. (Photo by Rachel Dornhelm/KQED)

They go together to the dining room to look over family pictures. Manger needs to be reminded who is in them. Including one of herself. “That’s me?” she asks. “That’s you,” her niece confirms.

“Am I supposed to remember?” says Manger.

Schoenfeld smiles at her encouragingly: “I don’t know if you’re supposed to. It’s OK either way.”

Manger has dementia. Schoenfeld is her “surrogate decision maker” meaning that legally, she is the person who makes decisions about Manger’s health care. Continue reading

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New efforts to keep the mentally ill out of jail

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BrainBy Michael Ollove
Stateline

Paton Blough has served multiple jail terms as a result of mental illness.

He said his various offenses included brandishing a shotgun, reckless endangerment, destruction of civic property, spitting on a police officer, being a public nuisance and threatening a public official.

Never was he charged with being mentally ill. That isn’t a crime, after all. But there was no doubt about why he had ended up in jail.

Blough, 38, has had bipolar disorder since his late teens. At times delusions convinced him of a worldwide conspiracy against him involving police officers, former President George W. Bush and Nazi ghosts.

“Can you imagine if we had two million people locked up for having a heart condition? Well guess what? We have two million people locked up with a health condition called mental illness.”

“Can you imagine if we had two million people locked up for having a heart condition?” Blough, whose last arrest was six years ago, said in a telephone interview last week from his home in Greenville, South Carolina. “Well guess what? We have two million people locked up with a health condition called mental illness.”

In many places, police, judges and elected officials increasingly are pointing out that a high proportion of people in jail are mentally ill, and that in many cases they shouldn’t be there. In recent years, many cities and counties have tried to reduce those numbers by training police to deal with mental health crises, creating mobile mental health units to assist officers, and establishing mental health support centers as an alternative to jail, among other measures.

In King County, Washington, a combination of ACT teams, supportive housing and intensive community-based treatments has resulted in a 45 percent reduction in jail and prison bookings among those participating. 

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Helping the mentally ill stay out of hospitals

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By Christine Vestal
Stateline

NEW YORK – It is a busy Friday afternoon. Staff members check in guests at the front desk. Other employees lead visitors on tours of the upstairs bedrooms, or field calls from people considering future stays. Aromas of garlic and roasted chicken seep out of the kitchen.

Community Access is not a bed and breakfast, although it feels that way when you walk through its unmarked door off Second Avenue on Manhattan’s Lower East Side. Also known as Parachute NYC, this quiet seven-bedroom facility is one of four publicly funded mental health centers in New York City (located in Manhattan, Brooklyn, Queens and the Bronx) that provide an alternative to hospital stays for people on the verge of a mental health crisis.

Parachute’s respite centers have no medical staff, no medications, no locks or curfews and no mandatory activities. They are secure, welcoming places where people willingly go to escape pressure in their lives.

Parachute’s respite centers have no medical staff, no medications, no locks or curfews and no mandatory activities. They are secure, welcoming places where people willingly go to escape pressure in their lives and talk to trained “peer professionals” who can relate to what guests are going through because they are recovering from mental illness themselves.

Without places like this, New Yorkers who suffer from serious mental illness would have little choice but to check into a hospital or a hospital-like crisis center when their lives spin out of control. Some people need to be hospitalized for severe psychosis and depression, but many others end up in the hospital because they have no other options.

Relatively rare in the U.S., respite centers like this one cost a fraction of the price of a hospital stay, and can be far more effective at helping people avoid a psychotic break, severe mood swing or suicidal episode. Continue reading

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Psychiatrists unveil new resource for patients

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apa-understanding-mentalBy Lisa Gillespie
KHN

As mental health professionals, policy makers and advocates focus on taking steps to mend the fragmented mental health care system, the role of patients and their friends and families is sometimes overlooked.

That’s why the American Psychiatric Association is releasing a first-of-its-kind book to decode in plain English the Diagnostic and Statistical Manual of Mental Disorders – a guide for mental health providers that is also used to determine insurance coverage.

The resource, Understanding Mental Disorders: Your Guide To DSM-5, includes in-depth explanations of risk factors, symptoms and symptom management, treatment options and success stories.

This gets at one of APA’s reasons for releasing this volume — to help create a more accurate picture of what a particular illness or disorder might involve. Continue reading

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Most Common Drug Ingredient in the US Kills Emotions

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Three red and white capsulesCommonly found in pain relievers, acetaminophen gets rid of more than just physical agony – it also diminishes emotions.

“Rather than just being a pain reliever, acetaminophen can be seen as an all-purpose emotion reliever,” lead researcher said in a news release.

via Most Common Drug Ingredient in the US Kills Emotions.

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US proposes rule for providing mental health ‘parity’ in Medicaid program

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Photo courtesy of Sanja Gjenero

By Jenny Gold
KHN

A federal law that passed in 2008 was supposed to ensure that when patients had insurance benefits for mental health and addiction treatment, the coverage was on par with what they received for medical and surgical care.

But until now, the government had only spelled out how the law applied to commercial plans.

That changed Monday, when federal officials released a long-awaited rule proposing how the parity law should also protect low-income Americans insured through the government’s Medicaid managed care and the Children’s Health Insurance Program (CHIP) plans. The proposed regulation is similar to one released in November 2013 for private insurers.

“Whether private insurance, Medicaid, or CHIP, all Americans deserve access to quality mental health services and substance use disorder services,” said Vikki Wachino, acting director at the Center for Medicaid and CHIP Services.

Medicaid and CHIP programs are funded jointly by the federal and state governments.

Even if the state has carved out some benefits under a separate behavioral health plan, patients would be protected under the rule. Medicare patients are generally not affected by the regulation, nor are those in Medicaid fee-for-service plans .

But the rule does affect the majority of the 70 million people on Medicaid who are in managed care plans, and the 8 million children covered by CHIP plans.

Insurers, advocates and the general public will have a chance to comment on the proposed rule. The government will then release a final version.

Photo courtesy of Sanja Gjenero

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Wanting mental health treatment and not getting it

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Jigsaw puzzle with one piece to add

By Michael Ollove
Stateline

More than a half-million adults who said they wanted help with their serious mental conditions last year couldn’t get it because they lacked the resources and weren’t eligible for Medicaid to pay for treatment, a new study finds.

Those people — an estimated 568,886 adults ages 18 through 64 diagnosed with a serious mental illness, serious psychological stress or substance use disorder at the start of last year — lived in 24 states that didn’t expand Medicaid eligibility under the Affordable Care Act in 2014, according to a study published this week from the American Mental Health Counselors Association (AMHCA).

More than a half-million adults who said they wanted help with their serious mental conditions last year couldn’t get it.

In contrast, 351,506 adults with those same mental health problems got treatment paid for by Medicaid in the 26 states and the District of Columbia, which did expand coverage of the state-federal health insurance program to eligible adults living on low incomes.

The upshot, said Joel Miller, AMHCA’s executive director, is “the health of hundreds of thousands of people would be improved” if all states provided Medicaid coverage as they were given the option to under the Affordable Care Act (ACA).

Photo: Willi Heidelbach
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When Facebook friends become depressing – The Washington Post

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Facebook ThumbA few minutes browsing Facebook can be a welcome distraction for knowledge workers dog tired after punching their keyboards all morning. But what seems like a mental break can also be an opportunity for devastating self-analysis: Are my Facebook friends’ boyfriends more beautiful than my boyfriend? Are my Facebook friends’ children more beautiful than my child? Are my Facebook friends’ lives better than mine?

Those familiar with this paralyzing spiral of doubt and shame, take comfort: It’s not just you. New research has drawn a line between logging into Facebook and symptoms of depression.

via When Facebook friends become depressing – The Washington Post.

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Battle for mental health parity produces mixed results

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Illustration of the skull and brainBy Jenny Gold
KHN

By law, many U.S. insurance providers that offer mental health care are required to cover it just as they would cancer or diabetes treatment.

But advocates say achieving this mental health parity can be a challenge.

report released last week by the National Alliance on Mental Illness found that “health insurance plans are falling short in coverage of mental health and substance abuse conditions.”

Jenny Gold of Kaiser Health News spoke with NPR’s Arun Rath over the weekend about the issue.

Rath noted that many patients have trouble getting their mental health care covered, and she outlined some of the issues confronting both patients and the insurance industry. Here is an edited transcript of her comments.

Where does parity stand?

It’s been a mixed bag so far. Insurance companies often used to have a separate deductible or a higher copay for mental health and substance abuse visits.  Right now, that usually isn’t the case. In that way, insurers really have complied. Continue reading

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Depression take its toll in the workplace, study

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RED # 18355 64-NA-193By Lisa Gillespie
KHN

For every dollar spent on treating depression, almost five dollars is spent on the treatment and workplace costs of related medical conditions like back and chest pain, sleep disorders and migraines – placing a greater financial burden on businesses and the health care system, according to new research measuring the economic impact of depression.

“The fact that they’re finding such greater costs with all these different [related conditions] underscores how the fragmented system is not helpful for our economy because people with mental illness are not getting the rounded health care they need,” said Lynn Bufka, assistant executive director of practice research and policy at the American Psychological Association, who was not affiliated with the study.

The average worker who had major depression disorder lost the productivity of about 32 workdays a year due to what’s known as “presenteeism.” That is a term for when an employee is at work but not completing daily tasks and responsibilities.

Among the study’s findings was that the total cost to the U.S. economy of major depressive disorder – a condition that results in having persistent depressive episodes – rose from $173.2 billion in 2005 to $210 billion in 2010, a 21.5 percent increase.

About half of that is for direct treatment and suicide-related services, but the rest is workplace costs. The rise is partially accounted for by the increase in population, but also because depression is being diagnosed and treated more often.

The incidence of major depressive disorder rose during this time period from 6.4 percent of the population to 6.8 percent.

In addition, some of this growth might have been caused by the nation’s 2008 economic downturn and tight job market, factors that combined to make it harder for those suffering from depression to retain their jobs and even more difficult for those with this condition who are job seekers to find work, according to Paul Greenberg, a study author and director of health economics at the Analysis Group, a consulting firm in Boston.

Meanwhile, the study also examined how depression plays out in the workplace.

Mental health experts and economists have long known that someone’s depression can have a significant cost on the workplace, Greenberg said.

For example, the study found that the average worker who had major depression disorder lost the productivity of about 32 workdays a year due to what’s known as “presenteeism.” That is a term for when an employee is at work but not completing daily tasks and responsibilities.

Experts say that, though this loss in productivity highlights the economic toll mental health issues have on the work place, small and medium-sized employers may not have the knowledge or tools to improve the situation. Continue reading

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