musings from boston

screams, whispers and songs from planet earth

Category: Musings (Page 1 of 7)

Poor Prognosis: The AHCA and America’s Mental Health Care


[This article was originally published on The Depression Army blog. Thank you, Dr. R., for editing. Note – this was originally written May 29. Three and a half weeks later, the Senate has indeed written their own AHCA proposal, and their “discussion draft” can be seen here].

People who struggle day-to-day with a mental health issue don’t usually spend a lot of time following politics. When the world is closing in, it becomes necessary to shut out all that extraneous noise, push away the distractions and focus single-mindedly on one’s well-being. However, with a new administration comes proposed changes to the American health care system that may make it more difficult for the less wealthy among us to find adequate mental health support.

Difficult as it is to take in all the information, ignorance is not bliss. People who are struggling need to be informed about — and sometimes even stand up for — one’s basic right to decent mental health care.

Mental Health Coverage Under the Affordable Care Act (a.k.a. Obamacare)

On, the official site of the Affordable Care Act (ACA), there is a mental health and substance abuse coverage page that clearly states the legal requirements of all ACA Marketplace health care plans. This includes behavioral health treatment (for example, psychotherapy and counseling), mental and behavioral health inpatient services and substance abuse treatment. Specifics depend upon where you reside and your health plan, but the law states that all ACA plans prohibit spending limits and must cover pre-existing conditions, which includes any mental illness. The ACA also provides “parity protections” for mental health services. This means that it enjoys the same protections as any other kind of health coverage in terms of deductibles, co-payments, out-of-pocket limits, treatment limits and care management.

In fact, there’s an entire government website devoted to mental health, with clear information about how the ACA has improved access to mental health services for many people, regardless of where they live and what type of plan they have. This official source says, “As of 2014, most individual and small group health insurance plans, including plans sold on the Marketplace, are required to cover mental health and substance use disorder services. Medicaid Alternative Benefit Plans also must cover mental health and substance use disorder services. These plans must have coverage of essential health benefits, which include 10 categories of benefits as defined under the health care law. One of those categories is mental health and substance use disorder services.” In the ACA program, mental health care is seen as an essential health benefit.

Despite the improvements to mental health care since the ACA first went into effect in 2014, a study by researchers at NYU’s Langone Medical Center found that mental care access in the U.S. is still inadequate. Nearly one in 10 Americans who had mental health problems in 2014 didn’t have insurance that would allow them access to treatment. For approximately 10.5 percent of people, there were delays in receiving professional mental health treatment due to insufficient coverage, compared to 9.5 percent in 2006. In 2014, 9.5 percent of those suffering with mental health issues couldn’t afford to pay for psychiatric medications, up from 8.7 percent in 2006.

The AHCA – Just Passed by the House of Representatives

The American Health Care Act, passed by the House of Representatives on May 4, seeks to roll back federal guarantees of mental health coverage and substance abuse treatment, instead leaving it to the discretion of individual states. Under the new plan, states can also opt-out of requiring that insurers cover pre-existing conditions. Other Essential Health Benefits (EHBs) left to the states to provide or not provide include emergency services, hospitalization, maternity and newborn care, rehabilitative services, chronic disease management, pediatric services and prescription drugs. The AHCA, as currently written, allows insurers in states that have opted out of covering EHBs to charge people more for their health insurance if they have pre-existing conditions.

What Do We Stand to Lose?

The ACHA bill leaves critical mental health care treatment and prescription medication coverage for poorer people up in the air. Depending on where you live, there may be state-provided financial assistance for psychiatric evaluations, counseling and potentially life-changing psychiatric drugs — or not. Should this bill go into effect, coverage that you’re currently receiving from your insurer, whether it’s through your employer or through the federal ACA marketplace, might go away. In a worst-case scenario, those families who need certain medical coverage for pre-existing mental health conditions may have to consider moving to a state where insurers will cover them. Unable to get proper care in their community, people with a serious mental illness are increasingly ending up in local jails, a sad development that is straining law enforcement. Mental Health America states that 1.2 million people living with mental illness are in jails and prisons every year. The Sentencing Project study referred to in the article found that six out 10 of those states with the least access to mental health care (Southern states) also have the highest incarceration rates.

The New Health Care Proposal: Here’s What Happens Next

As the House’s AHCA bill moves to the Senate for approval, the Congressional Budget Office(CBO) has issued their findings on the House’s proposed bill. The CBO estimates that the AHCA will leave 23 million more people without insurance by 2026 than if the ACA were to stay in place. They also discuss the dangers of leaving coverage decisions to the states. A CBO breakdown confirms that a state opting out of covering mental health care and prescription medicines, as well as pre-existing conditions, could cause out-of-pocket expenses to significantly rise for that coverage, leaving many priced out of the healthcare marketplace. The good news is that the U.S. Senate is unlikely to approve the House bill and in fact, they’re writing their own version. The bad news is that there are senators who may not heed the warnings in the CBO report.

What Can You Do?

First, don’t despair! There are many people who are aggressively fighting these radical changes to a healthcare system that, although flawed and in need of fixing, many people rely on. However, if you’re someone who is especially sensitive to mental health issues, it is imperative that you add your own voice to the choir of discontent. Indivisible is a nationwide organization that encourages people to take local action to express their concerns and tell their personal stories. Town Hall Project has an interactive database of town hall meetings by members of congress that constituents can attend. Add yourself to the mailing list of upcoming events in your area. If you’re unable to attend a meeting in person, you can also contact your senators directly to tell them how important mental health care coverage is for you and your family. You can also contact your House Representatives. When your representatives aren’t legislating in Washington, they should be back in their states to meet with their constituents. You can view the senate schedule and house schedule for 2017.

Above all, keep yourself well-armed with information! Important decisions are being made right now that could impact your mental health care and essential support services. If you believe that healthcare is a basic right, and that those living with mental illness should have the same rights as anyone else who suffers from a crippling affliction, Speak Out and Speak Loudly!

Your voice matters, and the voices of millions of sufferers will be heard in the voting booths!

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Letter from a Jilted Lover

Letter from a Jilted Lover

Dear Beloved,

This is very difficult for me to write, but it’s extremely important that I do so. I have tried to be patient. I offered my gifts to you freely, as a lover does, and all I expected in return was that you would respect me and treat me well. But something sinister has come between us that threatens to rip us violently from our warm embrace. Read more >>

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The Twins

Drawing based on a photograph by Alaa Alyousef via AP

Drawing based on a photograph by Alaa Alyousef via AP

It was the photograph, really. There is always a defining moment when an awful situation reaches its apex. In this case, it was the image of the grieving Syrian father and his 9-month-old twins. He holds the eternally sleeping, dead from poisonous gas babies for the cameras, for the world to see, as if to say “See? See what our world has come to?”

And we did see. In one crystal clear, revolting moment, we were spun once again into a darkened dystopia. It is a reality seen in harrowing fiction like Cormac McCarthy’s “The Road,” where our humanity is reduced to pushing around a shopping cart in a barren world, trying desperately to pull scraps of food and hope from the embers. Read more >>

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On Making the Unknown Known

Alone with Friends

J. Stoller

Alone in the company of friends. These are strange times. I’m ashamed of the weariness I feel, worried by the emptiness and the confusion. I find I’m forcing myself to make smalltalk, feeling like a fraud as I do so. Bereft of what was once familiar, I wander around the ornate rooms as conversation swirls around me. But maybe that’s exactly the point and what must necessarily come before progress?

“Whether you succeed or not is irrelevant, there is no such thing. Making your unknown known is the important thing — and keeping the unknown always beyond you.” – Georgia O’Keeffe

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Clinging To What No Longer Serves

Clinging to an old blanket

by J. Stoller

In times of trouble, people cling to the mundane and to the familiar company of family and friends. They gravitate to comfortable surroundings, to deeply-entrenched ideas and attitudes. They hold on tightly to old and tattered possessions to which they are accustomed, even if these objects no longer serve a purpose.

When feeling challenged and under siege, people will embrace what they already believe to be true, speaking in the same language, however tired or inappropriate for the new situation at hand.

Surrounding oneself with the theatrical props of stability is not the same as feeling stable, safe and secure in your heart. What is needed is a paradigm shift.

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What if… What then?

What if, just like MySpace, Twitter suddenly changed their code or shut down completely, and all of those clever things you thought up, all the people who “liked” you and made you an internet sensation for 24 hours, all of that disappeared into the ether. Erased from Earth’s fragile history, you’re left alone in your basement room, with your dusty books and hardened mind, while the real people you shut out of your life have drifted away to find more satisfying conversation and a more reciprocal love. What then?

These are false communications, as transient as a Tibetan sand mandala. But unlike the mandala, whose essense remains in the collective unconscious, your clever thoughts, in the morning light? No one will remember them.

Indeed, we are all fleeting, we are all grains of sand, though we disappear without a trace or our essence remains based upon the decisions we make — whether to truly communicate, or to build an emotional wall.

As you slowly discover that the old proverb is true, you reap what you sow, betray and betrayal, abandon and abandonment, disregard and disregarded — What now?

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Was 2016 The Year Mental Health Came Out Of The Closet?

Mental Health in the News

Overburdened law enforcement, soldiers and PTSD, Narcissistic Personality Disorder, celebrities coming forward and election anxiety

The stigmatization of mental illness and the tendency to push mental health issues under the carpet is far from over, but the conversation has begun. The year 2016 has been chock-full of news stories, discussions and public figures in solidarity or coming out of the closet with their personal struggles. Whether your daily news source is the local newspaper, network television, NPR or Facebook and Twitter, it’s hard not to notice that mental health issues have been popping up with great frequency. Read more on >>

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Winter Solstice Musings

Trying to unwind the gnarled thoughts from this fretful year, it seemed so very easy to sink comfortably into all the hatred and venom and take up arms. To become hardened to the perceived threat, rather than try to understand it. Gather comrades tightly around and fortify defenses, rather than reach out to the enemy. But all that did, in retrospect, was to widen the rift and poison the air around us.

It is far less comfortable, far less safe, to detach from and step out of enveloping womb of one’s world view. To gaze harshly upon oneself from the enemy camp and begin to question. Is there any room inside that hardened shell of righteousness for a different perspective?

In the quiet of winter, the cold hush of hibernation, there is the time and the space for contemplation.

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The Art of the Con: Donald Trump, Narcissistic Personality Disorder and the Divided States of America

In the past year, I have probably read more political commentary than I have over the course of my lifetime. It’s not that I wasn’t interested in politics and society before this election, but for a variety of reasons, this election cycle felt far more important and personal, and got me to questioning where exactly I stood on the bloody battlefield.

This article has been several months in the making. I’d start, then stop, then start again. The target kept moving. Every news article about Donald J. Trump, every nutty thing that emerged from his mouth, every media outcry, public reaction and friend’s Facebook post, and I would be rethinking my perspective. In the end, what I thought would be a philosophical view from high above the fray, as an impartial observer, became a hard look around myself, at the convictions and beliefs of friends on both sides of the divide, at self-righteous liberals in my own family and at the world outside my strange bubble. Because, as progressive and enlightened as we may like to think we are, we all live within our own self-created reality and, increasingly, in “reality bubbles” that only serve to reinforce our world view.

As the dust begins to settle, I see blindness and intolerance on both ends of the spectrum. I make no attempt here to arrive at any truths or come to any definitive conclusions. These are only observances. Read on

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Animal Deaths

When I called my friend Victor, I simply said, “I have a bad animal story.” He instantly knew he would have to console me, though at first he laughed. “You’re laughing? How can you laugh at something like this!?” He was thinking, of course, of the time he had helped me clear out a ton of junk from underneath my porch and we had come across a petrified dead squirrel that he initially thought was a piece of wood. I took one glance and knew better, as I ran shrieking from the storage space. The poor squirrel looked as if death had surprised him, as he was frozen into a shape that resembled a miniature Tyrannosaurus Rex.

I told him this story was worse, much worse. I had arrived home from the gym and started to turn the car into my driveway. I immediately spotted a young groundhog scaling a low retaining wall. He stopped and stared at me and I paused, admiring and greeting him. He scampered over the wall and back down into the yard. I then drove further into the driveway and promptly heard a high-pitched squealing. I had felt the impact with something small at about the same time, and my heart sunk. Turning my head to look toward the end of the driveway, I saw another young groundhog struggling to pull himself along to get away from the car, badly injured and unable to run. I watched, horrified, as he made it to the end of the driveway and turned at a front flower bed and toward my front walk.

I’d been seeing the pair of them — brothers, or so I imagined — for a few weeks now. They must have a hole nearby my front door, probably under this large, overgrown bush. I had seen them running down the front walk, scooting underneath the bush, and I had seen telltale signs of half-eaten plants. Once in a while I’d spot them hanging out on the walkway, near my front door. They were young, about the size of large rats, nowhere near the giant fat groundhogs one typically saw in the summer.

And now — now I had just killed one of them. I felt horrible. It was an accident, of course, just an awful accident. But it didn’t matter. Why hadn’t I checked the driveway before I barreled in? But who really does that? I had been busy looking at his twin, and didn’t bother to wonder where the other one was. I hadn’t even remembered that they typically moved around as a pair.

While in the shower, trying to wash away the memory, I recalled the other animal deaths I had witnessed in my life. Just a small handful, but all painful.

There was the time when I lived in St. Petersburg, Florida, in the late 1970s, when I accidentally ran over my own kitten. My biker boyfriend, Artie, had come across him in back of the Harley dealership where he worked. It had been abandoned and, come to think of it now, was probably feral. The little guy was crazy, so because of that (and my violent cat allergy), he lived outside and we fed him.

We were on our way to meet up with some friends and were in my car with the motor running. The kitten kept running up to the car, no matter what we did. We kept trying to shoo it away, toss it into the yard, anything.

When I tried to back out of the driveway, the kitten ran straight for the tires, and I ran him over. Never had I been so distraught or inconsolable. I remember sitting on my couch wailing hysterically, with Artie doing his best to console me.

Even when the animal’s passing was natural and I had nothing whatsoever to do with its demise, I couldn’t fully cope with it. Boo-Boo was my friend Victor’s beloved cat, and Boo-Boo (full name Sai Boo-Boo, a tongue-in-cheek reference to Indian spiritual leader Sai Baba) had bucket loads of personality (kind of a grouchy old man, really) and terrorized at least a few neighbors and clients. When Boo-Boo died, at an advanced age, I wrote a eulogy and attended the funeral at Victor’s family home in Southie, but could not bring myself to look at the body.

Though it wasn’t directly my fault, I took full blame when a backyard squirrel met his demise at the hands of a birdbath bowl that came crashing down off its base after he must have perched on it for a drink. There was no bottom piece to hold it in place, so it had to balance on top. I tried to center it so it would be secure, but clearly it wasn’t. I actually found the poor squirrel trapped underneath it, still alive, and moved the bowl so he could try to crawl away, though he was very badly injured. I’ll never forget the look of fear in his eyes when I approached him and maybe, possibly, the look of gratitude when I freed him, though I felt ashamed for what I felt was complicity in the crime. I was so traumatized by that incident that I actually called the town animal warden to come and dispose of the squirrel, which he was kind enough to do. The benefits of living in a small town.

Then there was the sin of the father. This was possibly the toughest one of all, given my love of birds. I was visiting my parents, and my dad, deeply immersed in the frustration and difficulty of having to care for my bed-ridden mother, had grown annoyed at the birds nesting in an air-conditioner in her room. She of course wasn’t in any danger and probably couldn’t care less about the noise. There was another window that was being used with a stronger unit, so there was no reason he had to suddenly remove this older unit from the window at the height of spring nesting season. But, as I realize now, his insistence upon taking immediate action was a symptom of a more pervasive illness. He was feeling powerless. I understand that. But even more powerless was the baby bird whose nest he disturbed.

I had helped him remove the air-conditioner, so I unfortunately had a front row seat to the carnage. As he started destroying the nest, the image that burned itself into my mind forever was of this new baby bird, fleshy and vulnerable, crying and reaching out for its mother, who I saw hovering in the sky nearby. The mother bird was also powerless, unable to help her offspring.

My dad, not immediately registering the situation, said in disgust, “see, there are even insects in here,” and continued to brush everything from the window sill onto the ground far below.

My fight-or-flight response immediately took flight into the bathroom where, door locked, I proceeded to cry hysterically for a half hour. My father will never truly understand why I reacted in that way. It wasn’t just the single act of killing a baby bird and destroying its nest. Baby birds die all the time, often at the hands of other animals, or due to weather, or to an accident or to any number of natural events. In my mind, this was clearly a metaphor. There was innocence being destroyed in the course of life’s harsh reality, and my own innocence was being brushed aside hastily and with no remorse, along with the nest and its fragile new life, onto the cold ground. In that moment, I felt as vulnerable as that baby bird.

The telltale sign of critters in our midst.

The telltale sign of critters in our midst.

All of these incidents flashed through my mind like a news reel as I walked to the front porch to retrieve the mail. I glanced out the window. About two-thirds of the way down the front walk laid the young groundhog. In trying to make it back to his hole under the bush, he could only make it that far. Shit. Profoundly sad, I went to get a shovel and a bucket. I would bury the poor guy underneath my giant blue spruce, the same place I laid to rest a dead bird I found years ago.

I stepped out the front door at the same exact time that his brother appeared at the front of the walk. As I started to walk towards the dead animal, his alive and no doubt frightened brother started running towards me. My mind raced. Did he see his brother lying dead on the ground? He surely must have, as he ran right past him. Was he going to attack me for killing his brethren? I am not privy to the inner lives of groundhogs, to know whether they even have a sense of unjust death or of revenge. But I wasn’t about to stay and find out. I retreated back onto the enclosed porch, as he ran right near me to scurry quickly behind the bush.

Once again, I called Victor. Would the groundhog come back to retrieve the body of his brother? Do they do that? Should I wait for a while? I still felt horrible. He assured me again that it wasn’t my fault, that it was an accident and how could I know that he was underneath my car? We spoke of animal customs, animal awareness, elephant graveyards and other such topics. He told me to go ahead and bury him and the sooner the better, while I still had light.

The burial took place under the blue spruce. The groundhog had looked so peaceful in death, just lying there on my front walk as if asleep. This time I looked carefully. As I took in his peaceful countenance, I became more peaceful myself. Far less distraught and focused on my task, it was easy to push him into the bucket and easier still to dig a small hole in the large open space underneath the 60-foot pine tree. I placed pinecones on top, with a stone to mark the grave.

I think now of the surviving sibling, alone in the world with no brother to frolic and play with. I wonder if I will see him again, and I know that if I do, I will be forever sad. He is alone now in the world, an only child, like me. My heart goes out to him.

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