Girl, 9, chastises dad for having marijuana, plants: http://bit.ly/cgGtfo

She did not fear beheading. It would be a relief. But how could she leave behind all the mad hatters. The bottle marked "Drink Me" would not serve her well either. She'd been down that rabbit hole before!

If she were to speak she was not sure she'd be understood as she herself understood little of the madness. But she was determined to try. She owed it to the hatters. She owed it to herself.

MENTAL HEALTH EQUITY LAW

Purpose

The law is intended to end the inequity between health insurance benefits for mental health/substance use disorders and medical/surgical care for group health plans with more than 50 employees. The law is projected to provide parity protection to 113 million people across the country, including 82 million individuals enrolled in self-funded plans.

Parity requirement

The law amends the Mental Health Parity Act of 1996 to require that a group health plan of 51 or more employees (or coverage offered in connection with such a plan) that provides both medical and surgical benefits and mental health or substance use benefits provides equal benefits for all types of care, without the predominant requirements and limitations often placed on mental health and substance use care unless those identical limits apply to medical/surgical benefits.

- Equity coverage applies to all financial requirements, including deductibles, copayments, coinsurance, and out-of-pocket expenses, and to all treatment limitations, including frequency of treatment, number of visits, days of coverage, or other similar limits.

- The act builds on the 1996 parity law, which requires parity coverage for annual and lifetime dollar limits.

- Mental health and substance use disorder benefits are defined broadly to mean benefits with respect to services for mental health conditions and substance use disorders, as defined under the terms of the plan and in accordance with applicable federal and state law.

- A plan may not apply separate cost sharing requirements or treatment limitations to mental health and substance use disorder benefits.

- If a plan offers two or more benefit packages, the parity requirements apply to each package.

- As under the 1996 law, mental health or substance use benefit coverage is not mandated. But if a plan offers such coverage, it must be provided at the same levels as medical/surgical benefits.

A group health plan (or coverage) that provides out-of-network coverage for medical/surgical benefits must also provide out-of-network coverage, at parity, for mental health/substance use disorder benefits.

Transparency

The criteria for determining “medical necessity” with respect to mental health or substance use disorder benefits must be provided on request to current or potential participants, beneficiaries or providers. A plan must also make reasons for payment denials available to participants or beneficiaries on request or as otherwise required.

Employer exemption

As with the 1996 parity law, small employers of 50 or fewer employees are exempt from the requirements of the law. State parity laws applicable to these employers, or to individual plans, will continue to apply.

Cost exemption

If a group health plan experiences an increase in actual total costs with respect to medical/surgical and mental health/substance use benefits of one percent as a result of the parity requirement (2 percent in the first plan-year to which the law is applicable), the plan can be exempted from the law for the following plan year.

Compliance report

By 2012 and every two years after, the U.S. Labor secretary will submit to Congress a report on group health plan (or coverage) compliance with the law. The report will include the results of any compliance audits or surveys, and if necessary, an analysis of reasons for any failures to comply with the law.

Consumer assistance

The U.S. Labor secretary, in cooperation with the Health and Human Services and Treasury Department secretaries, will publish and disseminate guidance for plans, participants and beneficiaries, applicable state agencies, the National Association of Insurance commissioners concerning the requirements of the law and the continued operation of applicable state law.

Enforcement

As under the 1996 law, the U.S. Departments of Labor, Health and Human Services and Treasury will continue to coordinate enforcement of the federal parity requirements, and are required to issue regulations to implement the law no later than one year after the enactment date. The Treasury Department is authorized to impose excise taxes on any plan that fails to comply with the law.

Source: Mental Health America

A number of themes run through this remarkable doc but steroid use is the most prevalent. Chris Bell's evolution from a black & white thinker who believes that steroid use is both immoral and dangerous to one of grey ambivalence, reminds me of my own journey in terms of illicit drugs. It's a journey few dare take and I applaud Bell's willingness to seek out both sides of the issue in order to better contemplate the grey. It's the journey where libertarian/conservatives and liberals often cross paths. How much should the government interfere in our lives to protect us from perceived dangers to ourselves?

One of the most interesting segments of the film questioned how we decide what dangers or risky behaviors we are willing as a nation to allow. The interviewee pointed out that we take calculated risks for a variety of reasons every day which are no more dangerous than steroid use. We still permit people to drink alcohol and smoke tobacco with relative ease. We issue no buyer beware statement when it comes to the selling of what we term "supplements," much of which have no proven health value and to the contrary could be proven dangerous if studies were demanded. We are permitted to get into various vehicles on a daily basis and drive or are driven at speeds which put our lives or the lives of others in constant danger. We are permitted to ski the slopes of mountains which have seen their thousand broken bones and brain injuries and deaths. We are allowed to ride motor boats and larger water vehicles with no license or testing necessary; to say nothing of owning guns licensed or unlicensed and the lives they take each year. We eat genetically modified food with no long term studies as to safety or nutritional value. We go bungee jumping, ride ATVs and trek up Everest where accidents and deaths are not uncommon. So why draw the line at certain substances? Why allow amphetamine based drugs to be given to children so they can compete better with those whose attention is determined by other genetics and yet not call it a performing enhancing drug but rather "leveling the playing field? How do we know when the playing field is leveled and should it be? Or should we simply be more accepting of peoples learning styles and encourage them in what they do well (strengths based) as opposed to punishing them for what they fail at (weakness based)?

I don't have the answers. But if we don't ask the questions the solutions will be forever from our reach.

When Loving Parents Raise Addicts | Nora Volkow | Big Think
Nora Volkow Absolutely Oh absolutely There's an enormous amount of evidence
about how important nurture is in terms of either protecting or making a
kid ...
http://bigthink.com/noravolkow/when-loving-parents-raise-addicts

Tricking Your Brain into Healthy Addictions | Nora Volkow | Big Think
Nora Volkow Yes indeed Unfortunately drugsagain it depends on the drug
obviously Not all of the drugs are the same In terms of how addictive they
are some ...
http://bigthink.com/noravolkow/tricking-your-brain-into-healthy-addictions

The Impossibility ofJust Say No | Nora Volkow | Big Think
Nora Volkow Many surprising findings have come across the studies that have
completely destroyed all of the hypotheses that we initiated with For
example ...
http://bigthink.com/noravolkow/the-impossibility-of-just-say-no

Why Diets Fail | Nora Volkow | Big Think
Nora Volkow Well again it's very difficult to diet A person wants to stop
smoking right They are addicted to smoking and it's not so hard to stop one
two ...
http://bigthink.com/noravolkow/why-diets-fail

The Unyielding Power of Dopamine | Nora Volkow | Big Think
Nora Volkow Dopamine is a chemical substance that serves to send messages
between two cells in the brain and that's we call neurotransmitters There
are many ...
http://bigthink.com/noravolkow/the-unyielding-power-of-dopamine

With no exaggeration, I spend 80 per cent of my workday doing paperwork or in meetings about it. A 6th day of work would not relieve me enough to make up the time to actually work with patients. I suppose this is why we've been told that we no longer have to see patient's individually except when going over their treatment plan or doing their initial assessment or taking their urine (that would be fun in group, wouldn't it?) We're supposed to learn everything we need to know about them in group. This is a skill that is eluding me as well. Especially when you have a patient who goes into a panic attack if you so much as look like you might ask her a question directly. Of course this does free you up to get more time in to do more paper work or consult about paper work or make phone calls about what paper work you need to send to a coordinating agency.

I used to work in a teaching hospital. We had rounds every morning where we actually discussed the treatment of patients. Kind of like group supervision, or at least that's what I've been told. Occasionally, because I worked on a private pay unit we'd discuss those patients who thought universal heath care coverage had already begun. It was amazing how many times they could forget, or their spouse forget or their personal assistant forget to bring in their universal credit card to pay their bills. But as they say, that's how the rich get richer. Now, working in an outpatient facility primarily funded by Medicaid, we too have rounds twice a week and case conference once a week. Once a week (case conference) we discuss absenteeism and the importance of the patient's being at treatment. Makes sense to me. Can't treat a patient if they're not there. But apparently a more important reason for having good attendance is cash flow. We have someone in charge of finances on site. Her job is to see to it that clinicians discuss in group the importance of attendance so we can get our Medicaid funds. It's also important to bring it up in group for the few who pay out of pocket to be sure that they understand that they actually must pay and not just promise to do so as so many have been confused into thinking. I do so wish that just once the administration would pretend that it's important to have patients attend treatment for treatment sake. Seems to me Medicaid payments come along with the patient so if we pretend the really important reason for attending is to get better then the agency will get their funds! I know, it's silly thinking.

In five months I don't think I've heard the term transference or counter transference once. I've tried to slide it myself every once in a while given that 50% of my clients suffer (do they actually suffer or does everyone around them suffer?) from every type of personality disorder available. But I'm usually met with blank stares or "We don't have to worry about that. The auditing agencies never check to see if we mention that on any of our forms." Apparently they don't check to see if there's been any individual therapy either. But they do care if there are 16 people in your caseload group instead of 15. I don't know what they expect you to do with the five extra people they say you can have on your caseload when its time for a group, or why they won't pay you for a group of 45 to whom you try to bring some education on the "physical effects of alcohol and cocaine." YOU try keeping the attention of 45 addicted individuals in early recovery for 60 minutes. Payment and a bronze star seem about right to me!

But I digress. This was about paperwork. The last week of the month is REAL crunch time. Patient's I have in drug court, TASC, DTATI, or with cases involving CPS (equivalent of ACS in NYC), MPS, DSS (and if you have someone on Medicaid you have a DSS client, which means almost everyone), or in shelters(almost everyone) all require a monthly report on attendance and drug screens. Apparently most substance treatment agencies cannot afford healthcare software which might make such reporting somewhat easier (though each agency also seems to require their OWN style form, so the last week of the month is spent searching through charts looking for paper work to back up "excused" absences and hand written sign in sheets to be sure the patient was there all other times. I know in NYC there is something called "Stars" which I believe is allowing agencies to track such reports on line. I would have thought Obama's campaign for online medical reporting would have translated into some funding to allow such things to happen elsewhere, but I guess I'm just a foolish optimist.

Maybe universal healthcare ISN'T such a good idea, given what hoops we're given to jump through for Medicaid. With private insurance you barely have to prove anything. Of course every 3 sessions you do have to call them and explain why treatment hasn't cured the patient yet in order for them to pay 50% of the next 3 treatment days. At about treatment day 10 they tell YOU the patient isn't going to improve anymore and they won't pay for any more days. Doesn't matter if you tell them they still have cravings to use and suicidal ideation--according to their book it doesn't matter because the actuarial odds show they won't recover now anyway. So simple, neat and quick. This is also helpful when it comes to backlogs of patients trying to get into treatment. No long-term, tedious, treatment. No reams of paperwork. They simply just say no. Hmmm I've heard that phrase before....

The short piece began by telling us that Private Wilhelm loved karaoke, surprising people with bear hugs and carrying on the family tradition of military service. We learned he was excited to be going places he'd never been before and seeing unusual sights. According to his mother he was "looking forward to going to Iraq." I was beginning to wonder if I'd ever be told how he died. But then it came, causing a sick flip to my stomach as I learned he committed suicide in Iraq the same day my only daughter turned 25.

The AP obituary didn't gloss over the death but noted that an investigation has led to charges "against four soldiers who the military says were mistreating some of the men in their platoon."

I'm still sitting with a queasy stomach--not wanting to imagine what "mistreatment by soldiers of men in their own platoon" could be.

I've known madness. I know of suicide. I know nothing of war and pray my children never will and no one elses children will find the pain so devastating that death by their own hand seems their only relief.

According to news sources, since the conflict began, 1,985 troops have died by suicide. This is nearly three times the number of all U.S. troops killed in Afghanistan within the same time period.

Continuing to allow our children to kill, be killed and kill themselves is surely "mistreatment" as well.

With most of our laws here in the US based on the English system of governance, we can trace our welfare state roots back to the Elizabethan Poor Laws of 1601 when managing the poor was actually codified and "workhouses," (rather than poorhouses) were found in parishes all over England. The system then, as now, was punitive in nature and based on the belief that it was the the poor's own fault for being so. In my mind we can trace this belief back to the Christian notion of "original sin," and that humans are basically untrustworthy, unreliable and given the opportunity, a pack of thieves. So then as now, being poor was a full time job and the opportunity to change such status was/is minimal. In fact I dare say virtually impossible unless those of us charged with their care find ourselves taking liberties with the system we are pledged to be accountable to.

The only way I might be able to accomplish all the paper work I am obligated to complete within a week's time, would be to work 6 instead of the 5 days a week I am hired to. And that would be a week without having to do intakes, minimal games of phone tag and certainly not the last week of the month when all the 20 reports containing attendance stats, urine drug screens and behavioral updates are due on each patient to each agency they are connected to. These reports have their purpose--to catch a thief. Are they absent more than 2 days this month? Is the marijuana still showing up in his urine? Do they participate in group? Do they own the fact that their use had criminal consequences? No? Off with their heads! Take away their shelter, their allowance of $45.00 every two weeks, the food stamps and the medicaid. Then they'll understand!

I must have missed the course which explained these interventions.

The first, the Winerip piece, could be a primer on expecting the unexpected when major depression is involved. Save it and pass it on to friends and family experiencing loved ones depression. It could also be a good article to share with someone experiencing depression as a way to open a conversation on suicidal ideation and/or plans.

The second piece, Maureen Dowd's mostly unopinionated opinion piece relates unfortunate statistics on the status of women's happiness as they age much of which stems from their desire to remain in their 20's straight through their 60's. While depression, clinical or otherwise, is not actually mentioned in the piece, my thoughts while reading it did jump to the Winerip piece which includes the notion that the boomer generation is statistically more depressed and suicidal than previous generations.

Oh, and finally a warning to those who get the Times and might be tempted to read the piece on Carl Jung's "Red Book." Don't. Whatever you learn from reading it that you didn't know already, isn't worth knowing. Wait til the book comes out.

Fashion & Style: A Life on the Decline, and Then the 'Why?'
By MICHAEL WINERIP
The economic collapse, and perhaps other issues, claims
another victim.

Full Story:
http://www.nytimes.com/2009/09/20/fashion/20genb.html?emc=tnt&tntemail0=y

Op-Ed Columnist
Blue Is the New Black
By Maureen Dowd
Published: September 19, 2009
http://www.nytimes.com/2009/09/20/opinion/20dowd.html?em

According to the below press release for this "cutting edge" treatment center, their psychiatrist can then prescribe just the right medication and nutritional supplements to make you all better in no time; reminding us how helpful this is for co-occurring disorders and eliminating the need to wait weeks to see if a particular anti-depressent does what it is intended to do! No more guessing!

This sounds even better than the promises Prometa was making a few years ago !!!

How do these places get away with this crap?!?

PRWeb, Mon, 07 Sep 2009 04:09 AM PDT
Florida Drug Treatment Center to Offer Cutting Edge
The Ambrosia Treatment Centers, who have locations in both Singer Island and Port St. Lucie, on Florida's Southeast coast, have announced the availability of neurotransmitter testing for their clients. This cutting edge testing will help clients in their recovery from alcoholism, addiction and related mental disorders
http://www.prweb.com/releases/dual/diagnosis/prweb2837134.htm

About

Everytime I think of all this I go back to the first class I took in graduate school which discussed "the poor laws," as they were hundreds of years ago in England. They are based on the belief in original sin and that all humans come into this world with a trace of evil. Both my patients and myself come to see my primary responsibility not as a treatment provider but as a warden. It's my job to catch them doing something wrong and either do something about it or let someone else know about it who will. Big brother has arrived, and he's me!

The first wake I remember was that of my grandfather, my father's father, John Drohan. He came to the US in the early part of the 20th century from Carrick-on-Suir, Tipperary. Unfortunately my family was not one for keeping good records or passing down oral history so I'm not sure what year it was exactly or why he came, leaving behind all of his family. He did return once, during "The Troubles," when my dad was an infant and his brother a few years his senior. But why they did I don't really know either.

But back to the wake. I remember it was very crowded. I remember no one told me what to expect or what to say and feeling very out of place. I didn't see my grandfather very often though he didn't live far. In fact he lived with us until his drinking, not getting any better, caused my parents concern that he might accidentally fall over the third floor banister while drunk, and kill himself. So they found him his own place and supported him there. I do remember his brogue however.

Irish wakes were made famous by James Joyce and films usually associated with Spencer Tracy. But those wakes took place before they were moved from the family home to the sterile, somber, and sober environs of the contemporary funeral parlor.

All this comes to mind because I attended the wake of a friend one evening this week. It's probably the first wake I've attended where most of the attendees were people I knew and who also were contemporaries of the deceased. Most had already lost their parents, as did "Walt," I'll call him. Walt was only 45. As of yet we don't know what happened. Not having been able to reach him, a friend called the police who found him dead in his apartment.

Walt didn't have an easy life. He got into drugs and alcohol at a young age, got into a lot of trouble though most of it was minor scrapes with the law, decided to join the Navy for a cure but as we all know, he took himself with him and a couple of years later was discharged for too many more "minor" infractions. He also suffered from schizophrenia and while the medication kept him mostly stable it also took a toll on his body. Through it all he kept up his attendance at 12-step meetings, reaching out his hand to others, being there for his siblings and parents and always having the time to stop and chat when it seemed like that was what you needed from him most. When I found myself in a psychiatric hospital for a few weeks due to a severe bout of major depression about 10 years ago, Walt was one of my constant champions. He visited, he called, he cared and perhaps most importantly he knew what it was like, and then some.

About six or seven years ago he began to lose his vision, he lost it completely a few years later. It didn't stop him from showing up at meetings, setting up chairs, helping with coffee, etc. This isn't to say he didn't have his own trips back to the hospital at times or that he didn't feel sorry for himself when everything got to be too much, he was human after all. But he was also resilient and a great power of example to us all despite the cards he was dealt. He became a practicing Buddhist during the last years of his life. I hope it brought him peace during his last moments on this plane of being.

As I grow older I've come to embrace the idea that life is waiting around for the next bad thing to happen. Sometimes I'm able to enjoy the good things that happen while I'm waiting too.