Mental Health Court September 10, 2011
Posted by Crazy Mermaid in Healthcare, Mental Hospital, mental illness, Mental Illness and Medication, Uncategorized.2 comments
According to the news program Frontline, as of January 2010, one out of every 100 people in the United States is incarcerated . Of that population, nearly 25% of these 3 million people have a diagnosed mental illness, and 16% of the prison population has a severe mental illness. At a cost of 7% of the operating budget of the United States, the figure for incarceration of the mentally ill totals $910,000,000. It’s no wonder that prisons are the largest mental health institutions in the nation.
The latest weapons to help reduce the population of mentally ill in prisons are Mental Health Courts. Designed as an alternative to incarceration of the mentally ill, the cost of these courts is substantially less than the $62 per day that prisoners cost the taxpayer, saving taxpayers tens or hundreds of millions of dollars.
Designed for violators who have committed a crime as a direct result of their mental illness, the program doesn’t allow anyone who has committed a felony to participate. The purpose of the program is to get those targeted mentally ill individuals help by giving them intense judicially supervised treatment including help with their mental illness that has up until that time eluded them in the judicial system.
In the Mental Health Court program, the prisoner, or client as he is known in the program, is given a choice of attending Mental Health Court or serving time in prison or jail. This program is entirely voluntary. If the client chooses Mental Health Court,he must participate in the entire program for the two year duration. A large part of this participation is receiving the needed mental health services as well as supervision by members of the mental health team, including the judge, prosecutor, public defender, and court mental health specialist. This team of people encourages the client to stay on track with the program.
As a result of attending Mental Health Court, the client, now medicated and a productive member of society, will graduate from the program in an official ceremony, receiving a certificate of graduation in front of friends and family. He then becomes a productive member of society rather than a burden on the already over-crowded prison population.
If the client drops out of the program or is terminated for any reason, he is sentenced for the crime. The penalty is no greater than if the client had not participated in the program, and the judge will normally take into consideration the fact that the client did make the effort to try Mental Health Court.
The goals of the Mental Health Court are to increase access to mental health resources, encourage a focus on recovery, prevent revolving door to the jail, give an opportunity to contribute to society, and spend less time in jail or prison.
As anyone with a mental illness can tell you, staying on the program and taking the needed medication goes a long way towards keeping the client out of the revolving door of jail. By the end of the two year period, the client is generally stabilized and capable of making the realization that he needs medication in order to function well in society. Hopefully, this realization will be enough to keep him medicated and out of the prison system, thus increasing his quality of life and decreasing the cost to American taxpayers.
The cost of housing mentally ill in jails is an expense we can all do without, as long as we are as a nation kept safe. We can use all the help we can get in these uncertain financial times.
Penny Smart, Pound Foolish: Stopping funding for Mental Illness Medication November 28, 2010
Posted by Crazy Mermaid in Health Insurance and Mental Illness, Healthcare, Medication, mental illness.Tags: Healthcare, mental illness, Mental Illness Medication
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Today I went to the pharmacy to pick up my 30 day supply of prescriptions for my mental illness. My prescriptions consists of Geodon, Lamictal and a few other drugs. My total bill for 30 days of medication was $1057 per month. Multiplying that out by the number of months in a year, I spend $12,684 for a year’s supply of medication.
Then there’s the psychiatrist visit. If – and this is a big if- I don’t have any major emergencies like hearing voices, I can get by with seeing him about every 4 weeks or so. That’s about $250 a month. Then there’s my therapist. She runs $125 an hour. I see her twice a month. $250 (it used to be weekly until the bill got too expensive). Between my therapist and my psychiatrist, I spend another $500 a month for their services. Don’t get me wrong: they’re worth their weight in gold.
The grand total for a year of care is $18,684. With a price tag like this, it’s easy to see why medication for mental illness is an easy target for a Legislature turning over every rock trying to find ways to cut their budget. But doing so would be penny-wise and pound-foolish.
People who are used to having their prescription drugs paid for by Medicaid, will no longer be eligible for those drugs if these budget cuts go into effect. So what will the net result of this change be?
A significant portion of people with severe mental illness are on disability. Surviving on less than $12,000 per month, they will no longer be able to afford their medications or therapy. Heck, they would have to spend more than what they make in a year on medication if their subsidies went away. Impossible. They will have to go without.
What does that mean for society as a whole? It means that we will have a significant percentage of the severely mentally ill off their medications. Although having the State pay for drugs for the mentally ill appears to be for the benefit of the person with the mental illness, in fact this is a matter of public safety.
Unlike someone who needs medication to thin their blood, a person with a severe mental illness won’t die if the drug coverage is discontinued. They won’t bleed to death or go into a coma without the drugs. So it’s attractive to the cash-strapped Legislature to cut out prescription drug coverage for the mentally ill from their budget. At a cost of thousands of dollars per person, it seems a logical way to save money.
But I hope the Legislature wakes up to this fact before it’s too late: mentally ill people need their medication for public safety reasons. If they’re disabled, they won’t be able to afford their medication without subsidies from the Government. They’re essentially unemployable because of their debilitating illness. They have no reserve of funds, living on the edge of poverty because of their disability. Without Government interference, there’s simply no room in their meager budget for medication.
The Legislature needs to understand that the medication for the mentally ill is needed as much as or perhaps even more than someone who takes drugs to thin their blood. If the guy needing blood thinners goes off his medication, there’s a good chance that he will suffer severe symptoms, including the possibility of his death. That isn’t the public’s and the Legislature’s perception of drugs for mental illnesses.
In fact, the un-medicated mentally ill are going to be much more expensive than the medicated mentally ill. Take me, for example. Without my medication, I would be in my own world, disconnected from my family and friends, lost in my own mind. I would once again be that mermaid, disrobing in public. Trees would talk to me. I would once again believe I had ESP. But the main problem is that without my medication I would become a danger to society. Believing that zombies are after me, or that I’m being held hostage or numerous violent scenarios will cause me to strike out at whoever tries to subdue me.
Imagine what the world would be like if suddenly all the people with severe mental illnesses- bad enough to be on disability- went off their medication at the same time. What if the people on antipsychotics stopped taking them after their “free” supply ran out? All of those psychotic people concentrated in Washington State won’t go quietly off their meds. They need those drugs to prevent their return to a psychotic state.
Washington State has the fewest hospital beds per capita in the Nation, so it’s not like we’ll have any room for the mentally ill in the mental hospitals. If they can get in, mental hospitals cost around $3,000 per day. But before they go there, they’ll pass through the doors of a “real” hospital- likely the understaffed, overcrowded, cash-strapped emergency room. Think of it: a person in a psychotic state in a room full of sick people.
If they commit a crime, which many are likely to do, they will swamp the legal system and the jails. Police taking on the task of dealing with this situation will short-change other areas of their responsibility. If you think medication is expensive, think about how expensive incarceration is. The last figure I remember reading is about $50,000 per year.
And what about the mentally ill people who injure others? A paranoid schizophrenic without medication will not be a pretty sight. Won’t those injured “sane” people and their loved ones appreciate what a good job the Legislature did by saving all that money?
I hope that the legislature comes to its senses before cutting those drug benefits. I hope they recognize it for what it would be: a public health crisis.
The Cost of Generic Drugs VS Name Brands: Lamictal June 9, 2010
Posted by Crazy Mermaid in Bipolar Disorder, Health Insurance and Mental Illness, Healthcare, Medication, mental illness, Mental Illness and Medication.Tags: Bipolar Disorder, Escalating Healthcare Costs, Medication, mental illness
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The Cost of Generic Drugs versus Name Brands: Lamictal
Although first approved by the FDA for treatment of epileptic seizures in December 1994, Lamictal wasn’t approved for maintenance treatment of Bipolar 1 Disorder until June 2003. The first drug since lithium that was approved for this use, it is also used “off-label” for treatment of schizoaffective disorder, Bipolar II Disorder, borderline personality disorder, and Post-Traumatic Stress Disorder.
I was started on Lamictal in the mental hospital to treat the symptoms of Bipolar I, but my supply of medication ran out about 1 week after I was discharged. When I got my prescription filled for a 30 day supply of Lamictal, I was shocked beyond belief to learn that the cost for that one month supply of 300 mg was in the neighborhood of $450, or $5,400 a year.
In July 2008, Teva Manufacturing began offering a generic form of Lamictal in the 150 mg doses that I require. Previously, it only made 25 mg and 50 mg doses, so it wasn’t practical for me to take 12 pills at a time in order to get the required 300 mg dose. When Teva began making the 150 mg pills in July 2008, it became practical to take two of them to equal my 300 mg dose. At that point, my insurance company insisted that I change from the name brand Lamictal to the generic lamotrigine. The cost of my medication was reduced from $450 per month to about $150 per month for 300 mg, or about $1,800 per year- a substantial savings of $3,600 a year, but still out of the realm of most people’s idea of a bargain.
Now, almost 2 years later, I’m paying $14 for a one month supply, or $168 for a year’s supply of yet another generic form of lamotrigine, this one manufactured by Cadila (Zydus). This drug is available to me through a mail-order prescription drug company, Medco, which is part of our insurance package. So what happened? How can a drug cost go from $5,400 per year to $168 per year within a two year period of time?
In one word: generics.
But are they safe? Are the generic formulas the same as the name-brand formulas?
To answer that question, I went onto the Federal Drug Administration’s website http://www.fda.gov/Drugs/DevelopmentApprovalProcess/ucm079068.htm#Reference%20Listed%20Drug to learn how the generic assessment is done. In a nutshell, the generics are tested on people just like the original brand-name drugs were tested, though the number of people they were tested on isn’t as large. In the end, the FDA decides whether the test results are good enough to grant the manufacturer of the generic form of the drug approval to sell his drug, and makes that determination available online to the general public. In the case of lamotrigine, each dose, by manufacturer, has been tested and approved by the FDA (see http://www.accessdata.fda.gov/scripts/cder/ob/docs/obdetail.cfm?Appl_No=077633&TABLE1=OB_Rx).
In the final analysis, it’s up to the patient to decide whether the generic brand works as well as the name brand, but according to the FDA, the active ingredients are the same.
Is $450 a month an appropriate amount of money to pay for a medication? Is it appropriate that the cost of the same medication varied from $5,400 a year to $168 a year within a two year period of time? Is it any wonder that our health care costs are out of control?
Who Is Thomas R. Insel and Why Should You Care? June 1, 2010
Posted by Crazy Mermaid in Healthcare, mental illness, NAMI, Recovery.Tags: mental illness, NAMI
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Who is Thomas R. Insel and why should you care?
I first came across Thomas R. Insel’s name in April 2010’s Scientific American article, Faulty Circuits. (I wrote a blog about that article). After seeing his name listed as one of the keynote speakers at NAMI’s (National Alliance on Mental Illness) Washington D.C. National Convention, I became “curiouser and curiouser”, to quote Alice in Wonderland. With the miracle of Google to aid me, I decided to do some research to assuage my curiosity . Who exactly was this guy?
As it turns out, Dr. Thomas R. Insel is the Director of the National Institute of Mental Health (NIMH). Part of the United States Department of Health and Human Services, it is the largest research organization in the world specializing in mental illness. Formally established in 1949, research is conducted in Bethesda, Maryland at a central campus- not too far from NAMI’s roots in Baltimore. Their mission, “transforming the understanding and treatment of mental illness” aims to reduce the burden of mental illness and behavioral disorders through research on mind, brain, and behavior, with particular focus on genetics, neuroscience, and clinical trials of psychiatric medication.
Based on blog entries In his Director’s Blog ( http://www.nimh.nih.gov/about/director/index.shtml) as well as the Scientific American article, it’s not surprising that his tenure at NIMH has been distinguished by groundbreaking findings in the areas of practical clinical trials, autism research, and the role of genetics in mental illness. What is surprising is the refreshingly honest glimpse into the state of affairs that his blog gives the general public.
In his March 30 entry, Who Will Develop the Next Generation of Medications for Mental Illness, Insel examines the mass exodus of the pharmaceutical companies from the psychiatric medication development programs. According to Dr. Insel, two of the major pharmaceutical companies, GlaxoSmithKline and AstraZeneca will no longer develop new psychiatric medication for a number of reasons that he goes into depth about in his article. He then comforts the audience with the exciting notion that “the scientific opportunities for progress (in the psychiatric medication development department) have never been better”, and then goes on to explain how NIMH can help get the job of developing new psychiatric medications done.
In today’s blog, Dr. Insel cites several surprising (to me, at least) statistics, including:
- Each year, there are nearly twice as many suicides (33,000) as homicides (18,000).
- The life expectancy for people with major mental illness is 56 years (the average life expectancy in the U.S. is 77.7 years).
- Mental disorders and substance abuse are the leading cause of disability in the United States and Canada.
Then, he moves on to show how much mental illness and incarceration are intertwined and what can be done about it. As he is in a position of authority, with the power to make changes, I have hope that he will be able to make a difference. This one man, in the right position at the right time with the right experience and knowledge, will no doubt make a great difference in the lives of the people living with mental illness, both inside the prison system and outside of it. He just might even change the face of the prison community.
Overall, his blog, highlighting the challenges and successes of his work at NIMH, presents hope for those of us suffering from mental illness that progress is indeed being made on the medical front.
I am excited to have such a distinguished gentleman in such an important position. Great things can and will be accomplished with Dr. Insel at the helm of the NIMH. In conjunction with NAMI, we will no doubt see great strides made in the way we look at and treat mental illness in the not-too-distant future.
Book Recommendation: Surviving Manic Depression May 28, 2010
Posted by Crazy Mermaid in Bipolar Disorder, Healthcare, History, mental illness.Tags: Bipolar Disorder, mental illness
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I just finished reading Surviving Manic Depression: A Manual on Bipolar Disorder for Patients, Families, and Providers by E. Fuller Torrey, M.D. and Michael B. Knable, D.O. I’ve read books devoted to exploring Bipolar Disorder, but none of them hold a candle to this one. I heard about this book when a gentleman from NAMI graciously provided me with the name of this book after I asked him how Manic Depression re-branded itself to “Bipolar Disorder”. Dr. Torrey meticulously wades through society’s current beliefs, making a compelling argument that Manic-Depressive is a more accurate term and should be brought back into general use. Besides providing an excellent platform for his argument, the book delivers on many different levels.
I found my hardcover copy at Amazon.com, for about $4 plus $4 in shipping in the Used Books section. The publication date of my copy is 2003, but there is a 2005 paperback version that I can’t speak to. Anyone with information on the newer book is welcome to send me your thoughts. I’d love to hear them.
Dr. Torry wrote his first book on Schizophrenia (which I haven’t read yet), which qualifies him to compare the two illnesses with authority. He takes advantage of his knowledge to bring his audience on an expedition to explore those differences in great depth. When I finished the book, I had a better working knowledge of Schizophrenia, which I wasn’t expecting from a book on Manic Depression.
My only complaint is that he doesn’t really get into depth on definitions until Chapter 3, and I would have liked to see that done right up front in Chapter 1.
Risk factors, causes, medications, and treatment strategies are all areas I’ve found in other books, but this one is done better than most I’ve read. He uses the lens of the Scientific Method to standardize knowledge, allowing him to easily gut some of the urban myths that have grown up around Manic Depression, while moving others from that urban myth category into reality. No sleight-of-hand here.
The coup d’gras is the appendix section. It’s amazing. He’s done a review on every major book I’ve ever heard of having to do with manic depression as well as on ones I never would have known about any other way. He’s reviewed websites, and in the process opened my eyes up to organizations I’ve never heard of but want to explore now that I know about them. This part, at the very end of the book, is worth the price of the book. He wraps up the book by declaring that we need a 21st century Dorothea Dix- someone to research and meticulously take note of the existing system and shine a public spotlight on the broken parts. I couldn’t agree more.
New Mental Health Parity Law February 9, 2010
Posted by Crazy Mermaid in Healthcare, mental illness, NAMI.Tags: Healthcare, mental illness, NAMI
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Sunday’s Wall Street Journal article by Jillian Mincer, Mental-Health Benefits, heralded the new Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, which took effect January 1, 2010. Paul Wellstone, Democratic Senator from Minnesota, and Pete Domenici, Republican Senator from New Mexico, formed an unlikely bond through their personal family stories of mental illness, coming together to ultimately pass a new law designed to make the world a better place for people suffering from mental illness.
The forerunner of this new act, The Mental Health Parity Act of 1996 (MHPA), was the first such effort. Basically, it said that a group health plan couldn’t impose annual or lifetime dollar limits on mental health benefits that are less favorable than any such limits imposed on medical surgical benefits. This act was necessary because it was common practice for insurance companies to pay more for medical illnesses than mental illnesses.
For example, if Harry required open-heart surgery, an insurance company limited the amount of money it would pay a provider to $2 million over the course of Harry’s lifetime for his heart. That same insurance company would turn around and limit the amount of money it would pay a provider for Tom’s depression to $750,000 over the course of his lifetime. The MHPA of 1996 mandated that if the insurance company allowed Harry $2 million in insurance for his heart, then Tom got $2 million for his mental health treatment. But that law didn’t go far enough. The insurance industry still managed to heap tons of discrimination on the treatment of mentally ill patients. So we went to work, cutting away some of the insurance industry’s wiggle room. The result was the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008.
The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 went into effect in October 2009. But the new coverage wasn’t available until only a little over a month ago (January 1, 2010), which is when new insurance policies went into effect.
The MHPAEA still allows companies to decide whether to offer mental health and substance abuse disorder (MH/SUD) benefits in their benefits package. They don’t automatically have to offer them when they offer medical health policies. So that means that the only groups that are affected by the new law are those that already have mental health and substance use disorder (MH/SUD) benefits in their benefit packages and choose to retain those benefits.
Key changes made by MHPAEA, which is generally effective for plan years beginning after October 3, 2009, include the following:
• If a group health plan includes medical/surgical benefits and mental health benefits, the financial requirements (e.g., deductibles and co-payments) and treatment limitations (e.g., number of visits or days of coverage) that apply to mental health benefits must be no more restrictive than the predominant financial requirements or treatment limitations that apply to substantially all medical/surgical benefits;
• If a group health plan includes medical/surgical benefits and substance use disorder benefits, the financial requirements and treatment limitations that apply to substance use disorder benefits must be no more restrictive than the predominant financial requirements or treatment limitations that apply to substantially all medical/surgical benefits;
• MH/SUD benefits may not be subject to any separate cost sharing requirements or treatment limitations that only apply to such benefits;
• If a group health plan includes medical/surgical benefits and mental health benefits, and the plan provides for out of network medical/surgical benefits, it must provide for out of network mental health benefits;
• If a group health plan includes medical/surgical benefits and substance use disorder benefits, and the plan provides for out of network medical/surgical benefits, it must provide for out of network substance use disorder benefits;
• Standards for medical necessity determinations and reasons for any denial of benefits relating to MH/SUD, must be disclosed upon request;
• The MHPA parity requirements under existing law (regarding annual and lifetime dollar limits) continue and are extended to substance use disorder benefits.
While these new requirements are getting us all closer to a more just mental health system, we still have a long way to go.
Note: Check out Time Inc.’s interview with Senator Pete Domenici. Senator Donenici, whose daughter suffers from schizophrenia, worked closely with National Alliance on Mental Illness (NAMI) in order to get his bill passed into law. A fascinating read. http://www.time.com/time/nation/article/0,8599,1848887,00.html.
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