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New Mental Hospital Beds Coming October 24, 2013

Posted by Crazy Mermaid in Involuntary Committment, Mental Hospital, mental illness.
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Finally, things are looking up here in Washington State.  Currently, we are 50th out of 50 in terms of mental hospital beds per capita for the State. Two new mental hospitals are scheduled to be online within the next few years.  A 68 bed facility at Fairfax Hospital, where I was involuntarily committed, broke ground in May of this year.  A 75 bed mental hospital, complete with a 25 bed facility for children, is seeking approval for a location in Smokey Point near Marysville in Snohomish County. Currently, Swedish Hospital in Edmonds, with 23 beds, is the only mental hospital facility in the 733,000 person county.  And it doesn’t handle children.

Bringing these two hospitals online should help reduce or end the practice of “boarding”.  “Boarding” is the act of keeping people housed in regular hospitals while waiting for a bed in a mental hospital to open up.  This is common in King and Snohomish County because there are too few beds. In King County right now, two thirds of all detentions for involuntary commitment end up being “boarded”- sometimes for days, while waiting for a hospital bed to be freed up.

I had my own experience with “boarding” when I was involuntarily committed five years ago.  During my psychotic break with reality, I thought I was a mermaid named Pangaea.  Life was good in the bubble universe I was in.  My friends included Bill and Melinda Gates, Oprah Winfrey, and the Dalai Lama among others.  Bill and Melinda provided me with all the money I needed (in my fantasy world), and everyone hung on my every word, telling me how gorgeous I was.  And I had ESP. This went on for months.

Then things turned nasty.  Zombies showed up, with the intent of capturing me.  It was at that point that I remembered something I learned in grade school:  when your environment isn’t safe, head to a police station or hospital.  So I convinced my husband to drive me to a hospital by telling him I was hearing voices.  Except I didn’t mean it in the traditional way, but I knew he wouldn’t understand that I had ESP.  Feeling my reality dissolving around me, I wanted my husband to take me to the nearest trauma center, Harborview Medical Center in Seattle, but my husband chose Evergreen Hospital in Kirkland instead.

Once we arrived, my friends told me via ESP that the hospital was a trap, and I changed my mind about wanting to be there.  But I had made an error in judgment by telling my unsuspecting husband that I was hearing voices in an attempt to get him to take me to the hospital.  With that confession on his mind, he wasn’t about to let me return home.

Once I displayed my fins to people in the waiting room (I could feel the flap of skin between my toes, since as a mermaid I had fins) and took off my clothes in the emergency room, they locked me in a room for hours as they waited for an overworked County Designated Mental Health Professional to examine me to determine whether to involuntarily commit me.  That was in the late afternoon.  After her examination, she determined that I should be committed (but I didn’t know that).  That’s where the “boarding” came in. She finished her evaluation at around 4 pm, deciding to commit me.  But where? At that point, she started looking for a bed at a mental hospital.  But there weren’t many choices, and they were all full.

Not knowing what was going on, I sat in that locked room, for hours.  Finally, around midnight, they showed up with a four point restraint board and expected me to jump on and get buckled in.  I refused, so they grabbed me by the throat and pinned me down and buckled me in, then came at me with a syringe and plunged it into my thigh. I passed out, coming to in a mental hospital.

With new hospital beds on the way, and with some money (thanks to a new tax that goes towards funding for mental illness) to get training for emergency room personnel, the experience I had should become a dim memory.  At least that’s what I hope.

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.
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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.

Geodon vs Risperdol vs Lithium October 31, 2010

Posted by Crazy Mermaid in Medication, mental illness.
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I can’t believe it! I just spent $589 for a one month supply of 80 mg of Geodon at  Fred Meyer Pharmacy, a nearby retail pharmacy. This same medication at Medco, an online pharmacy, is $233 for a one month supply. Still, that’s a lot of money. But we don’t yet know whether it’s going to work, so there’s no point in ordering a three month supply at this point. In the meantime,  I’m stuck paying $589 for a one month supply until we know for sure that it’s going to work. And it takes at least 3 weeks before we will know.

When I was in the mental hospital, they started me on lithium, which costs about $15 a month, to control and hopefully eliminate my delusions and hallucinations. But although Lithium is a powerful antipsychotic that almost always works, it has its own share of severe side effects, including a loss of coordination, tremors, restlessness, slowed intellectual functioning and weight gain. But the reason they use it in the mental hospital is because it almost always works for everyone in a severely psychotic stage, bringing them out of the psychosis sooner than any other drug.

In the hospital, I was on 900 mg of lithium, which is a large dose meant to snap me out of my psychosis as soon as possible.  In the controlled atmosphere of the mental hospital, the staff was able to closely monitor the drug, doing blood draws on me every few days just to make sure that I was on the proper amount. They can tell how much your body is metabolizing based on the blood draw information.  They don’t want too much of it in your bloodstream because the side effects get more severe, but not enough means you’re not getting better.

When I got out of the hospital, my first appointment with my new psychiatrist, Dr. K, was the day after my release.  When he examined my records and learned that I was on 900 mg of lithium, he continued me on the lithium, but lowered that dose to 600 mg.  I stayed on the lithium for several months, putting up with those terrible side effects. He promised me at that time that he would only have me on that high of a dose of lithium for a few months, which seemed like forever while I was in the middle of the treatment. Initially, I had to see Dr. K once a week, but that changed to every two weeks after about a month. During this time, he continued my blood draws, making sure that I was getting the proper dose.

After about 4 months, Dr. K said that I was stabilized enough to consider putting me on 80 mg of Geodon, a drug which had fewer side effects.  He explained that for most people, Geodon didn’t cause weight gain, and didn’t have the restlessness  or coordination problems that were the hallmark of Lithium.

Because the Geodon took several weeks to build up to the most effective dose, he continued me on Lithium, gradually reducing that dosage as the Geodon built up. Eventually, after several weeks, he began to taper off my lithium, finally eliminating it entirely over the course of several months.

However, while he was in the process of eliminating the Lithum, I had what I call a few “breakthrough” voices, which means that I heard voices. When this happened, he increased my lithium levels,  attributing the voices to the fact that the Geodon wasn’t yet at its effective dose. For several months, I roller-coasted through several episodes of increasing and decreasing my Lithium dose while I was taking the Geodon.

It was frightening when the voices returned, since I was afraid after every returning episode that the voices might not ever leave permanently.  After several months of this, Dr. K decided that the Geodon just wasn’t working for me.

Because of the terrible side effects of Lithium, he didn’t want to return me to that drug on a permanent basis. Since Geodon wasn’t working, he decided to try a drug with fewer side effects than Lithium, but whose success rate was greater than Geodon. That drug was Risperdol, whose generic form was Risperdone.

He started me on .5 mg of Risperdone, at a cost of about $100 per month for a 30 day supply, and that seemed to work fairly quickly.  But although the side effects of Risperdone are less severe than those of Lithium, they are still fairly severe. Those side effects included a less severe case of  slowed intellectual functioning and weight gain as well as sexual dysfunction and a sense of “flatness” of life in general.  But at least the voices were gone.

After about 2 years on Risperdone, I came to realize that I continue to have the occasional “breakthrough” voice, no matter what I do.  I have come to accept the “breakthrough” voices as part of my life, rearing their ugly head whenever my stress level gets too high. But I am much more comfortable with those voices, realizing that they do indeed to away after a little while.

Lately, though, I came to realize just how “flat” my life had become, registering neither excitement nor fear even in extreme situations.  I am fed up with this side effect, as well as the other side effects.

Coming to terms with the voices has allowed me the freedom to once again try Geodon, since the unwanted side effects of Risperdone are so much more severe than those of Geodon.  So Dr. K and I decided to try Geodon once more.

Although I am wary of hearing voices once again to the extent I heard them when I was on Geodon before, I am willing to try it again because I am in a much more stable place than when I first tried it, and because I am resigned to hearing voices occasionally, just like I hear them with the Risperdone.

So with trepidation, I went to my local pharmacy, Fred Meyer Pharmacy, to get my new prescription filled. However, I was shocked at the price: $598 for a one month supply. That is insane.

If the Geodon works, the voices will be gone for the most part, my sex drive will return, my weight will stabilize, my intellect will improve.  And most importantly, my life will lose its “flatness”.  I miss those emotions of happiness, sadness, fear, surprise. Is it worth almost $600 a month to have them?  I think so.  But it’s unfortunate that people without the means to pay for Geodon will be stuck.

New Mental Health Parity Law February 9, 2010

Posted by Crazy Mermaid in 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.