Oct 29

Obamacare and Mental Health: Provisions for Those Seeking Services

So, what’s up with Obamacare and mental health? What changes will there be for those seeking counseling or inpatient services? According to the White House:

The Affordable Care Act builds on the Mental Health Parity and Addictions Equity Act to expand mental health and substance use disorder benefits and federal parity protections for more than 60 million Americans. New health plans are now required to cover preventive services like depression screenings for adults and behavioral assessments for children at no additional cost. And starting next year, insurance companies will no longer be able to deny health care coverage to anyone because of a pre-existing mental health condition.

Serena Gordon, writing on WebMD, reports that about 32 million will be able to newly access new mental health and/or substance abuse benefits. In addition, improved parity will mean that one’s coverage should be comparable to that offered for medical and surgical kinds of treatment.

Other helpful changes regarding Obamacare and mental health include the following:

  • Extended coverage for young people—not only no denials based on pre-existing conditions but also the ability of young adults to stay on their parents’ poliices until the age of 26.
  • An end to annual or lifetime limits on the amount insurers will pay for mental health and substance use disorders.
  • More financial help for those whose annual income is between 100 and 400 percent of the federal poverty level. Some applicants will also qualify for a tax credit when purchasing an individual policy through the new state-run insurance exchanges.
  • Medicaid coverage expands to include anyone living at or below 138 percent of the federal poverty line (close to $16,000 for a single person). States, however, will vary on how this is administered.

Making all the anticipation more difficult, of course, is the seriously frustrating Obamacare website problem, which may unintentionally and ironically be adding to people’s anxiety, frustration level, and need for mental health services.

Below, from Saturday Night Live‘s most recent episode (Oct. 26th), is a spoof of the website issue. It features Kate McKinnon (incidentally, SNL‘s first openly lesbian cast member) as Kathleen Sibelius, Secretary of Health and Human Services.

Jun 24

“The Anonymous People” and the Public Recovery Movement

Many in recovery from substance abuse and other addictions choose anonymity, often participating in 12-step “Anonymous”-type programs. But a new documentary called The Anonymous People focuses on something called The New Recovery Advocacy Movement, an alternative to this more traditional approach.

From its website:

THE ANONYMOUS PEOPLE IS A FEATURE documentary film about the over 23 million Americans living in long-term recovery from alcohol and other drug addiction. Deeply entrenched social stigma have kept recovery voices silent and faces hidden for decades. The vacuum has been filled with sensational mass media depictions of people with addiction that perpetuate a lurid fascination with the dysfunctional side of what is a preventable and treatable health condition. Just like women with breast cancer, or people with HIV/AIDS, a grass roots social justice movement is emerging. Courageous addiction recovery advocates have come out of the shadows and are organizing to end discrimination and move toward recovery-based solutions.

The moving story of The Anonymous People is told through the faces and voices of citizens, leaders, volunteers, corporate executives, public figures, and celebrities who are laying it all on the line to save the lives of others just like them. This passionate new public recovery movement aims to transform public opinion, engage communities and elected officials, and finally shift problematic policy toward lasting solutions.

Watch the trailer below:

Greg Williams, age 28, is the creator of The Anonymous People and is reportedly himself at least 11 years sober from multiple substances. No longer “Greg W.”, he’s now fully out. Why? He’s on a mission to reduce the stigma attached to addiction and recovery.

As Williams tells BHere Today, “The bottom line is that addicts and alcoholics can speak publicly about their recovery without breaking the traditions of their 12-step groups. In my mind, they–we–have to. If we want to eliminate the stigma and shame around addiction, if we want addiction to be taken seriously by every medical professional in this country, if we want to change the nature of our disease, we have an obligation.”

Want to find the documentary? So far it’s been scarce. But click on the film’s website and sign up for email updates.

For further info about resources for recovery, check out Faces and Voices of Recovery online.

Feb 20

“Inside Rehab” By Anne Fletcher: Addiction Treatment Today

Just out is a new book by health and medical writer Anne Fletcher called Inside Rehab: The Surprising Truth About Addiction Treatment–and How to Get Help That Works, based on the author’s extensive research.

But first let’s go back to a previous book of hers. Over 10 years ago, Fletcher’s Sober for Good looked at myths related to alcoholism recovery:

Myth: AA is the only way to get sober.
Reality: More than half the people Fletcher surveyed recovered without AA.

Myth: You can’t get sober on your own.
Reality: Many people got sober by themselves.

Myth: One drink inevitably leads right back to the bottle.
Reality: A small number of people find they can have an occasional drink.

Myth: There’s nothing you can do for someone with a drinking problem until he or she is ready.
Reality: Family and friends can make a big difference if they know how to help.

Little has changed since then, she finds. Expanding on the above, Fletcher exposes 12 myths about rehab. Among them:

  • Rehab is necessary for most people to recover from addictions.
  • Drugs should not be used to treat the drug addict.
  • Highly trained professionals provide most of the treatment in addiction programs.

In a recent Psychology Today post, Fletcher reports that the lack of addiction expertise offered in many rehab programs is one of the worst problems she found.

As one expert I interviewed stated, ‘In few other fields do we place some of the most difficult and complicated patients in the health-care system with some of the least-trained folks among us.’ Most experts I interviewed agreed that the minimum degree for an addiction counselor should be a master’s degree, as it is for other mental health professions. A team approach is ideal at a rehab – with qualified addiction counselors, as well as physicians and mental health professionals who have expertise with addictions. Unfortunately, many states don’t even require a bachelor’s degree to become a certified or licensed addiction counselor.

Fletcher points out in an interview with Chrisanne Grise, Salon, that peer support from other addicts in the form of 12-step programs long ago became the foundation for many treatment programs: “I think in part because the medical system didn’t want to deal with addicts…”

Indeed, it’s common for clients in addictions treatment to be taught their rehab won’t work without 12-step groups. While other types of group counseling may also be provided, individual counseling often isn’t.

When patients relapse—and they often do—it’s not unusual for them to return to the same treatment model that didn’t work before. If it fails again—and again and again—who’s blamed? Often the patient. Who may be shelling out thousands of dollars in the process.

And don’t be fooled into thinking that the higher-cost, celebrity-populated rehabs are necessarily better than the others, Fletcher says. She tells Grise: “I was really surprised at the quality … of some of the low-income, community-based outpatient programs. [In some cases, these] provide treatment that is more state-of-the-art, science-based and comprehensive than that provided by prominent programs in this country.”

Some Reviews

Howard J. Shaffer, Ph.D., Director, Division on Addiction, The Cambridge Health Alliance (A Harvard Medical School Teaching Affiliate); Associate Professor, Harvard Medical School: “Make no mistake about it, this isn’t just a useful guide to addiction treatment, Inside Rehab is landmark: it is a brave, bold and paradigm-shifting contribution to the literature. Inside Rehab is a must read for anyone with a stake in addiction treatment. Bravo!”

Michael V. Pantalon, Ph.D., Research Scientist, Yale School of Medicine & CEO of the Center for Progressive Recovery: “This is THE definitive guide to effective rehab. Many of the stories are heart-wrenching, and I couldn’t put it down once I started reading it. Fletcher leaves virtually no stone unturned – not only do you get a cogent and highly informative summary of what good rehab should look like, you also get a bird’s-eye view of what it’s like to get good and bad treatment. I’m going to make it required reading for everyone who comes to my center. Finally, consumers will have a way to know how best to help themselves or their family members.”

Publishers Weekly: “Fletcher presents what works, why, where to find it, and how much it costs. It’s startling, difficult, and important information for those traveling toward recovery, and anyone who wants to help.”

Tony Miksanek, Booklist: “She concludes that no particular treatment of substance abuse is superior to others for most individuals. Flexibility — as opposed to a ‘one-size-fits-all’ approach — matters most. One authority on addiction agrees: ‘There are as many roads to recovery as there are individuals.’ Inside Rehab is a valuable road map for navigating the multiple pathways and programs dealing with the problem of substance abuse.”

Oct 29

Humorists and Mental Health: Many of the Mark Twain Prize Winners

Tomorrow night at 8 P.M. most PBS markets will televise the recently recorded presentation of Ellen DeGeneres: The Kennedy Center Mark Twain Prize. DeGeneres is one of many humorists who has addressed mental health issues in one way or another.

This humor award has been given annually since 1998. When DeGeneres found out she’d be receiving it this year, she reportedly remarked, “It’s such an honor to receive the Mark Twain Prize. To get the same award that has been given to people like Bill Cosby, Tina Fey and Will Ferrell, it really makes me wonder…why didn’t I get this sooner?”

Besides the humorists mentioned in the above quote, the other Mark Twain winners have been Steve Martin, Billy Crystal, George Carlin, Lorne Michaels, Lily Tomlin, Bob Newhart, Neil Simon, Whoopi Goldberg, Carl Reiner, Jonathan Winters, and Richard Pryor.

Now, please indulge me as I make all of this pertinent to Minding Therapy….

Ellen and Neil Simon have had depression. And when Ellen’s character needed to address her coming out process on her sitcom, she used therapy.

Both Will Ferrell and Tina Fey have struggled with shyness. No, really.

Here’s Steve Martin describing his history of panic attacks: “(F)or those who have them or had them – I don’t get them anymore, thank God – but it’s a terrifying experience of disassociation from your own self, and it’s a morbid sense of doom and you feel like you’re dying.”

Whoopi Goldberg famously feared flying, apparently because of witnessing a mid-air collision many years ago. It’s been reported, including on segments of The View, that she’s overcome this with the use of a technique called Thought Field Therapy, or TFT.

Jonathan Winters has admitted to having bipolar disorder.

Richard Pryor’s substance abuse issues were well known.

As forever-producer of Saturday Night Live, Lorne Michaels has overseen the work of many comedians in trouble with alcohol, drugs, and various mental health issues.

And if you thought that one was a stretch…

George Carlin once publicly denounced prayer as a form of mental illness.

Carl Reiner starred in It’s a Mad, Mad, Mad, Mad World (1963).

And Bill Cosby as Dr. Huxtable on The Cosby Show represented the picture of emotionally healthy, if also comical, parenting.

Finally, several of the Mark Twain Prize humorists are known for their portrayals of shrinks or their potential patients:

Bob Newhart not only played Dr. Bob Hartley on popular sitcom The Bob Newhart Show in the 70’s, but a MADtv skit featuring his character’s special brand of brief therapy is also frequently watched. See it here on YouTube.

Billy Crystal, of course, is reluctant psychiatrist-to-the-Mob-boss in the movies Analyze This and Analyze That.

Lily Tomlin was Trudy the Bag Lady in Jane Wagner’s play The Search for Signs of Intelligent Life in the Universe. Trudy: “I made some studies, and reality is the leading cause of stress amongst those in touch with it. I can take it in small doses, but as a lifestyle, I found it too confining. It was just too needful; it expected me to be there for it all the time, and with all I have to do–I had to let something go.” More recently, on TV’s Web Therapy, Tomlin has played the wacky mom of wacky shrink Fiona Wallice (Lisa Kudrow), who admits her to a mental hospital.

Below is Ellen’s Mark Twain Prize acceptance speech, in which she offers some perspective on how she chose her career—and on how having “low expectations” eventually led to much much more for her:

Apr 30

“Ninety Days” Later: A Post-Rehab Memoir by Bill Clegg

For his first book, literary agent Bill Clegg wrote about the pull of crack addiction—his own. Portrait of An Addict As a Young Man (2010) was called by the Globe and Mail “a skillfully conjured, slow-motion train wreck from which it’s impossible to look away.”

Ninety Days: A Memoir of Recovery, released earlier this month, is his follow-up. As an article in Salon reports, “The book begins with Clegg’s release from rehab and follows him as he struggles to keep clean for 90 days, a milestone for those in recovery.”

Give us 90 days and if your life doesn´t get better, we will gladly refund your misery, goes a recovery saying.

Indeed, “ninety days” refers to the concept, originating from the early days of AA, of recovery being more sustainable if an addict can make it 90 days without relapse. In addition, attending 90 12-step meetings in 90 days has widely been thought to increase one’s chances of recovery success.

The Salon article further describes the author’s experiences post-rehab:

Over the following weeks, he tries to rebuild his shattered life — befriending other recovering addicts, searching for a new apartment and shuttling from meeting to meeting — but before long, he is once again drinking, smoking crack and having anonymous drug-fueled sex. Thus begins a dramatic series of relapses…

Publishers Weekly review:

Clegg discovers that reaching that signpost is going to take him a lot longer than three months…By focusing on the struggle through each gray day, Clegg draws the reader into his claustrophobic existence. His distance from both his character and the world short-circuits the addiction memoir tendency toward melodrama. When specific details do seep in—selling his mother’s silver, a drug-fueled threesome—the impact is powerful. With understated craft, Clegg has written a harrowing story.

Kirkus Reviews:

Even the short journeys to his daily support groups sound like heroic odysseys….The outcome is never assured…Three scant months may not seem like a long time, but for all involved it was an epic period of transformation. At turns cautionary and inspirational, Clegg’s saga embraces both the weaknesses and strengths of human nature, while only alluding to the possibility of salvation. A gritty, lyrical and potent portrait of what it really means to be addicted.

As told in in interview found on www.thefix.com, although Clegg relapsed again the day after he finished writing the book, he has regained his sobriety and maintained it for about a year and a half.