The law included a six month extension of higher Medicaid federal matching funds for states – a major contribution towards some of the drastic slashes in mental health coverage in Arizona.

Recent budget slashes (I prefer that term over cuts as I feel it’s much more descriptive) in the state’s healthcare system for the poor have forced many people to search for alternatives to afford their medications. Some are going to Canada, while some have been fortunate to be able to get discounts directly from the pharmaceutical companies. I applaud the efforts of some of the drug companies to help and I wish they would all step up.

While illegal immigration and calls to enforce the border by sending in troops occupies the headlines, our state’s most vulnerable citizens are doing the best they can just to survive.  In my world they take priority over someone who has illegally crossed our borders to look for a better way of life.  Helping disabled and seriously mentally ill people is not only money well spent, it’s the “right” thing to do!

How Did Your Member Vote?

View the House roll call vote on final passage of HR 1586

Both McCain and Kyle voted no when the bill went through the senate.

Read further details on the provisions in HR 1586 designed to support state Medicaid programs into 2011.

NAMI Southern Arizona and Community Partnership of Southern Arizona (CPSA) are co-hosting this meeting to help answer your questions about the recent changes to CPSA’s system of care.

If you are not currently on AHCCCS (Medicaid, Title XIX), staff experienced in determining AHCCCS eligibility will be at the meeting.
A Community Resource List will also be distributed with contact information for a variety of services offered throughout Pima County.
Space is limited. RSVP Required by Monday, June 7th
Call 784-5378
(Spanish translation is available upon request)

Beginning July 1, 2010, deep budget cuts at the state level will affect publicly funded behavioral health services. Over 300,000 adults and over 7000 children  statewide could loose their coverage.  (things are complicated with the new federal health care legislation)  Because timely information sharing is critical, Arizona’s Department of Behavioral Health Services (DBHS) has set up a CLICK HERE: Web site to communicate with members, families and stakeholders – both to provide information and to obtain your input.

DBHS will post the latest information as it becomes available on topics including:

• Changes to covered benefits for adults with serious mental illness (SMI) who do not qualify for Medicaid (also called AHCCCS or Title XIX).
• Efforts to ensure there is a comprehensive and effective statewide crisis system for anyone experiencing a behavioral health crisis.
• Clarification of benefits related to supported housing for adults with serious mental illness (SMI).

Submit your CLICK HERE: questions and concerns to DBHS.   CLICK HERE: FAQs are updated each Tuesday by DBHS.

I don’t consider myself a “tax and spend” liberal, but if I had to choose one side I would definitely fall on the side of being a liberal because I believe we need to take care of our most vulnerable.  In this case, those vulnerable 310,000 people that fall below the national poverty level, but aren’t destitute enough to qualify.

Talk about insanity……as I have said before, these people will be forced to go to emergency rooms when they need care, or in the case of a person with a serious mental illness that can’t pay for their treatment something even worse could happen. Also, according to the article, with proposed cuts the state could be loosing 42,000 jobs!

Most of us are struggling in today’s economy, that’s a fact, but we are all in this together.  At least, I thought we were.  Yesterday two out of three local school districts lost their appeal to voters to approve budget over-rides.  If voters won’t approve a a very slight increase in property tax ($50 – $100 per year) to keep their school district’s head above water I’m not optimistic that they’ll vote to increase a “sin” tax for people that can’t afford health care.  Now, that’s a sin.

With yesterday’s accused “Pentagon Attacker,” Joseph Bedell, the link seems more clear cut. His family had struggled for years to get him into treatment.  But, as so often is the case unless he displayed an obvious threat to himself or others, they were limited in what they could do to help.  Even the law officer that stopped him for a moving violation in Texas could tell he needed to be in a hospital, but he wasn’t able to get him admitted. Mr Bedell was a threat to himself and others and no one paid attention.

There were so many red flags.  Like so many people in our country he was agitated with our government.  Like so many of us that are tired of the activities or in-activities of our legislature, he was frustrated and angry.  But, unlike most of us, he wasn’t able to contain his anger and acted out in the most savage way he could. 

As an advocate for people with mental illness, his tragic story reminds me once again how far we need to go when it comes to treating our fellow human beings that are suffering from brain disorders.  Inflammatory rhetoric and inexcusable callousness does not further growth as a species and can have a devastating effect on some of our most vulnerable.   Compassion and understanding have positive effects. Pushing those living with mental illness aside and pretending they don’t exist, that they are “terrorists,”   or that they are someone else’s problem has consquences.

Below is an excerpt from the most recent “E-News” from the National Alliance on Mental Illness.

For many group health plans, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act went into effect on January 1, 2010. The new law requires most group health plans to cover treatment for mental illness and substance use disorders on the same terms and conditions as medical conditions such as diabetes, heart disease, cancer and asthma. Specifically the new law bars health plans from imposing durational treatment limits (caps on inpatient days or outpatient visits) or financial limitations (higher cost sharing, deductibles or out of pocket limits) that do not also apply to medical-surgical coverage.

The effective date of the new law is actually the beginning of the first new plan year after October 3, 2009. The new law applies to all group health plans sponsored by employers with 50 or more workers.

• View NAMI’s factsheet on the new law
• View a Powerpoint presentation on the new law

Is Your Health Plan in Compliance With Parity?

NAMI is seeking information from individuals and families on how the new law is working. This information is critical to informing policymakers in the U.S. Congress and the Obama Administration on additional steps that may need to be taken to strengthen the law and ensure adequate enforcement. In addition, it is critical for NAMI to demonstrate to the larger public that parity is making a real difference in improving coverage of mental illness treatment and expanding access to critical medical services for children and adults living with mental illness.

A friend of mine, Scott Whitley,  is living with Bi-Polar illness,  is in recovery and works as a Resource Specialist and Board member at NAMI of Southern Arizona and a tireless advocate for people living with mental illness.  He agreed to share the following story about his non-disclosure and subsequent full disclosure.  I thank Scott for being so honest about a difficult decision and hope it will provide some insight for employers as well as employees.

 In peer support groups it has frequently been discussed if Manic Depressive Illness should be disclosed in the work place.

Often it comes down to what is the American with Disabilities Act position.

I would like to approach it by what it has meant to me.

I had to live with the consequences since I did not disclose. Not just for me, but my work place.

I have a form of Manic Depression Illness known as Bipolar 1 Disorder. This is what I will discuss. This is where my experience lies.

It was February 1989 when I was first introduced to mania. I ended up dropping out of school, ending a relationship with a woman, alienating my family for two years and finally landing in jail, a place I never thought I would be.  

The depression was short; it only lasted about two weeks and then I bounced back. In the period of six weeks I had my first manic and depressive episode. They are connected with me. That is why they call it Manic Depressive Illness; they are both part of the illness.

The next step in this story was going to Mexico to work on a new crop project that I had been offered. This started a period in my life I call “Manic in Mexico.” It sounds like a Jimmy Buffet song- but it was no song- it was a life changing reality.

I was supposed to be an important part of the project.

I had been recently diagnosed and put on a low level of a mood stabilizer. I was told it would be a slow process to get to a therapeutic range and it was necessary to have blood draws. At first it was every two weeks, then once a month. It was a slow process, requiring a responsible attitude. Of course I did not listen. I was given a medication, and thought, as with antibiotics, I would be cured after seven to ten days. Isn’t this how it works with illness?  Only with this illness you are not infected with a bacterium that goes away. Manic Depressive Illness is part of you, your make up, your being.

That May I went to Mexico. I was briefly educated about the illness and that it was an event for life. It would not disappear and medication was needed to control the illness. I did not listen. I wanted this dream job in Mexico. I was cured. Was I not cured? This is where a five minute decision changed my life.

I went to Scottsdale to have dinner to discuss the project with one of the organizers and money people. I was psyched. (Excited, NOT psychotic yet!)

I had put behind my behavior of February. It had not been me.  Besides, I was on medication, I was cured. My behavior was a fluke.

After dinner we sat down to go over the final details. Then it happened! He knew the woman I was involved with when I had my first manic episode. He liked her and wondered why we had broken up.

I knew what had happened; over two hundred phone calls to her in a ten day period ending in a verbal manic rage at her 85 year old 4’ 10” Ukrainian mother; then getting arrested and put in jail for a night. This led to two weeks of not being able to get out of bed. 

I did not know if I should tell him about the illness. Would I lose the opportunity to work on the project? My mind began to race over the decision. What was the worst that could happen?  I reasoned out that I was cured. The work was important to me. What could happen?

The next day I left for Mexico. The racing thoughts had just begun. Over the next several months the symptoms of mania occurred; racing thoughts, grandiosity, insomnia, hyperactivity, black and white thinking, hyper verbosity,  endless energy, intense passion about the work, then euphoria and finally a psychotic break with a manic rage. I was not of sound mind! The project ended.

I have often wondered if I had gotten the job had I disclosed my illness.  Then the next logical point: if I had gotten the job and more education about the illness, would I have been likely to ask for help before the symptoms exploded into full blown mania?

This is what I believe of that situation in Mexico. When things were beginning to escalate into mania what if I had reached out for help, had the support of people around me and was willing to accept help?  It might not have lead to mania; I might not have destroyed the project and my path in life.

Maybe I would have lost the job if I had disclosed. I did anyway because my behavior.

My illness is part of my being, therefore part of my work and my relationships.  It affects my decision making when I am symptomatic, not only with mania but also depression.

This why I find support groups so valuable, to discuss these situations that are faced by those of us living with Manic Depressive Illness.

Do I really want to live hiding and hoping no one finds out, living with where to put medication bottles so friends don’t find them?  Also when your mood starts to escalate, to whom do you turn?

Maybe the work place is still not the place for this. How do we change the environment?  Do I hide, hoping that nothing goes wrong?

I know the Americans with Disabilities Act have the legal slant on this. However, being responsible is more than a law for me.

I live with an illness that can affect not only me, but the people and the work around me.

Yes I did suffer for my decision. Now I live with my illness. I am open.

I do not walk up to people and say “Hi, I have bipolar disorder.”  For myself there is a time and place for disclosure.

After living with the diagnosis of bipolar 1 illness for over twenty years, I have learned that behaviors are symptoms and people judge you by your behaviors. I have learned through support, education and the right medication living with the illness is possible.

In my next work experience I handled things differently. This time I disclosed my Bipolar Illness. I felt it was necessary to do so because I would be going to Kenya on a new crop project as a volunteer. I knew I would need support due to the importance of the project. I learned from my previous experience that positive stimulus could throw me into mania. I needed feedback from the general manager and the colleague who accompanied me to Kenya;  if I was to go hypo-manic (just below mania), their feedback could  help me to prevent the mania from setting in.

At the end of the year commitment of volunteering my colleague and I were offered a contract to stay on in a paid position. Unfortunately, the funds for the project ended and I came back home. Nevertheless, I walked away with a valuable lesson. For me, I believe disclosure is necessary when I am seeking a position of responsibility. I am not saying this is right for everybody. What I am saying is take time to discuss it and think about it. This can be a life changing decision. It has been for me.

Governor Brewer wants to repeal the measures passed in 2000 requiring that all those below the Federal Poverty level be covered by the Arizona Health Care Cost Containment System, the state’s Medicaid System. If this is repealed, estimates of up to two thirds of the state’s citizens diagnosed with a serious mental illness will loose their coverage.

It’s obvious where they will go, or in worst case scenarios where these most vulnerable residents will be sent. Our emergency rooms will continue to be inundated with people seeking treatment for mild to serious symptoms and our prison system, already stretched to the limit will continue the latest trend as the nation’s mental health hospitals. Even the few lucky people that are able to afford an occasional visit to a private psychiatrist will have a difficult time paying for their medications. Many will have to make the choice between medication and food. Our homeless population already underserved and in crisis, will continue to grow.

Effective community based treatment is proven to be a more cost effective way to treat people living with mental illness. Hospitalizations and incarcerations are the most expensive, yet that seems to be where we are headed, especially now that the City of Tucson is also stopping funding for the mental health courts (another questionable cost saver). 

It seems like the dream of health care reform is turning into a nightmare.

A member of the family, we’ll call him the Father, was diagnosed with schizophrenia approximately fifteen years ago, but it wasn’t until this week that his sister was given that information.  They live across the country from each other and and don’t see each other often, but the sister has always know that her brother was “quirky.”  She knew he was brilliant and that he had scored very high on a IQ test while in high school and always considered him a genius.  Over the last several years she often wondered if her brother had a mental illness diagnosis, but no one else in the family thought it possible.  That is, no one besides her sister-in-law who finally shared the information after living with him for over twenty years and raising a family. 

The sister, who believes that mental illness should not be kept in the closet and needs to be spoken about feels frustrated and saddened by her brother’s family’s inability to share openly an illness that needs to be discussed.  It is the first step in reducing stigma.

All that can be done  is to encourage the family to be open.  This is an issue that they must come to grips with on their own, but here are some suggestions (some from the www.nami.org website) to anyone interested in reducing mental illness stigma. 

Use of Language is Most Important

•  Protest usage of single words like “crazy” “psycho” “wacko” or “loony” unless they refer directly to individuals struggling with mental illnesses or to the illness itself.
•  ”Schizophrenic” to describe a split decision made by Congress or any organization has become part of our cultural language. However, its misuse is being heard and corrected by many in the public arena.
•  Protest calling a person a “schizophrenic”: NAMI policy calls for PEOPLE FIRST: people, persons, individuals with a mental illness, schizophrenia, bipolar, clinical depression, OCD, panic disorder.

Above all else, get educated and know that mental illness, like any other illness is a biological disorder;  it can be successfully treated and recovery is more than possible, it’s probable.  Ignorance has caused people to abandon their family members and encouraged the person with the diagnosis to isolate themselves. 

Just like a person living with cancer or diabetes, a person with mental illness needs support and acceptance from their family and friends. 

There is a genetic predisposition, so everyone in the family needs to know what the symptoms and “red flags” are.  Sometimes is takes years, even decades before a person is diagnosed.  It is proven than the earlier a person receives treatment, the better the outcome.

Encourage our legislators to treat mental illnesses with parity so that insurance coverage is equal for mental illnesses with physical illnesses.

Bottom line is we need to accept people for who they are, with or without any illness and be there to support and encourage them as equal human beings.

If you believe, as I do, that mental illnesses are illness just like any other, than why was this man, who supposedly treated other people with brain disorders, not receiving treatment himself?  Did  anyone not notice how he was struggling?  According to the “God Blogging” post on this site, NPR interviewed others at Walter Reed who said he was. 

Which brings us back to the same problem, the same issues that continue to plague people with mental illness and their families.  Because of the stigma, because of the inattention by our health care system that doesn’t think the mind is part of one’s physical health, because of an overburdened mental healthcare system, because people suffering from a mental illness can feel isoloated and abandoned by their support structure, people with diagnosable brain disorders are falling through the cracks.  One again, as President Obama called this tragedy, “a horrific” catastrophe has occured in this country.

Who knows what was going on in Hasan’s head……Certainly listening to war stories from our returning Veterans experiencing Post Traumatic Stress Disorder was not an easy thing to do, but why is it that no one saw the signs, especially when he was set to deploy at the end of the month? Maybe Major Hasan will be able to shed some light on our questions.