The Death of hope: Couple believed Insure Tennessee could end separation
By Mike Gibson | [email protected] | Feb. 15, 2015,  The Daily Times.com

When the Insure Tennessee health care initiative died in a state legislative committee on Feb. 4, Larry and Linda Drain’s hopes died with it.

A retired couple in their 60s, the Drains received regional and even national press coverage last year because of their unusual — but not unique — situation: In order to stay solvent and maintain minimal health benefits, the Drains separated after 33 years of marriage.


“It felt like I had been killed,” Larry Drain said of the night Insure Tennessee was squelched the state Senate Health Committee. He’s seated in the cozy but haphazardly appointed room he rents in a neighborhood just outside downtown Maryville. His wife, Linda, is there, too, on one of her weekly visits from her home in a low-income apartment in Knoxville.


“I hate living the way I live,” Larry Drain continues. “I despise it. Living with your wife should not be a crime. And people should not have to die just because they’re poor.”


The Drains’ circumstance was a seemingly unfathomable Catch-22. When Larry Drain retired from his job as a mental health counselor at Blount Memorial Hospital in 2013, he knew that he and Linda would have to live simply, frugally for the duration of their golden years.


What he didn’t anticipate was that “frugally” might mean “without health care.” A couple of months after he retired, a government employee called and told him that his Social Security benefits were classified as “unearned income,” and therefore counted against Linda’s monthly $720 SSI checks.


Suffering from epilepsy and other medical conditions, Linda is dependent on expensive medications to maintain some semblance of a normal life. She also receives TennCare benefits to help defer the cost of her care.


What Larry learned next is that, should he go back to work again, Linda would lose her TennCare benefits, too. So in December of 2013, the Drains made the painful decision to live the remainder of their lives apart.


Barring a miracle, that is. And that miracle seemed to have arrived last year in the form of Insure Tennessee, Gov. Bill Haslam’s health care expansion plan that would have extended benefits to many of the state’s uninsured.


“We thought, ‘Thank God, there’s an end to this,’” Larry Drain says. “We started doing everything we could to advocate for it. It was a no-brainer. There are over 280,000 uninsured — the numbers are incredible. And this plan would have helped so many of those people.”


The Drains are no strangers to advocacy. Larry Drain first became involved in state-level health care policy during Gov. Phil Bredesen’s administration, when he wrote the then-governor a letter asking him to preserve health care benefits for the sake of his ailing wife.


The couple went on to speak at TennCare rallies and attend legislative sessions. And Larry wrote more letters about health care relief to Haslam when he took office, many of them viewable at deargovernorhaslam.wordpress.com. Drain says he counted 134 letters in total, on the ethics, the finances and the politics of health care reform.


The Drain’s story was eventually picked up by The Tennessean, and mentioned in USA Today. And then it went viral.


“A friend called and asked us one day, ‘Do you know how far your story has gotten?’” Drain recalls. “The count ended up being more than 120 newspapers, more than 100 TV stations. We even made the front page of The Daily Mail in England.”


In the meantime, though, notoriety notwithstanding, the Drains were eking out a living in separate homes. Larry lives in slightly cluttered apartment in a more-than-slightly rundown old house in Maryville, his chief companions being a trio of friendly house cats and a couple of stray chickens who have adopted his front porch as their home.


Linda’s path has been more difficult. Upon the couple’s separation, she lived for a time with her elderly mother, then stayed at an area homeless shelter.


Now she lives at a government-subsidized apartment complex for the elderly and disabled in Knoxville. Through her time living there, the Drains have met other couple thrust into a similar predicament.


“There’s so much tragedy there,” she says. “I met several other couples who had separated for the same reasons we did. Some of them were living in different apartments in the same building.


“I couldn’t do that, because I was unwilling to lie about it. But I do think God works in mysterious ways. He’s shown me different perspectives on this problem, and it’s made me a bigger advocate. I’ve tried to let others know how they can help change things.”


Larry says one of the men living in Linda’s complex, a former Chattanoogan, has been separated from his wife for five years. “I don’t understand how you do that,” he says.


In fact, Larry says their activism has led to an understanding of many dimensions of the health care issue — people from a diversity of circumstances, from veterans to the working poor, who have lost or been denied life-saving benefits.


“We met a lady in November, whose daughter died from a blood clot after breaking her toe,” he says. “Imagine: someone dying from a broken toe. When you can go to a doctor, that stuff doesn’t happen.”


The greatest tragedy of Insure Tennessee, says Larry, is that it died in committee, without ever seeing the light of day on the legislative floor. “They didn’t just vote down Insure Tennessee,” he says. “They voted not to vote. Seven people in a committee decided for everyone. It was the single most important piece of legislation to come through in the last 10 years, and it didn’t get a vote.”


Had it passed, says Drain, “It would have meant the nightmare was over. We could live together again.”


In spite of it all, the Drains says they still harbor hopes that the Insure Tennessee legislation will return, in one form or another. “I believe God is in control, and it will work out,” Linda says.


“My hope is that it will be brought back up again,” Larry says. “This whole situation is a human disaster, far past what happened to Linda and me. We’re resilient people. We’ll make it. But many people won’t.”

I was raised appreciating my family. However, in 1993, I met a personal health challenge that put me in great need of help and support. My family rose to the occasion with love and support I desperately needed. So, I learned anew the meaning of family in my midlife. Since that time I've worked to be there for my biological family and to be "family" to others with a similar need as mine.

Tragic California Case Exposes Failings in Our Mental Health Care System

CareforYouMind Feb 10,'15

Rusty Selix
Executive Director, Legislative Advocate
California Council of Community Mental Health

In April 2012, Fred Paroutaud, a California man with no history of mental illness, experienced a psychotic episode. Mr. Paroutaud was hospitalized and diagnosed with bipolar disorder. Just 72 hours after he was admitted, and despite the fact that he was still experiencing hallucinations, he was discharged and referred to outpatient group therapy. Because his condition remained unstable he requested alternate therapy and one-on-one sessions with a psychiatrist. He was denied both by his health plan and his condition deteriorated.

Concerned by his worsening depression, his wife appealed to the health plan again and again. She pleaded that her husband required more supervised and personalized treatment. While waiting for an appointment with his psychiatrist, and just two months after his first psychosis, he died by suicide.

Mr. Paroutaud’s widow is convinced that if more intensive and timely care had been available, her husband would still be alive. In October 2013, she and two other plaintiffs filed a class-action lawsuit against the health plan claiming they were harmed by its systemic denial of timely access to mental health services.

Why this story sounds familiar
While Mr. Paroutaud’s story is unique, his circumstances were not. Upon his release from the hospital, he needed intensive, monitored care. That’s not what he got. Generally speaking, commercial health plans limit coverage to two levels of care: level one is a once a week therapy visit for mild to moderate problems and medication management; and level two is hospitalization.

Those two narrow levels of care are appropriate for many people, but not all, and certainly not for all stages of mental illness. The absence of those critical, in-between levels of care is one of the ways that our mental health system falls short and where it fails people like Fred Paroutaud and his family.

When someone is in the midst of a manic episode or considering suicide, hospitalization can provide the opportunity to stabilize the condition. Upon discharge, many patients require medically monitored care in a residential facility or highly personalized care in a medically-monitored outpatient setting. Unfortunately, that level and type of care is almost impossible to find in commercial health plans.

There is another way
My hope for a health system that offers comprehensive mental health services to better address the needs of individuals with a mental health condition is not pie-in-the-sky wishful thinking. In fact, this model of care, with multiple levels and degrees of intensity, already exists within the California Medicaid system. In our public programs, care ranges from community-based health management through low-intensity community-based services, high-intensity community-based services, medically-monitored non-residential services, medically-monitored residential services, and medically-managed residential services (i.e., inpatient treatment).

This structure, with six levels of care, is the backbone of the mental health system under California’s Medicaid system, and it provides a complete, stepped approach to rehabilitation.

This type of care should not be exclusive to the Medicaid population. One of the 10 essential health benefits under the Affordable Care Act is rehabilitation; another is mental health care. This means that rehabilitation for mental health care isan essential benefit, and all Americans in commercial health plans are entitled to more rehabilitation-focused mental health services.

What you can do now
Fred Paroutaud was denied access to stepped treatment and his story is tragic. It is thanks to his widow and her persistence that we know about it at all. Unfortunately, many people suffer similar situations and denials of care, but we do not hear about them.

With increased national attention on access to mental health care, now is the time to tell us about the problems you are having in accessing the care you need. We want to know what services you were denied and the barriers you faced, such as unaffordable out-of-pocket costs, transportation issues, or lack of trained providers in your plan’s network, etc.  We also need to know what you did or didn’t do in response and how this impacted your or your family member’s recovery. As advocates and advocacy organizations, we are positioned and prepared to knock on the door of government regulators and health plans and point out the disparity in care and demand access to appropriate rehabilitative services.

Many commercial insurers don’t cover rehabilitation services because they don’t believe they have to. And if no one demands otherwise, they are unlikely to ever change. Share your story. Don’t take ‘no’ as the only answer. Let’s realize the parity we deserve.

Questions

• How have you been denied equal insurance coverage for a mental health condition? Tell us your story.
• What levels of treatment are available to you under your health plan? Are they sufficient?

Bio

Rusty has been Executive Director and Legislative Advocate for CCCMHA since 1987. He is co-author of California’s Mental Health Services Act, a tax on personal incomes over $1 million to expand community mental health care. At CCMHA, he has been instrumental in moving forward a variety of critical mental health-related initiatives, including ensuring the implementation of the federal Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program to serve children with severe emotional disturbances. He also serves as Executive Director of the Mental Health Association in California.

I'm grateful for all of the support that got me through my time of recovery. Today I appreciate the support I have in gaining more wellness each day.

Care for your Mind, Feb. 2015


Disparity, Not Parity, Describes Mental Health Status and Access in America Today



Paul Gionfriddo
President Mental Health America

That’s the bottom line message in a recent report, entitled Parity or Disparity: The State of Mental Health in America 2015, released by Mental Health America(MHA).

But the good news is that there are plenty of things we can do to change that – if we’re willing to change the way we approach mental illnesses in general.

MHA produced this report because we aren’t satisfied with the narrowness of the policy debate we have been having. It has been too much about public safety and post-crisis intervention, leading to a focus on inappropriate, back end, post-crisis care. These interventions occur long after mental health concerns—if identified and treated early—could be eliminated or mitigated, avoiding crises and tragedies.

Instead, we need to first call attention to the facts about mental health status and access, and second to issue a call to action that will move our thinking and our policy upstream, toward earlier interventions.

The facts

• 42.5 million adults have a mental illness, but fewer than 18 million receive treatment
• 6.2 million children suffer from an emotional, behavioral, or developmental  issue, but 2.4 million receive no treatment
• One in every three children and adults forego mental health care because of costs
• One mental health provider exists for every 790 individuals
• 19.6 percent of people discharged from state hospitals are re-admitted within 180 days

These national statistics are hard to hear, but they cover up some huge variations in states across the nation. For example,

• In Vermont, 57 percent of adults needing treatment receive it, but in Hawaii, only 27 percent do
• In North Dakota, 86 percent of children needing mental health services receive them, but in Louisiana, only 40 percent do
• In Massachusetts there is one mental health provider for every 248 residents, but Alabama has one for every 1,827 residents

Where you live matters
One surprise in our study is that the best and worst ranked states overall defy simple political categorizations. There are progressive and conservative states scattered among the best and the worst, as well as traditionally Democratic and Republican ones.

While politics may not matter, geography clearly does. The ten best states for your mental health are Massachusetts, Vermont, Maine, North Dakota, Delaware, Minnesota, Maryland, New Jersey, South Dakota, and Nebraska.

The ten worst states for your mental health are Idaho, Arkansas, Montana, Oklahoma, New Mexico, Louisiana, Washington, Nevada, Mississippi, and Arizona.

How do we close the gap?
The answer—and call to action—lies in a combination of federal and state initiatives.

• Extend the Affordable Care Act (ACA) subsidies to those living below the poverty level
  It makes no sense that a person just above the poverty level gets a subsidy that covers up to 100 percent of the cost of a basic insurance plan, while a person just below the poverty level pays full price. This would get more people with serious mental illnesses enrolled in private health care and correct a serious flaw in the law, an unintentional consequence of the Supreme Court’s ruling that made Medicaid expansion optional instead of mandatory.

• Expand access to Medicaid. 
  An estimated 3.5 million people with mental illnesses would benefit if the states that have not yet expanded Medicaid do so this year.

• End the practice of putting nonviolent people with mental illnesses in jails.
  People with mental illnesses account for more than half of the populations of some county jails; closing those jail beds would free up enormous local resources that could pay for community supports, including treatment.

• Look upstream toward early identification and intervention at all levels of government.
  Failing to invest upstream carries an enormous downstream cost. Only one in every ten children with a serious mental health concern currently receives the special education services needed to succeed in school. All school children should have access to mental health screening, just as they have access to vision, dental, and hearing screening. Medicaid can now reimburse for free screening so there’s no excuse not to do it.

• Build a larger, stronger behavioral health workforce to increase easy access to the best treatment options.
  Federal and state governments can tackle this problem by encouraging the training of traditional providers, improving provider reimbursements, including all drugs on drug formularies, and expanding the use of the peer workforce as part of clinical mental health teams.

We don’t have to stand for disparity anymore. Let’s make 2015 a year for mental health reform in America.  From the community, state, and federal levels, it is time to address mental health before stage 4, and make much needed changes to a system that is failing far too many.

Questions

• What are the most important calls to action outlined in this post?
• What actions will you take in 2015 to advance legislation that will support the action you identified?
• If you look at the Parity or Disparity report, is the assessment and ranking of your state consistent with your experience?

Paul Gionfriddo was named President and CEO of Mental Health America on May 1, 2014. He has worked in a variety of health and mental-health related positions during a career spanning over thirty years. In 2013, he was appointed by HHS Secretary Kathleen Sebelius to a four-year term on the 12-member National Advisory Council to the SAMHSA Center for Mental Health Services. Prior to joining MHA, he was a consultant, speaker, and writer, and author of a popular weekly health policy blog entitled Our Health Policy Matters.

There were tough times with life's setbacks when I needed a good friend. In a group of our peers, a group for support,we can "practice" being a good friend.

Jeffrey Schwartz 
Executive Director, Consolidated Credit Counseling Services of Canada


Disability and Debt: When One Happens to Canadians, the Other Follows


Phil Stewart-Burgoyne was earning great money in a highly specialized job: Driving a stand-up order-picker. He had a nice house and a strong credit rating -- life was good.

But he couldn't sleep. He heard loud music in his head, even though none was playing. In 2007, he asked his boss for some time off from work. The doctors thought he was suffering from depression. Instead, it was a neurological disease called Charcot-Marie-Tooth.

He was only 50, but he never worked again. I learned about him in my role as Executive Director, when he reached out to Consolidated Credit for help.

"It was totally out of left field; I never saw it coming," recalls Phil. "I guess my body did, and my mind did, and it was trying to tell me something."

As a union member, Phil had a disability insurance policy in place. Unfortunately, his insurance payouts were far less than the wage that he was used to. A loss of employment also meant a loss of identity, and Phil filled the emotional gap by spending money he no longer had. Within three years, he was $35,000 in debt.

"You got these credit cards, you get a cash advance, you end up going to the slots because you have nothing better to do, and it just gets worse... I was bored, I had nothing to do," says Phil. "I've never been like that in my life. Since I was 13, I've always worked."

Many Canadians are well aware that a disability could occur at any time. Ninety-six per cent of us believe it, according to a recent RBC survey. The same survey showed that more than three-quarters of us also believe that missing three months of work, due to disability, would put us in serious financial jeopardy.

But here's the kicker: only seven per cent actually think they have a chance of disability. That's right -- nearly all of us believe a disability could happen at any time, but almost none of us believe it could happen to us.

Phil warns people to safeguard themselves. He told me he was lucky to have disability insurance, but he wishes he did more. The stats agree with Phil, because one in three Canadians will experience a period of disability lasting longer than 90 days during their working lives.

Here are some steps you can take to prepare yourself for a possible disability:

Know where you stand. A budget is nothing more than a snapshot of money coming in and money going out. Use a budgeting app or old-fashioned pen and paper and find out exactly what your money is doing.

Adjust your spending. Once you have completely audited your spending, the results might surprise you. Find areas where you are spending too much, and try to make cuts. In the event of a sudden disability, you will probably find that your expenses far outweigh your income, so it's best to try to close that gap as best you can. Restaurants, cable packages, and cell phone plans are good places to start.

Disability insurance. If your employer offers disability insurance, make sure you fully understand the terms and coverage. If you don't receive disability insurance from your work place, speak with an insurance provider -- coverage can be affordable and invaluable.

Stay healthy. There are some disabilities that we simply cannot protect against, but there are many that we can. Exercise, eat right, and quit smoking, and you'll prevent a lot of problems while increasing your quality of life. Healthy living not only benefits the body but the mind as well.

Get help. If you are treading water with your debts while healthy, a disability will most certainly cause you to sink. Talk to a financial advisor or a trained credit counsellor to find out the best way to get financially healthy.