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loss of Innocent Life Due to Lack of Knowledge - Part Two




Larry Drain: Open Letter to Governor Haslam




A very personal plea for medicaid expansion: a letter to the governor

By Hopeworkscommunity

Dear Governor Haslam:
I want to start by first thanking you for your decision to restore funding to peer support centers in Tennessee.  As a mental health advocate I can tell you it is one of the best decisions you have ever made and I am so thankful you made it.

But my decision to write this letter is about much more than the peer support centers.  In your state of the state message you talked a couple of times about the importance of government giving good customer service.  You seemed to put a lot of stock in that idea.  It was not the first time I have heard you speak about it.  The decision to fund peer centers was a great example of good customer service.

My hope is that you will consider my request in the light of that concept.  I am in a desperate situation and without your help I dont know where to turn.

I want to ask you to reconsider your stance on medicaid expansion.  I know you are in a tough spot.  Anything that makes the Tea Party mad faces great obstacles in Tennessee and few things make them angrier than health care reform.  Perhaps what I am asking you is impossible for you to politically do.  Several people have told me it is.

As I said my situation is desparate.  Let me take a minute to describe it.

I have been “free” of health care insurance for many years.  It is a freedom I would gladly lose.  I have been told that I need surgery.  The surgery is a minor one that thousands of people undergo every year.  No insurance means no surgery.  The doctor tells me the lack of surgery though may not be a minor thing though, that in fact if my condition should become an emergency my life may be in danger.  I pray every day not to die a preventable death.  Many people have far more dangerous situations than me and face far more immediate risk.  Being poor should never, at least not in Tennessee be the cause of anyone’s death.  And without action on your part it will be though.

My desperation though is not based purely on issues of my health.  It goes far deeper than that.

My wife is disabled and has been on TennCare for a while.  She is a TennCare miracle.  Without it she would have died long ago.  Even with all her progress without it she would no live a month.  In order to save her insurance and in a very real sense her life after 32 years of marriage we have had to separate.  I dont know, without TennCare expansion we can ever live together again.

The situation is very complex, but let me share it with you as briefly as I can.  My wife receives SSI for disabilities.  Recently I took retirement from Social Security.  It was the worst decision I have ever made.

We found out that in Social Security’s eyes, even though our combined checks left us below poverty, we made far too much money.  Linda lost over $700 and her check was reduced to $20 a month.  I told Social Security that I would have to get a job in order for us to survive.  We figured without her check we had about $40 to live on for the month of January and we just cant live like that.  Who could??

Social Security told us that since her TennCare was disability based and not income based (like it would be if TennCare was expanded) that if I made over $85 a month her TennCare would be lost.

I love my wife and wont let her die.  The day after Christmas we separated.  The hope is that with a separate address she can regain her SSI check.  My hope is to move as close to her as possible.  Right now I do not see how we can ever live together again.

You do not make the rules for Social Security and none of that is your fault.  The law is what it is and despite its cruelty and hurtfulness we have no choice but to do our best to live with it.  A law that supports the break up of thousands of marriages seems so evil, but I dont right now see how I can affect it.

I am asking for your help though.  Maybe I dont have the right but I have no where else to turn.  I know you deeply love and care for your wife.  What would you say to me if our situations were reversed??

Please act.  Whatever the resolution please act.  My wife will keep her TennCare.  I will never do anything to put that in jeopardy.  Without your help though my marriage will not survive and for Linda and I that is a death of a different sort.








Who would be eligible for Medicaid?



http://www.urban.org/health_policy/health_care_reform/localmedicaidexpansion.cfmS.L. Brannon on DBSA Life Unlimited web site





Join Us in the Fight to Save Access to Mental Health Treatment: Act Now by Telling Congress You Care!

Posted on January 28, 2014


The Centers for Medicare and Medicaid Services (CMS) wants to significantly limit access to antidepressant and immunosupressant medication for people subscribing to Medicare Part D. Read today’s post to learn why you should be concerned, and what you can do to support the mental health community by raising our voices in Washington.

Earlier this month, the Centers for Medicare and Medicaid Services (CMS) announced a proposed rule that would remove antidepressants and immunosupressants from the protected class status under Medicare Part D and is considering removing antipsychotics from the same status the following year. If CMS adopts its proposal, it would reduce patient access to and the availability of mental health treatment.

Since it went into effect in 2006, Medicare Part D’s protected class structure ensures patients with mental health conditions have access to all or substantially all of the most appropriate medications, protecting them from “fail-first”1 experiences or other appeals processes. In many cases, delays caused by these processes can result in inadequate treatment and potentially tragic outcomes.

We need to ensure that all mental health patients have access to all the medications that they need. It is clear that CMS’ rule will signal a step in the wrong direction and the consequences will be detrimental. According to the World Health Organization, depression is currently the leading cause of disability worldwide. By 2030, it will be the leading global burden of disease.2 In the United States alone, the total direct and indirect cost associated with depression exceeds $83 billion annually.3

Ultimately if CMS’ rule is approved, there will be severe human, economic and societal consequences for not only mental health patients, but for all Americans. We must take action now.

Here’s How You Can Take Action Today

Now, more than ever, the mental health community of patients, families, friends and others need to join together to tell CMS and the Administration how big of a mistake implementing this rule will be for all Americans. Below you’ll find several ways in which you can make your voice heard during CMS’ open comment period, ending March 7,to protect antidepressants, immunosupressants and antipsychotics within Medicare Part D. The clock is ticking!

  1. Make Your Voice Heard by writing to your Member of Congress. Use the sample email letter to inform your member of Congress that the implementation of this proposed rule is a big mistake. Be sure to share any personal experiences and how this rule will impact you or a loved one.
  2. Share your personal stories: The Care For Your Mind blog is interested in your personal stories to help share the extent of the issue and how it will impact you or a loved one. While this rule is expected to decrease patient costs for medications, members of the mental health community understand the treatment for our conditions is far from one size fits all. Below are a few questions that may help you shape and share your story:
    a. What will happen if you lose access to your medications?
    b. Have you had a negative experience with “fail-first” experiences?
    c. How will the new rule impact you, your parents, other family members or friends?
  3. We encourage you to submit your personal story here for publication on our website. And in the meantime, join our conversation online by contributing to this blog below. Your voice counts and the time to speak up is now!
  4. Share this information with others:  Knowledge is power. The more people know about the proposed rule’s real life consequences, the more we can make our voices heard. Share this post and relevant information with your friends and family, on your social media accounts, through email and word of mouth offline.Together, we can send a powerful message and help ensure that patients have access to the medications they need and deserve.

At Care For Your Mind, we understand that your personal experience and ideas can help build a mental health care system that works.

1 Fail first refers to the practice of forcing doctors to prescribe the least costly drug in any class to patients first, even if the physician wants to begin treatment with a different medication.

2 World Health Organization. http://www.who.int/mediacentre/factsheets/fs369/en/

3 Greenberg, et al.(2003).The economic burden of depression in the United States: How did it change between 1990 and 2000? Journal of Clinical Psychiatry, 64, pp. 1465-1475


Severe Changes to TennCare for July 1, 2014



Below is the news release from Governor Haslam and our elected officials on cuts in services to Medicaid to be effective July 1, 2014. Tennesseans are loosing in every way as the expansion to Medicaid, with the huge funding it brings, is refused by Governor Haslam. I urge readers to use the contact information at the end of the release to inform our representatives and senators of the sufferings that will result by the implementation of Amendment 21.
Thank you, Larry, for bringing the announcement to our attention. [Larry Drain, Legislative Liaison for State Legislative Affairs, DBSA Tennessee]

Notice of Change in TennCare II Demonstration Amendment 21 

The Commissioner of the Tennessee Department of Finance and Administration is providing official notification, pursuant to 42 CFR § 447.205 and 59 Fed. Reg. 49249, of intent to file an amendment to the TennCare II Demonstration, as well as corresponding amendments to the Medicaid State Plan. The amendments will be filed with the Centers for Medicare and Medicaid Services (CMS), a federal agency located in Baltimore, Maryland, with a Regional Office in The State is required to meet certain advance notice obligations whenever an amendment to the TennCare Demonstration is filed. This demonstration amendment, which will be known as “Amendment 21,” is being filed with a proposed effective date of July 1, 2014. The benefits 
listed in this notice are currently supported with non-recurring funds that have been made available through a hospital assessment fee scheduled to expire on June 30, 2014. Should the fee be renewed, the changes contained in Amendment 21 will not occur.

Amendment 21 will eliminate certain currently covered services and establish benefit limits on others. Children under 21 will not be affected by these changes. Eligibility for TennCare will not be affected by these changes. Pregnant women and institutionalized persons will not be affected by proposed benefit limits; however, they will be affected by the elimination of coverage for occupational therapy, speech therapy, and physical therapy.

The specific changes to be made are as follows:
• Implementation of a combined annual limit of 8 days per person for inpatient hospital and inpatient psychiatric hospital services
• Implementation of an annual limit on non-emergency outpatient hospital occasions of 8 per person (an “occasion” is a day)
• Implementation of a combined annual limit on health care practitioners’ office visits of 8 “occasions” per person (an “occasion” is a day)
• Implementation of an annual limit on lab and X-ray services of 8 occasions per person (an “occasion” is a day)
• Elimination of coverage for occupational therapy, speech therapy, and physical therapy

It is our intention to submit this amendment to CMS with the request that it be approved in time for implementation to occur on July 1, 2014. Corresponding State Plan Amendments will be filed, where appropriate. We estimate that implementation of the amendment and corresponding State Plan changes will result in a decrease in aggregate annual expenditures of $302,722,400 in State Fiscal Year 2015. 

Copies of this notice will be available at county health departments in Tennessee, and on the TennCare website located online at http://www.tn.gov/tenncare/.

Written comments may be submitted by email to [email protected] or may be mailed to Mr. Darin Gordon, Director, Bureau of TennCare, 310 Great Circle Road, Nashville, Tennessee 37243. Persons wishing to review copies of written comments received may submit their requests to the same email and/or physical address.

Medicaid expansion? It's simple to answer the question



The question is a simple one. Do you, as a consumer, want more of your fellow consumers to get help or do you want fewer of your fellow consumers to get help? Now, I hope I know what your answer is going to be.

Peacefulness to you . . .

Medicaid expansion and the mental health budget

by hopeworkscommunity

The article below points out some amazing facts about the relationship of medicaid expansion to the mental health budget in many states. It is well worth reading and pondering.

Overall roughly 40% of state mental health budget dollars go towards paying for services for poor people with little or no insurance. In 2009 it amounted to over 16 billion dollars. With mental health parity now the law of the land mental health expenses can only go up. When a state like Tennessee refuses to accept federal dollars for medicaid expansion the only possible result is a growing strain on state mental health budgets that in the end can only hurt an already hurting system. It will be a larger and larger hole with more and more people trapped in it.

In Tennessee we see the developing storm. Let me start by saying I have no inside facts. What follows is my attempt to make sense of things. If anyone wants to share better sense I will gladly listen.

A large portion of the Tennessee state funds for mental health goes to people with little or no insurance. The behavioral health safety net and state psychiatric hospitals are part of the expense but by no means all of it. The money that the state could save in mental health spending will as things stand now not happen.
Mental health parity will drive the costs up in unspecified ways. In the last 8 years we have cut over 165,000 dollars in tax income from state coffers. Not suprisingly when too much demand is tied to too little money someone is going to be left out.

Unless something changes the peer support centers in Tennessee will be eliminated. 4.5 million dollars will be saved. I dont know how you count what will be lost. Perhaps a bandaid will be found and we may escape the choices ahead. I hope so. I fervently hope so.

The savings of mental health dollars that medicaid expansion might give is all I can see that offer the opportunity to build a system that really does work and doesnt have to be refought each year. Let Governor Haslam know what you think.

The Washington Post
(from Easy Browser)


ACTION ALERT: Sen. Murphy Bill


1 Comment


The bill, Helping Families in Mental Health Crisis Act (H.R. 3717), introduced by Rep. Tim Murphy of Pennsylvania, would cut funding for the Protection & Advocacy for Individuals with Mental Illness (PAIMI grant) by 85% and restrict DLAC from engaging in systemic or public policy advocacy.


The bill, in part, is a reaction to testimony at a Congressional hearing in which scant anecdotal information presented in a totally one sided manner portrayed the PAIMI program as part of the problem instead of, as we know it to be, part of the solution.  The implication was that PAIMI programs were using their resources and authority to keep people with mental illness from getting necessary treatment.  We know the opposite to be true – PAIMI programs have been at the forefront of advocating for people with mental illness to receive appropriate treatment ever since President Ronald Reagan signed the PAIMI Act into law in 1986.  Unfortunately, Rep. Murphy, who ironically is a proponent of evidenced based policy making, is ignoring the well documented evidence of 27 years of successful advocacy by PAIMI advocates on behalf of people with mental illness.


Among the many changes contained in its 135 pages, the bill would defund mental health consumer networks, a model in which people with psychiatric disabilities have opportunities to develop independence and personal growth in supportive environments with their peers; deny mental health block grant funding to any state that has not adopted a forced treatment regime (“Assisted Outpatient Treatment,” a euphemism for Involuntary Outpatient Commitment); and amend HIPAA law to make it easier to access the records of people with a mental health diagnosis. This legislation would essentially move the clock back on decades of progress in mental health, promote discrimination and stigma, use coercion and drugs as the blunt instruments of care, silence the advocates and keep people away from seeking the treatment they need.


We are convinced that the only way Rep. Murphy’s misguided bill can succeed is if the people who know the truth about the PAIMI program remain silent.  We need people who have benefitted from the PAIMI program, our allies, and members of DLAC’s Board and advisory councils which have guided our PAIMI program to speak up – to share what they know to be true - that DLAC and the PAIMI programs throughout America have been dedicated and effective advocates for people with mental illness.



We need you to contact the members of Tennessee’s Congressional Delegation (contact information below) and communicate to them the negative impact this legislation would have and urge them not to co-sponsor this legislation.  All you have to do is leave that message with the person that answers the phone. If you want to get into more detail feel free to use the talking points and background information in this email, but the key message is to ask your legislator not to co-sponsor H.R. 3717.


Talking Points


•             Representative Murphy’s legislation (H.R. 3717) will reduce funding for the Protection and Advocacy for Individuals with Mental Illness (PAIMI) program by about 85% leaving individuals with mental illness no independent advocates to help address the myriad of issues they face every day.

•             Representative Murphy’s legislation (H.R. 3717) will make it easier to discriminate against people with mental illness in housing, employment, and education, and lead to fewer individuals receiving the treatment they need.

•             Representative Murphy’s legislation (H.R. 3717) would remove the ability for our agency to fully serve individuals with mental illness. In its 27 year history, the PAIMI program has been highly successful assisting people with mental illness and should continue to have the broadest authority possible to ensure people with disabilities are free from abuse and neglect and receive the services and supports they need.  Contrary to the implication in Rep. Murphy’s bill our PAIMI program, Disability Law & Advocacy Center of Tennessee, has been instrumental in securing appropriate treatment for and ensuring the safety of:

o    Youth with severe mental health issues

o    People with mental illness in jails and prisons

o    People with mental illness residing in the community (board & care homes)


The links are to provide you background information should you want it.


Tennessee House Representatives


Rep. David Roe (TN-1)              

Rep. John  Duncan, Jr. (TN-2)    

Rep. Chuck Fleischmann (TN-3) 

Rep. Scott DesJarlais (TN-4)      

Rep. Jim Cooper (TN-5)             

Rep. Diane Black (TN-6)            

Rep. Marsha Blackburn (TN-7)   

Rep. Stephen Fincher (TN-8)      

Rep. Steve Cohen (TN-9)           


Thanks for reading. If you have any questions, please let us know. Please also feel free to share this email with others in your network.

Francisca Guzman

Media & Development Advisor

Disability Law & Advocacy Center of Tennessee

1 Comment

Mental health care is going in the wrong direction



A big step backward into the future: mental health “reform” Washington style

by hopeworkscommunity

The new mental health reform bill introduced by Rep Murphy provides for the following according to the Treatment Advocacy Center:

" Requires states to have commitment criteria broader than “dangerousness” and to authorize assisted outpatient treatment (AOT) in order to receive Community Mental Health Service Block Grant funds.

Allocates $15 million for a federal AOT block grant program to fund to 50 grants per year for new local AOT programs.

Carves out an exemption in HIPAA (Health Insurance Portability and Accountability Act) allowing a “caregiver” to receive protected health information when a mental health care provider reasonably believes disclosure to the caregiver is necessary to protect the health, safety or welfare of the patient or the safety of another. (The definition of “caregiver” includes immediate family members.)"


What does it mean?

1.  States will be substantially limited in their control over their own mental health policy.  This, in and of itself, represents a radical change of immense implications.  It is a wall once breached that will never be rolled back.

2.  The future direction of mental health policy will basically be in the hands of the Treatment Advocacy Center.  After years and years of failing to get states to follow their policy of coercion first to the degree they want their view would effectively become federal policy.  What they could never win by choice they will win by force.

3.  Much gains in knowledge about what really works and helps people with mental health issues would be rendered unimportant and out of fashion.  The notion of recovery would be given a death blow.

4.  States by federal statute would have to agree to commit more and more people.

5.  Failure to do so would make you ineligible for federal block grants that are the backbone of so many state mental health budgets.

6. Privacy laws would not allow so much privacy.  Confidentiality would have holes big enough to drive a hole through.

And that is only the beginning.  It is a step back into an era of mental health care that was a national disgrace and one in which a diagnosis of mental illness was a life sentence.

Send a Christmas Card to the Governor



hopeworkscommunity posted: "The plan as it currently stands is to
totally and completely eliminate funding for peer support centers in Tennessee.
45 centers will close and the over 3000 people served a month will be left out
in the cold. The post below talks more about the situation"
 Send a Christmas card to Governor Haslam
by  hopeworkscommunity

The plan as it currently stands is to totally and
completely eliminate funding for peer support centers in Tennessee. 45 centers will close and the over 3000 people served a month will be left out in the cold. The post below talks more about the situation.

What I am asking is two  things.

1. Send a christmas card to Gov Haslam. Share your knowledge and
experience with peer support with him. Let him know Tennessee deserves and needs  what peer support centers add to the mental health system in Tennessee. His address is:

The office of Governor Bill Haslam
1st Floor, State Capitol
Nashville,  TN   37243   

His email
address is .

Share this with at least 3 other people. Ask them to share it with at least 3
other people and so on.

This is the time to act. Let Governor Haslam know what you think. Make your card a Christmas gift to Tennessee.

The death of peer support in Tennessee.

There are 45 peer support centers in
Tennessee. Next year if things go as planned there may be none.

The initial recommendation of the commissioner of mental health to the governors  request for a 5% decrease in budget was to recommend that 4.5 million dollars be  taken from the budget for peer support centers. That would leave 0 for next year.

It makes you just want to shake your head. When I heard I emailed a
bunch of people. I thought I had misheard. I knew no one could seriously make such a suggestion. I was wrong.

Peer support centers do two primary things. They save money and they save lives. A lot.

For a few dollars a day per person served peer support centers give a chance at success for people who have never had success. People who have never made it in the community make it. The last figures I saw indicated a 90% decrease in psychiatric hospitalization. The savings from that alone should almost pay for the program. In a time when the jails are filling with the mentally ill how in the world can we shut down one of the most successful community based services we have?? This program defines the notion of “bang for your buck.” How is this in any way a savings?? We lecture our children about thinking before they act and considering the long term consequences of their actions. Shouldnt we expect the same out of ourselves and particularly our political leaders?

But it is more than an economic issue. It is more than a political issue. It is profoundly a moral issue and it is wrong!!!

If it actually sees the light of day it will be the planned abandonment of one of the most vulnerable populations in this state who basically have no where else to turn for this kind of help for a short term financial gain that in the end will cost far more than it saves. In plain terms it will be an act of large cruelty.

I urge you to stand loud and express your opinions. This is an old battle we thought done last year when support for peer support become recurring dollars. Once again we are a political football. Now is the time to end the game.

hopeworkscommunity | November 27, 2013