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May
30, 2006
TIMOTHY’S
LAW DAY AT “THE JOE”
The first, of particular interest to New Yorkers with mental health needs, are Changes to the Medicaid "Wrap-Around" Program for Full Benefit Duals Enrolled in Medicare Part D. In essence, on July 1st of this year, the Medicaid wrap-around benefit authorized by the Legislature for individuals who are now getting medications through a Medicare Part D plan will end, leaving just four categories of medications covered by Medicaid, including anti-depressants and atypical antipsychotics. Medicaid recipients will be able to access drugs in the four categories when 1) the drugs are not covered by a specific Part D plan, 2) when the patient does not meet the plan's utilization management requirements, and 3) when there are quantity limits inconsistent with the prescribed amount. The wrap-around benefit will not be available for early refills, refills for lost or stolen drugs, or extended or vacation supplies. The second concerns the Implementation of the Medicaid Preferred Drug Program, effective June 28, 2006. The first phase of drugs will be subject to the preferred drug program on this date, requiring prior authorization to access drugs not on the preferred list of drugs, and will include the following therapeutic classes: Angiotensin II Receptor Blocking Agents (ARBs), Angiotensin Converting Enzyme (ACE) inhibitors, Beta Blockers, Dihydropyridine Calcium Channel Blockers (CCBs), CCB/ACE inhibitor Combinations, and Bisphosphonates. As additional meeting of the Pharmacy and Therapeutics Committee take place, additional categories of drugs will be placed under the Preferred Drug Program. And, the next meeting of the Pharmacy and Therapeutics Committee is scheduled for June 9th. Among other issues, the Committee will address the Establishment of procedures for newly approved prescription drugs subject to the Preferred Drug Program, which will be used to address newly approved drugs within a therapeutic class subject to the Preferred Drug Program. Additional details on both of these matters is available at http://www.health.state.ny.us/health_care/medicaid/program/update/2006/jun2006.htm. IN THE NEWS: Secret
Sorrow Part 4: Escaping the Silence Editor's Note: This is the fourth in a six-part series. When Karen Padowicz's uncle called her on a December day almost 25 years ago and said her parents were coming to visit, she guessed why. "Roger's dead, isn't he?" she asked. Her older brother, 37-year-old Roger Maune, had hanged himself. It was an act that would shape the rest of Karen's life and career. She now works for the Warren-Washington Association for Mental Health, developing programs on mental health and suicide prevention. But speaking out about her brother's suicide didn't come easily. Her parents arrived at Karen's apartment in Schenectady that night, nodded tearfully, and quickly shuttered their pain behind silence. "No one wants to talk about suicide. That night was like any other night," Karen remembered. "My mother read a magazine. My father read the paper. My sister cooked. I said, 'Don't you think we need to talk about this?' " SPECIAL
BOND "Roger and I had a very unique relationship, like we were spiritual buddies or something," she said. She remembered the "trust game" they played as kids, which involved falling or jumping into her brother's arms without looking. "One day, I jumped out of my second-story bedroom window and he caught me," she said. "I trusted him with my life." Maybe that's why she woke up about 4 a.m. that night in Florida to discover her brother silently climbing over the balcony. "I jumped up and said in this kind of theatrical voice, 'Roger, you can't kill yourself on your parents' balcony! What will the neighbors think?' " Karen remembered. "That was the right thing to say. It brought him back." For the next two hours, Roger was lucid. Their conversation flowed as it had in the old days, and Karen thought everything was going to be OK. "Then it was like a switch turned on inside. He went from coherent to -- just this other place -- so quickly. And I sort of snapped, too, because it destroyed my optimism," she said. They fought, and Roger left the room. As he walked out the door, he turned to Karen and said: "Just remember, go toward the light." That was the last time she saw him. A
SENSITIVE SOUL "He and his friends were the kind of people I always wanted to be -- curious, interesting, passionate people. They were people who really lived," said Karen. In the late '60s, Roger was a striking young man. He was about 6 feet tall, with a Roman nose, big blue eyes and a reddish-blond beard. "He was such a pretty boy," said his younger sister, Lorraine Dejohn. "Damn it, he had the longest eyelashes, and that wavy hair -- oh my gosh!" In Karen's childish imagination, he resembled a young Einstein, and she considered Roger just as brilliant. "I called him the dictionary. Any questions I had, he just knew the answers to," she remembered. He was the artistic, "Beatnik" type who wrote poetry and listened to jazz. He sang beautifully, played several instruments, and loved to act. His intensely sensitive nature proved both a gift and a burden. "Once, he told me: 'Carrie, Carrie, do you know trees cry when you cut them?' I would crumble if I felt the things he felt," Karen reflected. "I mean, how do you live with that depth of feeling?" He didn't know. A
BLACK AURA For the next decade, he became increasingly convinced he was evil. "He was so totally sure that he had a 'black aura' that was harming people," Lorraine said. "He didn't want anyone near him." At the height of his paranoia, he would only talk to Karen from around the corners of rooms, fearing that his inner darkness was contagious. Soon, he moved away to Syracuse. He and Karen communicated through letters, but for a long time, she didn't understand the depth of his problems. "All I saw was this beautiful human being," she said. His parents and siblings tried to help him, but they rarely shared their struggles with each other. Stoic self-reliance was considered the best way to handle problems in the Maune family. Years later, Karen discovered that her family had a history of mental illness on both sides: a great-aunt and grandmother who went in and out of institutions after "nervous breakdowns"; a great-uncle who hanged himself; a cousin with bipolar disorder; another cousin whose teenage child committed suicide. She also found out that when her parents had picked Roger up at the hospital after his first breakdown, psychiatrists had warned them he was at risk of committing suicide. "If I had known that then, it would have shaped the decisions I made after, no doubt about it," said Karen. THE
BURDEN OF CARE Karen moved to Syracuse to care for him when he got out of the hospital, and discovered that he had been sleeping in his car in front of his apartment. "When I got there, I realized the extent of his illness," she said. Not long after that, he decided to stop taking his medication. Eventually, Karen's emotional resources were so exhausted by caring for Roger that her physical health was in jeopardy. She turned to her sister for help. Lorraine, divorced and living alone at that point, took Roger into her home. She talked to him over coffee and cigarettes at the kitchen table, night after night. She would have hugged him, but he wouldn't let her come close. A cloud of despair had enveloped him, and it was impossible to penetrate with words. "I talked to my brother until I was blue in the face, but I just couldn't help him," Lorraine said. "Now, he didn't say he was going to kill himself. He didn't go out looking for someone with a gun to kill him. But he kept talking about this black aura, and I couldn't get him to go to a doctor or sign up for unemployment. ... He didn't seem to feel he was worth the effort." After 10 months, Lorraine couldn't take it anymore. "He was driving me crazy -- and I'm not crazy," she said. In October, she sent him to live with their parents, who had just moved to Florida. SILENCE His body was cremated immediately, but it wasn't until almost a year later that his ashes were scattered on the land of a close friend. There was no funeral; no grave to visit. "When you don't have that, it haunts you," Karen said. "There's no sense of closure." She held out a small red jewelry box, lined with a yellowing square of cotton. "This is all I have left of my brother," she said, pointing at a few pebble-sized white fragments she snatched from the scattered ashes. She is creating a memorial stone in her backyard, to honor Roger and their father, who died of cancer three years ago. "My mother and father both had cancer twice, and I honestly believe it's because they held that grief inside," Karen said. "You know that Simon and Garfunkel song, 'Silence like a cancer grows?' It's really true." Her mother is still alive, but refused to be interviewed. "For my mother, the chapter is closed. It hurts too much," explained Lorraine. "She did say that losing a child should never happen to a parent." For both Lorraine and Karen, talking about their brother's death has been a form of healing. "I think this is important, so people can see how suicide affects not only the person who has taken their own life, but how it affects the whole family," said Lorraine. "I'm not stigmatized by it. My friends know that Roger committed suicide. It was horrible, terrible -- and I think it was preventable, but I didn't know what to do about it. I hope this helps other people." FEELING
THE PULL "I just did not care," she said. "My behaviors at the time were death-driven and death-seeking." As she lay on her couch in a stupor one Sunday, she began to lose feeling in her limbs. She was overwhelmed with a sense that she was dying. Then a thought came to her: "I think you're going into a diabetic coma. Eat some oranges." She did, and as her body revived, so did her mental clarity. "You could say that Roger reached out to me," she said. "I realized that he would never want this to happen." She said family members left behind by suicide often feel pulled toward self-destruction. "When someone chooses death, it's so contrary to the survival instinct that you think there must be something inside them that's broken," she said. "I began to see it as an inevitability that I would break, too -- so I almost sought it out." In the years that followed, she tried to bury her grief by becoming a workaholic, and has only recently begun to confront her emotions about Roger's suicide. "I remember thinking: Karen, if you focus on this, you may go totally insane," she said. "Working kept my mind on other things." Karen ended up at Warren Washington Association for Mental Health about eight years ago. She calls the mental health field "my professional swan song," the natural endpoint of the painful journey that Roger's death prompted in her personal life. Her goal is to reduce the public stigma surrounding mental health disorders, and get a message across to those struggling with them. "People need to seek treatment," she said. "We know more now, and treatment can be highly successful. You don't need to suffer the way people suffered in the past. There's help." She also offers a warning to those grappling with the grief of a loved one's suicide. "A lot of people seem to think that if you just ignore or deny something painful, it will go away -- but it doesn't," she said. "It becomes like a lead ball inside of you that grows thicker with each passing year, and makes it harder to access your core emotions. I still can't cry." She finds release in words, if not tears. "I love being able to talk about my brother -- to honor him; feel him again," she said. "I haven't been able to do that before." Roger is gone, but Karen feels that he left her with a gift. "He left me with this knowledge that people can get to a point where it becomes black and white: Do you want to die or live?" she said. "And once you realize that you want to live, it's a very powerful feeling."
Doing
More Than Their Times. By John
Q. LaFond and Bruce J. Winick The New York Legislature is debating whether to approve a sex offender civil commitment law. The law would allow the attorney general to confine sex offenders in secure hospitals indefinitely after they have served their prison sentences. This is a bad idea. More than a dozen states have tried this novel strategy for preventing sexual recidivism. Their experiences clearly show that these laws waste taxpayer dollars and embroil state agencies in endless litigation. Instead of warehousing a small percentage of sex offenders, states should use the money on cost-effective strategies like community supervision combined with mandatory treatment that would reach many more released convicts. These commitment laws, including the proposed New York statute, have vague and expansive definitions, allowing for the confinement even of convicted sex offenders who are not mentally disturbed or dangerous. Every state that has put these laws into effect has committed far more and released far fewer sex offenders than expected. As a result, these states are paying for ever growing numbers of patients in costly hospitals, many of them elderly men who require expensive medical care. By December 2004, 3,493 men had been confined nationwide under these laws; only 427 had been given conditional release (most of them) or final discharge. This has led to unexpected costs for state governments: Minnesota, for instance, initially expected to cap its population at 350. In January, however, Gov. Tim Pawlenty proposed borrowing $44.6 million to build another locked residential building for this population, this one with 400 beds. The Constitution requires that civilly committed patients must receive treatment for their mental disorders. And while treating sex offenders in secure hospitals is extraordinarily expensive — about $100,000 per person a year, not including the costs of construction and legal fees for the inevitable lawsuits — conditional release programs add even more expense. By December 2004, Washington State, which was one of the first states to enact this new commitment law, had about 220 hospitalized offenders and was spending about $105,665 per person per year. Experts say that a civil commitment program will cost New York $250,000 an offender for a single year. Simply put, states with these laws are spending an enormous amount of money confining relatively few sex offenders, while releasing many dangerous sex offenders back into the community with inadequate control. The impetus for civil commitment laws, of course, is the fear that freed sex offenders will assault again. But the data on sex-offender recidivism is unclear. For instance, a Justice Department study of 9,700 sex offenders released from prison nationwide in 1994 found that their overall re-arrest rate was much lower than that of other released convicts. Most experts, however, say that like sex crimes in general, sex-offender recidivism is vastly underreported. Still, the available evidence shows that sex offenders have a reoffense rate lower than all other serious criminals except murderers. What's worse is that once these civil commitment laws are enacted, they're almost never repealed or reconsidered. If New York is foolish enough to go down this path, then its law should allow some sex offenders to be initially treated and supervised in community-based centers rather than sent to prison-like hospitals. Having community-based treatment centers, which are usually less expensive than hospitals, will also ensure that an effective and safe discharge system is available for offenders sent to hospitals. Research shows that treatment can reduce sexual recidivism. And offering treatment in prison to sex offenders soon after conviction is far more effective than delaying treatment until the end of their prison terms. Delay allows sex offenders to rationalize and minimize their crimes and to avoid confronting their harmful attitudes and behavior. The possibility of post-prison commitment could critically impair prison treatment because inmates will fear that anything they disclose to therapists in prison will be used to confine them under these new commitment laws. Most sex offenders will return to the community, including a relatively small group readily identifiable as dangerous. The scarce resources squandered on committing a few sex offenders indefinitely would be better spent aggressively managing these high-risk offenders in the community after their release from prison. Intensive supervision by specially trained parole officers with light case loads, combined with mandatory treatment, periodic polygraph testing and real-time tracking through global positioning systems can reduce sexual recidivism. Sex offender management courts can enhance effectiveness by adding judicial participation and oversight. Everyone agrees that we have a moral obligation to prevent as many sex crimes as possible with the resources available. Only a public policy based on sound research can accomplish this important goal. John Q. La Fond, a former professor of law at the University of Missouri, Kansas City, is the author of "Preventing Sexual Violence: How Society Should Cope with Sex Offenders." Bruce J. Winick is a professor at the University of Miami School of Law.
Every day, millions of Americans are screened and treated for heart disease, cancer or diabetes by primary care professionals, but most go home without being screened for a mental illness. This is unfortunate, because more people suffer from mental illnesses than from the three other diseases combined. While mental illnesses can be as debilitating and life-threatening as many physical illnesses, research shows that fewer than half of the 54 million Americans who have a mental illness seek treatment. May is National Mental Health Month, and communities across the country are commemorating the occasion by raising awareness and encouraging Americans to learn more about mental health issues. While these events show how much we have improved understanding and reduced stigma, there are still many misconceptions about mental health that prevent people from seeking help or discussing the issue openly with friends and family. For more than three decades I have advocated on behalf of people who have mental illnesses, and I have gained hope as society became more educated and accepting. But as we learn more about how the brain works and develop more effective treatments, it grieves me that millions of Americans and their families still suffer in silence. It is even more disconcerting that in a time when we know the very most about how to help people, we maintain policies that prohibit many from getting access to services. Because insurers fear that their costs will increase, mental health treatment is not covered by insurance at a level comparable to other illnesses. Many states and the federal government have not legislated protections against this discrimination, although federal employees do enjoy such parity. Recently, the New England Journal of Medicine published the results of a study titled ``Behavioral Health Insurance Parity for Federal Employees,'' which revealed that when parity in insurance benefits for behavioral health care is coupled with management of care, insurance protection can be improved without increasing total costs. It is time to stop throwing up barriers to mental health care needed by so many Americans. It is encouraging that numerous federal and state laws protect Americans with mental illnesses and disabilities against discrimination at work and in their communities just as they do people with other illnesses and disabilities. These protections must be maintained and expanded. No one suffering from a mental disorder should feel alone or ashamed. One in five Americans has a mental illness, and millions more experience mental health challenges as they deal with grief, stress and the everyday struggles of life. Mental illnesses skip across socioeconomic boundaries, afflicting young and old alike in every community, ethnic group and income category. The World Health Organization reports that depression is among the leading causes of disability worldwide. It estimates that reduced productivity and missed work days due to depression cost the U.S. economy about $44 billion a year. Symptoms of mental illnesses can vary widely based on the disorder and individual responses. People experience mental health challenges in their own way. Because of this and the fear many people have about admitting their symptoms, it can be difficult to spot early signs. But if you find you have lost interest in things or activities that were once important to you, or a loved one seems to be behaving out of character, you should seek guidance from a medical professional. Mental illnesses are serious matters and can lead to disability, suicide and other life-threatening actions. Many people think nothing can be done to treat the more severe illnesses, but major advancements in medicine and community-based rehabilitation have prompted the development of several new and effective treatment options. Studies show that treatments for depression -- which affects more than 19 million Americans -- are effective in nearly 80 percent of those seeking care. It is unfortunate, then, that only half of those with this disorder seek treatment. All of us should be concerned and should pledge to increase mental health awareness until the stigma vanishes and mental illnesses are viewed simply as illnesses like any other. Hopefully, the time will come soon when the millions of our fellow citizens who need help seek it and receive effective treatments that place them on the path to recovery. ROSALYNN CARTER is a former first lady who continues today her work to combat the stigma against mental illness through the Carter Center's Mental Health Program.
New York City police are getting professional help in dealing with 911 calls involving the mentally ill. LifeNet, a $2 million program run by the Mental Health Association of New York City using city funds, enables police officers or ambulance crews to call for intervention from paid mental health workers. Officers are also routinely giving cards with LifeNet’s number to family members of emotionally disturbed patients. The aim is to get callers appropriate services and to reduce ED visits. Call volume reached 6,000 last month; 98% of the callers used a card given them by an officer, a spokeswoman for MHANYC says. The police also contacted LifeNet directly 600 times to get assistance at the scene of 911 calls.
Regarding "Time for parity for mentally ill" [Editorial, May 19]: Most people don't know that there is a separate and very unequal category of insurance coverage for mental health until they find it out the hard way - at the emergency room. There, they learn to their horror about the severe limitations on hospital stays and outpatient visits as well as inequitable co-pays and deductibles embedded in the fine print of their health insurance policies. This discovery, made by hundreds of thousands of New Yorkers every year, often triggers a downward financial spiral as families struggle to pay for the care their loved ones desperately need, forcing some to take out large loans, sell their houses and, most tragically, give up custody of their children to the state to get the needed care. State senators in Nassau continue to turn a deaf ear to the pain of their constituents, listening only to misinformed small business lobbyists arguing that parity will drive them out of business. What they fail to factor in is the cost of not passing Timothy's Law. Alleviating the cost of low productivity, tardiness, absenteeism and turnover caused by untreated or undertreated mental health and addictive disorders would more than compensate for the additional modest $15 a month increase in insurance premiums you estimate in your editorial. Above all, the cost in human suffering is too great to continue to ignore the one out of four people struggling with some of the most disabling of all known illnesses. Editor's note: The writer is Queens-Nassau president of the National Alliance on Mental Illness. |
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