Stigma toward those living with mental illness robs them of their voices. A verse in the Bible calls on us to support one another, especially those compromised by health and welfare issues. And our showing kindness cost nothing.
bp Hope Sept 2014
Demi Lovato & Bipolar: Stronger Than Ever! This platinum-selling recording artist is on a mission to spread her message of hope: We can get through dark times and find our strength!
By Rachel Rabkin Peachman
Platinum-selling recording artist Demi Lovato is a pro at performing in large concert venues. But on a Saturday afternoon just days before her 22nd birthday, Lovato took time away from her performing schedule to step onto a much smaller stage—with no backup band in sight. In an intimate lecture hall at Kean University in New Jersey, she spoke candidly to an enthralled audience about how she faced up to mental health challenges and lives well in recovery.
The appearance was part of The Mental Health Listening & Engagement Tour supported by Sunovion Pharmaceuticals Inc..
“It has become my personal mission to share with others that there is life on the other side of the dark times, and that they are not alone,” Lovato told bp Magazine afterward.
That’s a bit of a switch-up for the multitalented entertainer, whose early life was focused around her love of music and performing. Raised in Texas, she was acting and singing professionally by age 10. Her résumé as an adolescent includes Disney movies, her own Disney TV series, and two successful studio albums.
She achieved all that professional success even as she struggled to cope with emotional distress. Her inner pain found an outlet in eating disorders, substance abuse, and self-harm. As is true for many people, it took Lovato some time and setbacks before she fully committed to do whatever it took to get better.
So many of my fans have also experienced hardship … I think they appreciate my willingness to open up and put it all out there.
“There is so much shame and misunderstanding associated with mental illness,” Lovato reflected. “Along with that comes fear. I know that fear kept me from getting help.”
It wasn’t until Lovato had what she calls a “mental breakdown” in October 2010 that she went into treatment at a rehab facility. That’s when the underlying brain-based illness was diagnosed.
“When I finally got diagnosed with bipolar disorder, it was a relief in so many ways. It helped me start to make sense of my bipolar depression and the harmful things I was doing to cope with what I was experiencing.”
With a maturity that’s notable in a young adult, Lovato buckled down to get sober, find the right treatment plan, and adopt habits that help her maintain her wellness. She’s also turned her efforts outward, becoming an advocate for people affected by mental health conditions and substance abuse. (Lovato has a track record of public engagement, lending her support to causes like marriage equality, anti-bullying efforts, and civic involvement by Latino voters and young people.)
Lovato shared the early days of her recovery in an MTV documentary called Stay Strong, and published an inspirational best seller, Staying Strong: 365 Days a Year, all in an effort to save others from some of the pain she’s experienced.
“Imagine the hope we can give back to people by creating widespread support and showing the world that it’s possible to get through the darkest times and end up in a place of strength,” she said.
Lovato is proof positive that it’s possible to thrive with the right support and commitment.
“Since receiving help, I have been able to accomplish so much personally and professionally,” Lovato said.
In addition to holding her own as a judge alongside Simon Cowell for two seasons of The X Factor, she scored a recurring role on the popular series Glee. She released two more hit studio albums—the R&B-flavored Unbroken and Demi, an electro-pop compilation that made the charts overseas as well as in North America.
Top singles from those albums include “Really Don’t Care,” “Neon Lights,” “Heart Attack,” “Skyscraper” (which won the “best video with a message” award from MTV), and “Give Your Heart a Break.” Lovato is also known for the pop version of “Let it Go,” the belt-it-out anthem from the animated movie Frozen.
After wrapping up her second North American tour of the year this fall, Lovato is heading to the United Kingdom to tour with Enrique Iglesias.
Lovato’s music helps her process what she’s been through. On the resonant track “Warrior,” from Demi, Lovato sings, “And now I’m a warrior, I’m stronger than I’ve ever been … I’m a survivor in more ways than you know.”
Her devoted fans, known as Lovatics, do know—and Lovato welcomes their support.
“My fans are amazing. So many of my fans have also experienced hardship in their lives and I think they appreciate my willingness to open up and put it all out there,” Lovato told bp.
At her talk in New Jersey, that was clear. Alysa Bainbridge traveled from Leesport, Pennsylvania, to hear Lovato speak about bipolar disorder. The illness runs in Bainbridge’s family, and she admires Lovato’s courage to come out into the open despite stigma.
“That’s what I love most about her. She’s not afraid,” said Bainbridge. “She wants to make a difference by telling her story instead of hiding it, because she knows that it will help people.”
In that lecture hall at Kean University, Lovato shared her story with poise, down-to-earth humor, and a touch of sass. She took the stage wearing a black lace top and skirt. Her dark hair—which, in the past, has been shaved, blonde, and blue—was swept away from her face gracefully, with just a hint of blonde highlights glistening along the bottom.
Her appearance was part of the annual conference of New Jersey’s Depression and Bipolar Support Alliance. She chatted onstage with Allen Doederlein, national president of DBSA, for nearly an hour.
Here are highlights from their conversation, edited for clarity and length.
Q: What made you realize that you needed help?A: It took a mental breakdown for me to realize that I needed to go into treatment. I had tried many, many times to get help on my own, whether it was through a life coach, or through justmedication and not doing anything else to change my behaviors. And it never worked because I never combined all the things that I needed to do in order to live a happy and healthy life.
Rock bottom looks different for everybody. It doesn’t necessarily mean you have to end up in a psych ward or a sober living house to get the help that you need. It could be a moment of clarity in the car while you’re driving where you’re just sick and tired of being sick and tired.
I think that rock bottom for me was several things put together. What it took was a final intervention when my support group—my family, my management, my lawyers—said, ‘If you don’t get sober, we’re dropping you.’ My parents were there and they said, ‘If you don’t get sober, we can’t have you around your little sister. We’ll move back to Texas.’ That was a moment when I realized it was serious. It had been embedded in my mind from a very young age that I was never meant to be happy. And in fact, I thought it was a part of my “artistry” [using air quotes]. That’s what made me deep and artistic, just like Kurt Cobain and other troubled musicians and artists. I realized my illness shouldn’t stop me from being happy. And it shouldn’t define who I am as a person or an artist.
Q: You’ve mentioned self-harm, you mentioned self-medicating with drugs and alcohol, eating disorders, and then you’ve been brave and unique, frankly, in talking about bipolar disorder. Does that have a component that makes you feel vulnerable?A: Absolutely. First off, I see all of those issues as coping mechanisms for my manic [and] depressive states. But still, today when we talk about [bipolar], there’s a stigma around it that people don’t realize. For some reason, it’s a lot easier for people to talk about being bullied, or other types of mental illnesses, or addiction issues. It’s easier for people to say, ‘I’m an alcoholic’—even though that’s so difficult in the first place … But every time that I’ve ever talked about bipolar disorder—and even right now—a tiny part of me is still a bit uncomfortable because it makes me vulnerable sitting here and explaining to you that there’s something chemically wrong in my brain. And just because there is, it doesn’t mean that I’m crazy.
Since receiving help, I have been able to accomplish so much personally and professionally.
I am a normal human being with problems like everyone else. My “diabetes” happens to be my mental illness. And when I work out, when I take my therapy, when I take my medications, for me, that’s my treatment plan, that’s my insulin.
Q: After coming out of treatment, how did you keep your momentum?A: The way that I kept my momentum was always knowing in the back of my mind that I could lose the relationship with my family at any moment. It was also losing the ability to be able to perform onstage because I knew I could tarnish my career and my reputation. A habit of mine was self-sabotaging everything from relationships to progress. In order to break that pattern, I had to have a support team around me that really was honest with me, that told me what I needed to hear when I didn’t want to hear it. And for me, it was [committing to] sober living. Completely surrendering. The night of that intervention, in order to show them that I was going to fully surrender, I handed over my cell phone, handed over my credit cards, handed over my car keys. And I had a sober companion—which is someone who is with you 24/7—for over a year. Those were the measures that I needed to take in order to keep myself alive.
We’re not about surviving. We’re about thriving.
What people were seeing on the outside was a young Hollywood/Disney pop star. And I was really good at faking it, which is something I think a lot of people can relate to. In our society today, if you show any type of emotion, you’re considered weak. But I think that you actually show strength when you ask for help. It shows that you have some confidence in knowing who you are and saying, ‘It’s okay, I know I need help.’ Anybody who’s really good at faking it, I feel your pain, but I also encourage you to take contrary action.
Q: What do you mean by that?A: Contrary action is doing things for yourself when you don’t want to do it. For me, it’s working out when I’d rather watch [tv] shows. Or it’s going to an AA meeting when I don’t want to because I’m tired or it’s my day off. When I don’t [take contrary action], I feel it the very next day, if not later that day, especially with my medication. And I have to realize that every single thing in my life has to come together in order to form the right treatment plan for me.
Q: The right treatment plan can be hard-won. What does that treatment plan look like for you?A: I think [finding the right treatment plan] is a difficult journey and an emotional roller coaster. I also believe that it’s one that people are discouraged to take on because it takes, on average, about 10 years for someone with bipolar disorder to get accurately diagnosed. And I can relate to that because I knew there was something wrong [for years], and I was never told what it was until the day that I went into treatment.
But the right treatment plan is a combination of things. It’s seeing what works for you, seeing which doctors work for you, and it takes a while to process. But don’t give up. For me, my body had to adjust to certain medications and I didn’t know if they were going to work or not. It was a matter of me trying not to give up right away, to let my body adjust to them. And for so long I wasn’t consistent. Acceptance and consistency is my recovery.
Q: It’s so simple but it’s also so powerful.A: It’s complicated to make things simple and simple to make things complicated.
Q: The thought of knowing all of this when you are 21—the idea of knowing it when you’re 40, when you’re 50, when you’re 70—is impressive.A: Regardless of if I was 21 or 65 or 18, it is a blessing to know that I can get help. It is a blessing to know that there is hope. And sometimes it takes people 50, 60 years to have that moment of clarity and that ability to change—to have a spiritual experience or to finally hit rock bottom. I’ve lived a lot of life very fast at a very young age, and that put me in treatment at 18 rather than 45. Mental illness doesn’t discriminate based on age, gender, race, background, or ethnicity.
Q: I’m struck by how different this moment is than a lot of mental health conversations. The age of the front two rows [cheering young fans], and the exuberance and fun. That is what you, Demi, are bringing to the mental health community. Because we’re not just about surviving.A: We’re not about surviving. We’re about thriving. [Lovato waves her arm over her head and punctuates it with a dramatic snap of her fingers.] That really deserved a snap.
Q: I feel so encouraged that you’re taking this on.A: I’m excited about everyone here today. Because I truly believe that our future generation is going to consist of people who don’t have this negative stigma attached to mental illness. A while ago, people who were bullied were ashamed. But when people started speaking out, it became a conversation. People really started hearing—and I think that a lot of that was because our generation has an influence on people.
Another reason why I’m able to sit here and talk about mental health today is because I don’t take myself too seriously. I realize that when I speak about it, I don’t want it to be as heavy as it is. It is a very serious disease. And it ends up deadly. But I feel when you’re able to be authentic, honest, and find even the humor in it, it takes a little bit of the stigma away.
Q: And what we’re creating—mental health.A: Everybody in this room is helping to create it, no matter how old, who you are, or what species you are [referring to the therapy dog in the room]. It doesn’t matter as long as we’re talking about it. The more educated we become, the more aware people are of how serious this is, but also how common it is, and that it’s okay.
* * * * *
Demi in your cornerDemi Lovato, personal coach? That’s the feeling that comes through the pages of Staying Strong: 365 Days a Year (Feiwel & Friends, 2013), her book of affirmations and motivational advice.
Shortly after its release in November, the book entered the New York Times best seller list for advice books at No. 1.
The self-help volume is set up to be consulted daily. Each entry offers an inspirational quote, meditation, or lesson that Lovato found helpful in her own recovery journey, plus a goal to encourage the reader’s progress toward wellness.
For example, January 1 explains how Lovato created a meaningful, personal affirmation (“You are beautifully and wonderfully made”) and includes this invitation: “In this New Year, come up with a mantra that is just yours. Each day, look in the mirror and repeat it back to yourself.”
In her introduction, Lovato notes that “it’s important to have something that will motivate, inspire, and help us stay positive and keep moving forward.” Mission accomplished.
The Mental Health Listening & Engagement Tour Connects Demi Lovato with Mental Health Advocacy CommunityThe Mental Health Listening & Engagement Tour is a new kind of tour for Demi Lovato, a platinum-selling recording artist living with bipolar disorder. To support the mental health community’s vision of building a new generation of inspiring, informed mental health advocates, Demi is participating in a series of discussions with some of the nation’s leading advocates on the challenges currently facing the community. She is also candidly sharing her experience at advocacy events, encouraging and inspiring others with her own story of resilience and learning to live well with mental illness.
The Mental Health Listening & Engagement Tour is supported by Sunovion Pharmaceuticals Inc. as part of the company’s ongoing commitment to making a meaningful difference in the lives of individuals and families affected by mental illness.
In addition to her appearance at Depression and Bipolar Support Alliance New Jersey’s annual conference (where she posed with DBSA national president Allen Doederlein—above), tour stops include The Jed Foundation’s annual gala in New York City; the National Alliance on Mental Illness national convention in Washington, DC; and Mental Health America’s annual conference in Atlanta.
26 Little Signs You are getting over Depression
~ Thank you to themighty.com
To get a sense of how people with depression knew they were starting to feel better, we asked our mental health community to share little ways they knew they were recovering from depression.
Here’s what they shared with us:
1. “When I can wake up and get ready for the day. I shower, cook, clean up the house and just face the day like a ‘normal’ person…” — Amanda T.
2. “When I start cooking my own food again instead of wasting money on fast food. When I start showering and brushing my teeth on a more normal basis. When I start to laugh with meaning again. When my hobbies become enjoyable again. When I can get myself to work on time. When I sing. When I cuddle my significant other to enjoy his presence, not just to try and feel better. When I start enjoying the little things again, like a full moon or beautiful sunset.” — Stephanie F.
3. “Laughing, really laughing and realizing in that moment you are actually happy, and you forget everything else for those few seconds and relish in the moment because it’s been so long.” — Rebecca M.
4. “When I can start reading again. My concentration and focus improves.” — Sharyn H.
5. “It’s little things for me, and it usually happens without me noticing. Caring about what I put on in the morning, wanting to cook dinner, remembering and wanting to watch my favorite TV shows, actually laughing instead of saying ‘that’s funny.’ I’ll catch myself making the bed or washing my face in the morning and realize I am actually feeling better.” — Nichole H.
6. “When I no longer go to bed praying I don’t wake up and instead go to bed smiling because I feel worthy of life and happiness.” — Megan E.
7. “When my eyes get the life back into them. (When I smile with my eyes.) Becoming productive again. Spending less time in my room.” — Amanda A.
8. “When I start doing the things I love, no matter how skilled or unskilled I am: singing passionately; dancing as though my life depended on it; baking while licking the batter off the mixing spoons; and even laughing, and going outside, taking in just how beautiful the world can be outside of my windows.” — Ashley H.
9. “When I start noticing the beauty in the sunrise, how the clouds have different colors, actually seeing the leaves on the trees instead of them just being there. When I get motivation and energy to do stuff like housework, socializing, taking a walk. When I manage to enjoy a cup of coffee, not just drinking it to kickstart my level of energy.” — Rita O.
10. “Either of these, which will seem like the easiest things in the world for some people. 1. When I find I still can and do find things funny. 2. Getting up without feeling I’m about to explode from the pressure in my head or the need to immediately get back under the safety of the duvet.” — Louise F.
11. “I become more present during the day. Instead of feeling like I am just going through the motions, I begin to feel like life isn’t a hassle. To sum it up I look forward to my days and getting out of bed.” — Anjelica M.
12. “When I’m able to look past the present. When I am able to make future plans and further be excited about them. When I can see myself accomplishing more.” — Caroline S.
13. “When I feel like I can support those around me, like my husband and my mom. Like I can carry them on my shoulders rather than being crushed by the weight.” — Emily M.
14. “The days I accomplish something — anything — that’s when I feel like, ‘I can do this.’ After a year-long battle and months of therapy, I surprised myself when I not only played music but sang along! I imagine the true sign of getting better is when I can read, clean house daily, shower more than once or twice per week, and make a real meal more than once per week. It’s amazing how much of your life depression affects that others simply see as ‘normal.'” — Jazmyne F.
15. “Wanting to take care of myself. Simple things like taking a shower, brushing my hair, even putting make up on. Not because I have to but because I want to.” — Andrea B.
16. “When I actually try and make plans with the few friends I have left. Or I finally do household things I’ve been putting off for over a month because I don’t have the energy to get out of bed.” — Alexis M.
17. “I feel lighter. Like something has been lifted off my shoulders. I feel a warm burst of sunshine in my chest. I also feel relief.” — Sarah V.
18. “I start singing again, just humming while walking or doing things. I stop singing completely when depressed. First sign of light at the end of that dark tunnel is music back in my head and heart.” — Gaia F.
19. “When my sense of taste and smell improves and I can have lights on in the evening. (I normally live in the dark.)” — Julian N.
20. “When you can eat a meal willingly without your stomach feeling like there is a weight inside of it.” — Ashley B.
21. “Leaving the house to do things because I want to and not because I’m obligated.” — Alyse W.
22. “Singing in the car.” — Lucy D.
23. “When I wake up and don’t feel like I want to cry anymore.” — Adam B.
24. “When I no longer get angry at everything and everyone.” — Ceri C.
25. “I don’t have to force myself to smile.” — Hailie H.
26. “Colors get a little more vivid, and the world looks a little less hopeless.” — Michaela R
Choose life. When in doubt, when you are not sure... When there is a question choose life.
The question of Insure Tennessee is a question of whether or not we will choose life. It is not a question of a better way to choose life. It is not a question of not this but that. As more and more stories pour in it is obvious. For thousands of Tennessean it is increasingly each day a question of life or death... a question of life or needless and preventable suffering... a future of hope or one bound by despair. It is not about finding an answer. It is about the common sense and political will to grab the one (the only one) in front of us and stop the unnecessary misery that defines the lives of so many vulnerable Tennesseans.
Chattanooga voted last night to choose life. Their city council voted overwhelmingly in favor of a resolution supporting Insure Tennessee. They joined a growing movement of cities and towns saying they support their neighbors, their friends, their families. No one should have to unnecessarily suffer or suffer as a direct result of governmental policy. Insure Tennessee.
The movement is growing. Thanks to the leadership of people like Pam Weston in East Tennessee and Meryl and Randall Rice in West Tennessee and the stories and words of more and more Tennesseans the movement is growing. It is the growing crescendo of more and more ordinary Tennesseans saying "CHOOSE LIFE!!!!!"
Imagine a flood, a hurricane in Tennessee. The waters are rising.. People are dying.... Many are on top of their houses waiting for a miracle.. a boat... a something... someone who cares.... hope. The government has boats. But they decide to wait. "Let's make sure this is a good idea..."
The waters still rise. For some it is too late. For others it will soon be too late. Action matters. The hurricane is here for thousands of Tennesseans. And they are on top of their houses waiting.
Join the movement to choose life. Talk to your local government. Ask them to join Chattanooga and the other towns and counties that have acted.
Today. Today please choose life.
Larry Drain ~
Thanks to BP magazine for shining a bright light on a dark topic. I am glad to be a part of a support group that helps prevent suicide. For over 13 years our group has served the Jackson, Tn. community faithfully. "Thank you" to , A Better Tomorrow inspirational support group.
TAKING SUICIDE PREVENTION UPSTREAM
Across the country, school districts are providing mental health awareness and suicide prevention training for teachers and school personnel. Some are mandated or encouraged to do so by state law, others are motivated by recent incidents, and some introduce this kind of education because suicide is now the second-leading cause of death among youth aged 15-24.
Teacher and parent training are key components in any plan to address teen suicide. Increasingly, however, communities are recognizing that kids need to learn about mental health, too. Social and emotional learning across the lifespan reduces risk factors and promotes protection factors for violence, substance abuse, negative health outcomes, and suicide. One way to provide universal student training is by including a mental health component in the standard wellness or health curriculum. School districts and individual schools can implement individual, more targeted programs as well.
Knowing how to cope and developing resilience are at the core of mental health awareness and suicide prevention efforts being implemented in Massachusetts with children as young as elementary school. The Commonwealth of Massachusetts places a high value on suicide prevention, with dedicated line-item funding in the state budget for the Department of Public Health Suicide Prevention Program. With support from state officials, the DPH has launched suicide prevention programs across the state and for people across the lifespan.
Some of the skill-building and suicide prevention programs in Massachusetts schools are
There are dozens of programs that schools can use to promote skills development while fostering students’ mental health and their willingness to seek and accept help for mental health concerns. SAMHSA’s National Registry of Evidence-based Programs and Practices and the Suicide Prevention Resource Center Best Practices Registry include searchable descriptions for a wide variety of educational programs. For high school students, the SAMHSA Preventing Suicide: A Toolkit for High Schools has a comprehensive list of programs, but a search of the NREPP and BPR may yield programs added since the Toolkit was published.
What can you do? Find out how your school district handles mental health training and emotional skill building for students. If there is not currently a program and there is no interest from school officials, you might work with the parent-teacher organization, local mental health groups, and the local board of public health to raise awareness of the issue, then advocate for implementation of one or more programs. There may be grants available to cover the cost of training or there may be organizations in your community that would help subsidize the program.
The bottom line is that suicide prevention requires a comprehensive approach. It’s never too early to start and everyone – families, schools, communities, and peers that create supportive environments; individuals who learn and leverage positive coping skills; and mental and public health systems that treat and prevent risk factors – plays a part.
Editor’s Note: The Families for Depression Awareness Teen Depression Webinaris an accessible, free resource for training parents, teachers, and others who work with youth to recognize depression, talk about depression with parents and youth, and know what to do to help a young person struggling with depression. Register for the Teen Depression Webinar live with Dr. Michael Tsappis on September 30.
Thanks to the MA Department of Public Health Suicide Prevention Program and the Suicide Prevention Resource Center for their support in developing this post.
Thank you, Larry Drain, for making us think and feel about the serious matter of mental illness in the light of reality . . . Reality check, anyone?
hopeworkscommunity, Larry Drain
What is Murphy selling?
Donald Trump gave me the clue.
Even more than AOT or any other policy idea Tim Murphy is selling something far more visceral, far more compelling and far more appealing. Like Trump he is selling anger to those who feel like they or their loved ones have been hurt by a system that often doesn’t help very much. Like Trump he is selling justification and direction by telling them who is to blame. Like Trump he is selling redemption and hope by telling them if they just follow and support him he can change it. His message is one of quest and crusade and rescue of those hurt and victimized.
Like Trump he has never let the facts get in the way but that is not the subject of this post.
Murphy has tapped into something very real. It is far more than a few overcontrolling parents frustrated with their kids. I sat one night with one 72 year old man talking about his 38 year old schizophrenic son. The pain and outrage was real. His son had been attacked by police in a parking lot who thought he was drunk a couple of weeks before he sat down with me. He had been tased more than once and they thought some damage to his legs might be permanent. He was furious at the police but equally furious at a system that had never been there for his son and furious….well just furious that the son he loved was seemingly stuck in the life he had. I remember listening to a mother describe the day she screamed and begged the police not to shoot her son. He had a towel wrapped around his hand and they thought he might have a gun. I have heard a hundred more stories.
It is not so very different than the rage I hear when I hear people talk about the damage they feel the system has done to them. It is the rage of the 22 year old girl with no history of diabetes in her family who now, courtesy of the medication a psychiatrist had prescribed her, had just found out she now had diabetes. She screamed at me….”What the fuck am I supposed to do now?”
It is my rage. My nephew one night laid down in front of a train and died. He believed that treatment was for crazy people and he could think of few things worse than being crazy. He believed what the wider society told him about “mental illness.” He didn’t want to be embarrassed. He didn’t want to stick out. He tried to hide his desperation. He tried to macho his desperation. Finally he decided to kill it.
The rage is real. It may express itself different for different people but it is real.
I think people can find better lives. My nephew, my friend’s son and literally hundreds of thousands of other people deserve something better. And it literally makes me want to scream and scream and scream that so many never find it. It makes me want to scream when people are treated as less than people. It makes me want to scream when the only options people have are things that have already not worked. And it makes me scream when people in their zeal to control symptoms destroy the quality of the life they are trying to save.
Murphy is not going away. The rage is real.
I think back often to something I heard Robert Whitaker say once. He wondered if we would ever have an honest mental health system. What if it was just about what worked?
What if it was?
Maybe in the end that is the only real answer to the Murphys…
Tragic California Case Exposes Failings in Our Mental Health Care System
CareforYouMind Feb 10,'15
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
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
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
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.
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.
TennCare and the state budget process have been in the news. Cuts to funding for mental health in Tennessee have been proposed.
Gov. Bill Haslam said recently that he's talked with nine Republican governors who have expanded Medicaid for low-income people in their states. Haslam has been criticized for refusing last year to agree to $1.4 billion in federal funds to cover about 180,000 uninsured Tennesseans. After the TennCare state budget hearing, Haslam told reporters that he talked with Health and Human Services Secretary Sylvia M. Burwell this week and that he plans to make a decision about expanding Medicaid by Christmas.
Can we afford more cuts?
The next 12 days are critical
Please join NAMI Tennessee and other mental health advocates by saying yes to Medicaid Expansion and no to additional cuts for mental illness. Visit your local legislator and share this message now. We have a brief window before Christmas for our message to be heard. Your voice matters!
Day on the Hill will be March 18, 2015
Visits to legislators in their home districts make a huge impact. Visits now impact the budget process before the Governor presents his budget to the legislator and the public debates in the Statehouse begin. We also have a chance to impact the budget process and provide education to legislators by participating in Day on the Hill. We hope that you mark March 18, 2015 on your calenders and join us for this day of advocacy
Governor Haslam says he is not as "optimistic" about a Tennessee Plan as he was 6 weeks ago. I take this to mean the federal government is unlikely to accept any proposed elements of the Tennessee Plan that violate or contradict federal law or regulation. He is not going to be able to write the rules. He is going to have to follow them. If the condition of him fighting for Tenn Care expansion is for it to be an easy fight he is not going to make the fight.
The election has been in the strangest of circumstances the "dead period" (What kind of political system makes it off limits to talk about the most important issue to face for fear someone would have to take a stand on it?) It is now time to define the conversation that will govern the decision on Tenn Care expansion.
The people who would have us vote no on Tenn Care expansion will try to make us believe that a no vote is the only way to save us from a federal menace that will lead us to chaos. In face of all the facts to the contrary that is momentous argument to make but that has never stopped a politician yet.
The voice missing is ours. It is time for Tennessee to be for Tennesseans regardless of their socioeconomic status and for politicians to talk to the people they work for. Share your story and your concerns today. Call your legislator and speak to him today. You will only be heard if you speak.
You are invited to legislative plaza in Nashville on November 10. Linda and I will be having a "Speak to the people" rally. 46000 people have spoke. They have signed a petition urging Governor Haslam to expand Tenn Care and we will deliver that petition. Other people in the coverage gap will be speaking. We hope to see you there about 11am. Please share this post and spread the word.
Thanks a lot.
Larry and Linda
Tennessee Gov. Haslam orders state agencies to cut spending
By Andy Sher
Sunday, September 28, 2014
· NASHVILLE -- Gov. Bill Haslam has ordered state agencies to slash discretionary spending by up to 7 percent as his administration builds the new budget it will present to legislators early next year.
The move comes with the state’s general fund, which pays for most functions of government including education, showing a $302.4 million revenue shortfall for the fiscal year 2013-2014 budget that ended June 30.
Administration officials on Friday confirmed the directive given to departments. Agencies’ plans are due Monday. How much actually winds up getting cut and where in Haslam’s fiscal year 2015-2016 budget will depend on a variety of factors.
But after years of reductions, Tennessee may be on the verge of having to make tough choices next year, possibly abolishing entire programs, said one top lawmaker.
“I think that could be the case,” said Senate Finance Chairman Randy McNally, R-Oak Ridge. “In the past they’ve done some of that trimming through things like over appropriations [automatic holdbacks of funds] and positions unfilled for years.”
McNally added, “I think all of that’s gone now.”
He said the major problem with the state revenue picture is business franchise and excise tax collections.
In his Aug. 15 directive to departments, Finance Commissioner Larry Martin explained that “funding the services of state government within available revenues continues to be [a] challenge. As a result, it is expected that reductions will again be required in order to balance.”
Departments and other agencies are submitting plans in two parts. The first is to show how they would cut 7 percent. This is beyond the money the state customarily expects won’t be spent over the course of a year, known as the “over appropriation.”
The second part of the directive asks departments to provide a list of base reductions they would use to offset any proposed increase requests in areas officials consider vital.
Business taxes causing the problem
Flagging collections in Tennessee’s two main business taxes have been the main culprit behind recent problems.
The franchise tax on business property and the excise tax on corporate income forced Haslam, a Republican, and lawmakers last April to cut $276 million from the fiscal year 2014-2015 budget the governor presented to lawmakers last January.
As a result, Haslam, whom many think has national ambitions, was forced into the embarrassing position of breaking a promise he made in his State of the State speech: Providing teachers, state workers and higher education employees with 2.5 percent raises.
The total FY 14-15 budget, which took effect July 1, is $32.4 billion and 2.4 percent less than the last fiscal year’s $33.2 billion spending plan. Some $12.9 billion in this year’s budget comes from the federal government, according to a legislative analysis.
Last week, Haslam and other top officials were in New York where Wall Street’s three major bond rating agencies voiced concerns about problems with Tennessee’s business taxes.
“Because that was the cause of our shortfall, there were quite a bit of questions about that in terms of cause and whether we see a long-term trend there,” Haslam told reporters in a conference call Thursday after meeting with Fitch Ratings Inc., Moody’s Investors Service and Standard & Poor’s Financial Services.
The governor said part of the franchise and excise tax declines were due to overpayments made last year by businesses, which make payments in advance based on estimates.
“And second,” Haslam added, “the fact the businesses are getting a lot more strategic about how and what they pay. We’re trying to do work on our side to make sure we collect what we should. We had that conversation with all three agencies.”
He said one of the “key points” made to the bond rating agencies “is that last year when Tennessee had a surplus, we reacted in the right way and didn’t spend all that. This year we had a shortfall [and] we reacted in a way we have to by making cuts.”
Rating agencies “realize that revenues will rise and fall,” Haslam said. “They want to see if you are willing to adapt regardless of the circumstance.”
Haslam mentioned nothing to reporters about the latest efforts to “adapt” with the spending cut directive, which the Times Free Press obtained a day later.
A simple explanation?
The administration was put on the defensive last spring by legislative Democrats who said figuring out the problem with franchise and excise taxes should be a fairly simple thing. Rep. Mike Stewart, D-Nashville, said all they had to do was take a look at the top 50 corporate payers of the tax.
State Revenue Department officials are now studying the problems, with recommendations expected in January.
But a Nashville-based tax attorney, Brett Carter, agreed with Stewart last spring in an article he wrote for State Tax Notes, a national publication. And Carter thinks he’s figured it out a “likely” answer to the cause that indeed does appear fairly simple.
Using publicly available court documents, Carter points to the 2012 relocation of McKesson Corp.’s Southeastern pharmaceutical distribution center from Memphis across the state line to Olive Branch, Miss. Tennessee tax policies had previously resulted in litigation and Carter delved into the material.
While McKesson is just one company, Carter wrote, the court documents reveal the move was highly important because “McKesson’s facility served as the primary distribution channel for pharmaceutical companies throughout the United States and [the move] resulted in millions of dollars in franchise and excise tax revenue in Tennessee.”
Carter said the companies may have been paying more than $150 million in Tennessee franchise and excise taxes and saw a major opportunity to slash their costs by moving to Mississippi, which has lower taxes.
McNally said state lawmakers are looking at that and ways to restructure the taxes.
I found this article very meaningful for me. I believe it takes a lot of effort today, for most of us, to stay positive in a negative world. These are some lighthearted points on how to do just that.
12 Steps To Stay Positive In A Negative World
BY DR. JOEL KAHN
OCTOBER 8, 2014
This weekend we celebrated the Jewish holy day of Yom Kippur. One of the clergy scheduled an hour-long healing session sandwiched between the full day of prayers on this fast day. Fifty people showed up, some willing to share the pain they were feeling from recent diagnoses of cancer, loss of loved ones, or family traumas, and others remained silent.
When it was my turn, I brought up the challenge I felt trying to stay positive in a negative world. Cruelty, brutality and insecurity seem to me more palpable than in the past, perhaps due to 24/7 connectivity with reports of wars, tragedies and beheadings. I described steps I use to emphasize the positive during the day while still being grounded in the events occurring in the world.
Here are 12 of the techniques I use to maintain a positive outlook when the world seems so incredibly negative:
1. Control the amount of negative news in my life.
While I want to stay up on the events occurring in the world, sometimes a headline is sufficient to grasp new developments. I limit the time I spend with TV, radio and Internet, selecting only a few stories to read in full.
2. Control the number of negative people in your life.
I spend most of my days talking to patients about their problems, and some days are filled with more uplifting reports than others. However, I can select how much time I spend with relatives and friends that dwell on the negative. As painful as it may be at times, my calendar may not open to those who consistently drag me down.
3. Listen to music.
I find positive music playing in the car, my home and at work to be a great source of uplifting spirit. One of the most positive collections of music is what I have found in Kundalini yoga. I can feel bountiful, beautiful and blissful with just a few clicks of my phone.
I choose to practice a Kirtan Kriya as taught by Dr. Dharma Singh Khalsa, since it takes 12 minutes with a mantra and mudras that are simple. I often do this in the sauna, something I call saunitation, as it seems to clean out the junk in my brain.
5. Live consciously.
Awareness of my breath, the origin and nutrition of my food while eating, a blue sky, a purple flower, a bird’s song all can draw me into a feeling of gratitude for the moment that overcomes forces that can drag me down.
6. Practice gratitude.
Appreciating people for anything they may do to help during my day is always my goal, some days more successfully practiced than others. Helping others, holding a door, buying a surprise coffee for someone behind me in line (I call it random acts of caffeine), or letting someone merge into an intersection can be uplifting.
In my faith there are a couple prayers that are recited on awakening. A simple two-phrase prayer expresses thanks for the return of the spirit to the body after a night’s rest. Another prayer is odd, but one of my favorites: a prayer written over 1000 years ago to be recited after urinating or defecating to acknowledge that the body is still performing its daily miracle. Although an odd blessing, when I care for patients with bowel and bladder illness, I appreciate both how grounded this moment of reflection is.
8. Read positive books and interviews.
I've read my share of Dale Carnegie, Tony Robbins, Og Mangino, and Louise Hay but going back to them every now and then is a positive moment. Also, I select TED talks that describe new innovations, survivors of challenges, and insights into nature and feel better after viewing them.
9. Give hugs.
I love hugging others and, if my patients permit, I hug and scratch backs on most visits, which brings out huge smiles. I can just watch the stress of others diminish and my own stress decrease.
My phone is my pager, my social media, my calendar, and my tether 24/7. The smartphone is a wonder of technology that is on my waist, in my hand, or with me in the car. Some sacred time requires that it be shut off, whether it's one day a week as many religions mandate, an hour in the yoga room, or while meditating. I work to keep my phone and my brain far apart using speakerphone, Bluetooth or headsets.
Years ago, author Norman Cousins demonstrated the healing power of comedy on the course of ill patients and humor can play a healing role today as well. I often end my day with a few minutes of comedy that I have recorded on the DVR. I put the days’ worries behind, enjoy a few belly laughs, and think positively about the coming day.
12. Connect with animals.
My medical work day ends when I walk in my home and see two tails wagging with joy for the fact that I've returned. I have to lie down right then, whether in a suit or scrubs, to let Jake and Eva lick my face over and over. I doubt there's a better therapy after a long day, and I'm sure many of you feel that the love from a pet can counter so much negativity.
My wife and I have joked for years about moving to an isolated island where life is simple. Decades later, careers, children, and goals have kept us from fantasy. The Dalai Lama was quoted as saying, “When we meet real tragedy in life we can react in two ways, either by losing hope and falling into self-destructive habits or by using the challenge to find our inner strength.”
Ordinary heroes: Drains honored for speaking out for health care equality
y Linda Braden
Larry and Linda Drain are quiet, unassuming people. But when circumstances arose that threatened Linda’s life, they both began speaking out, their voices ringing loudly to bring awareness to — and a solution for — themselves and others who have fallen through the cracks of the health care system in Tennessee. Their income is too high to qualify for TennCare, Tennessee’s public insurance program, and too low to qualify for federal subsidies under the Affordable Care Act, also called Obamacare.
In acknowledgement of their efforts, the Tennessee Health Care Campaign presented the Drains with the 2014 Heroes for Health Award in August at the John Seigenthaler First Amendment Center, Nashville. The award was given “for your dedicated support to affordable access to high-quality health care for all Tennesseans.”
The event honoring the Heroes was part of the Tennessee Health Care Campaign’s 25th Anniversary celebration. In addition to the Drains, Laura Sell was honored for the major work she did as a volunteer to promote and support enrollment in the Patient Protection and Affordable Care Act, collaborating with the Blount County Public Library.
Larry said, “It was a very eventful night. We got to speak to a lot of people, meet a lot of people that were heavy-hitters that we knew about or read about. That was neat. And to get people to treat us like we were important. As we were walking out the door, I said, ‘Linda, do you ever get over being surprised when people treat us nice?’ I’m surprised every single, solitary time. It’s just been a strange happening. When it first started out, we didn’t have a clue ... The way we look at it is that we are extraordinarily ordinary people, and the idea that people would know who we are or that people would listen to what we have to say — I wouldn’t have predicted that in a thousand, million years. Then when it took off, it went insane.”
The story began with Linda, who has been drawing Supplemental Security Income (SSI) for some time because of epilepsy, brain surgery and additional health conditions. Larry said, “She has TennCare. She has to have the TennCare in order to live. If she does not have the medication, if she doesn’t have the medical care, she will die.
“Ten years ago, a good day for her was having 10 to 15 grand mal seizures. She went through brain surgery, and the last 10 to 14 years have been extraordinarily eventful, but the medication is her pathway to life.”
After Larry turned 62 last September, he decided to take early retirement and begin drawing Social Security.
“If I had to take all the dumb, stupid, worst things in my entire life that I have ever done, that one is so far to the top that there is not a second place,” he said. “The way we had it figured out, we could live if we took what she made in SSI and what I made in retirement. We weren’t going to be rich — in fact, we were going to be poor — but we would be able to pay our bills, do what we needed to do. We were going to be OK.
“After a couple of months, Social Security called us in and said, ‘You guys make way too much money.’ They were very nice, not cruel or mean or anything like that. ... But they said, ‘We have a limit on unearned income, and you guys are way over it.’”
Larry questioned how that could be, and was told that his Social Security retirement is considered unearned income. He said, “I asked them, how could that be unearned income? I worked 47 years for that. It’s my money. They said, legally it’s unearned income. They told Linda that her check for $720 was going to become $20. We were going to lose $700. I said, ‘I’ll just give the retirement back. I’ll just get another job and we’ll be OK.’ And they said, ‘Well, you can do that, but the only way you can do that is to give us back every single penny we have given you today.’ Well, if I could give it all back today, I would never have needed it to begin with.”
Larry thought he could continue drawing his retirement and also have a job to make ends meet. He said, “What they said after that has basically driven the whole situation. They said, ‘You have to understand, that because your wife is on TennCare, if you make over $85 in a month, she will lose her TennCare.’ So we went home, and we did all the figuring we could.”
Their projected budget for January would leave them with $30 for essentials such as food and gasoline, and the following months would be worse. “We looked at everything we could, trying to find a way. ... But there wasn’t a way,” Larry said. “We were in a position where, if I got a job to give us enough money to live on, it would kill my wife. It would take her insurance away, and it would kill her. If I didn’t get a job, we couldn’t live. We couldn’t live on a dollar a day. It just wasn’t doable. So on Dec. 26, after 33 years of marriage, we separated.”
The original plan was for Linda to stay with a relative until they could find her a permanent place so she could retain her SSI and TennCare. Larry would then find a place as close by as he could. Larry said, “At that time, our understanding was that, according to the way the laws were in the state of Tennessee, we would never again live together as man and wife.”
There were two possible solutions: Change Social Security laws or expand TennCare, the state’s managed Medicaid program which provides health care coverage primarily for low-income children, parents, pregnant women and elderly or disabled adults. Social Security laws were not going to be changed, but Tennessee Gov. Bill Haslam could spearhead expansion of Medicaid. Larry said, “If he expanded Medicaid, then Linda didn’t have to be a member of a category, she didn’t have to be ‘disabled,’ to get it. All she had to do was be poor. If he expanded Medicaid, then she would have her insurance, which meant we could live together, I could get a job, and although we’d struggle, we would live. Without him expanding Medicaid, we had no help at all.”
Letters to governor
Larry began drawing attention to the need for TennCare expansion by writing a series of letters to the governor. Some were very personal, some general and policy oriented, but in each letter, Larry pleaded with Haslam to submit a plan for TennCare expansion. The 100th letter was emailed on Sept. 2. As of that date, the governor had not responded to the Drains, but he did announce on Aug. 28 that he plans to submit a proposal to Washington to expand Tennessee’s Medicaid program. He did not release any details, however.
Larry said more than 1,200 individuals from across Tennessee have told him they also contacted Haslam. Larry’s 100th letter to the governor begins to list the names, and he plans to continue adding names in subsequent letters until every one is included.
Each letter is available atdeargovernorhaslam.wordpress.com and is viewed by 4,000 to 6,000 persons daily. In addition, a petition entitled “Gov. Haslam: Expand TennCare and Let Me Stay With My Wife!” at www.thepetitionsite.com has almost 46,000 signatures in support of the Drains.
The Drains’ story was told in the Nashville Tennessean and other major news outlets, drawing even more attention to those who, as Larry said, “didn’t fall through the cracks — we live in the cracks.”
Twenty-five miles separate this couple now. Linda is in Knox County, while Larry is in Blount County. They are waiting for the time when they can once again live together as man and wife without Linda losing her life.
Larry said, “I should not have to drive 25 miles to see my wife. It’s wrong in every sense of the word.”
Haslam may submit Medicaid expansion plan in fall
Tom Wilemon, firstname.lastname@example.org and The Associated Press
1 day ago
Larry McCormack / File / The Tennessean
Gov. Bill Haslam said Thursday that the state may soon submit a proposal to Washington to expand Tennessee’s Medicaid program but did not release any new details on how it might work.
Support for mood disorders: Allen Doederlien shares information Thursday
By Linda Braden Albert | email@example.com | July 20, 2014
A series of presentations focusing on mental health issues that began in March at the Blount County Public Library will continue Thursday as Allen Doederlein, president of the Depression and Bipolar Support Alliance (DBSA), speaks on bipolar disorder and depression. The presentations, sponsored by NAMI (National Alliance on Mental Illness) Maryville, are free and open to the public.
Doederlein said, “Our headquarters are in Chicago, Ill., and yet, we are really all over the country and have some incredible and important affiliates in Tennessee. The work they do is entirely volunteer. It’s done as a labor of love and it’s done from a very personal place.”
The organization is by and for people who live with depression or bipolar disorder. “That lived experience informs everything we do,” Doederlein said. “We provide information that’s easy and understandable, not written in ‘medicalese,’ not confusing but gets directly to what these conditions are and what you can do to live and get well. We provide empowerment. These are conditions that can make people feel disenfranchised, that can carry great stigma. We want to make sure that people are strong advocates for themselves.”
Doederlein said another goal is to raise concerns and needs to elected officials but also on a more personal level. “Also in their work places and their families — anyplace people with mood disorders may find themselves, to say, let’s work collaboratively and constructively to make sure everyone does well,” he said.
DBSA support groups provide valuable assistance and education for those with mood disorders. Doederlein said, “Our chapters operate free, in-person peer support groups. That’s a group that meets without a doctor or clinical professional present, just the people with a lived experience. There’s a great deal of scientific literature that shows that peer-to-peer experience is greatly beneficial and helps people get well and stay well.”
About 53,000 people are reached nationally in a year by these peer support groups, he added.
Doederlein said Larry Drain, president of the NAMI (National Alliance on Mental Illness) Maryville and initiator of the mental health informational series, is a wonderful example of someone with a great deal of power and intellect who has been challenged by mood disorders.
“He had taken that lived experience and made something in terms of giving back to others,” Doederlein said. “When you think that there are people doing that all over the country, it’s really, really something. Larry’s not only done that in terms of support but also as an advocate.”
At the national level, 50 percent of the paid professional staff and volunteers must, by charter, have personal experience in dealing with mood disorders.
“That perspective informs everything that we do,” Doederlein said. “That’s really important. Very often in health-related education or advocacy, it will be doctors talking to doctors, not really related to a person getting herself or himself well. We make sure that’s at the center of what we do.”
Mood disorders include a spectrum of conditions, including depression and bipolar disorder. Doederlein said, “About 21 million American adults are estimated to be affected by depression and bipolar disorder. That breaks down to about 14 million affected by depression, and between 6 and 7 million affected by bipolar disorder.”
Mood disorders are challenging, but they can be managed and those with the disorders can thrive and contribute to society, Doederlein said. A prime example — Abraham Lincoln.
To learn more, visit the DBSA at www.DBSAlliance.org or attend Thursday’s presentation. It begins at 6:30 p.m. at the Blount County Public Library.
Exciting news is always welcome. One of our own steps out to bring national attention to those suffering due to lack of medical healthcare coverage. Links to articles in The Tennessean and USA Today are below.
The NBC Today show asked to interview Larry and Linda. The interview is expected to happen today. Airing of their interview is expected some time this week. Let's all send our best wishes and thoughts to this couple as they do all that they can to see that no one else needlessly suffers in like fashion.
Links to Larry and Linda's story:
Decision on Medicaid Expansion holds coverage for many Tennesseans in balance
By Kristi Nelson
Posted June 2, 2013, updated June 4 2013
It was supposed to be one of the strongest tenets of the 2010 Patient Protection and Affordable Care Act. Instead, it became a political football, a metaphor for states’ rights. After the Supreme Court ruled that the ACA could not force states to expand Medicaid, Gov. Bill Haslam was among those who rejected the Medicaid expansion, instead offering his alternative “Tennessee Plan” for federal government approval.
But whether the federal government and the General Assembly will accept Haslam’s plan remains to be seen, along with how well it will work to cover those who currently don’t have health insurance.
“He’s either politically brilliant, or he’s making one of the worst mistakes he could make,” Rep. Joe Armstrong, D-Knoxville, told the News Sentinel in March.
What the ACA intended
Originally, the Medicaid expansion provision was to give state health insurance coverage to a group of people who made too much to qualify for Medicaid but too little to afford insurance on the health insurance exchanges, even with the planned government subsidies.
It expanded Medicaid to qualify people younger than 65 whose income is below 138 percent of the federal poverty guideline (a little more than $15,860 annually for an individual, a little less than $32,500 annually for a family of four).
It meant that, for the first time, low-income adults who don’t have children could get state Medicaid coverage, and it standardized other qualifications.
Many states, including Tennessee, limit Medicaid enrollment to certain categories of people. To qualify for TennCare, for example, you have to be low-income and pregnant, a child, blind, disabled, aged, or fall under multiple, specific categories.
Tennessee has nearly 1 million uninsured residents, of whom at least 140,000 and maybe more than twice that number, by some estimates, likely would enroll in Medicaid if it were expanded under the ACA guidelines. About three-quarters would have been previously uninsured. Under the ACA expansion, the federal government would pick up the entire cost of new, previously ineligible enrollees for the first three years, phasing to 90 percent by 2020. In Tennessee, federal funds would have amounted to about $1.4 billion in the first year alone.
States could receive federal matching funds for covering additional low-income residents under Medicaid as early as April 2010, with wide-scale enrollment beginning this October and coverage starting Jan. 1, 2014. However, in June 2012, the U.S. Supreme Court ruled that the federal government could not make states expand Medicaid — making a linchpin of the ACA optional.
So far, 20 states have moved forward with Medicaid expansion. Ten have rejected it outright, while 10 others are not doing it now but are looking at alternatives and have not ruled it out for the future (the government gives no deadline, though states waiting much longer to decide stand to lose federal funds for the first year). Three states are still undecided, while seven — including Tennessee — are crafting their own, alternate plans.
On March 27, Gov. Bill Haslam announced that Tennessee would not expand TennCare rolls under the ACA, instead offering up an alternative he called the Tennessee Plan.
“I don’t think just pure expanding of a system that we all agree is too costly for us, is too costly for the federal government to afford long-term, is the right way,” he said then.
The ‘Tennessee Plan’
Haslam’s proposal is that the state use federal funds not to expand TennCare but to purchase private insurance through the insurance exchange for people who would have qualified for coverage under Medicaid expansion.
He outlined the proposal in the broadest terms, including five “key points”:
Individuals identified as being eligible for the Medicaid expansion group would instead be directed to the exchange, where they would be allowed to choose any qualified health plan that offers a certain level of benefits (the Silver Plan).
The state would pay the monthly premiums, matchable with 100 percent federal dollars, for those people to enroll in the Silver Plan.
People in the Medicaid expansion group would be treated like all other people enrolled in the Silver Plan, with access to the same benefits and appeals process as other people in the plans.
People in the Medicaid expansion group would have the same cost-sharing as other Silver Plan enrollees with incomes below 250 percent of the federal poverty guidelines. (On average, Silver Plan policies would pay for 70 percent of health care costs, with the remaining 30 percent paid by the planholder.)
The arrangement would have a “circuit-breaker,” or “sunset,” ending after the three-year period of 100 percent federal matching dollars, and could be renewed only with approval of the General Assembly. (This is true for states accepting the Medicaid expansion as well; they can stop using federal funds and drop the expanded coverage at any time.)
In addition, Haslam would seek to reform the way providers are paid for services, with payment based on outcomes rather than a set fee for services. The money saved, he said, would be enough to cover the state’s 10 percent share of costs after the government’s share goes to 90 percent.
“One option for covering the Medicaid expansion group is simply to add them to the Medicaid rolls, or the TennCare rolls, in our case,” Haslam said of the plan. “We don’t want to do that. There are a lot of federal requirements that come with Medicaid that make it difficult to provide quality care in the most cost-effective way possible.”
But the federal government may not allow Haslam to forgo some of those requirements. While national Centers for Medicare and Medicaid Services guidelines indicate that the main tenets of the plan — using federal dollars to pay premiums for low-income people to have commercial insurance, and reforming payment — meet federal requirements, some of the details don’t align with federal requirements intended to protect Medicaid enrollees.
For example, Tennessee would need to give those with serious health conditions a choice of enrolling in TennCare or private insurance, unless CMS were to grant Tennessee a waiver to that requirement.
The federal government would require supplementation of benefits (sometimes called “wraparound”) to make sure the commercial insurance plans include all services that would be available through Medicaid. Hypothetically, this could be done through a supplemental premium to the Silver Plan insurance provider.
The government also limits co-payments for Medicaid-eligible enrollees.
There is also an appeals process in place, required by past Supreme Court rulings, so that Medicaid patients and their doctors can challenge insurance companies’ refusals to cover “necessary treatments.” Under federal law, Tennessee would have to allow Medicaid-eligible patients this due process.
A federal entitlement program, Medicaid was designed for a population upon whom “poverty imposes special needs and the need for special protections,” said Carole Myers, a nurse practitioner and associate professor in the University of Tennessee’s College of Nursing. “They don’t have the same voice in government as those with different economic statuses and organizational affiliations.”
Haslam acknowledged in April that Tennessee probably would have to limit co-payments and provide the wraparound services for Medicaid-eligible enrollees for the federal government to approve his alternative, but he said he still thinks his overall plan is “workable.”
Haslam’s plan is modeled on a plan by Arkansas, which also wants to use federal matching dollars to pay commercial insurance premiums for those eligible for the Medicaid expansion. But while Arkansas got legislators’ approval before approaching the federal government, Haslam has taken the opposite approach, presenting his plan to CMS first.
Haslam did not ask state legislators to vote on whether to take the federal Medicaid expansion funds this session, though he said he has not ruled out calling a special legislative session later this year to meet federal deadlines for the health exchange enrollment starting in October.
The Medicaid expansion is the only provision in the ACA that provides insurance coverage specifically to those between 101 percent and 138 percent of the federal poverty guideline. If Haslam fails to reach an agreement with the federal government, or does not opt to accept the federal Medicaid expansion plan (which he could still do), that population likely would remain uninsured.
However, the latest word among hospital executives and advocates is that an agreement could be near.
“I think (Health and Human Services) Secretary (Kathleen) Sebelius is really eager to find some alternative plans that meet the goals of the ACA but do so in creative ways and allow states to create plans beneficial to those individual states,” said Jerry Askew, senior vice president for governmental relations for Tennova Healthcare.
Through Tennova’s parent company, Health Management Associates, Askew works with hospitals in seven states. All of them, except those in Kentucky and West Virginia, have said no to the expansion.
“They’re all trying to figure out what to do. It’s really interesting to watch how the state is to meet their individual objectives,” Askew said. As for Tennessee, he added, “It is fair to say that the governor’s plan is being built on principles that the majority in the Legislature would agree with. But it’s not a given. It’s a lot of hard work.”
Consumer-advocate groups and hospitals were in favor of the expansion, especially since hospitals stand to lose money on uncompensated “charity” care that would have been partially covered, at least, if more people were insured through Medicaid. The Tennessee Hospital Association has said the state stands to lose 90,000 jobs and nearly $13 billion.
Having that population continue to go uninsured also means higher costs in the long run, Myers said, as studies have shown that those without insurance are less likely to get preventive or early care.
“When you are resorting to getting care only when it becomes so bad you can’t stand it, and you’re in the emergency room, it’s causing a major human toll,” she said. “We know that intervention on the earliest point of the illness trajectory is the most cost-efficient. The true measure of whether we’re successful in what we’re doing in health care is in whether people have long, happy, productive lives.”
Business writer Carly Harrington contributed to this report.
© 2013, Knoxville News Sentinel Co.
The death of the Murphy Bill: On being the national spokesman
The Murphy Bill as we know is dead. The Republican leadership in the House announced a change in strategy. They basically decided to toss in the towel on the more controversial parts of the plan and try to see if they can move forward on elements that seem to have a greater consensus behind them. There may be CPR efforts yet but it appears done.
It was a bill in trouble from the start despite the massive pr campaign that tried so hard to say it wasnt so. It managed to unify groups that might not agree on what kind of reforms they wanted, but were absolutely sure what they didnt want and that was the Murphy Bill.
Part of the problem was Murphy himself. He assumed that as "the only psychologist in Congress" he was the obvious and deserved national spokesman for mental health reform. He wasnt. Being a psychologist certainly didnt qualify for the role. Neither did being a member of the House of Representatives. It seemed that Dr. Torrey annointed him and for some reason they both thought that mattered. In the end it was hard to know where he started and Dr. Torrey ended and that was perhaps a fatal flaw.
He didnt understand that leadership was built or that it was a two way street. He alienated people who had lived mental health reform their entire adult lives. He thought it was about them joining him and never seemed to know it was the other way around. And he never realized that trust was everything and that when he snuck AOT into the medicare bill he destroyed his chances of trust with people whose support he needed.
He was naive. The only people who believe federal laws change everything are federal lawmakers and most of them know better. To say that his law was going to prevent the next shooting was simply ego. He believed his own press clippings and his posturing before the dead were even buried just seemed like rank opportunism.
Mental health reform is an ongoing effort by many, many people with different values and priorities. Sometimes it is its own worst enemy. People who cant stand each other have a hard time standing together for anything. Murphy I hope has to some degree taught people they can find unity despite their differences. And maybe the fragile unity borne of him will be the biggest take-away from the entire thing.
He may indeed try again. He probably will. Dr. Torrey most surely will. He has won many, many short term victories and will doubtless win more, but the big prize has eluded him again. He is not the national spokesman he has annointed himself to be either.
Thanks for the support
by Larry Drain, hopeworkscommunity
The following organizations have offered support of "Dear Governor Haslam". They have put links to this site or printed the letters on their websites. I really appreciate it. I invite you or your organization to do the same.
Tennessee Health Care Campaign.
Tennessee Citizen Action.
Tennessee Disability Coalition.
Tennessee Chapter Depression and Bipolar Support Alliance.
WRITE GOVERNOR HASLAM TODAY
hopeworkscommunity | June 1, 2014
byLarry Drain, hopeworkscommunity
Rep. Murphy has not went gently into the good night. Dr. Torrey will never go gently into the good night. They are trying it sounds like to provide cpr to their bill. Rather the things that didnt work the first time will work on second effort is anyone's guess. I think sometimes it is really hard for annointed national spokesmen to realize they are not and never were.
But this post is not about that. It is about a fundamental misunderstanding of the American mental health system that was part of the reason that may have doomed the Murphy Bill from the start.
Murphy seemed to believe we were doing far too much for too many. He thought people who were doing better in the system were robbing those who were doing poorly of help and resources. And he thought if resources were properly allocated things would be okay. Using terms like "worried well" he seemed to want to pit one group against another or at least give worried family members someone to blame. Somehow, I never really understood how, he seemed to think that this misallocation of resources was the fault of Samsha. It was us against them, with guys in black hats, just lacking an afternoon channel from being great soap opera. People were getting rich, famous and powerful off the worried well and just abandoned those in serious need. It had drama, moral outrage, and more than a little passion. It just lacked truth.
Anyone who had watched or been part of the last few years would tell you that state after state year after year had cut their mental health budgets to the bone. In some places there was only skin. The bone had long since disappeared. It was not that too much was done for too many. Too little was done for everyone. Many people lacked insurance and couldnt even access the services that were there. It wasnt misallocation of funds. It was abandonment. Never, not once, have I ever heard anyone touting the Murphy bill ever acknowledge this.
The baggage from Dr. Torrey obscured their vision. No state bought his love affair with psychiatric hospitals. It was too little bang for way too much bucks. No one believed. It was a cash cow around their necks that threatened to bankrupt their community systems. There was little or no proof it worked. When insurance companies basically stop paying for a service that service is on borrowed time. No one drank the kool aid any more.
There will probably always be psychiatric hospitals. But they will never be the centerpiece of the mental health system again. Putting your money into backline services, what you do when things go wrong, destroys your ability to keep things from going wrong. There was never any conspiracy. People just decided what they thought mattered and all of Dr. Torrey's pr and marketing campaigns just didnt change that. In the end I dont think federal law can bring back psychiatric hospitalization as the gold standard of mental health care. The truth is that even people with "severe mental illness" can and do make it in their communities with effective support and services.
The notion that one group of people needing help was more worthy than another and that they were in competition just seemed like such a mean and stupid notion. It completely just ignored the reality of the bloody battle for funding that is the reality for so many states. It was a pseudo explanation for the fact that state after state just said "Dr. Torrey we dont buy what you say and your way will not increase the amount of services for people with severe needs but radically decrease it."
Count me cynical. Count me way cynical. Murphy lost because it was never about a battle for the "severely mentally ill." It was a battle for Dr. Torrey and a vision found lacking a long time ago.
hopeworkscommunity | June 11, 2014
S.L. Brannon D.Div..