The holidays can be extra difficult for folk living with mental illness. And, yes, mental illness is a real illness. Most everyone knows someone dealing with it in a very real way everyday. So, let’s attempt to raise our awareness to the subtleties of mental illness and attempt to “be there” for our friends, family, and neighbors. Here’s a great article to help us get started!
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
DBSA Jackson provides a weekly support group meeting for people living with mood disorders. The group facilitators are volunteers with problems of their own. For the past 15 years, these facilitators have proven themselves to be among the "strongest people".
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 ~
This is a new campaign launched by national DBSA. Remember, "I'm here. "
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…
I'm writing my story in hopes that it will inspire others to share their story. I don't know if there is a "book" in everyone but I know for certain there is a story in there. I encourage you to share your story of overcoming some of life's challenges. Someone needs to hear what you have to say. They are waiting!
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.
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, email@example.com 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.
The Depression and Bipolar Support Alliance (DBSA) is the leading patient-directed national organization focusing on depression and bipolar disorder. The organization fosters an environment of understanding about the impact and management of these life-threatening illnesses by providing up-to-date,
scientifically-based tools and information. DBSA supports research to promote more timely diagnosis, develop more effective and tolerable treatments and discover a cure. The organization works to ensure that people living with mood disorders are treated equitably. Assisted by a scientific advisory board comprised of the leading researchers and clinicians in the field of mood disorders, DBSA has more than 750 peer-run support groups across the country. Nearly two million people request and receive information and assistance each year. DBSA’s mission is to improve the lives of people living with mood disorders. For more information about DBSA or depression and bipolar disorder, please visit www.DBSAlliance.org or call (800) 826-3632.
Allen Doederlein, President, DBSA
Steve Brannon, State Director, DBSA Tennessee
Daisy Jabas, Assistant Director, submitted this abbreviated itinerary:
I wanted to give each of you Allen Doerderlein's Tennessee visit intenery as it is known now.
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.
TMHCA is, once again, excited to announce an upcoming FREE WRAP® “refresher” course in Nashville, Tn. This training is funded by TDMHSAS.
Location: TAADAS Conference Room
1321 Murfreesboro Pike
Nashville, Tn.; Office 155 37217
COURSE DESCRIPTION: The WRAP Refresher Course is a three day, interactive course co-facilitated by TMHCA Advanced Level WRAP® Facilitators. The primary purpose of this Course is to sharpen & expand facilitation skills to further engage students in Wellness Recovery Action Planning.
Through attendance in this course, WRAP® Facilitators will:
1. Recognize expanded options on how to give group introductions.
2. Identify additional knowledge areas, Values & Ethics of WRAP®
3. Apply new skills to sharpen & expand group facilitation skills.
4. Develop new, creative approaches to Facilitation to accommodate participant challenges & different group needs.
The Copeland Center strongly recommends that WRAP® Facilitators attend a Refresher Course @ least every two years to stay up on new developments and best practices.
by Larry Drain
GOP Newtown bill hits impasse | TheHill
It sounds based on reports like these that the Murphy Bill is not going to pass as written. Things change I know, but it looks that way. There is I understand a democratic bill being written by Rep. Barber. Things dont seem to look really great. The really interesting thing is that it might not matter rather or not the Torrey crowd thinks they have made a great case. It may only matter whether or not they find common ground with people up to now they have shown no interest in finding common ground with. Rhettoric that they are so good with may not be their friend. Winning the battle may cause them to lose the war.
The next few weeks, next few months may be interesting. Common ground.... what a weird approach to American politics.
hopeworkscommunity | April 23, 2014
More on our speaker series
We recently announced the beginning of our speaker series in Blount County sponsored by Maryville Nami. Our first speaker on March 20 will be Sita Diehl National Director of State Advocacy for Nami national. I am very excited today to announce our second speaker today. On April 24 Doug Varney Commissioner for Dept of Mental Health and Substance Abuse will be coming to speak in Maryville. Tentatively his topic will be the scourge of drug abuse, particularly prescription drugs and meth, their relationship to mental health issues and efforts by the state to address these issues. It should be a great and informative evening. Please do all you can to spread the word about both of these presentations.
I'm sharing the news of my being among national Award Winners for accomplishments over the past year. It has been a pleasure to serve as State Director and local chapter President. And I consider it an honor to be recognized by DBSA national.
I appreciate all the wonderful support I was given by my fellow officers, Board members, and the chapter membership throughout the year. You may view the announcement on the national web site athttp://www.dbsalliance.org/site/PageServer?pagename=peer_chapter_spotlights
Congratulations to our 2013 Chapter Service Award Winners!
The DBSA Chapter Service Awards recognize exemplary service by DBSA
chapters, state organizations, and their leaders. Winners will be honored at the 2014 Chapter Leadership Forum in addition to receiving a cash award.
Steve Brannon of DBSA Jackson (TN) and DBSA Tennessee - Outstanding
Steve is an excellent role model for pursuing a wellness-focused life while living with a mood disorder. He fights stigma by openly sharing his journey in the local newspaper, on DBSA’s website, and on his weekly online newsletter. He has worked with the local police department to help educate and train police officers for crisis response teams. Steve was selected for DBSA Peer Advocacy Training and was a representative of DBSA for Hill Day in Washington, D.C.
At his local chapter, DBSA Jackson (TN), Steve gently encourages, trusts, and believes in support group participants. He instituted a monthly “share your inspiration” night in which group members report on what keeps them going, creating an environment of hope and personal growth. Steve is dedicated to further advancing DBSA’s mission into surrounding communities and across the state. The number of support groups has doubled in the past year under his direction, encompassing all major cities and some smaller cities across the state. He has traveled hundreds of miles at his own expense to conduct local chapter visitations as state director. Steve’s passion for the advancement of DBSA’s mission in Jackson and the state of Tennessee is so strong that he has diligently dedicated his time and resources for over a decade.
DBSA Tennessee - State Organization Service
DBSA Tennessee's amazing accomplishments made 2013 a rewarding year!
They supported chapters in their state by hosting educational presentations and training programs, giving them the tools necessary for successful chapters. With help from DBSA Tennessee, five local chapters were interviewed on television or radio to promote DBSA to the community. Leaders encouraged one chapter’s community outreach, resulting in a city-wide Mental Health Day declared by their mayor. DBSA Tennessee’s robust plan to help new chapters in the startup process helped find free meeting locations, assistance in affiliation fees and paperwork, and provided a sponsor from an already established chapter to assist the new chapter.
Five members of DBSA Tennessee attended DBSA’s Peer Advocate Training in Washington, D.C. and then created an advocacy plan for their state including a campaign against proposed budget cuts to close all 45 of Tennessee’s Peer Support Service Centers. DBSA Tennessee is a growing, thriving organization. With its advocacy for peer support and local chapter start-up, community outreach and commitment to peer education, DBSA Tennessee is one of the most energetic affiliates of DBSA.
DBSA Murfreesboro (TN) - Rookie Chapter Service
DBSA Murfreesboro began in July of 2013 with support from DBSA Tennessee.
The chapter started out with one support group, which saw its attendance
double in fewer than six months, becoming one of the fastest growing local
chapters in the state. The growth of the chapter can be attributed to the forces behind it that work tirelessly to get the word out about the group. Flyers and pamphlets are distributed to agencies and health care providers, the Salvation Army, local hospitals and businesses, and more. DBSA Murfreesboro provides post-hospitalization support for those who would otherwise have none. Educational materials, resources, and wellness tools are provided to each chapter participant. They have also started a family and friends support group.
Members of DBSA Murfreesboro participated in the state chapter meetings and backing of their U.S. Representative. For a chapter that achieved all of this in six months, DBSA Murfreesboro has a fine resume of accomplishments, but they consider their greatest success to be the level of support offered to each person who walks through their doors.
Mental health issues topic of presentations
By Linda Braden Albert | firstname.lastname@example.org | Posted 14 hours ago
A series of presentations on mental health issues will begin Thursday at the Blount County Public Library. The first presentation is by Sita Diehl, past executive director of the National Alliance on Mental Illness (NAMI) Tennessee and currently national director of state advocacy for NAMI National.
Larry Drain, recently named president of NAMI Maryville, said, “When they asked me to take the job, I really wanted to figure out a way not only to help NAMI but to help the community. Every day, nowadays, when you read the paper or watch TV or whatever, in one way or another, mental health issues are there. There’s a lot of bad information, misinformation, so the idea I had was that if we could bring a series of people to Maryville to talk about mental health issues, that would be a real, real positive thing for this community.”
Diehl’s current position entails her traveling from state to state, organizing efforts to make outcomes for mental health possible in each state, Drain said. “I’ve known her for years, and she was the very first person I asked. Her topic will be about finding support, whether you’re a family member, whether you’re somebody with a mental illness. She will talk a lot about NAMI, some about the mental health system in Tennessee. There will be a question and answer period after she gets through talking. Anybody who comes will be enriched by her.”
On April 24, Doug Varney, commissioner of mental health and substance abuse services for the state of Tennessee, will speak on mental health and drug addiction. Drain said, “I think he will talk some about prescription drugs and meth, what the state is trying to do to deal with some of these things. Especially in Blount County, it is such a live issue. ... He knows the topic inside out.”
Additional speakers in upcoming months include Ben Harrington, executive director, East Tennessee Mental Health Association; Scott Ridgeway, director, Tennessee Suicide Prevention Network; Allen Doderlain, national president, Depression and Bipolar Support Alliance; Pam Binkley, recovery coordinator, Optum Health, who will talk about emotional first aid; Lisa Ragan, director, Office of Consumer Affairs, Tennessee Department of Mental Health, who will speak on peer support, recovery, etc.; and Elizabeth Power, a nationally known expert on post-traumatic stress disorder. Mental health professionals from Blount Memorial Hospital have also been invited to speak.
Drain said, “I think this will be a quality addition to the Maryville community and I hope lots of folks will come. ... For a lot of folks here, the whole area of mental health, mental health treatment, the resources involved and things like that are so confusing. My hope is that all these speakers can shed some light, bring some facts and really help people in the Blount County area.”
Larry Drain, hopeworkscommunity
S.L. Brannon D.Div..