A Baffled Look

The straight dope on mental health

Month: August, 2013

Let’s Hope

A demonstration program created in the Affordable Care Act will test if having more hospital beds available for psychiatric emergencies will save taxpayers and hospitals money. Currently Medicaid won’t pay for admission to psychiatric hospitals w/ more than 16 beds. Eleven states (Alabama, California, Connecticut, Illinois, Maine, Maryland, Missouri, North Carolina, Rhode Island, Washington, West Virginia) plus the District of Columbia are participating in this three-year demonstration. The reason behind this demonstration is to see if allowing Medicaid to pay for care in institutions over 16 beds saves money in the long run. The program runs for 3 years.

The reasons behind this limitation, called Medicaid institution for mental diseases (IMD) exclusion, came about because of the wretched conditions of state mental hospitals in the middle of the 20th century. The history of how and why these state hospitals came about originally stemmed from good intentions (and you know what they say about good intentions). Before the state hospitals existed, poor mentally ill people were usually sent to squalid jails and almshouses. State hospitals were originally meant to be a humane alternative. States financed these hospitals, not the federal government. By the mid-20th century, these institutions became overcrowded and as squalid as the jails and almshouses had been. The media learned about the conditions in these state hospitals at around the same time the first antipsychotic, Thorazine (chlorpromazine), began use as a treatment that would allow some mentally ill people to live in the community. This led to the development of community mental health centers. Civil liberties organizations got involved and states drafted laws to ensure that mentally ill people were treated in the least restrictive setting. Lawmakers now viewed state hospitals as simply warehouses that provided little treatment. Legislatures deemed state hospitals as inappropriate for Medicaid. According to Centers for Medicaid and Medicare Services’ Medicaid Emergency Psychiatric Demonstration Design and Solicitation, the Medicare Catastrophic Act of 1988 further defined an IMD as a facility primarily used for inpatient psychiatric treatment with more than 16 beds were excluded from reimbursement from Medicaid.

Community mental health services were never funded adequately from the beginning. Inadequate treatment leads to psychiatric emergencies. Lack of available beds for these emergencies results in what’s called “psychiatric boarding” in general hospital emergency departments which don’t have the resources to provide appropriate psychiatric care. The demonstration program starts in 2014. Let’s hope that it succeeds in saving money because implementing this program nationwide will save lives.

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I’m not a professional. I’m an expert.

I joined Toastmasters because I have to give a presentation on the healing power of art show at the Orlando Museum of Art in November. The event organizer told me over 300 people might be there. I’ve never addressed a group of this size. I have to tell you a little about myself because it will explain why I was asked to do this show.
I’m a silversmith. I’ve worked in many other art mediums such as creative writing as well. I’m also mental health advocate. I would like to describe my path to advocacy for mentally ill people. I’ve had bipolar disorder since I was 14. Bipolar disorder is an illness characterized by extreme emotional highs and lows. It used to be called manic depression because of the shifts between mania and depression. During manic states a person will often feel euphoric, talk nonstop, take on many foolish risks, -like entering into dubious business ventures spending vast quantities of money they don’t have. They often sleep very little during mania. Bipolar depression is often punctuated with loss of interest in activities that you used to enjoy, isolation, suicidal thoughts and excessive guilt.
This topic may seem too personal to my fellow toastmasters here. I’m talking to you about it for the same reasons I’m open about my condition with others. If I keep silent about it, I’ll contribute to more misunderstanding and stigma towards mentally ill people. If I hide, I become invisible. To be invisible is to live without hope of acceptance and inclusion from others. Being invisible robs me of hope. I have to be hopeful to affect change.
Like many people with my condition, I was first misdiagnosed with depression and given an antidepressant which worked for my depression at first. It eventually led to mania. The reason antidepressants cause mania in people with bipolar disorder is because they’re supposed to elevate your mood. Mania can turn into psychosis, which is characterized by delusions – like believing you’re Jesus Christ, paranoia – the belief that others are out to get you – experiencing hallucinations such as hearing voices even when no one is around. It can be a very scary experience. Believe me, I know. This is what happened to me during my teens. I decided not to take the antidepressants because of this. I started to drink alcohol in order to control my mood. I became an alcoholic. Getting sober eight years later was one of the best things I did for my mental health. For the first seven years of my sobriety I saw a few therapists for depression. I did not see a psychiatrist because I was afraid of re-experiencing what happened to me as a teenager. I became manic during my seventh year of sobriety. I was hospitalized for it because I became psychotic. No one could understand what I was saying. I was incoherent. The psychiatrist in the hospital diagnosed me with Bipolar Disorder. This time the medication I was prescribed stabilized my mood. I felt much better.
Soon after I left the hospital I read an article in the Orlando Sentinel about a local drop-in center that serves poor mentally ill people, many of whom have coexisting substance abuse problems. This drop-in center, Pathways Drop-In Center, offered many services like a meal, shower, computers with internet access, an address for homeless people, cable TV, a washer and dryer. Although I wasn’t poor – I was pursuing a degree in digital media at UCF – I wanted to spend time with other mentally ill people. I fell in love with the place. Pathways offered a much needed service. Pathways provided activities too. I started a beading class. Helping them helped me. I felt grateful for what I had after seeing how difficult life was for Pathways’ clients. After I finished my degree, I decided to work for Pathways as general manager. I never, however, admitted to outsiders that I was mentally ill because I was afraid I’d be harshly judged. I worked there for two years. After working there I decided to go back to pursue a master’s degree in Social Work. I found a calling to advocate for others like me. Half way through my degree, I started having trouble with symptoms again. I didn’t want anyone in my graduate program to know I was mentally ill because it can be a nightmare getting licensed. I had to medically withdraw even though I had a 4.0 and belonged to two honor societies. It took a while to get my symptoms under control. By the time my symptoms improved, I realized I didn’t want to be a professional. I was already an expert after coping with mental illness for so many years. I could help other people already. I decided that I could help even more by admitting openly that I have a mental illness.
I started a blog called A Baffled Look that covers social justice issues about mental illness. I started writing stories about my time with Pathways. Mental illness became my muse. I joined Pathways’ board of directors. I realized that I wouldn’t have much to contribute to the board unless I spent more time there. I started an art workshop where Pathways’ clients can make collages, color, or just hang out. I started another blog about what happens during the weekly art workshop. Don’t worry. I don’t reveal their identities. They know I’m writing about them. I’m featuring some of their work along with mine at my November presentation. Most of the work featured in my presentation at the November show is collage. I like its ease and immediacy of expression. I call the blog Word Salad World because Pathways is a microcosm of larger issues facing mental illness. During one of my visits to Pathways, a woman put a picture of a Barbie doll in her collage. She told me that she lost her favorite doll when her family got evicted from their home when she was seven years old. I’m definitely putting her collage in my presentation.
Having two blogs where I acknowledge having a mental illness is as far out of the closet as you can get. I’m not hiding anymore. The more open I become about my illness, the more I can teach others about this issue.