Mental illness is all around us. My family has certainly been impacted heavily - see my post about my brother's death almost three years ago from depression complications. I will avoid posting names or specifics of anything else because of the unfortunate stigma that mental illness still carries, and I will refrain from posting statistics because if you care you can look them up yourself. Recently, a student died of similar causes, and I wrote again about that. I have written little about my own experiences for fear of repercussions in work or social situations, but for those of you who know me personally or have been reading for a while, I'm sure you are unsurprised.
I avoid ranting. I will do my best here to avoid ranting. But after what I have seen, this is a serious issue and merits address.
The way that our healthcare system is set up is broken, in many areas, but particularly in the area of mental health. Mentally ill people are already suffering intensely, often with intellectual and emotional difficulties, some of which move into physical pain. Their ability to eat and sleep can be affected. It is unsurprising, then, that many consider suicide. Suicide is the outcome of an untreated mental illness in the same way that death is the outcome of most untreated cancer, heart disease, diabetes, etc.
Often, the solution for mental illness appears to be self advocacy. We say that people should have called someone, or made an appointment with a healthcare professional, or found some strength inside themselves, or, or, or . . . This ignores reality. Mentally ill people are at their lowest capacity to advocate for themselves. I am not suggesting that they should be involuntarily committed (I wrote a whole post about psych holds and the conditions in psychiatric facilities), but expecting them to make appointments with strangers or call someone or argue with an insurance company or navigate a government bureaucracy to get community mental health or Medicaid or whatever is unreasonable. Or, if they have already done this but changed jobs, moved, changed insurance carriers, etc, expecting them to find a new provider and go through the whole process again is unreasonable. Expecting them to feel badly or reach out only on weekdays from 9-5 is unreasonable. Expecting them to continue seeking help after they are told that there is nothing wrong or are misdiagnosed is unreasonable.
Once people do get help, usually the first interventions are medications and talk therapy. Psychiatric medications are no joke - even widely used, generally safe ones like SSRIs can have pretty serious side effects, especially if the diagnosis is wrong. Many cause drowsiness or lack of cognitive function, which can for some people feel as debilitating as the original illness. These drugs can be extremely expensive, even with insurance, and will often be cocktailed in ways that make it difficult to understand how they are working and which ones are causing side effects. There really is not much research going on to develop completely new drugs that avoid these issues, given how much large pharmaceutical companies are already making off these drugs.
The other first line treatment is usually some form of psychotherapy. For this to work, the patient really needs to find a good fit, but referrals can take quite some time (in my case, I've been looking for a new one since late June and am having my first appointment tomorrow), and there is no guarantee of a good match the first time. With every new therapist, it is expected that the patient will run through a life story that often by that point contains a great deal of pain, reliving terrible experiences in the narration. This can become highly traumatic, again, for patients who have changed insurance coverage and can no longer afford to see a provider they liked. I seriously doubt whether describing everything bad that has ever happened over and over is a valid path to healing.
Treatments such as diet, exercise, lifestyle changes, sleep hygiene, osteopathic manipulation, lightbox therapy, and so forth are not taken seriously in terms of treating mental illness. Most insurance companies do not cover these treatments, perhaps because big pharma has convinced them not to, perhaps because there is little funding for this research, perhaps because compliance with them is lower. Whatever the reason, many patients will never be told that the vast majority of serotonin is produced in the gut and that dietary changes may help significantly. Many will never experience the body/mind release of pain and acceptance of care from a proper osteopathic balance ligamentous treatment. The objection is that these treatments are usually too expensive, but some psychiatric meds - an individual med, not the whole cocktail of two or three or four - can cost upwards of $600 a month and end up preventing people from working due to side effects. Noncompliance is also a serious issue with psych meds, often because of the cost or side effects.
I don't often make sweeping policy recommendations, but I will here.
1. Abolish insurance network restrictions, at least in the case of mental illness, so that once patients find providers that work for them, they can keep them. (While we're at it, let's have universal healthcare coverage that is not employer-based. This would address mental healthcare disparities in populations of color and the LGBT community.)
2. Require coverage of alternative mental illness treatment, not after everything else has failed, but to initially complement or even avoid pharmaceutical therapy.
3. Train healthcare professionals, educators, religious groups, etc to recognize signs of mental illness and take a systematic approach in concert with the medical establishment to support those suffering.
4. Require reasonable accommodation of those with mental illness and training for employers to understand what an individual illness might actually mean. Many mentally ill people avoid seeking help because they fear (often correctly) that if people find out they are ill, they will be perceived to be unstable, dangerous, or incompetent.
5. Fund research into alternative management of mental illness, using the therapies listed above and others. Currently, I cannot identify any clinical trials that use no pharmaceuticals (if you know of one, let me know), but I have actually found the best management to be in alternative therapies.
6. Allow homecare or hospice for patients experiencing significant suicidal ideation. Homecare allows for caregiver relief but keeps patients in their homes, where they will be most comfortable and theoretically have access to their best support system (family, friends, pets, soothing activities, religious communities, normal food) - things that are generally not accessible in an institution. If people are suffering enough that they could kill themselves at any time, this is not significantly different from a terminal cancer diagnosis, and they should be allowed dignified treatment.
7. Create teams of healthcare providers with different specialties. Psychiatrists, family practitioners, dietitians, social workers, and others should be working together closely. Cancer patients often have collaborative relationships with multiple doctors who will meet together to discuss therapies. Given the wide range of symptoms and side effects experienced by mentally ill people, it doesn't make sense for a psychiatrist to prescribe something but then refuse to be involved in managing its side effects.
I am sure that I am missing some recommendations. I am sure that most of these recommendations will never be implemented, and that even if they were, mental illness would not completely disappear. I am also sure that if I remain silent, I will not be part of the solution. So I am advocating, on behalf of myself and my brother and my student. Maybe if you join me, we can do something.
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