Illnesses, Images and Insights

People who suffer with mental illness have been attracting especially negative press recently.

Let’s look at the case of Mr. Alexis, the military contractor who killed 12 people at the Washington Navy Yard last month. According to The New York Times (October 5), his mother told his bosses one month before the shootings that her son had a history of paranoid episodes and most likely needed therapy. But Mr. Alexis’ managers at the Experts Inc., an information technology firm, decided to keep him on the job. An internal company investigation has found that they did not require him to seek treatment and concluded that the “Experts” mishandled Alexis and knew more about his mental problems than it disclosed.

(Alexis had been arrested three times in three states, including once after shooting out the tires of a car in what he told the police was an anger-induced “blackout.”)

In this case (and in others) signs and symptoms exist and are ignored; what appears  “out of the blue” and unpredictable is often not so.

Another kind of mismanagement (The New York Times, September 29) is the case of Melissa Morelli, whose treating physicians said “it was not safe for Melissa to go home” from the psychiatric hospital but whose family’s health insurance carrier would not continue to pay for her to stay. ”Over the course of five months, Melissa’s mother took her to the hospital roughly a dozen times, and each time the insurance company Anthem-Blue Cross, refused to pay for hospital care.”

Melissa’s mother sought the assistance of Connecticut state officials and an outside reviewer. She eventually won all her appeals, and Anthem was forced to pay for the care it initially denied. (“Anthem, which would not comment on Melissa’s case, says its coverage decisions are based on medical evidence.”)

Few people have the tenacity demonstrated by Melissa’s mother.  By implication, many people fall through the cracks. They may not receive the necessary treatment (in spite of paying the premiums) prescribed by the practitioners!

“Patients often find themselves at odds with health insurers, but the battles are perhaps nowhere so heated as with the treatment of serious mental illness,” according to another article in The New York Times (September 29).

A federal law, the Mental Health Parity and Addiction Equity Act of 2008, was aimed at avoiding fights like this by requiring insurers to cover mental illnesses just as they cover treatment for diseases like cancer or multiple sclerosis. The federal government has not yet written the mental health act’s final regulations for insurance companies, and a crucial gap remains between the act’s intention and application.

Many agree that, five years after President Obama signed it, the law has fallen short of its goal to create parity for mental health.

Mr. K. is a former patient from my practice. He was about forty years old when he reported to the Blanton-Peale clinic for counseling. He worked for a large corporation and reported abuses that he’d observed at work. He told me, “I am so angry that if I go back to work, I will shoot up the place.”

Mr. K. gave me permission to send the evaluation to his company. Within a year, I was called to court to deliver my findings. Of course I took his threats seriously and testified that he could not return to work.  Mr. K. was placed on full disability (worker’s compensation) which paid for weekly treatment and medication. Over many years, Mr. K. continued to rage about the company and express enormous gratitude to me, although I had done nothing more than acted in the line of duty. After more than ten years, he moved to another state where he presumably continued treatment.

When I read about the above cases in which appropriate treatment was denied, I realize the impact of Mr. K’s  treatment and his gratitude: It saved his life and perhaps those of several others.

I don’t like to think we have gone backward in our psychiatric care; but the confusion of our governmental policies and the failure to reel in the abuses of the health insurance companies have led (and, sadly, may lead to more) cases of violence.

Both Mr. Alexis and Melissa are like canaries in the coal mine. Their cases point to the noxious fumes (of system failure) penetrating and polluting our environment.

Conclusion: A dire situation exists in our health care system; mental health care does not have parity with physical illness for receiving care and reimbursement. Mental health practitioners, trained to determine the appropriate treatment, have lost power (to big business including insurance companies) to deliver the appropriate care.

Dear Reader, I welcome your response to this dire situation. jsimon145@gmail.com.