If the U.S. were my students, they'd flunk

The National Alliance on Mental Illness recently released a report card on America's health care system for adults with mental illness. Our grade: D.

At the Newhouse School of Public Communications, where I teach, this is a failing grade. We flunk when it comes to creating a support system for people with mental illness. We have no network of consistent services, no consistent access to mental health care, and no standardized system of licensing or treatment criteria.

We fail in other ways, too. We as a society fail to take seriously the ravages of mental illness. We step over those with mental illness both literally and figuratively. We turn our faces away. We perpetuate the shame and stigma of diseases like schizophrenia, bipolar disorder, and, yes, eating disorders.*

My students always want to know how they can raise their grades. I put the same question to all of you: How can we as a society raise our grades when it comes to mental illness?

Here's my two cents on the subject:
1. Offer incentives to those studying to be doctors and therapists. One reason we have such a staggering lack of good mental health providers is that in our current health-care system (or shall we say lack of health-care system) they can't earn as much as other docs. This is partly a function of how our disgraceful so-called health insurance system works. See 2.
2. Mental health parity is a good first step, but it's full of loopholes. Enact legislation that prevents health insurers from weaseling out of covering mental health issues. The track record is dismal, especially for eating disorders.
3. The first two items on the list would start us on the road toward lessing stigma around mental health issues. Shame on the health insurers for heaping more shame, and financial burden, on families struggling with these issues.
4. Talk, talk, and more talk. The more we talk about a subject, the less shameful it becomes. Social change takes time. Let's get started.

What are your ideas?





* I'm not a believer in classifying eating disorders as mental illnesses, but for now that's where they reside and so that's where we've got to live with them.

Tell President-elect Obama how you feel

Here's a chance to contribute to the next administration's health care agenda: Take 10 minutes to go to this site and post about an issue you care about. Mental health parity? Health at Every Size? More funding for eating disorders research? Whatever's near and dear to your heart, tell the change team. Today. Really. Because how often do we get a chance like this?

Make the call for mental health parity

According to the Eating Disorders Coalition, a lobbying group that Maudsley Parents is affiliated with, July 9th is National Call-in Day for mental health parity.

Says the EDC:

The US House of Representatives and the Senate negotiators have reached a final agreement on all the remaining mental health and addiction parity issues. However, approximately $4 billion over 10 years in offsets is needed to pay for the bill and must be found before parity can be brought to the floor in both chambers for final passage. Once an offset has been found, there is commitment from leadership in the House and the Senate to bring the bill up for a vote as quickly as possible.

Although House and Senate leaders have not decided yet where they will find almost $4 billion over 10 years to pay for the cost offsets required by Congressional rules, negotiations have successfully concluded on the key policy provisions. This compromise is the result of long negotiations and advocacy of organizations all across the country. The compromise includes many key provisions that were included in the House-passed bill, the Paul Wellstone Mental Health and Addiction Equity Act and would be an important step in ending insurance discrimination facing people with addiction and mental illness. Here are some key points in the compromise:
- The compromise requires parity in insurance coverage for addiction and mental health treatment for both in-network and out-of-network coverage. This does not mean that the bill requires that insurers cover addiction and mental services, only that if they do cover these services, there must be parity with medical/surgical benefits. This of course would be a very positive development both in requiring fairness in insurance coverage and taking a strong stand against discrimination toward people in recovery or still suffering from addiction and mental illness.

- The compromise requires plans to disclose their medical necessity criteria and reasons for any denials of coverage. This would be a major breakthrough, as many plans refuse to disclose medical necessity criteria or reasons for denial, especially when addiction treatment is sought.

- On the issue of protection of state laws, the compromise bill language is silent. The House bill explicitly protected state laws, and in earlier versions the Senate bill explicitly preempted state laws. Silence is a victory for those of us who agree with the House approach that state laws should be protected, since in most situations Congress must take explicit action to overrule a state law in order for state laws to be preempted. However, to make protection of state laws even more ironclad, we will be working to ensure that the legislative history of the bill makes clear that the sponsors’ intention is to protect all state laws. That way, as important as the passage of a federal parity law would be, stronger state laws would remain in effect and states would be free to enact additional stronger protections in the years to come.

Wednesday July 9th is National Call-in Day so please call your Member of Congress and Senators on July 9th and tell them that now that an agreement has been reached between the House and the Senate, Congress must find the money to fund this historic mental health and addiction parity legislation and pass parity now.

For more information, visit our National Call-in Day Online Advocacy Action Center.On the website you will see background information, a script for the call and a tool you can use to punch in your zip code and get your Member of Congress and Senator’ names and phone numbers.

Progress on parity

According to a press release from the Eating Disorders Coalition, eating disorders "were front and center" in the debate that ended with the House passing its own version of a mental health parity bill, 268 to 148. The House version is much better than the Senate version passed last year, but it's unlikely to be the one passed in the end.

Still, the fact that we're even talking about having a mental health parity bill in this country just blows my mind. It's about goddamn time.

I love this quote from EDC executive director Marc Lerro: “We made our points so often that members of Congress started making our points for us. In committee meetings, Republicans and Democrats alike described how parity could affect people with eating disorders.”

Now that's activism at work.

Another good quote comes from David Wellstone, son of the late Senator Paul Wellstone of Minnesota. He felt the Senate bill didn't go far enough and refused to let it be named after his father, saying, “My dad always believed that you can’t leave people out." The Senate version would not protect people with eating disorders to the same degree as the House version.

But it's a start.

Make a call for mental health parity

Last week I learned, to my shock and horror, that because my daughter had anorexia, we cannot get health insurance, except through a large group plan (i.e., through an employer). We can't become freelancers and buy our own health insurance because, as our agent said, "You'll never pass underwriting."

What we need in this country is real true health care reform, not some bullshit foisted on us by the greedy health insurance companies. And I hope to God I live to see the day it finally happens. In the meantime, we can do something now by helping to pass a federal mental health parity law. The U.S. Senate has already passed its version; now the House of Representatives is getting ready to debate its version.

Please take a few minutes to call your Representative and advocate for passage of H.R. 1424, coming up for debate this Wednesday. The Eating Disorders Coalition--one of the most effective advocacy groups in the eating disorders world--suggests saying something like this:

I am a constituent of Representative ______ and a supporter of the Eating Disorders Coalition. I am calling to ask that the Representative vote for H.R. 1424, the Paul Wellstone Mental Health & Addiction Equity Act. Parity is a fair and affordable solution to insurance discrimination against people with eating disorders and other mental disorders. It will save lives and families.

But you can say whatever you want. Just make the call. Please. In this era of pressure politics it really makes a difference for the folks in Washington to hear from the little people.

The number to call is 866-727-4894.

(Not sure who your Representative is? Go to this site, click on the little hand on the upper left hand side of the page, and enter your zip code to find out.)

All of us who have found ourselves in DSM at one time or another thank you kindly.

Do your Monday morning best for mental health parity

This just in from the Eating Disorders Coalition:

"Thank you for all your unified effort in supporting the passage of mental health parity! We are close to victory in the House of Representatives— to pass H.R. 1424, the “Paul Wellstone Mental Health and Addiction Equity Act”. This bill would require health plans to cover eating disorders and has made it out of 2 committees and the subcommittee of Energy and Commerce. The last step in order for the bill to go to the floor for a vote is to get moved out of the Energy & Commerce Full Committee. That mark-up is scheduled for next Tuesday, October 16th. We need your action on this!

If your Representative is a member of that Committee, please call him/her on Monday morning to urge a “YES” vote on the bill, and a “NO” vote on all weakening amendments!"


And here's the list of representatives on that crucial committee. If yours is on there, please give him or her a call. The EDC has even written a suggested script for you to say when you do call: "“I’m calling to ask the Congressman/woman to VOTE FOR H.R. 1424 on Tuesday in the Energy & Commerce Committee, and to VOTE AGAINST all amendments to substitute weaker language. Americans deserve the same mental health parity protections that members of Congress enjoy, for all mental and addictive disorders, not just the ones health plans choose to cover.”

Go forth and help make policy. And parity.



FULL COMMITTEE

John D. Dingell (MI), Chairman

Ratio: 31-26
Henry A. Waxman, CA Joe Barton, TX, Ranking Member
Edward J. Markey, MA Ralph M. Hall, TX
Rick Boucher, VA J. Dennis Hastert, IL
Edolphus Towns, NY Fred Upton, MI
Frank Pallone, Jr., NJ Cliff Stearns, FL
Bart Gordon, TN Nathan Deal, GA
Bobby L. Rush, IL Ed Whitfield, KY
Anna G. Eshoo, CA Barbara Cubin, WY
Bart Stupak, MI John Shimkus, IL
Eliot L. Engel, NY Heather Wilson, NM
Albert R. Wynn, MD John Shadegg, AZ
Gene Green, TX Charles W. "Chip" Pickering, MS
Diana DeGette, CO, Vice Chair Vito Fossella, NY
Lois Capps, CA Steve Buyer, IN
Mike Doyle, PA George Radanovich, CA
Jane Harman, CA Joseph R. Pitts, PA
Tom Allen, ME Mary Bono, CA
Jan Schakowsky, IL Greg Walden, OR
Hilda L. Solis, CA Lee Terry, NE
Charles A. Gonzalez, TX Mike Ferguson, NJ
Jay Inslee, WA Mike Rogers, MI
Tammy Baldwin, WI Sue Myrick, NC
Mike Ross, AR John Sullivan, OK
Darlene Hooley, OR Tim Murphy, PA
Anthony D. Weiner, NY Michael C. Burgess, TX
Jim Matheson, UT Marsha Blackburn, TN
G. K. Butterfield, NC
Charlie Melancon, LA
John Barrow, GA
Baron P. Hill, IN

Eating Disorders Coalition action alert

Anyone who's ever tried to get a mental health issue covered by insurance (or, as they're called in our state, "behavioral health issues") will want to act on the EDC's latest action alert:

"You can help Pass the Paul Wellstone Mental Health and Addiction Equity Act (H.R. 1424) today by calling House Speaker Nancy Pelosi toll-free at 877.978.9996 and telling her that you support the passage of this mental health parity act."

Another step toward mental health parity

From an e-alert sent out by the Eating Disorders Coalition (EDC):

Senate Agrees to Remove Barriers to Mental Health Coverage
Republican senators this morning removed language from the Senate's parity bill that would have made it more difficult for people with eating disorders to get treatment under many health insurance plans. The senators heard from business leaders and insurance companies, who last night decided to strike the preemption section of the Mental Health Parity Act of 2007 (S 558). Mental health advocates believed that the preemption clause would weaken the parity bill, leaving it up to state laws to determine whether eating disordhttp://www.blogger.com/img/gl.link.gifers would be covered.

"This is a huge step forward," said EDC President Kitty Westin. "It shows that our work is paying off. It appears that the Senate will vote on parity this afternoon before the summer recess begins. If that happens, then mental health parity will probably be on top of the House agenda in early September, when Congress returns."

The EDC has actively supported the House and Senate bills.


What happens next?

The Energy and Commerce Committee of the House of Representatives will probably vote in early September on the House parity bill, the Paul Wellstone Mental Health Equitable Treatment Act of 2007 (HR 1424).

What can you do?

If you are represented by a member who serves on this committee, call, write, or visit the member in August and explain why you think mental health parity is needed. Most members are spending much of August in their home districts, close to where you work or live.

HOUSE ENERGY & COMMERCE COMMITTEE

John D. Dingell (MI), Chairman

Democrats Republicans
Henry A. Waxman, CA Joe Barton, TX, Ranking Member
Edward J. Markey, MA Ralph M. Hall, TX
Rick Boucher, VA J. Dennis Hastert, IL
Edolphus Towns, NY Fred Upton, MI
Frank Pallone, Jr., NJ Cliff Stearns, FL
Bart Gordon, TN Nathan Deal, GA
Bobby L. Rush, IL Ed Whitfield, KY
Anna G. Eshoo, CA Barbara Cubin, WY
Bart Stupak, MI John Shimkus, IL
Eliot L. Engel, NY Heather Wilson, NM
Albert R. Wynn, MD John Shadegg, AZ
Gene Green, TX Charles W. "Chip" Pickering, MS
Diana DeGette, CO, Vice Chair Vito Fossella, NY
Lois Capps, CA Steve Buyer, IN
Mike Doyle, PA George Radanovich, CA
Jane Harman, CA Joseph R. Pitts, PA
Tom Allen, ME Mary Bono, CA
Jan Schakowsky, IL Greg Walden, OR
Hilda L. Solis, CA Lee Terry, NE
Charles A. Gonzalez, TX Mike Ferguson, NJ
Jay Inslee, WA Mike Rogers, MI
Tammy Baldwin, WI Sue Myrick, NC
Mike Ross, AR John Sullivan, OK
Darlene Hooley, OR Tim Murphy, PA
Anthony D. Weiner, NY Michael C. Burgess, TX
Jim Matheson, UT Marsha Blackburn, TN
G. K. Butterfield, NC
Charlie Melancon, LA
John Barrow, GA
Baron P. Hill, IN

Fat--it's all in your head

At least according to this editorial in the American Journal of Psychiatry, exploring the question of whether to make obesity a brain disorder in DSM-V.

Of course, it's not really clear what exactly they mean by brain disorder. Anorexia and bulimia are listed in DSM-IV as brain disorders, sorta, and I have to say, I'm not sure what that means, either. Insurers still treat them as mental health issues rather than biologically based illnesses, and use that as a way to skive off covering them (at least in beknighted states like Wisconsin, which have no mental healthy parity laws).

It depends what the rationale is here, really. What we now know about eating disorders like anorexia is that some people are genetically and biologically predisposed to them, and that environment seems to play some kind of role in triggering those who are susceptible. Maybe that's true for obesity. That makes more sense to me than suggesting that all so-called obese people are compulsive eaters, which we know ain't true. Yo-yo dieting might be the environmental trigger, resetting the metabolism over time in ways that result in obesity.

But if an entry in DSM-V is going to result in more stigma attached to being obesity, I think we should say no thanks.

What do you think?

Taking a lesson from autism

An article in my local paper got me thinking yesterday. If the autism parents can get their shit together to push for more comprehensive insurance coverage of their kids' illness, why can't we?

Jim Lock himself, one of the gurus of the Maudsley method here in the U.S., once told me that eating disorders parents should model ourselves on the autism parents. As a group they've dedicated themselves to not just supporting their children but to advocacy on all levels--especially, now, with regard to insurance coverage.

The article quotes an autism professional as saying "Most of the major autism organizations, both providers and support groups, have come together in agreement that insurance coverage for all individuals with autism is a positive and important need."

Same goes for anorexia and bulimia, as well we know.

Like anorexia, autism is often not covered, or covered poorly, because it's classified as an emotional disorder rather than a brain disorder. But I say, if your brain isn't considered part of your biological body, then what is it--a disembodied organ floating in space?

One of the autism advocates is quoted as saying "We're continuing to work together in the hope legislators take notice that the need is not going to go away and we're not going to go away."

Hey, what about us? What about those of us who have watched our children waste away or go through hell, only to be told that insurance doesn't cover therapy, or IP treatment or whatever the doctors are recommending at that moment?

What about people like Anna Westin, whose smart, articulate parents fought like hell to get her well, only to be turned down by insurance eventually? Anna committed suicide, and her parents took her experiences to the state insurance commissioner and to the courts and won not just money but also changed the way insurers in Minnesota cover anorexia.

We could do this, state by state. That's what it's going to take, probably, unless we can get the federal mental health parity bill passed.

I'm sick of "steps forward," though, and "making progress." We aren't making progress when it comes eating disorders. What will it take?

Mental health parity

Here in Wisconsin, we don't have mental health parity, a fact I often moan about. If only we had it, I often thought during my daughter's recovery, we would be able to get the treatment we need for anorexia, bulimia, and other eating disorders.

Parents in New Jersey, where there is mental health parity, found that insurers still discriminated against e.d. treatment, denying and disqualifying it in the face of medical advice. Dawn Beye is one parent who got sick and tired of waiting for her insurer to do the right thing and cover her daughter's treatment; she and other parents filed a class action lawsuit to have anorexia classified as a "biologically based illness." Apparently insurers in New Jersey differentiate between biologically based mental illnesses (depression, etc) and non-biologically based mental illnesses.

I guess they think anorexia is all in our heads. They ought to read NAMI's stance on this, not to mention the opinions of many other clinicians and professionals. But then we all know that health insurers know more than doctors when it comes treatment protocols and appropriateness. Right?

When I rule the world, we'll have national health insurance (which goes without saying). And that national health will cover evidence-based treatment for eating disorders, plus support families using the Maudsley method and other approaches yet to be discovered for helping their children recover from e.d.s.

Beye's daughter is still in-patient after 10 months. Beye and her husband still don't know how they're going to pay for her treatment. They could wind up owing several hundred thousand dollars if Aetna doesn't do the right thing and cover the IP treatment.

As my grandmother would have said, it's a shanda. And if you don't know what that means, look it up in Leo Rosten.