Blog

mixed episode
  • Insurance, the Final Frontier

    In America, we love our health insurance. We also love to hate our health insurance. Most people obtain it through their employer and never have to give it much thought beyond griping about a service not covered, an expensive deductible, or a pharmacy co-pay. Costs are rising and we are being asked to shoulder more of the burden with increased deductibles and co-insurances. However, with coverage provided by employers it still often falls to the back of our minds. 

    I first started thinking about insurance when I spent a year seeing a therapist who did not accept insurance. Why? Because he could. He didn’t want the “hassle” of dealing with insurance companies. We spent a year paying out of pocket for my sessions and hoping to get reimbursed for what we spent. We rarely did, as the insurance company made the paperwork so overwhelming, so challenging to understand that as a family in crisis it seemed like one more headache not needed at the time. The majority of the time we would be told by the insurance company that I exceeded my allotted sessions for the year and “too bad. 

    I did not think about insurance again until I found my dream job, which unfortunately does not provide insurance for employees. Why, you ask? Because there are only 10 full-time employees and employers with less than 50 full-time employees (FTE) are not mandated by the government to provide insurance. There is no tax penalty for said employers, but they would be eligible for tax credits if they chose to offer insurance. Now, as an individual, I can get penalized in a tax penalty if I don’t obtain insurance on my own. My family does not qualify for subsidies in the Affordable Care Exchanges and we are then mandated to pay dearly by purchasing a plan at retail value. For our relatively healthy family of five, it costs approximately a mortgage payment a month. Fortunately, or unfortunately, depending upon how you view it, we pay over 8% of our annual household income in premiums and would not be penalized for lack of coverage.

    Why the obsession over insurance? Let’s look at a hypothetical but all too real scenario for Americans who rely on the Affordable Care Act for coverage. For the sake of utilizing what I know I will pick on my family.

    Well, as person with mental illness, I depend on that coverage to keep me in remission. I depend on that coverage for my prescriptions and ability to afford to see my treatment team. I never wanted to be a position where I would have to choose money over mental health. Except now I am. What if we were to fall behind in premium payments by just one month? Insurance companies are now actively dropping coverage for just that, without opportunity to make good on the premium due. One would learn of coverage loss either via letter or when attempted to pay. The insurance companies are now holding firm that there is no recourse in such situations until the new calendar year occurs. One can always appeal, however appeals are based on whether or not medications and care are for what the insurance companies deem as life-threatening. Let me repeat that: what the insurance company deems as a life-threatening condition or medication. Mental illnesses get denied on the basis that the condition is not life-threatening and medications are not life-saving.

    My family and I beg to differ based on the history of mood episodes. We object based on the number of times suicide was attempted while manic. We object based on the simple fact that with consistent medication I have proven the ability to remain stable, employed, out of the hospital and most importantly without active suicidal ideation. My medications are life-saving. They saved my life. They saved my life repeatedly.

    This means in a mood episode, I cannot afford my medications. This means I cannot afford to see my treatment team. We have children to feed, to clothe, and provide opportunities for. Keeping food on the table will always trump paying out of pocket for my psychiatrist. This means in my current mixed state – still running amok – I have to cancel my previously scheduled psychiatrist appointment because I cannot afford it. This means I white-knuckle it until January 1, 2017.

    I don’t parent well white-knuckling. I don’t “wife” well white-knuckling. I throw all my emotional energy into my job, as I always do which leaves nothing left over at the end of a workday for the people who actually matter most to both my heart and my brain.

    Despite this hypothetical scenario described, what still angers me, leaving me simultaneously sad is that I would still be one of the lucky ones in this country in terms of mental health care and access for my illness. I have the ability to speak up, fight, appeal and appeal again to get coverage reinstated. There are an awful lot of people in our country who cannot, whether it is out of fear, stigma, lack of financial resources or the physical ability (such as our homeless).  It is inexcusable in today’s day and age. It is inexcusable 6 years into the Affordable Care Act. It is inexcusable 8 years after the passage of The Mental Health Parity and Addiction Equity Act.

    My mental illness and need for insurance coverage for treatment and medication is no less important than someone with cancer or heart disease. What will happen should I have a hypothetical brain attack of neurotransmitters running wildly in my head and become unstable? I do not want this disease to claim me as a statistic, nor anyone else for that matter.

     

  • Is it me or Isn't it me?

    “It is you. Not everyone has your diagnosis.”

    We go back and forth in the mental health community about language all the time, how it can hurt, how labels matter (or don’t for some). One infallible truth however is that words do hurt and we can’t take them back. I did an exercise with my children on the day prior to school starting to demonstrate this very point, taking a tube of Aim toothpaste, squeezing the entire tube onto a plate. I asked the kids if they thought they could get the toothpaste back in the tube exactly as it been previously. They laughed and told me “no way!” We reviewed that once words are out there, you cannot put them and some people will never be the same. We took the time to talk about being kind, thoughtful citizens of the school community. I do not know three days into the school how long the toothpaste experiment will last, but we are working on it.

    “It is you. Not everyone has your diagnosis." 

    Not everyone has my diagnosis. It’s true. As of 2014, there are an estimated 5.3 million adults in the United States with bipolar disorder. This statistic does not differentiate between bipolar 1 and 2 disorder. (www.treatmentadvocacycenter.org/resources/briefing-papers-and-fact-sheets/159/463)

    I somehow do not believe words like this can be slung so carelessly at someone however in my situation. Those eight words leave someone, including me, with the impression that my disorder and my symptoms are my fault. I’m 41 years old. I know when I am being a jerk for the sake of being a jerk. I also know when I feel utterly helpless and cannot control my swirling tornado of emotion, thought and word due to a mood episode and resurgence of symptoms. Thus begging the question, is it really me?

    There is nothing I dislike more than my diagnosis and the impact it will wreak on my daily life from time to time. There is nothing worse than hearing your child ask you where Mommy went because “this isn’t my Mommy right now” when you are in a manic rage. It stops you in your tracks, kicks you in the stomach and renders one unable to breathe. It hurts because I didn’t ask for this. I did not ask to become ill. My children didn’t ask for an ill parent either. All of us (the kids and myself) asked for love and some understanding of our behaviors. The kids, because they are immature with developing brains and will do obnoxious things at times. Me, because I cannot achieve remission again without love, patience, time and a solid treatment team.

    “It is you. Not everyone has your diagnosis.”

    Not everyone has my diagnosis, and the things I CAN control are simple: putting down the phone and staying away from social media when it’s bothersome to me and liable to set me off. Sitting down every single night with the kids for dinner. Instituting family time every single night regardless of how tired I am. Bedtime snuggles and hugs. I can show my kids how much Mommy is always there, even when my brain is misbehaving, neurotransmitters have run amok and makes it physically impossible.

    I can’t put the toothpaste back in either. All I can do is work as hard as possible every day to make sure I never squeeze it out in the first place.

  • Mania, the Remix

    Raise your hand if you love a good remix. Personally, I am all about the remix. My current favorite is the Mike Posner “I Took a Pill in Ibiza” See B remix taking a lovely acoustic song and transforming it into a jam worthy of the finest kitchen dance party one was ever invited to. There are always exceptions to the remix rule and the original holds, such as the current Calvin Harris /Rihanna collaboration “This is What You Came For.” Strictly the original please for my tastes.

    I Took a Pill in Ibiza, remix, Vevo        

    This Is What You Came For, Vevo

    Raise your again if you are wondering what this has to do with mental illness. I assure you plenty. Now I am in the midst of what feels like the Calvin Harris of all remixes – manic episode with mixed features.

    DSM V criteria of a manic episode with mixed features states: “Full criteria are met for a manic episode or hypomanic episode and at least three of the following symptoms are present during the majority of days of the current or most recent episode of mania or hypomania

    -       Prominent dysphoria or depressed mood as indicated by either subjective report or observation made by others.

    -       Diminished interest or pleasure in all, or almost all, activities (as indicated by either subjective account or observation made by others

    -       Psychomotor retardation nearly every day (observable by others, not just subjective feelings of being slowed down).

    -       Fatigue or loss of energy.

    -       Feelings of worthlessness or excessive or inappropriate guilt (not merely self-reproach or guilt about being sick).

    -       Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or specific plan for committing suicide.

    The mixed symptoms are observable by others and represent a change from the person’s usual behavior. The mixed symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication other treatment).

    Let’s review (briefly) a manic episode: a distinct period of abnormality and persistently elevated, expansive or irritable mood and abnormally and persistently goal-directed activity or energy, lasting at least one week and present most of the day, nearly every day (or any duration if hospitalization).

    During the period of mood disturbance and increased energy or activity or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior

    -       Inflatable self-esteem or grandiosity

    -       Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)

    -       More talkative than usual or pressure to keep talking

    -       Flight of ideas or subjective experience that thoughts are racing

    -       Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed

    -       Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless non-goal-directed activity).

    -       Excessive involvement in activities that have a high potential for painful consequences (e.g.’ engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).

    The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

    The episode is not attributable to the physiological effects of a substance or to another medical condition.”

    (Taken directly from the text of the DSM-V, section on bipolar disorders)

    How is my mixed episode playing out? I’ve met the criteria for mania through well over a week now of increased-goal directed activity, less sleep, more talkative, flight of ideas, distractibility and the buying sprees. The mixed component? Decreased mood, thoughts of worthlessness, crying daily, fatigue and thoughts of death.

    I don’t want to have another episode. I wanted to blame my irritable, hateful state on the state of the world today. That is not going to go over well either. People are going to be haters, but my disorder is life-long with periods of relapse and remission. My pdoc is on vacation and the coverage in his office always throws more benzodiazepines at me to solve the problem. That is not what I need. What I need is to lose the fear of speaking up about my mood and getting help with the team I trust the most is unavailable.

    When I changed specialties for my nurse practitioner practice, I guarded my stability and current remission state more carefully than the gold at Fort Knox. I slept, I deceased alcohol consumption, and I took my medications more faithfully than ever before. On a visceral level, I know that this episode is not my fault. I know this episode happened to just occur in spite of the best care possible.

    Here is what frightens me the most about this mixed episode. One, it caught me off guard and I could not recognize it for what it was for several weeks, as I have never experienced one before. Two, I am scared to speak up without my treatment team in town. I am a medical provider and people rely on me. Unless you stand in my shoes, you cannot possible understand what it is like to keep your brain held together for 8 hours every day, in a state of constant adrenaline because patients will always come first and to cause harm would cause you to go to the depths of hell. Three, do I need a medication change – AGAIN?

    Lastly, I fear I will become a victim of the system. I worry my disorder will claim me versus the other way around. I constantly worry about being just another statistic of this brain disease.

    It’s not quite Vegas for this remix and I don’t have a huge crowd cheering me on unlike our dear Calvin, though.