Time To Go

Six years ago I began this blog not knowing what to expect. I knew I wanted to reach out to those with mental illness with the hope of offering information and encouragement to those who dropped by.

As a Christian I realized there was a line I needed to walk due to the sensitive nature of the blog. I would be dealing with topics that were controversial as Christians were not in agreement as to the validity of mental illness.

This past week I’ve been sick.  Nothing serious but enough to keep me laying down and away from the computer. I have never gone more than a day or two without posting and I decided not to post while I was sick these last few days.

It was during this time I decided it was time for me to step away.

I’m turning sixty next month and I’ve been thinking about that a lot and it very well may have influenced my decision. At this point in my life stepping away may enrich my relationship with God.  That above all things is what I desire most.

There’s so much I could say but I would be typing forever. I would like to leave you with a portion of scripture I’ve used often through the years. Thank you for being a part of my life.  Allan

Romans 8:35  Who shall separate us from the love of Christ? Shall tribulation, or distress, or persecution, or famine, or nakedness, or peril, or sword?
Romans 8:36  As it is written, “For Your sake we are killed all the day long. We are counted as sheep of slaughter.”
Romans 8:37  But in all these things we more than conquer through Him who loved us.
Romans 8:38  For I am persuaded that neither death, nor life, nor angels, nor principalities, nor powers, nor things present, nor things to come,
Romans 8:39  nor height, nor depth, nor any other creature, shall be able to separate us from the love of God which is in Christ Jesus our Lord.

 

 

 

 

The High Cost Of Health Care For Untreated Mental Illnesses

 

Taken from  Insurance News Net  which can be found   HERE.

Call them frequent fliers. Or super users. Or loyal customers.

In hospitals across the country, they’re known to doctors and nurses as the people who come back time and again for care.

A tiny percentage of patients, they rack up an inordinate share of medical expenses, often preventable. Among Colorado Medicaid enrollees, they spend an average of around eight times as much as their peers.

And many of them – nearly three-quarters by an Aurora study’s recent count – have a mental illness.

It makes intuitive sense, and research confirms it: A troubled mind can take a toll on the body, and vice versa.

This simple fact is leading medical professionals and health officials in Colorado to rethink how to curb high costs in the health care system. What they have found is that it’s impossible to treat the most expensive customers of emergency rooms and other hospital services without addressing mental health.

“You can’t improve the overall health if you’re not treating the whole person,” said Dr. Angela Green, who co-directs an Aurora- based project called Bridges to Care.

Health care costs, many of them preventable, rank among the biggest indirect impacts from mental illness, an analysis by Rocky Mountain PBS I-News has found.

Medical expenses associated with mental illness reached an estimated $2 billion in Colorado in 2013, according to 2005 figures from the federal Substance Abuse and Mental Health Services Administration, updated for growth and inflation.

Lost wages cost even more. Workers with mental disorders earn $16,000 less per person, according to a 2008 study published in the American Journal of Psychiatry. I-News estimates Colorado’s share of these lost wages at $2.9 billion.

The costs keep piling up: $425 million for disability pay in 2012, according to the Social Security Administration; $62 million in state education spending for children with emotional disorders in 2012; $44.7 million to hold inmates with mental illnesses in seven county jails, according to a 2010 City of Denver survey of the metro- Denver counties; $28 million budgeted this year to treat state prison inmates.

“We’re spending a lot of money on mental health, but in all the wrong places,” said Moe Keller, a former state legislator who is now an advocate with Mental Health America of Colorado. “We’re spending an inordinate amount of money in jails because we’re not treating mental health as a physical health issue, in courts because we’re not treating mental health as a physical health issue, in emergency rooms, in prisons.”

Keller believes the money would be more wisely directed to the front end, to screening for depression in primary care offices and treating people for mental and physical health problems in the same place.

Around the state, health officials and hospital administrators are coming to the same conclusion.

Treating the whole person

Christina Jackson seemed to sleep only an hour at a time after her sister died in March 2013. Her daughter had to coax her to eat. She cried a lot. And then, in July, chest pains punctuated a crying jag. Jackson was having a heart attack.

The heart attack was followed by a stroke that left Jackson, who is 47, blind in one eye. Her hopelessness and anxiety deepened.

By last fall, Jackson had visited the emergency room at University of Colorado Hospital in Aurora three times in six months – the point that alerted Bridges to Care to intervene.

Bridges to Care, which is run out of Metro Community Provider Network safety-net clinics in Aurora, launched its frequent-flier program last year. The program, funded by a federal grant, is part of a national movement aimed at stemming health care costs by improving the way care is given to the most costly consumers in the medical system.

In Colorado, this idea is gaining ground in scattershot efforts launched by state Medicaid administrators and hospitals, including Denver Health.

These efforts diverge in how they flag frequent fliers and facilitate care. But they share a philosophy of coordinating services and giving personalized attention to help people navigate a complex health care system more efficiently.

It’s the relationships between care coordinators and patients that can help turn up the undiagnosed and untreated mental illness.

Along with getting a care coordinator, each person who enrolls in Bridges to Care receives a home visit from a therapist and a psychiatric nurse practitioner.

The Aurora project has collected detailed profiles of 57 people who have graduated from its two-month program. Around 72 percent of them were diagnosed with one or more mental illnesses. About a quarter of them had depression, 20 percent had anxiety disorder and 11 percent had bipolar disorder.

Those findings are in line with what health officials and doctors are seeing across Colorado.

Mental illnesses collectively make up the most prevalent conditions among Medicaid clients who frequent the ER six times or more in 12 months, according to an I-News survey of the state’s seven regional Medicaid administrators tasked with improving care for low-income Coloradans. They’re more common than diabetes, asthma or any other driver of ER use.

Around 33 percent of these frequent fliers have behavioral health claims, but that’s likely an underestimate of the true disease prevalence, Medicaid administrators say.

“When you look at the claims data, it doesn’t help paint the picture at all,” said Jenny Nate, community strategist for Rocky Mountain Health Plans, which helps administer Medicaid for much of the western half of the state.

“Sometimes behavioral health diagnoses get missed or minimized,” Nate said. “So it’s hard to get the real story.”

On top of that, Medicaid clients get their physical care and their mental health care from separate places, making it harder to track overlap.

Building relationships and cutting costs

That’s where care coordinators like Alyssa Murphy come in.

Murphy, a former AmeriCorps volunteer, was assigned to guide Jackson to a primary care doctor and make sure she could get an appointment when she needed it.

“I really love her,” Jackson beamed at Murphy, who was sitting in Jackson’s duplex in east Aurora.

Before, she couldn’t seem to get a doctor’s appointment when she needed it and hospital staff didn’t seem to care about her. Murphy seemed genuinely interested in her well-being. “She helped me through it.”

Jackson graduated from the two-month program at the end of January without going to the hospital once during that time. While her depression hasn’t lifted, Jackson has found that its burden was eased by the personal attention and a sense of empowerment about her health.

As time-consuming and resource-intensive as it is to provide care this way, it’s actually expected to cut medical costs, Green said. Six months after graduating from the program, 79 percent of the patients were either visiting the emergency room less frequently or not at all.

With an eye toward reducing Medicaid expenses, state government recently launched pilot programs to do similar work in regions with the highest concentration of what they call superutilizers.

The state’s intervention targets people who visited the emergency room six times or more in 12 months, or used 30 prescriptions – a population that cost an average $25,187 per patient in 2013. By comparison, the average Medicaid patient costs $3,000 a year.

Care coordinators will be assigned to high-cost medical customers in Pueblo and Colorado Springs to make their health care more efficient.

Behavioral health will be a key part of the approach, said Patrick Fox, deputy director of the Office of Behavioral Health at the Colorado Department of Human Services.

“Most of these superutilizers have a physical health problem and behavioral health component,” Fox said.

He gives the example of a Medicaid client who was treated for a blood clot in her lung. Afterward, every twinge in her leg or chest would send her, panicked, to the ER. She went every two or three weeks.

“She didn’t understand that her risk of this coming back was nonexistent. Somebody needed to explain it to her,” Fox said. “It was not a severe persistent mental illness, but in a regular primary care office, there’s not time to look for a behavioral health condition. It doesn’t get diagnosed.”

At the same time, it isn’t uncommon for frequent fliers to have a mental illness that’s the main driver of their ER visits. Around 14 percent of the frequent ER users in central Colorado counties, including El Paso, have a primary diagnosis of mental illness, and 18 percent in the state’s southeastern counties, including Pueblo.

When Denver Health designed its frequent-flier program, it specifically targeted people with co-occurring mental illnesses. To qualify for an intensive outpatient intervention, patients had to be admitted to the hospital three times in the past six months – or twice, with a mental illness diagnosis.

The reason for this, said Tracy L. Johnson, who directs health care reform initiatives at Denver Health, is the growing body of research nationally showing the relationship between preventable hospital readmissions and mental illness.

Challenge of coordinating care

As big as the financial costs of untreated mental illness can be, the personal ones are much greater. Poor mental health can come hand- in-hand with substance abuse, unemployment, homelessness, high rates of smoking and poor access to medical care.

In part for these reasons, people with severe mental illnesses die an average of 25 years earlier than others, according to a 2008 study by the National Association of State Mental Health Program Directors.

Such statistics have convinced many of the benefits of coordinating physical and mental health care. But the mechanics of doing so are often more difficult.

Keller, the mental health advocate, ticks off a list of obstacles that stand in the way of integration. Much of it has to do with reimbursement. Physicians can’t bill for anything that doesn’t have its own billing code. And the payment model doesn’t account for the lengthier office visits that a mental-health visit requires.

There are other barriers, too.

Nurses, doctors and psychologists are often unaccustomed to working in a team. And broad interpretations of medical privacy laws prevent the sharing of information.

Colorado is applying for a federal grant to integrate its physical and behavioral health care, and Keller believes the Affordable Care Act will go a long way toward reforming payment for mental health.

“There are some good things happening,” Keller said. “We’re not there yet.”

 

Another Common Phrase I Hate

Taken from  Notes From The Well  which can be found   HERE.

“everything happens for a reason.”

ugh. makes me want to slap somebody every time i hear it. it’s usually said by someone that doesn’t know what to say to comfort someone that is hurting. usually, it’s not malicious, just thoughtless. instead of just being there for the hurting person, sharing their load and crying with them, they feel this need to say something profound or that will fix it. it usually doesn’t.

there’s a few reasons i hate this platitude.

one is that this platitude assumes a really twisted economy. it presumes that for good things to happen, bad things must happen. as if we must pay in pain for joy.

it also devalues loss and suffering. as if there is some outcome down the road that will be “worth” present loss and suffering. do you think that any parent that lost a child could come up with one outcome that would have made their child’s death ok? if God said he could achieve world peace, but at the cost of your spouse or parent or treasured loved one, would you be able to say “oh, in that case, sure. i mean, that’s a fair trade.”

further, it sets up a false expectation that for every misery we experience, we will be able to see a future positive outcome that was enabled by that misery. i just don’t think that’s how it works. i don’t think i will ever be able to point to a blessing and say “oh, that’s why i was molested! now i get it. sure, that was worth it.” i think this sets us up for disappointment and a distrust of God.

last for now, the real reason we are tempted by “everything happens for a reason” is that we really, desperately want a reason. we can’t understand why this wretched thing is happening to us. it doesn’t seem fair, and we feel like God owes us an explanation.

in reality, we do not need a reason. “why” will not comfort us. “why” will not mend our broken hearts. because there is no “why” that is sufficient for our suffering.

what we need in our suffering is Jesus. we need more and more of Him–his person and his presence and his grace. we need the gospel: that Jesus loved us so much that he died for us and that we are dependent on him every moment. and that he is sufficient to meet all of our needs–even in the most painful circumstances, in the things we are sure we cannot survive.

for me, this is a moment by moment struggle. am i going to side with my flesh and demand a why? am i going to indulge myself and feel entitled to an explanation? or am i going to press into my Savior, and believe Him that his grace is sufficient for me?

Faint Not: Streams In The Desert, May 10th 2014

 

I had fainted unless…     Psalm 27:13

How great is the temptation at this point! How the soul sinks, the heart grows sick, and the faith staggers under the keen trials and testings which come into our lives in times of special bereavement and suffering. “I cannot bear up any longer, I am fainting under this providence. What shall I do? God tells me not to faint. But what can one do when he is fainting?”

What do you do when you are about to faint physically? You cannot do anything. You cease from your own doings. In your faintness, you fall upon the shoulder of some strong loved one. You lean hard. You rest. You lie still and trust.
It is so when we are tempted to faint under affliction. God’s message to us is not, “Be strong and of good courage,” for He knows our strength and courage have fled away. But it is that sweet word, “Be still, and know that I am God.”
Hudson Taylor was so feeble in the closing months of his life that he wrote a dear friend: “I am so weak I cannot write; I cannot read my Bible; I cannot even pray. I can only lie still in God’s arms like a little child, and trust.” This wondrous man of God with all his spiritual power came to a place of physical suffering and weakness where he could only lie still and trust.
And that is all God asks of you, His dear child, when you grow faint in the fierce fires of affliction. Do not try to be strong. Just be still and know that He is God, and will sustain you, and bring you through.
“God keeps His choicest cordials for our deepest faintings.”
“Stay firm and let thine heart take courage” (Psa. 27:14)
Stay firm, He has not failed thee
In all the past,
And will He go and leave thee
To sink at last?
Nay, He said He will hide thee
Beneath His wing;
And sweetly there in safety
Thou mayest sing.
–Selected

Praise & Worship: May 9th, 2014

Song List

1.  Almighty God-  All Sons & Daughters

2.  Rise Again-  Dallas Holm

3.  There Is A Redeemer-  Robin Mark

4.  Sometimes Alleluia-  Chuck Girard

5.  Who I Am Hates Who I’ve Been-  Relient K

6.  Come Ye Sinners-  Todd Agnew

7.  Age To Age (His Glory Appears)-  Hillsong United

8.  Fall On Me (Set Me Free)-  Vineyard

9.  The Light In Me-  Brandon heath

10.  Prodigal-  Michael Gungor Band

11.  One Dark Night-  John Michael Talbot

 

 

 

 

 

 

 

 

 

 

Antidepressants & Self Harm

Taken from  the  Los Angeles Times   which can be found    HERE.

About a decade after the Food and Drug Administration first warned that antidepressant medications increase the risk of suicidal thoughts and behaviors in children, new research has found that kids and young adults starting on high doses of antidepressants are at especially high risk, especially in the first three months of treatment.

Among patients 24 and younger, those who started treatment for depression or anxiety with a higher-than-usual dose of selective serotonin reuptake inhibitor (SSRI) were more than twice as likely to harm themselves intentionally than those whose treatment began at the customary dose and increased slowly, the study found.

For every 150 such patients treated with high initial doses of SSRIs — antidepressants marketed under such commercial names as Zoloft, Paxil, Prozac, Celexa and Lexapro — the study suggests one additional suicide would be attempted. By contrast, young patients starting SSRI therapy at doses considered customary were at only slightly elevated risk of self-harm, about 12% above the level of their depressed peers not taking medication.

The latest research on depression treatment, conducted by epidemiologists at Harvard University and the University of North Carolina, was published Tuesday in JAMA Internal Medicine.

The researchers found no increased risk of suicidal behavior among adults older than 24 who started medical treatment for depression or anxiety at larger initial doses.

About 18% of young people diagnosed with depression were prescribed an initial antidepressant dose that was higher than that recommended by clinical guidelines: For the antidepressant fluoxetine (better known by its commercial name, Prozac), for instance, a standard dose would be 10 milligrams daily for the first week, increasing to 20 milligrams for the next three weeks, and only then considering any increased dose.

Given that antidepressants appear to be less effective in young people than in older patients, and that higher doses do not appear to bring more or faster relief, the author of an invited commentary in JAMA Internal Medicine suggested that prescribing physicians should abide by the well-worn maxim “start low, go slow,” and monitor patients closely during their first several months of treatment.

The study used medical records to track 162,625 U.S. residents, ages 10 to 64, who were diagnosed with depression and prescribed SSRI between 1998 and 2010. It found that more than half of antidepressants in that period were prescribed by primary care doctors, and about an additional quarter by practitioners not specialized in mental health. Even in children, fewer than 30% of antidepressant prescriptions were issued by psychiatrists.

The authors acknowledged that they could not discern why younger patients on high initial doses of antidepressant were more likely to try to harm themselves. Although it could have been the dose at which these young patients began their therapy, it is equally plausible that younger patients who are correctly perceived to be in a mental health crisis are more likely to be treated more aggressively, but not more likely to get better with SSRIs.

It might also be that those started on high-dose SSRIs are more likely to discontinue their therapy and to suffer from “discontinuation syndrome,” which can bring physical symptoms of anxiety and is sometimes linked to unpredictable behavior.

‘Greyhound Therapy’ And America’s Mental Health Crisis

Taken from the   Huffington Post   which can be found   HERE.

By some estimates, one in four Americans suffers from a diagnosable mental illness, which includes depression, eating disorders, and post-traumatic stress disorder. Yet conversations on mental illness are uncommon. That was until last year, when a schizophrenic man disembarked from a Greyhound bus in Sacramento, California. He had been placed on the bus by a Las Vegas psychiatric hospital, and was told to call 9-1-1 when he arrived. The Sacramento Bee newspaper uncovered that he was just one of possibly 1,500 patients a Las Vegas hospital had shipped off. Patients were sent to nearly every state across the country, often landing in places they had never been without any support. It’s a practice known as “greyhound therapy,” and this story opened my eyes to what many of us have long ignored.

Greyhound therapy, or patient dumping, is nothing new. But never has it been uncovered on such a wide scale. In the first episode of our new documentary series for AXS TV, Dan Rather Presents: One Way Ticket to Nowhere, we get to the bottom of the story with what happened and why. We found former hospital employees who were willing to go on the record for the first time, as well as patients who had the courage to come forward with their personal stories. The Nevada story proved a jumping off point for a greater examination of our system of care. What we found was disheartening: America’s mental health care system is in crisis.

Fifty years ago, the last bill President John F. Kennedy signed into law was designed to fund community centers for the treatment of people with mental disorders. The idea was to move people out of the infamously inhumane state-run psychiatric hospitals (think One Flew over the Cuckoo’s Nest), and treat them closer to home. Psychiatric drugs and outpatient clinics could, in theory, provide better care and allow individuals to live a more normal life. However, Kennedy’s wish never became a reality. Budgets for mental health care were cut, and as state hospitals closed, patients were left on the streets. At the same time, prison populations nearly doubled in many states, making jails the new mental institutions. According to a report released by the Treatment Advocacy Center last month, there are roughly 356,268 inmates with severe mental illness in prisons and jails, compared with 35,000 patients in state psychiatric hospitals.

Nevada’s patient dumping has been roundly criticized, so we sought to better understand how it happened by spending time with the Las Vegas police department, homeless service organizations, emergency room physicians, and mental health experts. These people are typically the first line of contact for people with serious mental disorders, and they’re all struggling to figure out how to best serve those in need. Las Vegas, which has faced tremendous growing pains as it’s more than doubled in size over the past 20 years, is also trying to change course and do better. But it’s an uphill battle.

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