The Brick Walls Keep Rising

Could you imagine breaking your leg and having to just sit with it until the system could fit you in? You, from the outside, look fine, bone is not piercing skin, no blood, and you just need to sit there and suck that shit up. The doctors are overworked, there aren’t enough, the backlogs go for days, and no one will accept your insurance or just simply has no room in their schedule for you. 

Get real, you can just go to the hospital- get yourself ALL fixed up and ready for further evaluation when an orthopedic doc can fit you in to cast that leg. This doesn’t make it any less painful or difficult, but the access it there.

WELCOME TO THE MENTAL HEALTH SYSTEM-

Hypothetically- if you actually accept that you need/want help and get over that barrier alone, the rest is history. Except this is not the case by any means, and it severely varies by regions across the United States. 

I’m going to give you my own stories navigating this impossible system. You cannot see a mental health disorder (maybe a disheveled person or frantic emotions can allude), but you can’t look at someone and shout “YOU HAVE SCHIZOPHRENIA.” Like- you not only will look like the person with Schizophrenia, but you’re being absurd.

Affordable Care Act-

I feel that the background of why mental health and the medical system are pretty funky needs to be explained to give a foundation to the rest of my story. This under my own interpretation and research.

 I’ve worked within it for 3 years, written Plan Documents for Medical Plans, worked on Case Management for claimants with expensive and horrendous conditions, and obviously, am subject to the same system. This law CHANGED EVERYTHING, and all the while happening right as my generation was entering the adult world. Most people my age have no idea the differences (damn Millennials- just kidding I love us)- just that it’s bad or good (depending on personal opinion), actually from working within the industry- most people, regardless of age, have no clue about this system period. The system is not created to make it easily understandable either.

Anyways, Prior to Affordable Care (ACA), you could only be on your parent’s coverage until the age of 19 (state medical plans also kicked you off at this time). But, that changed and now you can be covered up until age 26. 

I know many people covered under this provision- no shame in that game. Now within the time frame of my move to Arizona and my move home back to Washington, ACA began changing the health care system of America. 

Granted, it was voted in by our Senate March 21, 2010, signed into law by President Obama March 23, 2010, and up-held by the SCOTUS (Supreme Court) in 2012, but there was a roll-out process for all of the different mandates between 2010-2015.

 Regardless of my jargon from working within the insurance systems, things take time to change- you can’t sign a law like Obamacare (which is the EXACT same thing as ACA- ya filthy animals) into existence and expect 300 million people to get on-board the next day or even month or year (years now), and then ALSO expect a smooth transition. It was rocky, and as much as a proponent as I am for health care equality across the board there are a lot of repercussions associated with the enactment of this law.

Okay so where this law is PHENOMENAL, is that now people had access to healthcare that they were not guaranteed before, it also blocked insurance companies from making you meet a ‘pre-existing condition waiting period,’ then it began enacting Preventative Care services making them 100% free to the member covered under the insurance plan, and finally expanded the requirements of what a Plan covers.

What this Meant-

  1. Any health plan, prior to ACA, usually contained pre-existing condition clauses in their fine print. Meaning, you have been diagnosed with Bi-Polar prior to being on this plan- well we won’t pay a single claim or cover you for any part of this condition until you’ve been on the plan for more then let’s say 3 months or even 6 months. It might even bar you from the Plan altogether. This wasn’t just for mental health, but ANY expensive, risky, previously documented condition. I.e. diabetes, pregnancy, epilepsy, sleep apnea, cancer, etc. SORRY NO COVERAGE FOR YOU– you’re too risky. Or on the other side, you will be accepted (maybe with no waiting period), but your premiums will be higher, any costs related to your condition wouldn’t be covered, your deductible is higher, or maybe they suspend prescription drug coverage to you altogether. Hey best of luck!
  2. Preventative care services are game changers. You have GUARANTEED coverage for mental health screening (like depression), birth control, shots, screening labs, annual physicals, etc- covered at 100% (subject to plan guidelines- like being in-network).
  3. Expanding the requirements as to what a plan covers is essential. In regards to mental health, ACA completely expanded the requirements to offer coverage for mental health and chemical dependency treatments; this made it a mandate for most plans to offer this. Before, you could have very well been on a plan where they didn’t cover any sort of mental health related claims accumulations and that in itself is a huge roadblock, are you going to pay $200 a visit to see a psychiatrist? Probably not- prior to ACA one third of plans didn’t cover any sort of addiction/chemical dependency treatments, and almost one fifth had ZERO coverage for mental health period.

Here is where things get a little hazy as to the effects and personal struggles for navigating the system. Before, pretty big chance many didn’t have coverage (or if they did, it was inadequate). Between signing the bill into law and initiating the roll-out, almost a million Americans with zero coverage had access. That is great! 

Yet, that is like opening the doors to Wal-Mart on Black Friday, with the line around the block and people’s faces pressed to the door, and having two checkers at the registers. Well- shit. There just aren’t enough providers, hours in a day, appointments in a week, or resources available (even seven years later) to meet this demand- let alone with guaranteed great care. We just turned out psychiatrists, counselors, and psychologists into legitimate social workers with hundreds of patients, all needing important and life-depending care and you are one person.

Arizona-

I lived in Arizona for 3.5 years, and was diagnosed going onto my 4th year (the lead up can be seen in other blog posts). This would be about 2013-2014 where ACA is just beginning to snowball. I was over medicated and thrown highly addictive benzos and medications that have real street value for those not prescribed.

No follow-up. No calls. Refills for days. No requirements. Nothing.

A suicidal, recently diagnosed COLLEGE STUDENT with 4 mental health disorders walked out of her college health center over-prescribed (with highly addictive medications) and zero follow-up. I easily slipped in and out of the system as I chose (with zero resources and help to know what the hell I was doing), but at least the resources were available when I needed them. 

I could walk-in with a mental break and be helped fairly quickly (this is a life time in the mental health world because of how time begins to change within your mind during breaks), but at least I had legitimate access.

Washington-

Moved back home just in time for open-enrollment for medical plans and all of the new requirements were going into place. I refused to acknowledge treatment at first and tried to just stay away from medications- still terrified of the system. I want to say I went un-treated and un-medicated for about 6-7 months before  I had great coverage and reevaluated that I needed the help.

I went to my old doctor, which I had from childhood, and accepted she me back when I moved home. She began with an anti-depressant and a phrase, “I’m not qualified to prescribe or treat major mental health disorders and I will refer you, but take these depression meds in the meantime.” 

Okay- a doctor saying they can’t be a doctor to a certain condition- pretty huge stamp on my ticket for the Crazy Train.

I was referred to a tele-medicine doc in Seattle, where I had to go into my doctor’s office, get set-up on a Skype call to this psych doc. He asked extensive questions, confirmed I had a slew of issues, and prescribed me anxiety meds, the depression med, and the Tegratol (bi-polar med). This med, also, requires lab tests because of what it can do to your body in too high or too low of dosages, so factor that in to the scenario. I couldn’t afford the lab tests and my prescriptions were about to run out from my psych doc, and he would not re-prescribe until he got that lab test. This became a circular game where I was panicking (see the medications blog to understand the entirety of this scenario) and  trying to make it work.

I tried working things out with the Psych doc and he simply stopped calling me back. His receptionists didn’t respond to ONE phone call for over three weeks- I called what seemed like every other day. Eventually the meds ran out and I stopped trying with this provider.

 I figured what was the harm in trying to get her to re-prescribe these same drugs since I already had the diagnosis, with documented prescribed drugs from a qualified doctor for my disorder, and I could not afford the lab testing, yet I found myself begging her to keep me afloat with the medications- tears and all. I didn’t want to start all over (and my mind could not handle it): suffering from the withdrawals, suffering from the Bi-Polar episodes- the great crazy highs and the awful crashing lows, or even upsetting my life where after the last year I was finding little pieces of stability (new job, new living situations, health care from my employer, and about to re-start my senior year in college in order to graduate).  She agreed to write them with two refills and a somber warning that she WILL NOT do this again, and another referral- this was the last appointment I held with her.

I searched. I called. I left messages. Nothing. I went off of the medications around the end of 2014. I couldn’t gain access, and then my mind convinced me that I was meant to be off of them and I would be fine.

This did not work well. I was up and down for many moons. Bouncing from sleeping around and lavish spending (on my budget that would be going out to dinner and the casino- don’t get crazy, there were no jets or poppin’ bottles in the club) to cutting myself and not being able to keep going. I had incredibly high stress levels too, bad dating, new position within my company with A LOT more responsibility, taking 22-23 credits for an entire school year in order to graduate with my undergrad, family stuff, relationship issues and getting his problems dealt with, car issues left and right, obviously financial issues with poor spending, etc. Now my life was not literal episodes of Shameless, but there were definite times of pure, certified, crazy. From the outside looking in I had it together, for those close to me- they knew something was wrong, and I knew I wasn’t healthy.

Summer of 2015, I was hitting a break- and a really bad one. Just split up with my boyfriend and I could feel it coming. I began SCOURING the area for medicine-prescribing doctors (because you can’t just go anywhere and demand it)- SCOURING. I worked in insurance, I knew how to navigate the system, and I had employer-sponsored private (and killer) health insurance, and very firm/unquestionable diagnoses, and documented medications. I had printed lists of prescribing mental health docs- LISTS, hundreds of providers. I called every single one. I called in-patient centers, I crossed to out-of-network lists, I called state ran centers, I called social workers, I left messages, I cried, I begged, I broke. Nothing.

This doesn’t make sense. I had never in my life run into so many barriers. I went so far as to say I was on the verge of taking my life to get them to see me (for them to try and push me to the top)- I was told to turn to the ER for a psych watch/evaluation. There are many reasons why this  was never an option in my mind- stories for another day, but the only way I was ending up in psych eval at a hospital was if I was forced or found.

I was turned away because they simply didn’t have the appointments, they didn’t have the providers, because I DIDN’T (yes you read that right) have state-assisted insurance (some facilities work solely under this guise), they could see me in 3-4 months, I could go talk to a counselor in the meantime, I could pay out of pocket the full cost of the visit because my insurance wasn’t accepted, I could travel to Seattle for an appointment next month.

 A full-time employed, college graduate, with private health care, and who worked in insurance could not gain a serious appointment with a provider. That is what these barriers did. I saw counselors, hoping they could slide me to the top of a colleague’s list, yet I could still go nowhere.

My Plan-

I didn’t have one, but things were getting darker. My soul was hitting the ultimate low and I knew with the time frames at hand and how long it takes for the medicines to even begin to work (4-6 weeks) that I was running out of time. Eventually, when you realize something is wrong with your brain (seriously wrong with that) you begin to notice patterns, recognize when imbalance is there and where it is heading- sometimes it takes a little time to recognize these actions and feelings aren’t truly yours, but you inevitably know- at least I do. SO I went to as many medical doctors as I could for a plethora of reasons and found myself begging each and every one- showing them my unstable and depressed side to take it serious, with papers and health summaries accompanying me to prove that I am in need and know what I need to get by. This started that summer with a trip to Urgent Care for a day when I recognized that I was too unstable, the receptionist said, “Uhm mam’ we don’t treat those disorders, you can still be seen under your own request, but it won’t be dealt with.” I told her to kindly, “Go f**k yourself, because I was not giving up.”

Of course those weren’t word for word my words to that woman, and the doctor I saw listened. He researched, called another doctor in to confer (to make sure that there would be no-way his prescription would hurt me), and gave me a three month supply- under the guise it would not happen again and I needed to find a psychiatrist (no shit Sherlock)- he gave me a list of providers. I called and received the same damn excuses. A few months later these meds were coming to an end, and that same fear became creeping back into my chest- a thousand pound brick was being lowered onto it, I have anxiety so I’m used to this feeling, except the bricks are usually maybe a few hundred pounds.

I had an annual check-up with my gynecologist and explained the circumstances. I told him about the year I had with this system and how everyone was against me: the system, doctors, insurance seemingly. I was just about to give-up and that heart-broken, I’m giving up cry slipped out. The one where you have hit the bottom, you have nothing in site to help and you’re accepting the fate you are about to receive. Then my VAGINA DOCTOR (preventative care visit- thanks Obama) prescribed me enough to get me through the end of the year and to, more importantly, be continuous in my medication plan.

The Millionth Time Trying-

The end of 2015 came and my employer switched insurance companies to Group Health. Group Health (with its bad reputation with some members/Group Death I have heard it referred to as) has multiple, large centers with multiple and many prescribing doctors, counselors, etc all across the Puget Sound.

I called the first Monday of the New Year to get access as soon as possible in 2016. I would have had to travel to Seattle to be seen before the scheduled visit I received in Tacoma and take time off of work, pay the $30 in gas it would take with my 98 Jeep Grand Cherokee, and parking- while also needing to make that a continuous plan. I just accepted the next appointment I could locally, after my birthday in March- three months later.

My meds were running out from the Gynecologist. I had to find a Group Health PCP and fast to see if there were any options. A call was placed, the doctor I was scheduled with wanted to call me back later that evening, to get health history in advance, since it was my first time at Group Health. This, also, seemed convenient because then the appointment wasn’t about paperwork and silly questions. She called me at the wrong time, when I couldn’t hide my daemons. 

She called me right after I had gotten home from work. I felt defeated that day, I was crawling into a depression, nothing was seemingly going right, I was approaching that bottom, and the thoughts became creeping.

My body just gave out onto my bed where I stared at some unrelated prescription bottle I had from years ago, just contemplating what would happen if? What would I feel like if I did the unspeakable, who would find me? Would I get scared and throw it up or call an ambulance on myself? What would my family and friends be like without me? This is selfish, why as such a giving person can I be so selfish? WHY CAN’T ALL OF THIS END? OR WHY CAN’T I AT LEAST BE HAPPY?

The phone rang. It was the doctor. I pulled myself together with the convincing charm I had and what normalness I had left. Yet, she knew something wasn’t right in my voice and she kept asking all of the right questions. So all of the awful depths of my mind began spilling into my words and I was seen the next day, with another nurse and a social worker. I had a continuous supply of my meds until the psychiatric consultation, but she saved my life. That was a year ago. My struggle doesn’t end here, but the peak does.

Real Talk-

If you have made it through this entire post- I commend you, it is long- like the hell I have been through.

This story needed to be told. There needs to be an entire overhaul as to how our society and our medical professionals handle mental health. Your protocols aren’t good enough, peoples’ lives hang in the balance. If this was one story or one bad experience- then I’m a whiner, but years of tormenting hell at your hands and the condition I cannot turn off, like you can choose to not answer the phone or turn me away? Our system isn’t good enough. Guess what? I did everything I was supposed to do. I went every appropriate route and you almost broke me when I CRIED AND BEGGED for help.

God forbid I didn’t have health insurance, didn’t have access to different systems, didn’t have wit and manipulation tactics, didn’t have some string of luck, and, most importantly, didn’t have a fire to keep going and keep trying. Thank God that I wasn’t (and am not) an angry person, a person on the edge of society, a person with no resources, a person who didn’t understand how to access resources or use them, a person who took their life or hurt others.

You want to talk and argue about gun laws, you want to talk about social welfare programs being for the welfare abusers, you want to talk about your fear of terrorists and ISIS, want to talk about school shootings, about the climbing suicide rates, about horrendous incarceration stories or people with repeated records?

How about you start with the damn mental health system? How about we NORMALIZE talking about the unspeakable? How about we give access to EVERYONE who needs it? How about we realize that 60% of mass shooters since 1970 displayed symptoms of acute paranoia, delusions, and depression BEFORE committing their crimes.

These are the findings of studies from mass shooters conducted by medical doctors, psychiatrists, and researchers:
(1) Mental illness causes gun violence,
(2) Psychiatric diagnosis can predict gun crime before it happens,
(3) US mass shootings teach us to fear mentally ill loners, and
(4) Because of the complex psychiatric histories of mass shooters, gun control “won’t prevent” another Tucson, Aurora, or Newtown.

I am not saying this to persuade or dissuade, I am not saying this to scare you, and I am definitely not saying this for any political means. I am saying this so we stop trying to blame human fallacies on anything other than the fact that humans are flawed by design. I’m saying this to normalize a conversation that is so taboo. I am saying this to ruffle your feathers and make you feel something outside of your own little world- WE HAVE TO WAKE UP and CHANGE what is not right within our society. We will keep having mass causalities (when its not guns, it’ll be bombs, and when we outlaw every component of bombs, it’ll be knives/machetes- whatever), we will have the highest suicide rates, we will have kids without parents and parents without their kids, and we will never stop fighting. That is your reality and that is the future of our lives.

We are not perfect and that is okay. Our brains are different, our emotions, and our motivations ALL ARE DIFFERENT and by design, but while we are arguing over what is at fault there are people dying on all sides, and we have every means to stop it, but we choose not to.

I will only ever hope that your medical struggle is a few hour wait at the ER with your broken leg.

Love a little harder, don’t ever let it take you, and keep climbing those walls- one day we will destroy them.

M.

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4318286/

http://www.asaging.org/blog/implications-affordable-care-act-mental-health-care

https://www.mentalhealth.gov/get-help/health-insurance/

https://www.cms.gov/cciio/programs-and-initiatives/other-insurance-protections/mhpaea_factsheet.html

 

 

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