Mental Health -- Even With Insurance Patients Are On Their Own

Have you ever tried to get mental health care for a family member? I mean even with insurance.

My heart goes out to families whose children turn eighteen and suddenly doctors won't talk with them -- they're out of the loop. And if young patients won't seek or accept medical help, as one doctor told me today, "it has to go to a stalemate." The patient has to be found on the street or go over the line and be arrested - hopefully not shot in the process.

Even then, the patient will be lucky to get a few days of care before being sent on his way without adequate follow-up care.

What happened to our understanding that people with mental illnesses do things to show they want our help? Patients not mentally well enough to know where to seek health care and those who've give up are lost because help from someone else is intrusion. It's really messed up.

If you have a child with ADHD or Asperger's Syndrome, for example, don't expect to be able to be of much help after he or she turns 18. You're out of the picture. Really! I know that's hard to believe. But it's true.

You may be seen as an intrusion, an obstacle, or part of the problem, but you're not going to be a partner unless your child asks for you to be involved. If he thinks he is old enough to handle his own health care, or confused enough to believe so, hold on because you're in for a long, tough time of worry and frustration.

Since you can't help, the medical system will not serve his needs. They know such patients can't speak for themselves. They know you've been kept in the dark, so you can't do anything. So he'll get some attention and then off he goes - maybe to the streets because they don't have to call you.

You have to wonder if they keep this going so they can toss patients away whenever it suits. Surely psychiatrists somewhere must know this is wrong. Surely there must be some with the guts to speak out on behalf of patients who need help even if they don't ask and who need an advocate even if they don't know it.

With no one to advocate for patients, it's easy to abandon them and it saves money. The current system makes this possible. How about that for a nation with supposedly superior health care!

It's inhumane to say the least. And that, believe it or not, is even if you have insurance.

Dr. Reardon also blogs at bardscove.

Check here to see where your state stands.

Comments

[JBruce]

My son, Will, a paranoid schizophrenic adult, excluded my wife and I from being involved with his mental health treatment . In June of 2006 I returned home from work to find my wifes body. Will, in a state of deep psychosis, had killed her.

The mental Health laws are seriously stacked against the families of severely mentally ill adult loved ones, and as you point out Dr. Reardon, this is many times completely independent of the family's health insurance situation. Mental Hospitals have been closed or severely downsized in all 50 states. Administrators are under severe pressure due to bed shortages, a long waiting line, and the astronomical cost of inpatient treatment. Add to that , pressure from patients rights advocates, who routinely challenge involuntary treatment seemingly regardless of the consequences, and the point of least resistance for the mental health administrators many times boils down to just plain doing nothing.

The system is completely lopsided. Those who have the most interest in the welfare of the gravely mentally disabled- the families- are powerless in the system. Yet home is where the system sends these people- at least, until that time when it becomes too much, and the single working mother trying to care for a 13 year old, and a psychotic 19 year old has to make Sophie's Choice. And when these people wind up wandering the streets and living under bridges, the rest of the population wonders "Where do these people come from?"


Robert (Joe) Bruce

[geoduckling]

Dr. Reardon, I find your characterization of adults 18+ with ADHD as "Patients not mentally well enough to know where to seek health care", who "can't speak for themselves", are somehow "confused" or misguided "If he thinks he is old enough to handle his own health care" and because of this need others to speak out on their behalf and run things rather then allow them to experience independence (with the pitfalls that come with striking out on your own) to be deeply, deeply offensive.

I am a 21 year old college student who, without access to insurance through either of my parents (and their employers), my own employer, my school or my state, sought assessment and have begun receiving treatment for ADHD. All of the ADHD students I've met since are, fully capable intelligent adults. I realize that we are not the only population mentioned in your article, but it stings.

The medical system that we currently have is broken. It maximizes shareholder profits at the expense of the health of the people, but this tragedy, this outrage should absolutely not be framed in terms of giving parents more access to their adult children's private data unless it has been legally determined that the child is not competent. Even under those circumstances it sets a dangerous precedent for further invasions of the privacy of wider groups.

[Kathleen Reardon - Huffpost Blogger]

Be assured I was not referring to ADHD in these terms. And I agree with your view of the medical system and the importance of patient rights. But I've been close enough to observe patients with very serious conditions denied outpatient assisted care after being in a hospital. In cases like these, we need to protect rights, avoid hasty precedents as you mention, but also assure that patients are not treated with indifference and negligence because no one is able to advocate for them.

[Weirdwriter]

Oh dear, yes. And not just for the parents of afflicted children. Try being the child of an afflicted parent who can't get help even if she acknowledged that she needed it.

Try being an adult, finally out of the house of nightmares, and various social workers and assisted-living managers call you to try to "do something" about curbing your parent's behavior -- but they won't tell you what her diagnosis is because of "patient confidentiality."

[Kathleen Reardon - Huffpost Blogger]

Yes. Surely among us are experts sufficiently capable of finding a middle road or at least a road that serves the patient, protects their rights, but does not leave them adrift and their families at a loss. Is that so much to ask?

[JDM73]

We have a long, long way to go before mental illness is taken seriously in this country. All that "mental illness" means to most people is some vague affliction from which that wacky cable TV detective Monk suffers.

[0emissions]

As a Canadian watching and reading all the vindictiveness and paranoia from the Republicans regarding a reasonable and just health care plan,I think your mental health problems are very serious.Quite a percentage of your population seems to be afflicted.

[Dap]

My Dearest Dr. Reardon,

It has been awhile sinc I last droped in on ya, sorry but I've slowed downd quite a it, anyway your still my gal you "GET IT" and that's whay I will always heart you. Thank you for you... Agape always dapper

[americaforme]

Compassion is not popular these days, when it comes to money hungry insurance companys. All the crimanily insane were let out on the streets in the early sixtys, and told to monitor themselves. They are housed by prisons now, locked up because of their brain chemistry. They offend as soon as they are let out of the system, so they can go back to jail and be care for. The revolving prisons gate's is a disgrace to our medical progress. Millions in prison to make profit for Big Business. Vets who need constant, individual, mental Health are shucked out to die because of insurance. Fetal Alcoholism victums roam the streets. not knowing their right hand from left. To let these people die is beyond comprehension. Autism is beginning to be a major challenge. Social Security, isn't available. Insurance is out of the question. We have a week moraly sick society, that oesn't take care of its own.

[LaurieAnn]

Very well stated. I am in a complete quandary over how my currently 12-year old moderately-high functioning autistic son will live as an adult. My family currently owns a second, small home in the same town which has no mortgage. As the rules for supplemental social security stand currently, my son would be ineligible to own that home and still receive SSI. I've already come to grips with the fact that he'll have to live with us for the rest of our lives but after we're gone, he'll be on his own.

The U.S. is currently a very scary place for those who cannot take care of themselves.

[darker]

RABIDLY GREEDY INSURANCE EXECUTIVES
should have
their minds
EXAMINED!

TOO RICH TO BE RESPONSIBLE
for decent health care for their clients?

DEPORT THE RICH.
Let them go live in Monaco, Geneva and Dubai with their $$$$$$$$$$­$$$$$$$$$$­$$$$.

[dwatkins9]

People over eighteen are legally adults, and adults in this society are in full possession of their civil rights unless and until a judge says otherwise. That means that they don't have to accept medical treatment except under certain narrow legal circumstances, irrespective of whether they need it or not. Similarly, they hold the privilege, and any doctor who violates their confidentiality is asking to be disciplined, sued, or worse. The legal rights of the mentally ill were strengthened forty-odd years ago, in response to the abuses to which mental patients were often subject in the 1950's and before, as Prof. Reardon knows perfectly well. Don't like it? Change the laws.

[jmc15]

As a family member who has experienced the difficulty of trying to obtain help for my daughter who has a diagnosis of schizoaffective disorder, I agree with the assessment that Dr. Reardon has made of our current mental health system.

After attending a NAMI (National Alliance on Mental Illness) Family-to-Family Education class I learned that my daughter had not simply fallen through the cracks of the mental health system but that the system was set-up to ignore those with a severe mental illness until they were a "clear and present danger to self or others" as required by Pennsylvania's Mental Health Procedures Act of 1976.

Thankfully an organization called the Treatment Advocacy Center exists, http://www.treatmentadvocacycenter.org/ which has been my main source of advice in advocating for a change to our out-dated law. One of our state senators has proposed a new assisted outpatient treatment (AOT) law, Senate Bill 251, modeled after the successful Kendra's Law in New York.

Thank you to Dr. Readon for bringing this mostly ignored issue to light. Sadly, the fall-out from the neglect of those with untreated mental illness is that most of these very vulnerable people are now either homeless or incarcerated. Laws do need to be changed, and the outpatient commitment laws, such as Kendra's Law, our proposed SB 251, and the law just signed by New Jersey's Governor Corzine this week, are the way to ensure timely, compassionate treatment in the community.