Tom Hale -Psikoterapia zentroa

The State of White America

    I've been watching with some interest the reaction of critics to a new book by social scientist Charles Murray, Coming Apart: the State of White America, 1960-2010.    I haven't read the book yet since it was just published about ten days but I will probably read it in the next month.   This is a huge compliment, which means it has been bumped up through a tall pile of very good books I am slowing plowing through.

    What is the big deal  about this book?

    First, Murray (born 1943), is an American libertarian political scientist, author,columnist, and pundit currently working as a fellow at the American Enterprise Institute, a conservative think tank in Washington, DC.   He is best known for his controversial book The Bell Curve, co-authored with the late Richard Herrnstein in 1994, which argued that intelligence plays a central role in American society.    They proposed in the book that intelligence is a better predictor of many factors including financial income, job performance, unwed pregnancy, and crime than one's parents' socio-economic status or education level.    Also, the book argued that those with high intelligence (the "cognitive elite") are becoming separated from the general population of those with average and below-average intelligence, and that this was a dangerous social trend.  Murray's ideas were roundly criticized by liberals, in particular, as racist and simplistic.

    Second, the new book addresses the issue of class in America at a time when many people, especially Republicans, have been claiming that raising the issue of "class" is a liberal divisive political strategy.   And now we have a conservative Republican, devoting 400 pages to the subject.   

    As you might expect, writers have been all across the political contimuum in their responses.   Charles Brooks, columnist for the NYT said, "I'll be surprised if there is another book this year that so compellingly describes the most important trends in American society''.  While Brooks is not a commentator I am particular fond of, I suspect he may be right on this.  

    It seams that Murray's basic  premise is that the "white working class is no longer a part of a virtuour silent majority; it has become increasingly alienated from the "founding virtues" of American civic life."   He goes on to say, "our nation is coming apart at the seams, not ethnic seams, but the seams of class."   

    My first response is that finally we can begin to talk about the state of the American family again without being politically incorrect. 

     This seems to be primarily a book of scholarship, not politics.  Murray has approached the topic as a work of scholarship, full of charts, footnotes and regression analyses.  He uses the data to create an imaginary white world of two classes, the new upper class, "Belmont" and a new lower class, "Fishtown".     And what he sees for America in the new, emerging social construct should make us all shiver.   The two worlds are so vastly different in so many ways, includeing income, illegitimacy rates, crime, and joblessness,  with Fishtown slowly sinking.    What are we going to do about it?

    The controversy seems essentially to be found in the response to Murray's description of this sad, new American world, and along the classic political lines.  Murray makes suggestions for change in the last chapter of the book and these are being roundly challenged.   Good.   It sounds like a conversation is breaking out.   I hope that this book stimulate a huge, non-political conversation.

    As a psychotherapist whose early training was in family systems, I have for years been concerned about many of these same issues, and the slow decline of the quality of life in working class communities has troubled me.   As health care availability has eroded for the working poor, fewer and fewer services have been utilized by them and the help necessary for them to challenge the trends being reported here were/are missing.   If we are looking at real solutions to some of these issues, adequate, affordable health care is imperative.

 

 

Returning Home

    I had mentioned several posts ago that I was a mental health provider for the U.S. Military, primarily through TriCare, and now through OneSource.   Tricare is the "insurance company" for military personnel and retirees and OneSource is a new, additional mental health care program for N.G. and Reservists returning from the Middle East.

    I recently received a notice from Karen Remley, MD, MBA, FAAP, Virginia Health Commissioner, and Paul Galanti, Virginia Commissioner of Veterans Services, advising mh providers of important information about returning vets and resources that can be used.  I've printed parts of the letter here for all of you to read, even if you're not in Virginia, because of its relevence.  The resources are excellent to know about.   I'll say more about it very soon in another post.

 

    Virginia is home to hundreds of thousands of veterans, many of whom served multiple deployments in the wars in Afghanistan and Iraq, and may become patients of yours. According to the U.S. Department of Veterans Affairs (VA), there are more than 800,000 veterans in the state. That means 1 in 8 Virginians is a veteran. 

    Over the next six months, 1,200 – 2,000 servicemen and women in the Virginia National Guard will be returning home, many from the front lines of combat. While some will make their way through the VA for their health care, many will not; they will come to you. Each of us would like to provide the very best care to every patient and knowing their specific medical and social history can significantly change our diagnosis and treatment plan. Below are resources available to assist you in the coordination of care and support and to provide straightforward language to begin a discussion with a patient who may be a veteran. And lastly, there’s information on where to turn for additional services for these brave men and women. 

    First and foremost, there is the Virginia Department of Veterans Services Virginia Wounded Warrior Program (VWWP). Mandated by law, VWWP provides behavioral health, rehabilitation services and support to veterans, National Guard members, reservists and their family members. These services are coordinated through local/regional VWWP consortia consisting of community providers, including community services boards, brain injury services providers, VA Medical facilities and other public and private providers. To learn more about VWWP and to locate the Regional Coordinator who serves your locality, go to www.wearevirginiaveterans.org. The Regional Program Offices can be accessed under “contact.”  

Here are three other great resources for clinicians:        

VWWP Web page specifically for clinicians http://wearevirginiaveterans.org/Resources/For-Clinicians.aspx·        

The Citizen Soldier Support Program, which provides training courses for health care providers such as “A Primary Care Approach,” at www.aheconnect.com/citizensoldier·        

If you are caring for a veteran, the US Department of Veterans Affairs maintains a toll-free Caregiver Support line at 1-855-260-3274. 

Finally, I have also placed on the VDH website (www.vdh.virginia.gov/clinicians/ ) several informative presentations that offer an in-depth look at the changing face of our veterans, the challenges they and their families face when they return home, potential long-term care and what we as health care providers need to know.

    

Your Soaring Health Insurance Premiums - NYTimes.com

As a follow-up to the recent post on the recent Kaiser Family Foundation, the NYT in a recent editiorial, summarized their thinking on the report and the impact of the Health Care Reform Bill recently passed.   Considering that the amount the U.S. spends on its health care is the most of any country in the world, expenses can be reduced.    It is also still amazing that insurance company profits continue to rise.   As long as we have a "for profit" health care system, these items will be difficult to control.

 

             "Annual premiums for employer-sponsored health coverage soared by 9 percent for families and 8 percent for individuals this year from 2010, far faster than wages or inflation.  Republicans, predictably, blamed health care reform for contributing to the rise.  In fact, the reforms accounted for only 1.5 percentage points of the increase this year.   The value to millions of Americans who are already getting expanded coverage and benefits is undeniable.

    So what is driving up insurance premiums?  The main factors, analysts say, were (1) increased medical care costs and (2) higher profits for insurance companies, which charged a lot more in premiums than they paid out for medical services.  Both problems are being addressed by the health care reforms.  But, clearly, they will require even more vigorous attention.

      This latest survey by the Kaiser Family Foundation and the Health Research and Educational Trust found that the average total family premium climbed above $15,000 in 2011, with the worker paying roughly $4,100 and the employer about $10,900.   Since the survey started in 1999, worker contributions to premiums have increased 168 percent, while wages have gone up 50 percent.

      The two reforms that affected premiums — together making up about one-sixth of the 9 percent premium increase for a family plan — required that parents be allowed to keep children up to age 26 on their policies and that many insurance plans cover preventive services like cancer screening and immunizations at no cost to patients.   Some 2.3 million young adults were enrolled on parental policies and 28 million workers (plus their dependents) benefited from preventive care provisions.

     The reform law has two provisions that kicked in this year and could help hold down premiums in 2012.   Insurers will have to spend at least 80 percent to 85 percent of their premiums on medical care, which will force them to keep the premiums closer to their claim payments.  And insurers seeking rate increases of 10 percent or more in the individual and small-group markets must disclose and justify their proposed rates, allowing state regulators an opportunity to reject them or force them down.

     The reform law also provides $250 million for grants to help states strengthen their ability to challenge insurers’ rate requests.   Only about half the states give insurance commissioners power to veto rates deemed excessive; all should allow regulators to reject unfair increases before they happen.

     For the longer term, the reform law will create a slew of pilot projects in Medicare to find ways to reduce the cost of delivering care. Any effective strategy should be pushed quickly into the private sector.    Until the underlying health care costs are reduced, it will be hard to hold premiums down."

Health Insurance Costs Rise Again

     As a follow-up to the last post about Wendell Potter, there is bad news of rising health care cost.  There was this from yesterday's Washington Post:

 

        "Health Insurance Costs Shifted to Workers

    Premiums for employer-sponsored health insurance continued to escalate this year even as the share of workers getting less generous coverage reached a new high, according to survey data released Tuesday.

    In 2011, for the first time, half of workers at small firms with individual policies faced annual deductibles of $1,000 or more. In 2006, that figure was 16 percent. At large firms, the share has grown from 6 percent to 22 percent over the same five years.

    At the same time, the survey by the Kaiser Family Foundation found that premiums for family plans rose 9 percent in 2011, after several years of slower annual growth. A similar recent survey by the consulting firm Mercer found that yearly premium increases have been hovering around the 6 percent mark and will grow by slightly less in 2012.

    Both sources point to the same fundamental long-term shift:

    Faced with continually climbing premiums, a record share of employers have moved to plans that require workers to pay more out of pocket.

    'Without any real national discussion or debate, there’s a quiet revolution going on in what we call health insurance in this country,' said Drew Altman, president of the Kaiser foundation, which conducted the annual survey of employers in conjunction with the Health Research & Educational Trust. 'Health insurance is becoming less and less comprehensive. . . . And we expect that trend to continue.'

    Employers seem to be turning to cost-shifting as an alternative to dropping coverage outright.

    During the first half of the decade, the share of companies offering health insurance shrank from 68 percent to 60 percent, and the figure for very small firms dropped from 58 percent to 48 percent. But since about 2005 that decline has leveled off.
 

    Premiums paid directly by workers have galloped ahead of wage increases and inflation — rising 131 percent between 2001 and 2011 for family plans.

    Employer costs for those plans have gone up 113 percent over the same period, as some have asked their workers to take on a higher proportion of premium costs.   Still, employers are primarily coping with rising health-care expenses by moving their workers into plans with higher out-of-pocket costs such as deductibles, co-pays and co-insurance."

 

  The NYT had their own take on the Kaiser Report:

 

    "The Kaiser Family Foundation and Health Research & Education Trust are out this morning with their annual survey of employer-based insurance.

    The results, unsurprisingly, aren’t pretty: health insurance premiums for employee-based health insurance have increased 113 percent since 2001 and are expected to more than double from an average of $15,073 today to $32,175:

     These are  pretty terrifying statistics - and keep in mind, that’s just for the employer-based insurance market.

    It doesn’t include individual market plans, where even bigger premium increases are more common. Health insurance costs have risen fast enough to eat up an entire decade of earning increases, a Health Affairs study found last month, and this new survey shows they could continue to do so for the next 10 years, too.

    In addition, over the past decade, not only have employees’ benefits cost more, as medical costs have risen, but employers have come to expect subscribers to pick up an increasingly large part of the tab:

    Proportionately, workers have been expected to pay increasingly more of their health insurance bill. This shows up in deductible levels, too: 28 percent of employers’ plans for single coverage now have a deductible over $1,000, up from 6 percent in 2006.

    The health reform law has mechanisms to control the cost of health insurance. The new medical loss ratio regulation requires that insurers spend at least 80 percent of subscriber premiums on medical costs, limiting the amount that can go to profits and administration. In the small group market, where some employer-based plans fall, it requires the review of any double-digit rate increases. But even if these mechanisms do get insurance costs to go down, that doesn’t mean the change will trickle down to employees: the health reform law doesn’t really touch how employers divvy up the bill.    (A follow-up to this NYT story is also worth reading.)

    There’s been a trend developing for over a decade now where employers expect employees to pay a bigger chunk of the insurance bill. If a higher worker contribution has become the new normal, decreases in the cost of health insurance may not necessarily mean lower costs for the consumer."

 

    Where is the good news in all of this?   I'm not sure that there is any on the horizon right now.   It primarily means that the standard of living for most Americans continues to be eroded and health care, something that we have all taken for granted for so long, is part of the decline.    Perhaps it is part of a growing call to action for all of us, a call that we must respond to if we are going to be a part of controlling the directon of our lives.   The first and most immediate response is to get informed (try this site on the WP about health care reform)about these issues to begin with and stay informed if we are not.   Become a participant in the dialogue about your life and the direction it is taking.   None of us can afford to do any less.

"The Mental Health Parity Act May Save The Day"

 

    Finally something new on the Mental Health/Addictions Parity Act. 

    Former CIGNA executive-turned-whistleblower Wendell Potter is still writing about the health care industry and the ongoing battle for health reform. Potter is the author of Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR is Killing Health Care and Deceiving Americans.  I've written about him before and his book and feel he is an important voice in the mix of information we get about health care.  

    Potter also has a web-site, NationofChange, in which he regularly writes about his work and the industry.   It's a good site and one of sections on it is "Ask Wendall", in which people write in and ask questions about difficulties they are having with accessing health care.    Many of the inquiries “Ask Wendell” has received pertain to mental health and behavioral issues.

    Here is something he wrote about recently:

 

 

    "Until recent years, insurers in general provided little or no coverage for treatment of mental illnesses. It took an act of Congress—literally—to change that. The Mental Health Parity Act (MHPA), which became law exactly 15 years ago today, requires that annual or lifetime dollar limits on mental health benefits be no lower than the dollar limits for medical and surgical benefits offered by a group health plan.

    Because insurers were finding ways to get around the law’s requirements—they were, for example, limiting the number of provider visits and the number of days they would cover for inpatient psychiatric hospitalizations—Congress amended MHPA three years ago by closing some loopholes. Nevertheless, many Americans with mental health problems still face more coverage limitations than those with physical illnesses, as the letter below illustrates. If that is happening to you, fight back.

 

    Dear Wendell,

    My son was diagnosed with severe psychotic depression. He is slowly recovering, but he still has a way to go and does best when he can see his psychiatrist four times a week. Anthem Blue Cross will only pay for two sessions a week. We've tried to fight this, but they won't budge, saying their psychiatrist has decided my son's condition only warrants twice weekly sessions. Their psychiatrist has never met my son, so how can they justify this judgment call? Is this legal? How can they justify this when there is no longer a cap on the amount of treatment? Is there any way we can fight this?

Lisa

Dear Lisa,

    What your son is experiencing is a practice in the insurance industry known as "partial denial," and it very possibly could be illegal.  As a first step, you should initiate an appeal right away. But don’t stop there or even wait for the results. Become a “squeaky wheel.” Insurers hate squeaky wheels. Anthem executives very possibly will agree to the number of sessions your son’s psychiatrist believes is necessary when they realize you will squeak long and loud if they don’t.

    You should have two or three levels of appeal available to you: one with your health plan and at least one with an outside review company.

    If you lose the first round and have to request an outside review, do so promptly and notify Anthem executives in writing that you are giving them seven days to respond or you will contact your state’s insurance department.

    Be prepared to do just that. If you file a complaint with your insurance department, send a copy of it to the benefits manager where you work (if your policy is through an employer) and to Anthem bigwigs. 

    Doing all of this will send the message that you are not going away.

 

    Actually, the MHPA is being integrated, albeit slowly, into the coverage of most health care insurance company, including Anthem; in fact, Anthem has seemed to me to be one of the companies that has been more proactive then most in implementing it.   Value Options has also been a leader.  As Potter says, "it may save the day".    The law's full implementation will change many of the concerns raised above but until it works better, taking his suggestions may be necessary.  But, as always, get informed.   Go on-line and see what you can learn.   Then ask your insurance company and your therapsit about how it works.   They should have some answers for you.   Then you might ask Wendall.

Military OneSource Program

    One of the sad realities of my professional world is that my practice has slowly evolved, over the years, to one that consists primarily of almost entirely the middle class.   I say "sad" because my personal roots are in the blue collar world and I try very hard not to forget "where I came from".   The reality, however,  is that particularly at this time of economic hardship - at least from an American standpoint - health care benefits continue to shrink and mental health care are shrinking the fastest.  Even with the Mental Health Care and Addictions Parity Act, not yet implemented, the poor and the most disenfranchised are quickly falling through the growing cracks in the fragmented mental health care system.

    Poor people, unless they are seriously chronically ill and fit into the shrinking pot of money that individual states are mandated to provide, are simply not receiving mental health services.   Even if I were to offer services free or at costs they could afford, most of them just don't find their way to my office.  Help of this kind is just not imaginable for them.   Not surprisingly,  the single most important variable in the diagnosis of Major Depression is economic status.   Poor women in America are by far the most likely group to suffer from this mood disorder.

    Addiction services have loooong gone by the wayside unless you consider the prison system a viable alternative.   The seriously chronically mentally ill, now that most states continue to close state mental hospitals while shifting responsibility to the localities, make up another larger percent of the population of the prison systems; usually they just live under bridges or behind grocery dumpsters eating left over, spoiled food.   The private sector, ie the "faith-based" communities, have not been able to absorb the cost of the needs of either of these populations.    

    One exception is the military.    Tricare, a military insurance program, has long made mental health services available.   And now a new program, Military OneSource (MOS) is being implemented for our military personnel and their families, and will make additional services available.   MOS will include face to face and telephonic non-medical counseling, as well as a number of other important services such as financial and spouse career counseling.   

    The program will cover more then six million active, reserve and National Guard personnel and their families.  Although those covered by the MOS program are concentrated around military bases because of the reserve and National Guard compenents, individuals eligible for this program live in virtually every community. 

    I am honored to be a provider for the program and helping the thousands of men and women who have  served our country now as the two wars we are in seem to be winding down.  I will be reporting on this as it develops in the coming months.   

 

Cross-check: Are Antidepressants Just Placebos with Side Effects?

    This essay just appeared in the most recent issue of Scientific American and is worth reading and considering. 

Are Antidepressants Just Placebos with Side Effects?

By John Horgan  | Jul 12, 2011 02:30 PM | 

"I have first-hand experience of the devastation of depression, in myself and those close to me. Although I have been tempted to try antidepressants, I've never done so. Of course, like everyone reading this column, I know many people who have been treated with antidepressants—not surprisingly, because according to a 2005 survey, one in 10 Americans are now under such treatment. Some people I know have greatly benefited from their treatment. Others never find adequate relief, or they experience annoying side effects—such as mania, insomnia, emotional flatness or loss of libido—so they keep trying different drugs, often in combination with psychotherapy. One chronically depressed friend has tried, unsuccessfully, to stop taking his medications, but he experienced a surge of depression worse than the one that led him to seek treatment. He accepts that he will probably need to take antidepressants for the rest of his life.

We all, to greater or lesser degrees, have this kind of personal perspective on antidepressants. But what does research on these drugs tell us about their efficacy? The long-smoldering debate over this question has flared up again recently, with two medical heavyweights staking out opposite positions. In a New York Times essay, "In Defense of Antidepressants," Peter Kramer, a professor of psychiatry at Brown, insists that antidepressants "work—ordinarily well, on a par with other medications doctors prescribe."  

Kramer's article seeks to rebut a wave of negative coverage of antidepressants, most notably a two-part essay in The New York Review of Books (which can be found here and here)  by Marcia Angell, former editor of The New England Journal of Medicine and now a lecturer in social medicine at Harvard. Angell cites research suggesting that antidepressants—including both selective serotonin reuptake inhibitors (SSRIs) and other medications—may not be any more effective than placebos for treating most forms of depression.

Angell highlights a meta-analysis, carried out by the psychologist Irving Kirsch, of trials of a half dozen popular antidepressants submitted by drug companies to the U.S. Food and Drug Administration. Many of the studies were never published because they failed to yield positive results. (The practice of burying negative results from trials is still quite common, as this recent Scientific American blog post points out.) After analyzing all the FDA studies, Kirsch concluded that placebos are 82 percent as effective as antidepressants. According to Kirsch, this difference vanishes if antidepressants are compared to "active placebos," which are compounds such as atropine, an alkaloid that blocks certain nerve receptors and causes dry mouth and other symptoms, that have distinct side effects.

She recommends that doctors be prohibited from prescribing psychiatric drugs "off-label"—that is, for disorders and populations, notably children and even toddlers, for which they have not been approved. She also urges that we "stop thinking of psychoactive drugs as the best, and often the only, treatment for mental illness or emotional distress.... More research is needed to study alternatives to psychoactive drugs," including exercise and psychotherapy (although of course studies of psychotherapy reveal that it may also work by harnessing the placebo effect)."

via www.scientificamerican.com

 

 

     Clearly, the debate rages on.  The article by Horgan is part of the latest round in the dialogue and it started with Marcia Angell's recent two-part article in the NYT criticizing the efficacy of antidepressants, and the printing, also in the NYT, of a psychiatrist's (Kramer) rebuttal;  links to both are included above.  

The writer of this essay/blog, John Horgan, weighs in and summarizes the debate.    Horgan is an American science journalist perhaps best known for his 1996 book, The End of Science.   He has written for many publications, including Scientific American, The New York Times, Time, Newsweek.  His awards include two Science Journalism Awards from the American Association for the Advancement of Science and the National Association of Science Writers Science-in-Society Award. His articles have been included in the 2005, 2006 and 2007 editions of The Best American Science and Nature Writing.  He graduated from the Columbia University School of Journalism in 1983. Between 1986 and 1997 he was a senior writer at Scientific American.  He has credentials.

 

    So, where do I stand in this argument?  

    If you've been reading this blog for very long, you should have a fairly good idea where that is. I believe that antidepressants are really the sum of their side-effects.   My clinic experience, and most of the research I've read that I trust, has led me to the conclusion that the drugs themselves actually have little actual therapeutic impact - other that of a placebo and that what people are responding to are the side-effects.   These side-effects vary from drug to drug and include reducing anxiety, reducing lethargy, and increasing/decreasing sleep, which can be good things. People become dependent on, but not necessarily addicted to, relief from these troubling co-morbid problems and then often have a hard time with cessation of the the primary drug - the anti-depressant - because of their need for continued symptom reduction.  

 

   Subsequently, I do not necessarily encourage the patients I see who are depressed to take medications, but neither do I discourage them.  Many people I have seen are taking anti-depressants for symptoms of depression but not necessarily "clinical depression".  So I strongly encourage patients early on to become very, very knowledgeable about depression and what they might do to make reasonable changes, (i.e. be informed consumers) and we talk about the use of anti-depressants in a context of possible options.   The continued use of anti-depressants, as we learn more about the history and quality of the research has made it become  a very controversial issue in the medical community.    More honest conversations of the type seen in the above exchange are absolutely imperative.  I do, however, support my patients in their decisions.

 

    But do I believe that psychotherapy works by harnessing the placebo effect?   Absolutely - but that's not the only reason it works.  Good psychotherapy should also encourage resilience, courage, coping skills and trust in one's self.   I think that's a reasonable, ethical outcome.

Hot Coffee

We just watched the HBO documentary of the week, Hot Coffee, and were so impressed on multiple levels.   The basic theme of the movie is a defense of the right of American citizens to seek monetary compensation for financial wrongs done to them by others, a basic right that is ensured by the Constitution of our country.  

The director/author of the film is Susan Saladoff and her documentary starts right out with a controversial example, and what most people consider the trump card in any frivolous lawsuit dissussion: the California case in which Stella Liebeck was awarded $2.7 million for being burned by a cup of overly hot McDonald's coffee.   She not only explores the myths about this particular case, but several others, including medical liability, torte "caps" and the waiver of individual rights for wrongs done required in order to work for many major corporations, especially Halliburton.

"Hot Coffee" makes a strong case that corporate America, through sympathetic politicians to whom it gives wads of money, has successfully capped damages awards in dozens of states.   

Traditionally, the documentary argues, the courts have been the only realistic avenue of restitution for the average victim of professional or corporate malfeasance. Damage caps and other restrictions, it says, are increasingly taking even that avenue away.

"Hot Coffee" doesn't get into other lawsuits that have fueled the "frivolous" fire. It does argue strongly that the recent wave of restrictions on damages has punished legitimate victims while giving too many perps something close to immunity.   The US Chamber of Commerce is one of the pressure groups criticized in the film.

Why is this film cited here?   While I hate paying my liability premiums each year, and mine are due this month, it is a part of being a responsible professional.   And my insurance won't cover me if I am, in fact, negligent  -  unless you consider the $1.8 million dollar cap imposed 2006 by the Virginia Legislature.    You might want to see how it works where you live.

 

 

 

"When a Child’s Anxieties Need Sorting"

    "According to the American Academy of Child and Adolescent Psychiatry, 15 million children in the United States suffer from some kind of psychiatric disorder, like bipolar disorder or  schizophrenia, but about 80 percent never get help. And the illnesses tend to be discussed in hushed tones. 

via www.nytimes.com

 

        The above is from a NYT article this morning on the Child Mind Institute (CMI) in New York City and its director, Charles Koplewicz, MD.   After reading the article, I went to their website and was surprised and pleased by what I read.   

 

    “People think of child psychiatry as playing with kids on the floor,” Dr. Koplewicz, 58, said recently at his office at the Child Mind Institute, his new children’s mental health care treatment center on Park Avenue and 56th Street. “We need to educate them and change the way they think about childhood psychiatric illnesses, so the shame goes away and it improves access to care,” Koplewicz says in the article.

 

    "According to the American Academy of Child and Adolescent Psychiatry, 15 million children in the United States suffer from some kind of psychiatric disorder, like bipolar disorder or schizophrenia, but about 80 percent never get help. And the illnesses tend to be discussed in hushed tones. “If your child has a rash, for instance, you can call up your friend to talk about a dermatologist, but it would be very rare to call up your friend and say my child has a mental health issue and could you recommend a doctor for me.” 

 

    I have found in my years working that these words are unfortunately a summary the treatment for children with psychiatric disorders in this country, at least in my area.    It was so refreshing to read that somewhere people are addressing these issues in new ways and using the new technologies to reach a larger audience.

 

 

 

 

    And while I know that most parents who read this might not be able to go to New York for treatment or even if CMI would see their many out-of-state kids if they could get there.   But the reach of the clinic goes far beyond their geographic area  or office space to help children and their parents.   The treatment approach described in the site is not only reflected in their website but extended through it.   The website is a prototype of the new technology available today and its potential to inform parents of troubled children.   For example, the site is full of stories of and by children who have overcome/mastered their illness.

 

    Again, from the site:

 

            "Your child can feel better. And so can you.

We believe that the rule of thumb in all medicine—diagnosis drives treatment—is just as critical in psychiatric care. Our clinicians figure out what's causing your child's symptoms and then help you choose the most appropriate evidence-based treatment. We give kids the highest standard of clinical care as well as the opportunity to help build the science leading to improved diagnosis and treatment of psychiatric and learning disorders. This is real science offering real hope. 

We recognize the different spheres of your child's life—home, school, and friendship—and that the problems in one area can affect another. Our goal is for your child to improve in each of these spheres. We partner with you to evaluate your child's progress and adjust treatment modalities whenever necessary. We work with you to form a partnership with your child's pediatrician. This gives us the opportunity to get input and support from an expert who's familiar with your child's medical history and physical development.

Teachers are also important allies. Kids act differently at school than at home. As we consider your child's learning needs and social challenges, we work with you to form a partnership with your child's teacher - a partnership that gives us insight into how your child is doing at school and what kind of services and learning accommodations may be needed. 

The Child Mind Institute is dedicated to helping all children and teens get the care they need to live healthy, fulfilling lives."

 

    So go to the website cited above and take a look.   Listen to the stories.

 

Further Punishment for the Obese

"Under an Arizona Plan, Smokers and the Obese Would Pay Medicaid Fee"

By TIMOTHY WILLIAMS

Published: May 30, 2011

via www.nytimes.com

 

    "Arizona, like many other states, says it is no longer able to finance its Medicaid program adequately. As part of a plan to cut costs, the state has proposed imposing a $50 fee on childless adults on Medicaid who are either obese or who smoke. In Arizona, almost half of all Medicaid recipients smoke; while the number of obese people is unclear, about one in four Arizonans is overweight, according to the Centers for Disease Control and Prevention. The state’s plan must ultimately be approved by the federal government. Monica Coury, spokeswoman for Arizona’s Medicaid program, discusses.

 

 

Q. Why is it a good idea to charge people a fee for being overweight?

A. The issue is this: we can’t keep complaining about the rising cost of health care and not drill down to what that means on the individual level. Maricopa County [where Phoenix is located] has started a program among its employees where smokers have to pay $450 more for health insurance than nonsmokers. They take a swab to detect nicotine. The bottom line is that there’s plenty of evidence and studies that show there is an undeniable link between smoking and obesity and health care costs.

 

 

Q. What has been the response from critics?

A. Some people have suggested it is discriminating against obese people. To me, it is a matter of fairness. We have an obligation to provide health care coverage to 1.35 million people. And we’ve got a budget crisis, so if there’s something you can do to help out — we’re just asking you to put a little more back into the system. What we want to test is whether making people pay is going to affect behavior. We think it will.

 

 

Q. How would disabled people be affected?

A. We’re not talking about the disabled, the elderly, pregnant women or children, and certainly there would be exceptions for certain conditions, like cancer. We are talking only about able-bodied people who have the capacity to manage their weight."

 

 

    Once again, does any of this make sense?  When did smoking and obesity get linked?   On the smoking issue, our prisons are full of drug addicts, and smoking is clearly an addiction; are we just a bill away from now making it a crime?    Would it not then be logical to consider obesity an "addiction" as well and punish them even more than the trauma they already feel?   And, will we eventually criminalize being "fat"?  

 

    Who really sponsored the Arizona plan?    In reality and after the reviews it will be subjected to, there is very little chance it will ever become state policy.  But its mere presence on the table for discussion is alarming enough.

 

    Rising ealth care costs in this country are simply not driven by the obese and any other problems of the insured.